My friend Joe mentioned to me that he was in a Steelers bar in Seattle and amused by my amazement and football naivete, he went on to explain about the imploding of the steel mills in the late 70s, job lost and migration of loyal Steeler fans out of Pittsburgh to major cities…
The latest Bureau of Labor Statistics revealed both the number of unemployed persons at 11.7 million, and the unemployment rate, at 7.6% in March, 2013. About 46.2 million Americans lived below the official poverty level in 2010 and about 10.5 million individuals were among the “working poor.” The working poor are individuals who were in the labor force for at least 27 weeks during the year but still had incomes below the official poverty level. Our work affects our health in many ways and vice versa (check out the issue brief by RWJF on work and health).
Work and workplace provide us with income, benefits, opportunities to obtain food, housing, medical care but also a source of stress and potential exposure to physical risk and hazards, all with implications for physical and mental health. Americans are known to work longer hours compared to most Europeans and the US is one of the few developed nations without universal paid sick days. There is also another disheartening statistics: since 1977, the life expectancy of male workers retiring at age 65 has risen 6 years in the top half of the income distribution, but only 1.3 years in the bottom half (not surprising).
There are a number of work-based strategies to improve health—smoke-free workplace, lifestyle management/wellness, screening, prevention, flexible work (Yahoo, Best Buy no more?), retraining, etc. However, tough time has a way to erode many of these programs from the decline in unions to work-place-based education and training and better wages…As a physician (not an occupational health doc), having daily encounters with patients burdened by work-related health problems in some form or another although this is rarely ever their primary complaint, what should be my role? Particularly workers in lower-status and lower-wage jobs? Are they empowered to make change? Could I facilitate this process, provide access to the right skills and resources to break this vicious cycle of unemployment or work environment and poor health. I’m back to the question: What doctors can do about social determinants of health?
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"