Employment and job creation build prosperity and carry important health benefits, both for individuals and entire communities. There is a large and growing body of literature demonstrating a positive correlation between employment and individual and community health.

Employment can be defined as a contractual relationship between the worker and an employer for financial or other reward that is sustained over a period of time. It can be used as a socially acceptable means of earning a living and may involve a set of technical and social tasks performed within certain physical and social contexts. In the US, employment serves as the main source of income of the country’s residents.

Across multiple studies, higher income was consistently associated with better health, including a reduced overall risk of mortality and reduced rates of such chronic diseases as heart disease, diabetes, and stroke. Mortality rates are lower among those who are employed compared to the unemployed. Re-employment after a period of being out of a job has beneficial effects on physical health, psychological distress, and certain psychiatric conditions. Employment also reduces the risk of depression and psychological distress, improves general mental health, and, over time, predicts a positive trend in perceived health and physical functioning in both women and men. Quality employment can be beneficial to people with physical and mental disabilities who are able to work. One important caveat is that the relationship between employment and health and well-being is moderated by job quality and there is a growing literature that low-security, high-stress, or long-hour/shift jobs may not benefit and could actually harm employees’ health.

Spokane County, Washington

When the leaders of Washington State’s Spokane County saw the signs of growing poverty and homelessness in their jurisdiction—a problem that has taken an especially severe toll on the school children and their mental health--they turned for help to the closest and most reliable resource at their disposal—the county’s strong high-tech employment base which includes numerous biomedical and technology companies and quality universities.

Government, academia, business, and nonprofit sectors came together to develop educational resources for public school students to help the graduates secure high-demand, high-paying jobs, building a pipeline to better employment and out of health-harming poverty. Expansion of the nearby Academic Health Science Center, a major driver of the local economy with the campus’ estimated total economic impact of $350 million and 1,800 jobs created to-date, opened additional opportunities in medical training. Thanks to the curricula uniquely attuned to the regional health needs, the center is also helping fill the gap in rural health care.

With public school graduation rates rising from under 60 percent in 2009 to above 80 percent in 2013 and various community redevelopment efforts underway, the Spokane County initiative illustrates how a focus on career development and increasing local employment opportunities can help advance both residents’ prosperity and well-being.

A Virtuous Cycle

While employment is generally beneficial for health, the reverse is also true: healthier people tend to be more productive and efficient at their jobs than those who are sick while poor health may drive some people into unemployment.

Various factors are responsible for the association of employment with beneficial health outcomes. Employment is the principal source of such essential psychological needs as time structure, social contact, collective purpose, social identity/status, and activity and the ability to meet these needs correlates strongly with the individual’s well-being. Having a job may serve as an important source of economic resources, including health insurance. People who hold well-paying jobs tend to live in healthier neighborhoods, are able to eat more nutritious foods, and have better access to health care. Many employers offer to their staff various prevention services and wellness programs that are not available outside the workforce (although many of them are beginning to expand these programs to the nearby communities—see below).

Increasingly, worker wellness programs include referral to addiction treatment, a provision especially relevant in the times of an ongoing opioids public health emergency. In addition to a heavy health toll, this crisis has caused major damage to the US economy, including losses related to workforce performance and participation. In 2013, about 70 percent of the 22.4 million adult drug users in US were employed, either full-time or part-time. A substantial portion of the cost of the prescription opioid crisis to our economy, estimated to have reached $504 billion in 2015, is attributable to the losses of employee productivity. Furthermore, between 1999 and 2015, increased prescribing of opioids accounted for nearly 20 percent of the decline in labor force participation observed among male workers during the same period of time.

Gainful employment is associated with a reduced prevalence of illicit and prescription drug use and alcohol and drug disorders compared to unemployment and thus can be seen as a valuable protective resource. On the other hand, problematic substance use, along with the often co-existing history of incarceration, decreases the chances of a sufferer’s finding and holding a job, making it harder for him or her to take advantage of this benefit.

