Chapter 12 Broadening OHP Impact.docx

Opportunities for Broader Impact Throughout this book we have focused on ways in which OHP professionals can use their knowledge and methods to protect and promote worker health, safety, and well-being (WHSWB). Up to this point, we have examined essential OHP theories, research findings, and interve...

Opportunities for Broader Impact Throughout this book we have focused on ways in which OHP professionals can use their knowledge and methods to protect and promote worker health, safety, and well-being (WHSWB). Up to this point, we have examined essential OHP theories, research findings, and intervention methods with an emphasis on workers in specific work settings. Many of the essential OHP topics, theories, research evidence, and methods discussed in this book, however, can be more broadly studied and applied to address a variety of major societal challenges. This broader utility of OHP knowledge and methods is true now and will continue to be true even as changes occur to the nature of work, organizations, and workers. The anticipated future of work, as outlined by futurists and respected institutions (e.g., International Labour Organization [ILO], 2019a), will likely involve new technologies and ways of working, as well as new forms of work altogether. What will not be so different in the future, is that these advancements will result in new demands to which workers still must adapt. Also, some workers will continue to have more opportunities and advantages than others. OHP professionals can help organizations and workers adapt to future work-related demands while improving the overall WHSWB situation for all workers. While the future unfolds, we must not ignore current opportunities we have to develop and shape workers, organizations, and society in ways that support sustainable work, which protects workers’ rights and dignity, and ensures equitable and safe working experiences for all (ILO, 2019a). With this chapter, we hope to encourage you to broaden your thinking about how OHP knowledge and methods can be extended to several important societal-level issues, including: (a) protecting human dignity and rights; (b) addressing social determinants of health, safety, and well-being; and (c) contributing to peace and social justice. Protecting Human Dignity and Rights As emphasized by governments, policy institutions, and even religious traditions and teachings, human dignity and rights should be protected in and out of work environments. Providing such protections requires coordinated efforts between organizations and governments, as well as supportive forces operating within society more generally. There is much work to be done within our global society to fully protect human dignity and rights. Even just focusing on work contexts, many workers worldwide do not receive sufficient and equivalent protections for the work-related risks they regularly face. Entire subpopulations of workers are basically exploited for the value they can create for their employers (e.g., migrant farm workers in unsafe conditions, sex workers, child laborers). Sometimes worker exploitation results from organizational cost management efforts, thinly veiled as limited, part-time, or even “flexible” work opportunities. This is often the situation when organizations leverage contingent labor (e.g., migrant workers, temporary or part-time help) or gig workers (e.g., independent contractors, online crowdsourcing workers) as a strategy for controlling administrative and operational costs. These employment arrangements can become exploitative if workers are prevented from obtaining adequate pay, benefits, other rewards, safety protections, and job security that would otherwise be available to full-time workers. Indeed, gig workers often earn less than minimum wage to engage in work that offers little security or formalized benefits (O’Connor et al., 2020), and in many cases involves more work-related risks for interpersonal mistreatment, sexual harassment, and even assault (e.g., Ravenelle, 2019). Sometimes environmental circumstances create situations in which exploitative working scenarios unfold. As an example, consider the experiences of essential workers during national lockdowns due to the COVID-19 pandemic. Many individuals willingly and heroically continued to support essential societal functions (e.g., healthcare, education). Many others, however, had no real choice but to keep working so they could put food on the table. Regardless of how they are justified, these types of labor relationships flout human dignity and rights, and damage societal functioning. Some workers are drawn (sometimes out of interest, sometimes out of necessity) to socially undesirable occupations (i.e., dirty work). Ashforth and Kreiner (1999) defined such work as involving physical contact with undesirable things (e.g., janitor, mortician), questionable morality (e.g., exotic dancer, pawn broker), or social taints (e.g., tabloid reporter, telemarketer). Morally dirty work tends to be associated with more purely negative views (i.e., “dirtier” work) than socially or physically dirty work, which may be undesirable, but seen as necessary to societal functioning (Ashforth & Kreiner, 2015). Workers in numerous occupations face demands that are not only undesirable, but disproportionately risky in physical, psychological, and social ways. These characteristics are present in so-called 3-D (i.e., dirty, dangerous, and demanding) work roles and commonly experienced by migrant and undocumented workers. It is important to note, however, that these characteristics are also often experienced in more mainstream roles, including in healthcare or military occupations (e.g., de Boer et al., 2011; Porter et al., 2018). Dirty and 3D work is demanding in and of itself; a main objective for OHP professionals supporting workers in these occupations is to help them reduce the amount of additional personal effort they need to put into legitimizing their work for themselves and others. Existing research shows us that within these occupations, workers and their managers use a number of strategies, like reframing or distancing from critical others, confronting negative stereotypes, and finding meaning in the work as ways of coping with work-related stigma (Ashforth & Kreiner, 1999; Ashforth et al., 2007; Bosmans et al., 2016). OHP professionals can help organizations and society to prepare, support, and respect the rights of such workers who willingly sacrifice their physical, social, and psychological health. Maintaining a positive identification with one’s work is important to all workers, even those who do not struggle with negative stigma due to the nature of their work. With this in mind, one other area in which OHP professionals can help in protecting human dignity and rights involves assisting workers as they transition into retirement, often coping with the lasting consequences of prolonged strain, and a loss of identity and purpose that comes along with stopping work (Alimujiang et al., 2019; Froidevaux et al., 2016). A number of OHP professionals and organizations are already demonstrating commitment to addressing the issues outlined in this section, but there is still much work to be done. Collaborating with organizations and policy-making institutions, we can help to ensure that protecting WHSWB is a priority for all workers. Keep in mind that by protecting workers’ dignity and rights, we are also reinforcing broader community and societal norms supporting protections for human dignity and rights that extend far beyond the boundaries of a single organization. Addressing Social Determinants of Health, Safety, and Well-Being As noted in an excellent review chapter by Donkin et al. (2014), there are documented and substantial disparities in the health status and quality of life for different groups of people within society; these “health inequities arise from the conditions in which people are born, grow, live, work, and age and inequities in power, money, and resources that give rise to these conditions of daily life” (p. 1). In line with this, the Centers for Disease Control and Prevention (CDC) proposed five key social determinants of health as part of its Healthy People 2030 campaign: economic stability, education access and quality, healthcare access and quality, neighborhood environment, and community context (CDC, 2020). A major source of social influence with the power to address these types of health determinants and inequities are the organizations in which people work. Healthy, safe, meaningful, and fairly compensated work support a number of essential elements highlighted by this CDC campaign. There are at least three ways in which OHP research and practice can directly address social determinants to health, safety, and well-being. Comprehensive Management of WHSWB Protecting and promoting WHSWB requires targeted efforts to address the topics discussed throughout this book. Also valuable are efforts to more holistically consider and address the factors that influence WHSWB. An increasingly visible example of this latter type of comprehensive approach is the Total Worker Health® initiative (National Institute for Occupational Safety and Health [NIOSH], 2020; Schill & Chosewood, 2013). This program acknowledges the need to holistically care for workers using methods that transcend the boundaries of work and nonwork role domains. Also along these lines is the World Health Organization’s (WHO) Healthy Workplace model, which emphasizes WHSWB as a priority for organizations and policy makers that not only benefits workers and organizations, but also families and communities (Burton, 2010; WHO, n.d.). The European Working Conditions survey, through the European Foundation for the Improvement of Living and Working Conditions (Eurofound) is another tangible example of changing society-level attention to worker well-being (Eurofound, 2020). This recurring survey began in 1990 and gathers data on factors affecting well-being, including traditional measures of safety, hazards, and work hours, as well as factors that transcend the workplace, such as work-life balance and feelings of financial security. Collectively, these examples highlight a broader way of thinking about and responding to WHSWB, its antecedents, and its consequences. This perspective also helps us understand the importance of our next couple of areas in which OHP can help to address social determinants of health, safety, and well-being. Occupational Health Inequity Ensuring WHSWB for all workers includes addressing occupational health inequities or, “avoidable differences in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage such as work arrangements (e.g., contingent work), socio-demographic characteristics (e.g., age, sex, race, and class), and organizational factors (e.g., business size)” (NIOSH, 2019; para. 1). Numerous studies document such health inequities at work, highlighting instances of disproportionate exposure to job hazards and insecurity, as well as disproportionate access to valuable resources like health insurance and paid leave (Landsbergis et al., 2014; Lipscomb et al., 2006). An implication of such inequity is that the burden of suffering, morbidity, and mortality is disproportionately experienced by some members of society more than others (Macik-Frey et al., 2016). Some efforts to advocate for workers and reduce disparities require the action of local, national, and international governing bodies. Formal policies and initiatives (e.g., availability of workers unions, wage-related legislation) have already made an impact for many communities (Siqueira et al., 2014). However, attempts to address occupational health inequity and disparities within specific organizational settings do not have to be all that complicated. An elegantly simple example comes from a “chair campaign” program introduced in Korea to provide service workers with the opportunity for rest during work shifts (Lee et al., 2011). This program successfully improved seating options for many workers and more generally increased societal awareness of this basic need. As discussed throughout this book, there are many demands inherent in just about every occupation, but there are also ways to match these demands with necessary resource and limit exposure to these demands. Economic and Basic Needs Insecurity Another major social determinant of health, safety, and well-being for workers and their families is consistent and sufficient resources to meet income, healthcare, food, shelter, and other basic needs. Unfortunately, many people are not able to meet at least some of these needs. It is estimated that approximately 9–10% of the world’s population lives in extreme poverty, with two-thirds living on less than $10 per day (Our World in Data, 2019; World Bank, 2020). Although managing food, shelter, and other needs may be a bit beyond typical OHP areas of practice, our knowledge and expertise can help address income and benefits security, two resources that enable workers to access other resources necessary for survival and maintaining a decent quality of life. Organizations can serve as platforms through which needs identification and screening can occur. Organizations can also facilitate distribution of care, support, and other resources where needed. OHP professionals can help with these efforts, given that they require organizational decision makers to stop believing that who and how we are at work can somehow be segmented or kept separate from who we are outside of work. As we discussed in Chapter 9, work and nonwork roles are typically much more integrated than we often like to believe. Digging into a particularly essential area of need, the effects of income (in)security and economic stress on workers, and their dependent families and communities are not commonly studied in the OHP or even in most applied behavioral or social sciences. This is particularly true when it comes to economically vulnerable populations, which historically have not been the focus of most OHP attention (for an excellent discussion of this history from a closely related Industrial-Organizational psychology perspective, see Gloss et al., 2017 and Saxena, 2017). The paradox here is that often ignored low-income workers regularly confront some of the most complex work and nonwork demands. In our research and practice, OHP professionals can broaden our attentional scope to consider the experiences of low-income workers, particularly those who would be considered working poor (Klein & Rones, 1989). As defined by the U.S. Bureau of Labor Statistics (BLS; 2020), these are individuals who are working or actively seeking work for at least 27 weeks of the year, but whose income still falls below national poverty rates. In 2018, this applied to 4.5% of the American workforce, with higher rates among part-time workers, workers in the service industry, women (particularly single women maintaining families), racial minorities (Black/African American or Hispanic/Latino), and less educated workers (BLS, 2020). As noted by the ILO (2019b), the numbers of individuals in poverty who are working versus not working are surprisingly similar, suggesting the opportunity to work is not enough to prevent poverty. This conclusion is supported by other studies that have shown that the working poor are often more in need of supports like long-term food assistance than those who do not work (e.g., Berner et al., 2008). Workers (and their families) in these situations can feel quite hopeless. Consider working parents that work full weeks, yet their earned income does not even amount to the costs of the childcare needed to enable them to work. This can feel like a losing battle, where the “solution” (to get a job) creates new demands on already limited financial resources. OHP professionals can help to inform and support business leaders and policy makers who are attempting to generate real solutions to these types of challenges. There really are numerous opportunities for OHP professionals to be involved in fighting against economic insecurity. This includes advocating for formal policies to ensure workers have a living wage (as noted in Chapter 3) and are not denied wages they rightly earn in more ambiguous or contingent work situations (Siqueira et al., 2014). Even when such public policies do not exist, we can encourage organizational leaders to provide workers with fair compensation and access to benefits as strategies for protecting WHSWB and strengthening communities. Organizations can also provide non-monetary resources that can improve financial security within communities, like financial education and literacy workshops and career development opportunities (e.g., skills training, continuing education for career growth). OHP professionals and organizations can even intentionally help those who are not in the workforce through connections with hiring agencies and non-profit organizations that support those often overlooked in our society, such as those who are homeless or previously incarcerated. Finally, OHP professionals can advocate for smart investments in communities that can improve individuals’ ways of responding to income- and work-related stress (e.g., Probst et al., 2018). An essential element to such efforts is creating support resources, in organizations and communities, where individuals experiencing financial hardship can obtain resources they need without experiencing shame. While we have focused mainly on the financially vulnerable here, we want to acknowledge that all workers can experience the poor health effects of stressors like job insecurity, unemployment, and underemployment (Creed & Klisch, 2005; Friedland & Price, 2003; Park & Baek, 2019; Shoss, 2017). There is also growing evidence of strong relationships between income insecurity and psychological and physical health (Kopasker et al., 2018; Vandoros et al., 2019). From the perspective of the conservation of resources (COR) theory (Hobfoll, 1989), which we have referred to many times in this text, income is a resource in and of itself, but also a means to acquisition of many other more directly useful resources. Consider the stability and access to resources a decent income affords (e.g., ability to pay bills; self-esteem; peace of mind). In contrast, think