Chapter 5 worker physical health.docx

In this chapter we provide an overview of the essential physical health outcomes that can be impacted by work, as well as how physical health can impact workers’ performance. Given these connections, we provide examples of how physical health can be protected and potentially improved through prevent...

In this chapter we provide an overview of the essential physical health outcomes that can be impacted by work, as well as how physical health can impact workers’ performance. Given these connections, we provide examples of how physical health can be protected and potentially improved through prevention and promotion efforts in the workplace. More generally, we discuss how physical health fits into the broader worker health, safety, and well-being (WHSWB) framework emphasized throughout this book. In the following sections of this chapter, we explore the theory and research pertaining to physical health among workers. We also describe various indicators of and methodologies for studying physical health, and present practical suggestions organizations can use to protect, manage, and improve worker physical health. By the end of this chapter, you should be able to: LO 5.1: Explain how work both affects physical health (as a cause) and how it is affected by physical health (as an outcome). LO 5.2: Describe common physical health issues associated with certain types of work. LO 5.3: Describe the challenges of working with a chronic condition and ways in which organizations can support these workers. LO 5.4: Discuss the complex issue of where the responsibility lies for maintaining good physical health (i.e., worker vs. employer) and example strategies that organizations can use to protect and promote physical health. How Working Affects Physical Health Most occupational health psychology (OHP) professionals would agree that workers are physically healthy when they are free of symptoms that interfere with daily life and when they are able to successfully do the things they want to do. This rather broad definition aligns with the World Health Organization’s (WHO; 2014) perspective on well-being as more than the absence of symptoms. As noted in our chapter lead-in, physical health is important in OHP not just as an outcome or consequence linked to work exposures and experiences, but also as a factor contributing to individuals’ work-related abilities. This dual perspective is easy to reconcile if we think of physical health as a resource that is affected by work and can affect a worker’s ability to complete tasks. There is a vast literature documenting how work environments and experiences directly affect physical health. This might be through exposure to environmental hazards or strenuous and repetitive tasks that create direct wear and tear on a body’s systems (Gatchel & Kishino, 2011; Redden & Larkin, 2015), or in response to work-related psychosocial stressors (e.g., incivility, perceived constraints) that trigger the body’s stress response and can damage workers’ physiological systems over time (Ganster & Rosen, 2013; McEwen, 1998). In the following sections, we focus on several examples of physical health conditions linked to experiences at work. Our goal is to illustrate the variety of ways work can affect physical health and help you begin to recognize many common physical health conditions that could be good targets for preventative measures. We more fully address environmental demands and work-related safety matters that contribute to physical health risks in Chapters 10 and 11. Exposure-Related Conditions Some physical health concerns can result from exposure to environmental stressors. Extreme temperatures can affect workers’ physical health and functioning in outdoor work settings, but also indoor environments that get extremely hot because of the nature of the work and/or associated machinery and processes, or which stay extremely cold out of necessity (e.g., refrigeration rooms) or because climate control is impossible (e.g., large manufacturing facilities). Some of the physical effects of extreme temperatures are acute, like dehydration, joint swelling, heat stroke, burns, hypothermia, or frostbite (Redden & Larkin, 2015). Effects of extreme temperatures on outdoor workers can also have long-term consequences, like increased risk for skin cancer due to prolonged sun exposure (Stepanski & Mayer, 1998). Another unfortunately common physical health effect associated with work in certain occupations is hearing loss (National Institute for Occupational Safety and Health [NIOSH], 2019). Workers in environments that are characteristically very loud, such as aircraft maintenance (Guest et al., 2010) or mining (Sun et al., 2019), may be especially susceptible to hearing loss. Some occupations may even present multiple risk factors for hearing loss (e.g., aircraft pilots exposed to loud noises and frequent pressure changes). Not as obvious, is the reality that occupational hearing loss can also result from exposure on-the-job to chemicals classified as ototoxicants (NIOSH, 2018), which damage the auditory system through their effects on the inner ear via the bloodstream or neural pathways. A final example of exposure-related conditions are those linked to poor air quality and aerosolized contaminants, which can contribute to respiratory conditions. The most commonly- known work-related respiratory condition is pneumoconiosis, often