Work Matters for Health

On average, American adults spend nearly half of their waking hours at work

Where we work influences our health, not only by exposing us to physical conditions  that have health effects, but also by providing a setting where healthy activities and  behaviors can be promoted.  In addition to features of worksites, the nature of the  work we do and how it is organized also can affect our physical and mental health.   Work can provide a sense of identity, social status and purpose in life, as well as  social support.  For most Americans, employment is the primary source of income,  giving them the means to live in homes and neighborhoods that promote health and to pursue health-promoting behaviors.  In addition, most Americans obtain their health care insurance through their jobs.  Not only does work affect health; health also affects work.  Good health is often needed for employment, particularly for lowskilled workers.  Lack of employment among those who are unable to work because of ill health can lead to further economic and social disadvantage and fewer resources and opportunities to improve health, perpetuating a vicious cycle

Employment-related health problems have significant human and economic costs for individuals and for society overall. In 2007, over 5,000 fatal and 4 million nonfatal work-related injuries and illnesses  were reported in private industry workplaces; about half of the non-fatal injuries  resulted in time away from work due to recuperation, job transfer or job restriction. Some reports have found that the total economic costs to the nation of occupational illness and injury match those of cancer and nearly those of heart disease.

Healthy workers and their families are likely to incur lower medical costs and be more productive, while those with chronic health conditions generate higher costs in terms of health care use, absenteeism, disability and overall reduced productivity. Workplace injuries and work-related illnesses have a major financial impact on both large and small employers.  In 2006, the cost to employers for workers’ compensation totaled $87.6 billion.This issue brief examines how work can affect health, exploring the health effects of  both physical and psychosocial aspects of work as well as of work-related opportunities and resources.  Examples of promising approaches to making work healthier also are provided.

Personal Health Record (PHR)

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual understanding a PHRU

The most salient feature of the PHR, and the one that distinguishes it from the EMR and EHR, is that the information it contains is under the control of the individual. The concise definition above names the individual as the source of control, but that leaves room for others acting in the individual’s interest—their agent or agents—to have control over access to the PHR. An agent may be expressly designated by the individual but not in all cases; examples of an agent acting for an individual include parents acting for children, or, in the later stages of life, children acting for parents.

Exercising control. The individual is distinctively the guardian of information stored or accessible within a PHR. Similar to the role of a librarian, a person managing a PHR decides what volumes of information to include, how they are maintained and ordered, and who can read them or “check them out.” Standards and policy will need to determine if and how individuals can delete or modify information in a PHR that originated from an EHR and how these modifications are communicated to other providers with whom the data in the PHR are shared.

Portability. Having control also means that an individual’s PHR can exist independently of the entity that sponsors it—the PHR is portable. This requirement for portability excludes models in which sponsors such as health insurers or health care providers give individuals access to health-related information that is dependent on the individual remaining with that sponsor.