about the loss of personal comfort, efficacy, and tangible resources that comes along with insufficient income. When examining these issues, there are other theoretical perspectives that are also relevant and deserve more careful consideration by OHP researchers and practitioners, including the health capital (i.e., “Healing”) and “Breaking Point” models of mental health that are well-described by Watson and Osberg (2017). OHP professionals who decide to dig more into these topics should note that simple measures of employment and objective income fall short of capturing workers’ often complex actual financial experiences. Perceived income adequacy measures have been developed to understand the perceptual nature of income-related stress (Sears, 2008). Other complexities include accounting for stress associated with personal debt, which has received relatively little attention in the organizational psychology literature (Sinclair & Cheung, 2016), despite increased attention to the weight of debt covered in the general media. Debt may be a contextual factor that alters the personal value and meaning of income as a resource, and can make threats to employment and income much more salient and debilitating. Keeping these points in mind can help to propel future OHP research and practice efforts in this area. Contributing to Social Justice and Peace Protecting workers’ dignity and rights, ensuring basic needs are met, and comprehensively tackling issues of WHSWB are all ways in which organizations and OHP professionals can support social justice. OHP professionals have much to offer this area of research and practice, though this is another area that is not currently mainstream within this discipline (for a fascinating history of these issues in a global context since the early 1900s, we encourage you to read the special centenary issue of the World at Work magazine; ILO 2019c). Work organizations are often microcosms of their surrounding communities. If and when an organization figures out how to demonstrate and act in a socially responsible and just manner internally, this can have many positive and stabilizing ripple effects externally. Unfortunately, when an organization and its members do not demonstrate or model such values and behaviors, the effects can be further division and instability in the external community. In this way, there are opportunities for organizations to be mechanisms for increasing social justice and even peace in their broader communities. One such opportunity is linked to efforts to address issues of inclusion and diversity within organizations. Often this involves developing and implementing policies and practices that support tolerance and fair pathways to development and advancement within these organizations. These efforts can have effects that transcend the boundaries of any particular organization. Inclusion is a critical social justice issue for organizations, and a critical WHSWB issue for OHP professionals, as experiences of bias, discrimination, or even subtle mistreatment toward minority group members can do more than create frustration or discomfort. These sorts of experiences can relate to real, substantial psychological and physical health outcomes for workers, as well as harm to the organization that can accrue from turnover costs, productivity loss, and withdrawal (e.g., Cortina et al., 2017). Studies even suggest that working conditions can affect the expression of bias and discrimination toward members of the community that workers serve. For instance, one study found that non-black physicians exhibited more implicit and explicit bias when they experienced higher levels of burnout, which has further implications for the proper treatment of colleagues and patients (Dyrbye et al., 2019). Organizations with a culture that demands inclusion and mutual respect can go a long way in the treatment of workers and those affected by their work. Perhaps, this sort of commitment can even lead to a broader sense of peace in our communities. Consider initiatives to modify policing work role boundaries by embedding law enforcement officers into communities as a way of having a greater impact by building community partnerships (Crowl, 2017). Other examples of this type of deep community engagement also abound, from internship and apprenticeship arrangements between manufacturing companies and local schools, to medical and legal practices donating expertise and support to free health clinics, to grocery stores helping to sustain local food banks. There are a lot of possibilities to do good in the world when organizations think about the true reach they have into the communities and societies in which they exist. Research, Intervention, and Evaluation Considerations for Broader Impact OHP professionals have a rich knowledge base and methodological skillset that can help with identifying and explaining ways in which working and work organizations can be leveraged as mechanisms for broader societal benefit and change. In this section, we highlight special considerations for OHP professionals who venture out of traditional areas of research and practice to understand and advocate for the topics outlined in this chapter. First, regardless of where this type of work may take you, we encourage all OHP professionals to operate within the guidelines of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (www.apa.org/ethics) or a similar set of guidelines that may be more specifically suited to your region of the world. Even if you are not licensed as a psychologist yourself, adhering to such standards helps to protect the broader profession of psychology and the dignity and rights of others with whom we work. At a high level, this means doing our best to operate within our own boundaries of professional competence, and to operate with the intention of truly bettering the lives of workers and their communities. This means demonstrating respect and reserving personal judgment when we work with vulnerable and marginalized groups (e.g., those who are currently or were previously engaged in dirty work, incarcerated, or