referred to among miners as “black lung”. Because respiratory disease has disproportionately impacted miners, NIOSH (https://www.cdc.gov/niosh/mining/) and the Mine Safety and Health Administration (https://www.msha.gov/) have developed many resources for addressing this and other health and safety risks for this population. However, pneumoconiosis and other respiratory conditions do not just affect miners. For instance, rare lung diseases developed by non-smoking manufacturing workers have been linked to a variety of production chemicals (Stanton & Nett, 2019). Similarly, grinding and brewing of coffee is associated with mild respiratory symptoms among coffee production workers and baristas (McClelland et al., 2019). Even in typical indoor office settings, workers can develop “sick building symptoms” from poor air quality, among other factors (MacNaughton et al., 2017). In sum, it is important to consider that the air quality in any work environment could contribute to respiratory symptoms. Repetitive Strain and Musculoskeletal Disorders Physical and psychosocial demands of work can affect workers’ locomotor systems (including bones, muscles, joints). Work-related musculoskeletal disorders (WMSD) may result when work-related demands (especially physical ones) are chronically present, and often when workers are either ill-prepared, poorly supported, or otherwise unable to properly respond to these demands. Generally, WMSD are understood as resulting from a physical load being placed on the body, affecting workers’ tissues, muscles, and bones to the point at which the worker cannot sufficiently adapt or sustain the load without injury or damage to the body (NIOSH, 2001). There is great variety in WMSD, including neck and upper back pain, conditions affecting the elbow and other joints (e.g., epicondylitis, or “tennis elbow”), wrist pain (e.g., carpal tunnel syndrome), lower back pain, and pain in the knees or feet (e.g., Buckle & Devereux, 2002; Hernandez & Peterson, 2012). A variety of work characteristics (discussed more in Chapter 10) may contribute to WMSD, including: heavy lifting, overexertion, repetitive motions, prolonged standing, and vibrations from machinery. Work-Related Stress Many models of workplace stress (discussed in detail in Chapter 6) highlight a connection between work-related demands and physical health. Research testing these models demonstrates that the effects of stress exposures are not purely psychological and often do take rather serious physical forms. Indeed, many of the top risk factors for mortality, including high blood pressure, high blood sugar, and obesity (Ritchie & Roser, 2020) are physical in nature and linked to chronic exposures to stressors, which often come through our work-related experiences. Psychosomatic Symptoms Think about how you feel during and after a stressful day at work. You might experience a headache, tightness in the upper back, or digestive issues. These are all forms of psychosomatic symptoms (i.e., noticeable physical effects of a psychological experience). In addition to the examples mentioned above, psychosomatic symptoms linked to work-related stress can take many forms (e.g., gastrointestinal problems, sleep disturbances, and fatigue; Nixon et al., 2011; Spector & Jex, 1998). Sleep Problems Stress experiences can also negatively impact workers’ sleep quality in the short-term and potentially contribute to longer-term conditions like chronic fatigue or insomnia. As you probably would expect, sleep disorders are more common among workers with non-standard work hours (Burch et al., 2005). Shiftwork sleep disorder is a specific label for sleep problems linked to disrupted sleep-wake cycles due to shiftwork schedules (Drake et al., 2004). Insomnia and other sleep problems are a concern in and of themselves, as well as contributing factors to other psychological and physical health conditions among workers (Vallieres et al., 2014). Put simply, our body systems require regular and sufficient sleep to function well. Cardiovascular Health Although not commonly seen as a psychological phenomenon, cardiovascular health is a major physical health concern for OHP professionals. Clear evidence links work-related stress experiences to cardiovascular health (Kivimaki et al., 2006) and it is no secret that work environments and demands influence our lifestyle behaviors, which also influence cardiovascular health. Cardiovascular health is consistently and negatively impacted by high work-related demands and low control (Kuper & Marmot, 2003), an imbalance between effort and reward at work (Eddy et al., 2017), and feelings of injustice at work (Kivimaki et al., 2005). Cardiovascular health is also impacted by irregular work schedules; by some estimates, night shiftworkers have a 40% higher risk for cardiovascular disease (CVD) than day shiftworkers (Boggild & Knutsson, 1999). Similarly, more cardiovascular health issues have been observed among workers in occupations that impose unusually difficult demands, like having to be constantly “on-guard” (i.e., threat-avoidant vigilance) to avoid disaster (Landsbergis et al., 2011). Complicating this picture a bit more is that the many work-related and psychosocial risk factors for CVD are not evenly distributed across all workers and the broader population. For instance, those with a lower socioeconomic status are often more at risk for CVD (Landsbergis et al., 2011). These