Economic Stability

About This Literature Summary

This summary of the literature on Employment as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the High School Graduation, Housing Instability, and Poverty literature summaries. 

Literature Summary

Every day, many people are either working or looking for work.1,2,3 Multiple aspects of employment — including job security, the work environment, financial compensation, and job demands — may affect health. This summary describes how several of these aspects of employment influence health.

The Bureau of Labor Statistics (BLS) defines the labor force as individuals who are either employed (i.e., those who are working for pay or profit) or unemployed (i.e., those who are jobless but are available to work and have actively looked for work in the past 4 weeks).2,4 People who are neither employed nor unemployed are not part of the labor force.2,4 As of December 2019, approximately 260 million people in the United States were eligible for the labor force. Of those eligible, 63 percent participated (i.e., were employed or unemployed), and the remaining 37 percent were out of the labor force (e.g., retired).5

In addition, some workforce participants are underemployed, a term that indicates “involuntary part-time employment, poverty-wage employment, and insecure employment (i.e., intermittent unemployment).”6 Underemployment includes situations where the social status and income of a job does not match an employee’s education, abilities, and skills.7,8,9

Harmful workplace conditions, including psychosocial stress, can increase the risk for negative health outcomes.1,10,11 In 2019, there were 2.8 million nonfatal and 5,333 fatal injuries at work.12,13 Workers are prone to injuries and illness if their job includes repetitive lifting, pulling or pushing heavy loads;1,14 poor-quality office equipment (e.g., keyboards and chairs);1,15 long-term exposure to harmful chemicals such as lead, pesticides, aerosols, and asbestos;1,16,17 or a noisy work environment.1,18,19 In addition, highly demanding jobs and lack of control over day-to-day work activities are sources of psychosocial stress at work.10 Other sources of workplace stress include high levels of interpersonal conflict,20 working evening shifts, working more than 8 hours a day, and having multiple jobs.1,21 These stressors put people at risk for mortality22 and depression,23 and they may be correlated with increased parent-child conflict and parental withdrawal.24 People in highly stressful jobs may also exhibit unhealthy coping skills such as smoking or alcohol abuse.25 

Level of educational attainment is linked to disparities in employment because it affects the type of work people do, the working conditions they experience, and the income they earn. Workforce participants have different skill levels and educational backgrounds, which creates inequalities in wages, opportunities for advancement, job security, and other work benefits.26 Individuals with less education have fewer employment choices, which may force them into positions with low levels of control, job insecurity, and low wages.9 Individuals with less education are also more likely to have jobs that are physically demanding or include exposure to toxins.9

Genderi is also an influential source of workplace disparities. Men are more likely to work longer hours, hold higher-status jobs, and have more physically demanding jobs. However, women report more work-related physical and mental health problems.27 Men tend to receive less support from coworkers and supervisors,27 while women are more likely to experience sexual harassment28,29 and related alcohol abuse.28,30

Racial and ethnic disparities also exist in the workforce. White people are more likely to work in white-collar clerical jobs and to assume managerial positions, while Black people are more likely to work in blue-collar service jobs.26 Some racial/ethnic minority groups are also more likely to be unemployed.31 In October 2019, the unemployment rate for Black people was 5.4 percent, compared to 3.2 percent for White people.31 Additionally, Black people are more likely than White people to work in jobs that have a higher exposure to environmental risk factors and a higher risk for injury or illness.32 Workplace inequalities among racial/ethnic minority groups may cause anxiety, depression, and physical pain.30 

Unemployment can also have negative health consequences. Those who are unemployed report feelings of depression, anxiety, low self-esteem, demoralization,6,8 worry, and physical pain.33 Unemployed individuals tend to suffer more from stress-related illnesses such as high blood pressure,34,35,36,37 stroke, heart attack, heart disease, and arthritis.8,38,39 In addition, experiences such as perceived job insecurity, downsizing or workplace closure, and underemployment also have implications for physical and mental health.8

Some strategies have been implemented to mitigate the negative health effects of unemployment and improve employee health and well-being. The Federal-State Unemployment Insurance Program provides temporary financial assistance to eligible workers who lost a job for reasons beyond their own control.40 Although unemployment benefits vary by state laws, some research indicates that larger state unemployment benefits may alleviate poor health outcomes associated with unemployment.41 A federal agency that supports workers is the Occupational Safety and Health Administration (OSHA), which helps regulate safe work environments. OSHA outlines the rights of workers and offers opportunities for workers to request a workplace inspection or file a safety complaint.42 Finally, employers may offer a range of resources and benefits to improve the well-being of their employees, including health insurance, paid sick leave, and parental leave. Employer health insurance provides access to affordable medical care and financial protection from unexpected health care costs.43,44 In 2019, 71 percent of civilian workers and 69 percent of private industry workers had access to health insurance, while 89 percent of state and local government employees had access.45 Additionally, paid sick leave allows employees to seek medical care for themselves or dependent family members without losing wages.46 Some employers also offer parental leave after the birth of a child, which is frequently unpaid. Maternity leave has been associated with a number of positive health outcomes for both women and children.47

