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The Goal of the Program
The goal of
this program is to understand the rapidly changing nature of work
and its effects on the health of Californians. Dramatic changes
are occurring in the structure of work, and these changes, taken
singly or in combination, have significant implications for health.
Major shifts include an increasing number of workers whose positions
require advanced technological training and a decreasing number
of positions available for people whose education has not progressed
beyond high school; lifetime careers that include more moves,
transitions and occupational changes than those of any previous
generation, sometimes accompanied by an erosion of mutual obligation
between employees and employer; growth of the contingent labor
force and contract employees; a decrease in the number of workers
whose rights are protected by unions and for whom internal advancement
ladders exist within their place of work; and a significant increase
in the number of women in the workforce, which has increasingly
made work a family concern.
Because of its size, diversity and
fast pace of economic evolution, California is an ideal laboratory
within which to examine the relationships between the evolving
worlds of work and health. A solid body of existing research connects
many aspects of employment and mobility to health outcomes, but
rapid changes in the organization of employment and opportunities
for advancement leave many important questions unanswered. Through
the Future of Work and Health Program, the Foundation is seeking
to support projects that can yield better understanding of work
and health relationships that are future oriented and specific
to California.
The California economy creates an
important backdrop for improving or depressing the health of Californians
because of its central role in creating jobs, influencing the
amount and distribution of income and wealth, shaping the relationship
between employers and employees, and determining the feasibility
of employment sponsored health benefits and programs. Because
the California economy is so central to the future of work and
health in California, The California Wellness Foundation awarded
a grant to the Institute of Regional and Urban Studies (IRUS)
to provide consultation in shaping this program. Another grant
was awarded to the University of California, San Francisco, Institute
for Health Policy Studies, to work with the Field Institute to
conduct a three-year longitudinal survey that will examine important
work and health relationships in California and create a database
on the work and health of Californians that will be widely available
to other researchers.
The California Wellness Foundation
convened a Future of Work and Health Advisory Panel charged with
the task of identifying those issues and trends most important
to the future of work and health, including researchers as well
as practitioners in both of these fields. The panel reached agreement
on three broad trends called the Program Framework.
The Program
Framework
Getting
left behind by a changing economy:
The past three decades have brought about wrenching changes in
the structure of the California and U.S. economies. Some industries
and occupations have declined sharply while whole new industries
and occupations have developed. Skill requirements are continually
changing even for existing occupations. A significant portion
of the California workforce has struggled with these rapid economic
changes as real wages and opportunities for upward mobility have
been frozen by the difficulties in adjusting to changing job and
skill requirements. Many individuals have seen their former jobs
disappear and have faced the need to begin new career paths. These
changes affect the health of Californians. Research points to
clear connections between low wages and poor health, as well as
between perceived lack of mobility (a "stuck" feeling) and ill
health.
A widening of income inequality:
A relatively new body of research demonstrates that wide gaps
between the rich and poor - in counties, states and metropolitan
area - are associated with poor health. Those geographic areas
in which income levels are not sharply divided between the "haves"
and "have nots" are better for residents' health than those with
large income disparities. Income inequality has widened in California
and the nation since the mid-1970s, mainly associated with educational
levels, i.e., people with college degrees have experienced rising
incomes while most other groups have experienced small gains or
income losses after adjusting for inflation. As a result, inequality
affects a broad cross section of Californians, with the least
educated 70 percent of the state's residents falling behind the
best educated 30 percent. The panel identified gaps in our knowledge
of how inequality and health are connected and how best to respond
to the persistence of inequality.
A changing contract between employer
and employees:
Very significant health implications are associated with many
of the changes occurring in the structure of work. For example,
an increasing percentage of Californians work evening and night
shifts, which have statistically higher rates of on-the-jobs accidents
and deaths than standard work hours. Far more people hold part-time
or contingent positions with no job security or advancement potential.
Significantly, access to health care itself has decreased as employers
have dropped health insurance as a workplace benefit or asked
for employee contributions that exceed the financial capability
of their staff. Profound changes in work arrangements are likely
to continue with a continuing decrease in the connections between
work and benefits like health and pension coverage, a continuing
spread of work hours throughout the 24-hour day, increases in
the number of multiple worker families, and conflicts between
work and family arrangements. |
