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Developing the Concept of Employment Quality for Population Health

We spend a good portion of our lives at work, and aspects of that work—the sort of work we do, the environment the work is in, the time of day we work, among many other factors—have a significant impact on the health and quality of our lives.  A growing body of research shows that factors related to the contractual and relational aspects of employment – like how predictable and stable your employment is, your pay, the hours you work, your access to health insurance and paid family leave through your job-- also matter to health. Despite this, there has been very little attempt in healthcare to look at workplaces and the quality of employment among patients, the communities served, and even among healthcare workers themselves. This oversight is changing, however, due to work being done by the Director of Utah Center for Promotion of Work Equity Research (U-POWER) and OEH research associate professor, Emily Ahonen, PhD.

In a recent publication, Ahonen and her colleagues begin the work of creating a framework to define employment quality in ways that facilitate its measurement across differing structural, cultural and social circumstances. Particularly, the paper—titled, “Investigating Employment Quality for Population Health and Health Equity: A Perspective of Power”—focuses on power relations and dynamics and the ways that power shapes the quality of a worker’s experience.

The paper uses the allegory of a railcar that represents employment quality aspects, such as pay and contracts, exchanged for the labor workers provide.  The railcar can move along a track representing a range of better and worse forms of employment quality.  In their allegory, both workers and employers have power resources to shift the location of the railcar on the track, but, in many cases, employers have a greater stock of resources than workers to influence the contents of the railcar towards things like lower pay, no paid time off, and limited-term contracts. In addition, where the railcar sits on the track is not only influenced by the negotiations between employers and workers but by the social, political, and cultural contexts in which those negotiations take place. Employers tend to have more influence in these things as well—advantages such as lobbying and close ties between public policy offices and private companies—to set the grade of the track’s slope to be in their favor. The result is often low employment quality for workers to the benefit of the employer. Because it has been this way for many decades in the US, people and society have normalized this circumstance, making it hard to see and thus difficult to engage with and address, including in research and practice.

In providing a visual device to understand the role of power for employers and workers in shaping employment quality, Ahonen et al. provide a necessary structure that helps researchers and clinicians alike incorporate work experience into the complex picture of a patient’s social determinants of health. In turn, making power explicit in research on employment quality and health will facilitate more accurate measurement of EQ in the population. Having a conceptually solid way of measuring the impacts of work on a person’s health provides a clearer picture of the reasons for their overall physical and mental well-being.

“With this publication, we’re encouraging people to name and recognize something we all implicitly know – that power shapes population health,” says Ahonen. “Bringing power to the fore makes it more likely we will act to change work in favor of population health and health equity.”

Ahonen’s article is published in the International Journal of Environmental Research and Public Health. It can be found here.