Additional research is needed to better understand the beneficial effects of employment on health and to promote interventions that address disparities in employment and health. This additional evidence will facilitate public health efforts to address employment as a social determinant of health.


i The Centers for Disease Control and Prevention (CDC) define gender as “the cultural roles, behaviors, activities, and attributes expected of people based on their sex.”




U.S. Department of Labor, Bureau of Labor Statistics. (2017). The employment situation: October 2017. News Release. https://www.bls.gov/news.release/archives/empsit_11032017.pdf


U.S. Department of Labor, Bureau of Labor Statistics. (2017). American time use survey — 2016 results. News Release. https://www.bls.gov/news.release/archives/atus_06272017.pdf


U.S. Department of Labor, Bureau of Labor Statistics. (2015). Labor force statistics from the current population survey: How the government measures unemployment. http://www.bls.gov/cps/cps_htgm.htm


U.S. Department of Labor, Bureau of Labor Statistics. (2020). Employment situation news release. https://www.bls.gov/news.release/archives/empsit_01102020.htm#cps_empsit_annual_c.f.1


Dooley, D., Fielding, J., & Levi, L. (1996). Health and unemployment. Annual Review of Public Health, 17, 449–465.


Friedland, D. S., & Price, R. H. (2003). Underemployment: Consequences for the health and well‐being of workers. American Journal of Community Psychology, 32(1), 33–45.


Avendano, M., & Berkman, L. F. (2014). Labor markets, employment policies, and health. In Social Epidemiology (pp. 182–233). Open University Press.


Berkman, L. F., Kawachi, I., & Theorell, T. (2014). Working conditions and health. In Social Epidemiology (pp. 153–181). Open University Press.


Shain, M., & Kramer, D. M. (2004). Health promotion in the workplace: Framing the concept; reviewing the evidence. Occupational and Environmental Medicine, 61(7), 643–648.


Brooker, A., & Eakin, J. M. (2001). Gender, class, work-related stress and health: Toward a power-centred approach. Journal of Community and Applied Social Psychology, 11(2), 97–109. https://doi.org/10.1002/casp.620


U.S. Department of Labor, Bureau of Labor Statistics. (2020). Employer-reported workplace injuries and illnesses (annual) news release. https://www.bls.gov/news.release/archives/osh_11042020.htm


U.S. Department of Labor, Bureau of Labor Statistics. (2019). Table A-7: Fatal occupational injuries by worker characteristics and event or exposure, all United States. https://www.bls.gov/iif/oshwc/cfoi/cftb0333.htm


O’Neil, B. A., Forsythe, M. E., & Stanish, W. D. (2001). Chronic occupational repetitive strain injury. Canadian Family Physician, 47(2), 311–316.


Ross, P. (1994). Ergonomic hazards in the workplace: Assessment and prevention. American Association of Occupational Health Nurses Journal, 42(4), 171–176.


Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. (2004). Worker health chartbook, 2004. https://www.cdc.gov/niosh/docs/2004-146/pdfs/2004-146.pdf?id=10.26616/NIOSHPUB2004146 


U.S. Centers for Disease Control and Prevention. (2006). Adult blood lead epidemiology and surveillance — United States, 2003–2004. Morbidity and Mortality Weekly Report, 55(32), 876–879.


Hager, L. D. (2002). Hearing protection. Didn’t hear it coming ... Noise and hearing in industrial accidents. Occupational Health and Safety, 71(9), 196–200.


Nelson, D. I., Nelson, R. Y., Concha-Barrientos, M., & Fingerhut, M. (2005). The global burden of occupational noise-induced hearing loss. American Journal of Industrial Medicine, 48(6), 446–458. https://doi.org/10.1002/ajim.20223


Schieman, S., & Reid, S. (2009). Job authority and health: Unraveling the competing suppression and explanatory influences. Social Science & Medicine, 69(11), 1616–1624.


Caruso, C. C., Hitchcock, E. M., Dick, R. B., Russo, J. M., & Schmit, J. M. (2004). Overtime and extended work shifts: Recent findings on illnesses, injuries, and health behaviors. Department of Health and Human Services, Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health.


