1. This project is supported by a grant from the National Institute of Occupational Safety and Health Grant #R01-OH07381-02, “Health Disparities among Healthcare Workers.” Acknowledgment to Angelo d’Errico for data analyses. The Impact of Workplace Injury and Illness in the Healthcare Sector on Regional Economic and Social Well- being Dr. Monica Galizzi, Dept. of Economics Dr. Laura Punnett, Dept. of Work Environment for the PHASE-in Healthcare Project

2. “Outcomes” of Work-Related Injury and Illness HEALTHWORK Pain Mental distress Functional losses Absenteeism Employment stability Household work capacity

3. Health and Work: A reciprocal relationship HEALTH WORK Pain Mental distress Functional losses Absenteeism Employment stability Household work capacity

4. Our Research Questions How do these outcomes vary by socioeconomic status in the healthcare sector? How much of the socioeconomic relationship is explained by the work environment?

5. What do we already know about the effects of disability on labor force participation? It varies by socioeconomic status The effect of specific health problems varies by gender Type of health care and disability insurance system also play a role

6. Risk of chronic disability* due to low back pain is inversely related to income level Monthly wage: * >90 days off work Volinn et al. 1991

7. What do we already know about “outcomes” of on-the-job injuries? Both personal and firm characteristics affect the length of time off work Problems recur after first return to work Substantial income losses Effect on household work capacity

8. Preliminary PHASE data show:  High proportion of female workers  Minority and young workers disproportionately represented in low socioeconomic status jobs and heavy work  Several job titles associated with low levels of “job control”(decision latitude)  High rate of work-related injury

9. PHASE partner facilities: Nursing home workers are younger than hospital employees

10. PHASE partner facilities: White/Anglo employees disproportionately in higher socioeconomic level jobs

11. Variation in “Job Control” among healthcare workers - Has this changed since 1977? Karasek & Theorell 1990

12. Questions to be explored: How does socioeconomic status affect the predictors of: – Successful return to work – Income losses – Social and family burden What is the total regional cost of workplace injury and illness?

13. Hypothesized Findings Because of gender: –High level of future unemployment, of income losses, of social losses Because of race/ethnicity: –Low probability of employer accommodation Because of low job control: –Higher rate of chronic problems and future unemployment Because of skills of workers: –High adjustment costs for employers and costs for “consumers”

15. PHASE partner facilities: Whites disproportionately employed in hospitals vs. nursing homes

16. Absenteeism* is higher in lower employment grades Feeney et al. 1998 * 7 days or less

17. The importance of job control in accommodation and return-to-work Hemingway et al. 1997 Decision latitude: