Original publication
This article was originally published on January 18, 2019 for Physical Therapy Products. You can view the original here: Worker health and population health: Connected. (8)
This version is a cleaned, structured reference edition that preserves the substance of the original content and keeps the full reference list intact.
Why this topic matters for therapists and employers
Therapists have a long history with both employee health and population health. In the 1930s, early work hardening concepts developed as occupational therapists created industrial therapy programs for patients in mental hospitals, and early job matching concepts emerged as jobs were analyzed for their physical and mental demands. (1)
Physical therapists expanded this work in the 1980s as pioneers such as Susan Isernhagen and Keith Blankenship advanced functional testing protocols through Functional Capacity Evaluations (FCEs). These evaluations became widely used for describing work ability, setting goals, and measuring progress in work hardening and work conditioning programs. Today, FCE approaches include both standardized and job-specific formats.
Both professions also have a documented role in wellness and population health through their practice guidelines. Physical therapists, for example, are called upon to participate in prevention and wellness activities such as health screening and health promotion, and they are well positioned to contribute as members of primary care teams. (2)
Employee health on the job
Employee health on the job spans the full employment lifecycle: hiring, training and placement, day-to-day work demands, and injury or illness management through termination or retirement. As the workforce ages, retirement tends to occur later, and evidence indicates that fatality risk at work increases with age, with falls as a leading injury type. (3)
Labor force projections also indicate growth in older employee age groups, especially those ages 65 to 74 and those 75 and older. (4) These trends make it even more important to manage job demands and health support systems proactively.
Musculoskeletal disorders (MSDs) remain a major contributor to cost. Bureau of Labor Statistics reporting has shown that sprains, strains, and tears are among the most common injuries resulting in days away from work, job transfer, or restriction across multiple industries. (5)
Managing employee health at the workplace
Therapists have a skill set that positions them to help employers manage MSDs and age-associated conditions that affect safe performance at work. That includes support with hiring procedures, job-specific training and placement, early intervention strategies, and return-to-work planning when injury, illness, or disability affects a person’s ability to work safely.
To be successful, this work should account for the employee’s current safe work abilities and the actual demands of the job. The most important foundation is objective and accurate physical demands information linked to essential job functions. Once validated, this information can support multiple employer services, including:
Prevention
Job-function-based testing at the offer stage can support hiring and placement decisions. Job-specific training can be more meaningful for new employees and can also be used for periodic review. Job-appropriate exercise programs can reduce preventable injuries and help employees feel better at work.
Early intervention strategies can also reduce risk by raising awareness through body mechanics, posture, and exercise. These services can be provided individually or in groups and are commonly described as job coaching.
Stay at work and return to work
Job-function-based testing can also help identify an employee’s specific abilities and support job-related goals during medical and rehabilitation management. It can inform transitional placement, temporary assignment, and when needed, temporary or permanent accommodations.
While MSDs often drive the largest and most visible cost impact, the benefits of this approach extend to other conditions as well. All parties affected, including employees, employers, and payors, can benefit when decisions are grounded in objective job demands and current safe work abilities.
Managing employee health in large populations
Population health studies continue to show that healthy employees tend to have lower risk of injury, illness, and disease than those whose conditions are medically managed, often with medication.
Poor health habits contribute to declining health and rising healthcare costs, including work-related costs. Research has shown that workplace health initiatives can reduce sick leave absenteeism and reduce healthcare costs for companies. (6)
More than 70% of U.S. adults are classified as overweight or obese using body mass index (BMI) as a measurement tool, and weight-related issues are strongly associated with cardiovascular disease, Type 2 diabetes, and high cholesterol. (7) Medication may manage these conditions, but for many, weight management and healthy activity can substantially improve outcomes.
When employees stop smoking, maintain healthy weight and activity levels, manage stress, and get adequate rest, the benefits show up across stakeholders: employees experience better quality of life, employers benefit from productivity and quality improvements, and payors benefit from reduced preventable utilization. Costs decrease when health improves.
The connection between employee health and population health
Employee health on the job and population health overlap significantly. One enhances the other, and neither should be neglected. However, primary prevention is often funded directly by employers and employees, because reimbursement systems typically focus on identifying and treating injury or illness after it exists.
Employers are increasingly investing in health improvement and injury reduction programs for employees and families. The return can be meaningful when programs are comprehensive and high quality. This is a space where therapists can enter, lead, and contribute cost-efficient programs, often as part of a diverse team.
To achieve maximum benefit, teams should incorporate multiple elements of employee health and involve other health professionals at appropriate levels. A team that operates within scope of practice and maintains strong ethical standards can elevate service quality and expand the impact on workforce health.
References
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Matheson LN, Dempster Ogden L, Violette K, Schultz K. Work hardening: occupational therapy in industrial rehabilitation. Am J Occup Ther. 1985;39:314-321.
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American Physical Therapy Association. Guide to Physical Therapist Practice 3.0. Available at http://guidetoptpractice.apta.org/. Accessed January 7, 2019.
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Dong W, Wang X, Daw C, Ringen K. Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study. J Occup Environ Med. 2011;53(4):372-380.
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US Bureau of Labor Statistics. Career Outlook. Projections of the labor force, 2016–26. November 2017. Available at https://www.bls.gov/careeroutlook/2017/article/projections-laborforce.htm. Accessed January 10, 2019.
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Bureau of Labor Statistics, US Department of Labor. The Economics Daily. Workplace injuries and illnesses resulting in job transfer or restriction in 2017. Available at https://www.bls.gov/opub/ted/2019/workplace-injuries-and-illnesses-resulting-in-job-transfer-or-restriction-in-2017.htm. Accessed January 10, 2019.
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World Health Organization. Fact Sheets. Protecting workers’ health. Available at https://www.who.int/news-room/fact-sheets/detail/protecting-workers%27-health. Accessed January 10, 2019.
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Cleveland Clinic. Health Essentials. Study finds obesity itself raises risk of diabetes and cardiovascular disease. Available at https://health.clevelandclinic.org/study-finds-obesity-itself-raises-risk-of-diabetes-and-cardiovascular-disease/. Accessed January 10, 2019.
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This article was originally published for Physical Therapy Products: https://ptproductsonline.com/practice-management/workplace-injury-management/worker-health-population-health-connected/.