Sabbath, E. L., Mejía-Guevara, I., Noelke, C., & Berkman, L. F. (2015). The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers. Social Science & Medicine, 146, 111–119.


Simmons, L. A., & Swanberg, J. E. (2009). Psychosocial work environment and depressive symptoms among U.S. workers: Comparing working poor and working non-poor. Social Psychiatry & Psychiatric Epidemiology, 44(8), 628–635. https://doi.org/10.1007/s00127-008-0479-x


Repetti, R. L., & Wang, S. W. (2014). Employment and parenting. Parenting, 14(2), 121–132.


Hoel, H., Sparks, K., & Cooper, C. L. (2001). The cost of violence/stress at work and the benefits of a violence/stress-free working environment. Geneva: International Labour Organization, 81.


Kalleberg, A. L. (2011). Good jobs, bad jobs. Russel Sage Foundation.


Campos-Serna, J., Ronda-Pérez, E., Artazcoz, L., Moen, B. E., & Benavides, F. G. (2013). Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: A systematic review. International Journal for Equity in Health, 12, 57. https://doi.org/10.1186/1475-9276-12-57


Gradus, J., Street, A. E., Kelly, K., & Stafford, J. (2008). Sexual harassment experiences and harmful alcohol use in a military sample: Differences in gender and the mediating role of depression. Journal of Studies on Alcohol and Drugs, 69(3), 348–351.


Rospenda, K. M., Richman, J. A., & Shannon, C. A. (2009). Prevalence and mental health correlates of harassment and discrimination in the workplace: Results from a national study. Journal of Interpersonal Violence, 24(5), 819–843.


Okechukwu, C. A., Souza, K., Davis, K. D., & Castro, A. B. (2014). Discrimination, harassment, abuse, and bullying in the workplace: Contribution of workplace injustice to occupational health disparities. American Journal of Industrial Medicine, 57(5), 573–586.


U.S. Department of Labor, Bureau of Labor Statistics. (2019). Unemployment rate was 3.6 percent in October. https://www.bls.gov/opub/ted/2019/unemployment-rate-was-3-point-6-percent-in-october-2019.htm


Assari, S. (2018). Health disparities due to diminished return among Black Americans. Public Policy Solutions, 12(1), 112–145.


Burgard, S. A., & Kalousova, L. (2015). Effects of the Great Recession: Health and well-being. Annual Review of Sociology, 41, 181–201.


Murray, L. R. (2003). Sick and tired of being sick and tired: Scientific evidence, methods, and research implications for racial and ethnic disparities in occupational health. American Journal of Public Health, 92(2), 221–226.


Kasl, S. V., & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32(1), 19–38.


Frumkin, H. E., Walker, D., & Friedman-Jiménez, G. (1999). Minority workers and communities. Occupational Medicine, 14(3), 495–517.


James, S. A., LaCroix, A. Z., Kleinbaum, D. G., & Strogatz, D. S. (1984). John Henryism and blood pressure differences among Black men. II. The role of occupational stressors. Journal of Behavioral Medicine, 7(3), 259–275.


Robert Wood Johnson Foundation. (2013). How does employment — or unemployment — affect health? Health policy snapshot. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403360


U.S. Department of Labor, Bureau of Labor Statistics. (2012). A profile of the working poor, 2010. News Release. https://www.bls.gov/opub/reports/working-poor/archive/workingpoor_2010.pdf


U.S. Department of Labor, Employment & Training Administration. (n.d.). State unemployment insurance benefits. https://oui.doleta.gov/unemploy/uifactsheet.asp


Cylus, J., Glymour, M., & Avendano, M. (2015). Health effects of unemployment benefit program generosity. American Journal of Public Health, 105(2), 317–323. https://doi.org/10.2105/AJPH.2014.302253


U.S. Department of Labor, Occupational Safety and Health Administration. (n.d.). OSHA worker rights and protections. https://www.osha.gov/workers


Institute of Medicine Committee on Health Insurance. (2009). America’s uninsured crisis: Consequences for health and health care. National Academies Press.


Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health — what the recent evidence tells us. New England Journal of Medicine, 377(6), 586–593.


U.S. Department of Labor, Bureau of Labor Statistics. (2019). Employee benefits in the United States news release. https://www.bls.gov/news.release/archives/ebs2_09192019.htm


DeRigne, L., Stoddard-Dare, P., & Quinn, L. (2016). Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Affairs (Millwood), 35(3), 520–527.


Burtle, A., & Bezruchka, S. (2016). Population health and paid parental leave: What the United States can learn from two decades of research. Healthcare (Basel), 4(2).

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