disproportionate health risks for certain demographic groups are often connected to disproportionate work-related demands and limited resources. These topics are often studied under the broader label of health disparities (Williams et al., 2010). Worker Behaviors and Physical Health In addition to the effects of psychosocial stressors, we make daily behavioral choices that affect our physical health. Sometimes these choices are about how we will behaviorally adapt or otherwise respond to stressors (Juster et al., 2010; McEwen, 1998). More generally, these health-related behaviors or lifestyle habits may include exercise, eating habits, and use of alcohol, tobacco, or other drugs. Health-related behaviors do indeed explain some of the connection between work-related stress and indicators of metabolic health risks (French et al., 2019). Many of these behaviors are established risk factors for developing physical health issues like hypertension or CVD (WHO, 2017). Organizations as Facilitators or Hindrances Health-related behaviors and lifestyle habits are personal by nature, but organizations play a substantial role in creating and sustaining the environmental context in which many of these behaviors occur (e.g., opportunities for physical movement, nutritional options, and self-care flexibility). In other words, where and how we work can affect the degree to which our lifestyles support or detract from our physical health. As one example, workers on extended or non-standard work schedules are less likely to exercise and more likely to have high body-mass index (BMI) scores than workers on traditional schedules (Bushnell et al., 2010). Findings like this highlight the importance of ensuring that workers have opportunities and resources to support healthy living (e.g., workers without leisure time or schedule flexibility may be unable to make optimal health-related behavior choices). Workplace social norms and support can also influence health-related behaviors, especially with respect to substance use (Moore et al., 2012; van den Brand et al., 2019). Similarly, it is easy to understand how social norms at work can influence nutritional choices. Consider how the following questions reveal the power of social norms around eating at work: Do workers typically bring their own food or go out to lunch? Where do workers tend to eat? Are healthy options provided at a similar cost at on-site dining facilities? Is there even break time for a meal or do convenience options have to suffice from fast food or vending machines? In short, although behavioral choices are ultimately made by individual workers, OHP professionals recognize that these behaviors are influenced by factors in the work environment. How Worker Physical Health Affects Work We have focused on ways in which work-related experiences and exposures can impact worker physical health. It is also important to consider how one’s ability to work effectively and safely is affected by underlying physical health conditions, which may or may not be work-related. This is a relatively understudied area for OHP professionals, but we can better understand how our physical health affects work through the lens of Conservation of Resources theory (COR; Hobfoll, 1989). Specifically, physical health is a resource that influences and supports our abilities to respond to stressors and acquire additional resources (e.g., objects, conditions, energies). This theory helps explain how the effects of poor physical health can compound and accumulate. For example, a worker who suffers frequent migraine headaches is likely to experience impaired concentration on work tasks, feelings of general inefficacy at work, and potentially absences from work (Collins et al., 2005). This single physical health resource depletion can then lead to multiple ripple effects. Worker performance and organizational health can be directly impacted when a physical health condition inhibits, limits, or prevents normal functioning, and/or requires frequent time away from work. Many chronic physical health conditions are linked to some degree of work impairment (Collins et al., 2005). As a few examples, chronic musculoskeletal pain or WMSD are linked to worker self-reports of difficulty completing work tasks (de Vries et al., 2013). Workers with Type II Diabetes may be likely to retire early, take more sick days, and be less productive than their non-diabetic peers (Breton et al., 2013). Workers experiencing irritable bowel syndrome (IBS) report taking more sick days, more difficulty concentrating at work, and perceived effects on productivity than those without this condition; chronic conditions like IBS can also affect social relationships, due to concerns that symptoms will interfere (Hungin et al., 2005). Workers managing chronic physical health conditions may experience stress over perceived stigma or concerns about being treated differently because of their conditions (McGonagle & Barnes-Farrell, 2014). Chronic physical health conditions can also deplete one’s psychological and energy-related resources. For example, workers with chronic pain often report negative affect and exhaustion at the end of the work day (Fragoso & McGonagle, 2018). Although working while managing a physical health condition is not easy, there can be associated benefits. Work can serve an adaptive role for an individual who may be managing some form of noncontagious illness or physical health