A new handbook with key contributions from members and associates of ICLS examines recent developments in research on the relationship between work and health and considers the policy implications of these developments. In this blog Tarani Chandola, one of the handbook’s authors, argues Covid has highlighted a need for robust understanding of how long-term exposure to different environmental factors can deepen inequalities in a crisis.
A pandemic may look like a sudden event, with little relationship to what went before it. But Covid has shown us otherwise – the conditions in which people lived throughout their lives up to that point had a profound effect on how they responded to the crisis, both physically and mentally.
There are both specific workplace factors and wider social impacts which can interact profoundly with our ability to weather crises – and studies which monitor individuals throughout their lives can play an important role in helping to understand and to mitigate them.
Specific workplace factors include:
- Exposure to chemicals in the workplace. Traditionally, occupational monitoring tended to focus on substances which could be inhaled, but the use of biomarkers and biomonitoring is now increasing our understanding of the effects of chemicals and bio-hazards which come into contact with the skin or which are ingested/inhaled.
- Work which impacts on the musculoskeletal system. In order to prevent disability we need long-term perspectives on how workplace organisation, psychological and social factors and wider public policy affects chronic pain and limitations in mobility and dexterity, reducing people’s ability to work..
- Conditions such a long hours, shift work and night work which are known to have long-term effects on health, including heart disease, behavioural issues and injuries at work. Better understanding of these factors can enable better employment support along with the implementation of preventive strategies. A better understanding of sex and gender differences is also needed to ensure these strategies are equitable and effective.
- Practices which lead to psychological and social stress at work, leading to stress and burnout. Increased understanding of how genetic factors interact with these over time is now supporting improvements to clinical practice.
Wider social and technological factors include:
- Emerging trends in career endings and beginnings, in the type and amount of earnings, in job content, work scheduling practices and social protection at work. Life course research is enabling us to identify how these trends affect those whose employment histories can be seen as precarious, discontinuous or chronically disadvantaged.
- Increases in non-standard work and precarious or part-time contracts which are transforming post-industrial labour markets. Research across these economies helps us to understand how the policy which governs labour markets creates differential impacts in different employment systems.
- Technological innovation such as digitalization, which has great potential to improve working conditions, but which also brings threats to job quality and to health. Organisations, managers, workers and worker representatives need clear understanding of how to manage these changes over time.
We need sophisticated workplace exposure modelling which can take into account all these factors. Workplace organization, management practices and human resources strategies can generate domino effects, each amplifying the impact of the others. Life course studies can provide the basis for this work. Life course epidemiology has moved on from the simplistic models described in Figure 1a, to a more integrated model as shown in Figure 1b, where events and outcomes occur repeatedly over the life course and are influenced by multiple layers of exposures that interact with the work and social environments.
How did accumulations of existing conditions and recent changes lead to variations in how Covid affected different groups of workers? Even if we cannot yet see these patterns with total clarity, we know they exist. And the pandemic can provide us with a rich backdrop for detailed statistical modelling on the workplace and its long-term effects on health.
We have started this work, using an existing study from 2017 which details common occupational health trajectories – although this is subjective, it has the advantage of starting from a pre-pandemic baseline. It identifies challenges, risks and trends in the workplace – changes in work organization, ageing populations, diversity, more people working with disabilities, globalization, work-life factors. Added to this are the effects of climate change, changes in worker representation, emerging technologies and big data, as well as increased health inequalities.
Using this framework along with information from life course studies, we can study the effects of Covid on different groups. We can see that while the pandemic is often characterized as having radically changed working lives and ruptured pre-existing dynamics, it really represented an acceleration of certain patterns that were already in place.
These impressions need to be worked on further: we are developing detailed models which can confirm or refute them. We hope they will inform the whole field of occupational health.
Why does this matter? It matters because employers need clear pointers on how they can reduce risk factors and improve their workplaces. Applying a life course perspective can help them to understand sensitive periods in an employee’s life – for example, when young people first start work – and to act accordingly. This can be particularly important for those with a history of mental health problems.
A life course perspective can help employers gain a perspective on the importance of workers’ past experiences: where they grew up, who they grew up with, their education and their health are all key factors which they bring with them to work.
A key challenge for the future will be in learning to predict trends which are needed in the long term but also – as Covid has shown us – in the short term too. It can help to inform our responses to future shocks, but it can also help to give us a window on trends which need longer-term solutions.
The large-scale cohort data we use in life course studies will be hugely valuable in all of this. It will enable us to collaborate across national borders and to develop new theoretical frameworks, concepts, and definitions in occupational health. That is our route to a more nuanced understanding of issues which face employers and employees across the globe.
The Handbook of Life Course Occupational Health, edited by Morten Wahrendorf, Tarani Chandola and Alexis Descatha is published by Springer .