homelessness). Sometimes this may mean walking away from professional opportunities when the goals for a particular collaboration are not aligned with these principles or our professional and personal values. This can be difficult, but we need to remember that positive change can begin (and end) with one person and as OHP professionals, we simply cannot turn a blind eye toward intentional disregard of workers’ rights. Second, researching and practicing outside the boundaries of typical work organizations will also challenge our methodological skills; our challenge is to develop and use methods that fit the population and context in which we are working. As a couple of examples, even though internet-based surveying is convenient and effective for many research efforts, in some work and community settings, limited access to technology, different communication preferences (e.g., in person vs. phone vs. email), and population-specific language and reading level needs may require us to use a different approach. When engaging in research, we may also need alternative sampling methods like purposive sampling to target specific demographic groups or snowball sampling to reach members of difficult-to-reach populations. We have learned that it is incredibly valuable to talk with members of your target population before all methodological decisions are finalized. Ultimately, learning about the work and nonwork experiences of workers and other community members can help us design and implement more effective research studies and interventions. As an example, Cuervo et al., (2020) used a qualitative research approach to understand the community context for low-wage immigrants, along with their work experiences and work-related values. Another impressive undertaking along these lines is presented by Saxena (2015), who used qualitative ecological momentary assessment methods to understand and prevent the spread of a communicable disease among rural farmers in northeastern India (see also Saxena & Burke, 2020 for a discussion of policy-related implications associated with this work). Applying our OHP knowledge and methods to the types of issues outlined in this chapter may also require us to be creative and clever in the design and implementation of our research and intervention efforts. For example, Reeves et al. (2017) demonstrated positive effects of a national minimum wage increase in the United Kingdom on workers’ mental health using data gathered through a natural experiment, showing an effect equivalent to that of antidepressant medications. A second example comes from Backman et al. (2011), who demonstrated (with a quasi-experimental design) how providing fresh fruit at the worksite (not just education about nutrition) significantly increased workers’ consumption of fruit and vegetable consumption in and outside of the workplace. This study is a great example of how an intervention at work can have positive effects that extend to the health of workers, families, and communities. Third and finally, OHP professionals can broaden their impact by expanding their collaborative networks. We will not be able to create effective change initiatives that transcend the work environment without the help of those who have expertise in these broader domains. We can work with health psychologists, economists, community psychologists, anthropologists, public health specialists, epidemiologists, and others (as noted in Chapter 1) to develop more effective solutions to the broad health, safety, and well-being challenges faced by workers and other members of society. While such collaborations will often open our minds to new perspectives, there will also be certain common principles that are applicable in a wide variety of research and practice situations. As one example, the theory of planned behavior has been applied to encourage adherence to safe work practices (Johnson & Hall, 2005), but also as a framework for understanding and intervening to affect a wide range of health behaviors in larger communities (e.g., smoking, diet, safe sex practices, teeth brushing; Godin & Kok, 1996). Our main point here is that we do not necessarily have to create anything new or complex to extend the impact of OHP to the broader societal challenges outlined in this chapter. However, we are likely to improve our chances of making a difference if we collaborate with professionals from other disciplines. Concluding Thoughts and Reality Check Our world is unfortunately characterized by a great deal of inequality and injustice linked to people’s differential access to material, psychological, and social forms of resources needed for maintaining health, safety, and well-being. There is a real opportunity to address the concerns outlined in this chapter through the reach and influence of work organizations and governing institutions who can collaboratively ensure that workers and communities have access to the resources needed to survive and thrive. It is our hope that all OHP professionals will openly consider and seek out opportunities to protect human dignity and rights, consider social determinants of health, safety, and well-being, and contribute to social justice and peace in whatever area of research or practice they are primarily engaged. Protecting WHSWB is a direct way of strengthening organizations, but also families, communities, and society. Work environments are often the most controlled environments that people regularly occupy and the reservoir from which we all draw some of our most significant resources (i.e., income and benefits, meaning and purpose, affiliation with others). If we keep this in mind and broaden our perspectives even just a little bit, the potential impacts of OHP research and practice on society are tremendous. Although the effects of work are complex, the work we do as OHP professionals can be simply described: We support strength and resilience in workers, organizations, families, communities, and societies by protecting and promoting worker health, safety, and well-being. In all seriousness, your work as an OHP professional can literally improve the world.