condition (Karanika-Murray & Biron, 2019). For instance, remaining involved in work (to the extent possible) following an injury or development of WMSD is associated with positive psychological health and long-term ability to remain at work (Howard et al., 2009). Similarly, working can provide a sense of purpose and help fill time for people who are living with or recovering from a physical illness or injury. These points are noted because they are directly aligned with underlying OHP principles that physical wellness for workers involves more than just removing or reducing symptoms. Why Worker Physical Health Matters Despite a widely held public belief in the importance of physical health, OHP researchers and practitioners in this domain continuously have to fight for resources (time, money, personnel, etc.) to support studies or interventions to address worker physical health. Here we explore two main sets of reasons why protecting and promoting worker physical health matters. Healthy Workers are Good for Business Workers struggling with physical health issues are often less able to be present and productive at work. Thus, there is real value to doing what is possible within organizations to maximize the number of workers who are in good physical health. This is especially true in physically demanding occupations, where physical abilities affect daily job requirements. This is also true for less physically demanding work, though gaining buy-in from leaders to promote and protect the general physical health of all workers can be especially challenging. Most organizational risk management efforts are driven by the goal of managing costs. Costs associated with worker physical health are very real, including employer-provided healthcare benefits, lost productivity due to illness-related absences, and worker’s compensation claims linked to occupational illness or injury. In the USA alone, occupational injuries and illnesses (primarily physical) are estimated to annually yield direct medical costs totaling $67 million and indirect costs up to $183 billion (Leigh, 2011). Other nations report similarly high costs, such as €15 billion for costs of worker illness and injury in the United Kingdom (Health and Safety Executive, 2019). There are free tools available to see these costs in more practical terms, like OSHA’s “$afety pays” calculator that estimates costs of specific conditions (https://www.osha.gov/safetypays/). One of the biggest sources of cost associated with physical health problems is lost productivity, which also occurs when workers are physically present, but not physically well (i.e., presenteeism; Johns, 2011). Meta-analytic findings report small to moderate negative correlations between physical conditions, like hypertension, sleep problems, and somatic symptoms, and measures of performance (Ford et al., 2011). There are also risks to consider where some physical health complaints, like fatigue and sleep problems, are related to safety concerns (Kao et al., 2016; Williamson et al., 2011). Proactively addressing worker physical health with targeted promotion efforts is also justified for business and financial reasons. Programs and policies promoting worker physical health are a strategic investment in a resource that is worth protecting. Physical health promotion programs often work by encouraging positive health-related behaviors. Encouraging physical activity in particular has a number of organizational benefits from health-costs savings to better performance, both supported by empirical findings and/or a strong theoretical rationale (Calderwood et al., 2020). There is indeed evidence of positive return on investment (ROI) in physical health promotion efforts, even for smaller organizations (e.g., Goetzel et al., 2014). Participation in such programs may also positively impact worker attitudes and reduce absenteeism (Parks & Steelman, 2008). Personal and Societal Reasons Working while managing a physical health condition can take a toll on workers in a variety of ways, including the experience of negative emotional and cognitive states (Fragoso & McGonagle, 2018). When workers develop and engage in physically healthy lifestyles, either motivated themselves or by their organizations, these types of issues may be mitigated. There is growing evidence that participation in physical health and wellness programs does improve or sustain worker health (Merrill et al., 2011). Investing in efforts to improve worker physical health has implications for workers’ broader quality of life, and even impacts that extend beyond the organization. Investing in workers’ physical health can improve their abilities to fully engage with their families, communities, and society more generally. For maximum impact, OHP efforts to protect and improve worker physical health would include programs, policies, and other initiatives in and outside of work environments. Promising explorations along these lines are underway in the area of population health (e.g., Kindig & Stoddart, 2003). Methodological Considerations and Practical Recommendations Working to understand and improve worker physical health involves gathering and analyzing a variety of different forms of data. There are numerous methodological details and practical recommendations to consider when engaging in research and practice in this area of OHP. Measuring and Monitoring Physical Health Evaluating worker physical health in