Community Level Impacts

While employment’s benefits for individual’s health have been known for some time, there has been less discussion in public health literature of the health advantages that improved job opportunities can exert at the community level. In addition to providing personal income, employment addresses broader societal needs: it helps accrue, through the collection of taxes, resources for various community programs. This in turn reduces the need for social benefits, and helps maintain social cohesion. Community revitalization due to an influx of well-employed and higher earning residents can help make neighborhoods healthier, including through the creation of new opportunities for physical activity and improved nutrition. Common examples include: new parks, walking trails and bike lanes, and grocery stores and farmer’s markets supportive of healthful eating. There is even evidence that lower county-wide unemployment rates are associated with reduced rates of the opioid-related deaths and emergency department visits related to opioid overdoses.

County-level analysis of economic and health data in Tennessee in 2014–2016 revealed that labor force participation positively correlates with the County Health Ranking score—a measure of county’s vital health factors, such as obesity, smoking, access to healthy foods, and air/water quality—whereas reduced unemployment is associated with fewer poor or fair health days reported in a county.

In addition to wellness programs for individual workers, employers are beginning to offer broader wellness programs geared towards entire communities. For example, the pharmaceutical company GlaxoSmithKline (GSK) has recently launched the GSK IMPACT Grant initiative providing support to networks of organizations helping improve health and well-being of underserved youth. Sodexo has started a program where an employee can invite a community member to participate in its staff wellness program.

How can we take advantage of health benefits of employment and job creation for both individuals and our communities? We must take collective action to promote the link between health and employment and to make broad health-fostering employment opportunities available to all of our residents. That means finding new ways to mobilize public, private, and charitable resources to adapt to the demands of today’s economy.

The Private Sector, Non-Profits, And Community Organizations

As the US Surgeon General, I plan to use the visibility of my role as the Nation’s Doctor to increase public awareness of the health benefits of employment, and the employment and prosperity benefits of health and wellness, including for both individual employees and entire communities. Our goal should be to create healthier communities, which move more Americans into supportive, health-nurturing jobs.  This will allow more people across our Nation to seize the economic opportunities embodied in our strong market economy.

I will also convene stakeholders and encourage partnerships to collaboratively pursue this important economic and public health priority. I encourage all community leaders to join me in this effort.

Small and large business owners are one group of collaborators critical to this initiative’s success. Their input will be invaluable in developing job training programs better attuned to today’s employers’ needs as well as in brainstorming the strategies to maximize employment opportunities for various groups of job seekers. For example, employers often express a concern that many applicants they interview are unfit for work due to poor health or substance use issues. Recruiters can carry negative attitudes and biases towards the unemployed.

Future discussions with employers and businesses should support a change in attitudes towards employee and community health and well-being. This is about moving their collective perception of worker health: what once may have been considered an unavoidable expense, must now be seen as a business strategy critical for any business’ fiscal (and socially responsible) objectives and inseparable from its bottom line. If businesses want to both lower healthcare expenditures and position themselves as employers of choice, they need to realize that investing into communities equates to investing in their workforce.

Another important area for coordination with the private sector lies in improving employers’ recognition of addiction as a chronic illness rather than a character flaw that might undermine an employee’s performance. With this recognition, employers may choose to better incorporate support for substance use treatment into the employer-offered wellness programs and health care benefits, and reconsider a history of substance misuse as a disqualifier for initial and/or continued employment. Companies, such as Belden in Richmond, Indiana, are using a new approach that emphasizes screening and treatment, vs testing and loss of a job opportunity.  

Other essential stakeholders in the future health-employment discussions include federal and state providers of social benefits, social services workers, non-profits, faith-based organizations, and various public health advocacies. These entities can all partner to help develop new and optimize existing educational, training, workforce reengagement, and worker support programs.

The government engaging businesses and non-profits in such discussions will additionally set an important precedent of enhancing health promotion, which is in line with the Institute of Medicine’s 2003 Future of Public Health report’s call for the corporate community and public health agencies to enhance joint efforts.

In conclusion, employment not only provides essential material resources, but also offers considerable benefits for individual and community health. In turn, community health and wellness clearly leads to increased opportunities for employment and prosperity, both for individuals and the communities in which they live. As the Nation’s Doctor, I call upon the representatives of the private sector, non-profits, government, and community organizations to work together to maximize quality, health-nurturing employment opportunities for all US citizens who are able to work. In doing so, we can create an America where all individuals, their loved ones, and their communities, can achieve the greatest standards of living and thriving.