The problem. Losing a job has an immediate impact on an individual's financial situation. But how does this loss, or worry about a potential job loss, impact health outcomes among adults in the United States? Little was known about the association between health and job insecurity—believing that there is a good chance of losing one's job in the future—during midlife, a period when social disparities in health widen substantially.
Grantee perspective. Sociologist and epidemiologist Sarah A. Burgard, PhD, MS, had just completed her doctorate in sociology and her Master of Science degree in epidemiology from the University of California at Los Angeles. She wanted to transition from her focus on disparities in maternal and child health to concentrate on working lives and health outcomes in adults. "Think about how many hours a day you spend in the workplace," said Burgard. "It is a huge social influence on our health. I was ready to show that health disparities matter and that they change and are exacerbated across the life course."
In Robert Wood Johnson Foundation Health & Society Scholars, Burgard found the opportunity she was looking for to study adults and the intersection between health and work stability. In 2003, she began her two-year interdisciplinary fellowship at the University of Michigan, one of the six participating universities in the Health & Society Scholars program. For more information on the program, see Program Results.
Burgard was attracted to the University of Michigan because it is a center of ongoing research on health, work and retirement. The University of Michigan "has one of the most integrated research communities interested in the development and management of midlife health experiences, with a strong program to understand the impact of working lives on health," said Burgard.
"The Robert Wood Johnson Foundation program is set up to allow scholars to make a substantive shift in what they study. It allowed the time and resources and mentorship I needed to make a dramatic change in my research focus and topics. It was profound."
Results. At the University of Michigan, Burgard and two Health & Society Scholar colleagues began examining how health and work are related. They used research data from two University of Michigan-based studies: the 'Americans Changing Lives study (which focuses on differences between Black and White Americans age 60 and over), and the Midlife in the United States study (a national survey of the health and well-being of more than 7,000 Americans ages 25 to 74). They also used data from the Wisconsin Longitudinal Study (a long-term study of a random sample of 10,317 men and women who graduated from Wisconsin high schools in 1957).
Burgard says they "focused on the reciprocal links between job insecurity and health among American workers." She and her colleagues noted these key findings in "Toward a Better Estimation of the Effect of Job Loss on Health" (Journal of Health and Social Behavior, 48(4): 369–384, 2007, abstract available online) and in "Perceived Job Insecurity and Worker Health in the United States" (Social Science and Medicine, 69(5): 777–785, 2009, abstract available online):
- Individuals who lose their jobs for health-related reasons have the most precipitous declines in self-rated mental and physical health.
- Job losses for other reasons have substantive and statistically significant effects on subsequent depressive symptoms, with smaller effects on poor health.
- Persistent perceived job insecurity is also associated with harmful changes in health and increases in depression.
Burgard notes that she and her colleagues were among the first to examine the relationship between perceived job loss and its impact on health.
Afterward. After completing two years as a Health & Society Scholar, Burgard joined the University of Michigan faculty as assistant professor of sociology and epidemiology and assistant research scientist at the Population Studies Center. (She was promoted to associate professor and associate research scientist in 2011.) She continues to collaborate with her Health & Society Scholars colleagues on research, academic papers and grant proposals.
Burgard's work during the program led to a series of additional, related papers and continued research into the impact of employment insecurities and disadvantages on adult health. A large part of Burgard's research was published during the national recession from December 2007 to June 2009, and the New York Times, the Associated Press and other media reported on her findings.
"The recent recession, which has been an incredibly difficult time, was a fortuitous time to invest in this research," Burgard admitted. It "has only heighted our need to understand the consequences of job insecurity and employment disruptions for workers."
As of April 2011, Burgard was a member of the research team for the Effects of the Recession and the American Recovery and Reinvestment Act of 2009 on Workers and Families: A Panel Study in Southeast Michigan, 2009–2011, conducted by the National Poverty Center at the University of Michigan and designed to study how the collapse of stock and housing prices and instability in the labor market have affected the well-being of adults and how increased federal spending through the American Reinvestment and Recovery Act may help cushion the negative economic effects.
The study involves surveys and interviews of 900 individuals in Southeast Michigan (Wayne, Oakland and Macomb counties). Burgard's role is to study events that link job loss, foreclosures and financial insecurity to mental and physical health. It is funded by the University of Michigan along with the Office of the Assistant Secretary of Planning and Evaluation, the U. S. Department of Health and Human Services, the Ford Foundation and the MacArthur Foundation.
Burgard was also working as one of the principal investigators on a MacArthur Foundation grant to study the effects of the housing crisis on vulnerable workers and families (through 2012). In both studies, Burgard collaborates with former Health & Society Scholars.
"I think the most unexpected and perhaps biggest blessing has been the connections with my scholar friends after we left the program," Burgard said. "I could never do this kind of transdisciplinary population-health research on my own. The program is a living thing that extends beyond the period when one is officially a scholar."
RWJF perspective. RWJF created the Health & Society Scholars in 2001 to build the field of population health. "There is a growing recognition that health is the result of the interaction of multiple factors including socioeconomic and physical environmental factors and health behaviors," said Senior Program Officer Pamela G. Russo, MD, MPH, leader of RWJF's Public Health Team. "The evidence shows that these types of factors play a much larger role in determining health at the population level than do the traditionally considered health care and biological determinants of health."
"The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities," said Russo.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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