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The Robert Wood Johnson Foundation and the World Health Organization (WHO) identify employment as a "social determinant of health." The WHO defines social determinants of health as "the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels 1." The way that people earn a living in the United States is related to population health in many ways. In the United States the unemployment rate is often used as an indicator of economic prosperity. However, unemployment and employment can also be used as measures of population health. Wages, employee benefits, workplace safety, work hours, workplace policies, and unemployment all have effects on health. According to the Robert Wood Johnson Foundation, "a stable job with fair pay leads to better health 2."

According to the World Bank, in 2013 65.7% of the United States population was between the ages of 15 and 64, which is the age range that the World Bank Office for Economic Development and many other organizations define as "economically active," or of working age 3. This means that the majority of the United States population is of the working age. However, from the unemployed to underemployed to persons in the highest income brackets, not all kinds of employment effect health equally. Like many other indicators that are operationalized within the group of "social determinants of health" a "social gradient" is often seen when health outcomes are stratified across levels of employment. According to the CDC, the term "social gradient in health" refers to the stepwise fashion health outcomes improve as socio-economic position improves4.

Employment, like and income and poverty status, is used in many epidemiological studies and epidemiological surveillance activities. Like income and poverty status, a "social gradient" effect can be seen across levels of employment for many health outcomes. For example: according to the Robert Wood Johnson Foundation, since 1977 the life expectancy of male workers retiring at age 65 rose 6 times for workers in the top half of the income distribution, but only 1.3 times for workers in the bottom half 5. Unemployment has been associated with many negative health outcomes, including suicide and cardiovascular disease 6. Many epidemiological studies have trouble analyzing the effects of income, poverty and employment separately, as these factors are often related 6.

The following persons may be at risk for the negative effects of unemployment, underemployment, and other types of workplace conditions:
  • Unemployed persons. In 2009, one study found that unemployed persons were 54% more likely to report only fair or poor health 7.
  • Persons in lower income brackets. According to the same study, in 2009 persons in lower income brackets were less likely to have a regular doctor, less likely to have had a blood pressure check, and less likely to have had a cholesterol check in the past five years than persons in the highest income brackets.
  • Persons in dangerous professions. According to the Bureau of Justice Statistics, in 2012 there were 30 million non-fatal workplace injuries8.

According to the WHO, A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace9. Some evidence based employment related strategies for improving public health are:
  • Increasing minimum wages to living wages10.
  • Providing adequate healthcare benefits to all workers.
  • Providing adequate paid sick and vacation leave to workers11.

Employment, and employment level is tracked at national, state, county and other levels through surveys conducted by the United States Census, primarily the American Community Survey.

The information provided above is from the New Mexico Department of Health's NM-IBIS web site ( The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Thu, 30 March 2017 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site:".

Content updated: Tue, 28 Feb 2017 10:28:45 MST