organizational settings may be for descriptive purposes (i.e., completing an organizational health risk appraisal or establishing a baseline understanding of worker health), prescriptive purposes (i.e., determining what physical health issues need the most attention), or predictive purposes (e.g., trying to anticipate where the greatest costs or risks are going to develop). There are multiple measurement methods to support each of these purposes. Given the complexity of physical health, the best strategy will likely involve measuring multiple indicators of your targeted physical health domain. Physical health is a form of individual difference that can be difficult to observe, so studying it (particularly in work settings) often requires self-reported information from workers. A simple and practical method for obtaining a quick check of overall physical health is to ask individuals to rate their physical health relative to similar others (e.g., those of similar age, occupation, or other meaningful individual difference; DeSalvo et al., 2006). More detailed data may come from self-reported physical symptoms (e.g., headaches, muscle aches, digestive problems) rated in terms of prevalence, frequency, and/or severity (e.g., Spector & Jex, 1998). You could also gather data on functional impairments experienced in daily living (e.g., Rand Health Care, n.d.), or perceptions of confidence or efficacy associated with specific forms of physical effort. It is also possible to enlist trained healthcare professionals to measure and evaluate physical health, using indicators like physiological measurements, blood tests, and other forms of laboratory-based assessment. Other indicators of health might include more objectively verifiable measures such as weight, waist circumference, or BMI. These types of indicators have all been linked to certain disorders and may even function as direct risk factors in some situations. However, all forms of physical health measurement (even these latter options) are imperfect, due to the complexity of the human body. For example, objective indicators of physical health like heart rate and blood pressure may be recorded at “unhealthy levels” due to the influence of a sudden stimuli just before the measurement. Individuals with a high degree of muscle mass can often be flagged as extremely overweight based on BMI calculations, even if they are in excellent physical health. It is important to recognize these limitations, especially if physiological indicators are being monitored as a way of incentivizing or penalizing workers who are involved in organization-sponsored physical wellness initiatives. Worker physical health and especially its effects can also be studied using data regularly gathered by organizations for talent management purposes (e.g., absentee rates/sick days, injury rates, disability rates, and health, pharmacy, and workers’ compensation benefits claims). These metrics are also imperfect and need to be considered with a clear head and broad perspective. As an illustration, sick day counts are inherently imprecise; some workers may take a sick day when they are not actually sick and other workers may come to work even while sick to save sick days. Ultimately, a mix of objective indicators and subjective self-reported data is likely to provide the most complete information for identifying physical health needs and challenges within a particular workforce. Intervening to Promote and Improve Physical Health Physical health interventions undertaken by OHP professionals regularly incorporate perspective and collaborators from related disciplines including public health, industrial hygiene, ergonomics, human factors, and occupational medicine. Despite this professional diversity, there are several essential strategies for change and methodological elements needed when designing, implementing, evaluating, and sustaining physical health interventions at work. In this section, we present recommendations to support successful physical health interventions. Regardless of the level of the intervention (i.e., targeted toward individuals, groups, organizations), it is important to keep in mind that attempting to influence human behavior is difficult if change efforts are not aligned with workers’ own desires (e.g., Howard, 2006). Therefore, any intervention strategy is likely most successful when it helps workers achieve their own visions of good physical health, rather than an externally derived standard. Strategies for Individuals Employee wellness programs are perhaps the most common form of organization-based effort to promote worker physical health. These programs tend to be proactive in approach, incentivizing healthy behaviors (or disincentivizing unhealthy ones) and can involve a variety of elements, including education, goal-setting, and long-term monitoring of physical health indicators (Parks & Steelman, 2008). Simple initiatives, like walking programs, can increase worker physical activity, and even lower blood pressure and some health care costs (Swayze & Burke, 2013; Zivin et al., 2017). Programs that involve financially incentivizing healthy choices (e.g., attending educational workshops, receiving preventative screenings, engaging in exercise) are shown to maintain or improve physical health, as evidenced by biometric screenings and other self-report measures (Merrill et al., 2011). Wellness programs targeting the management of risky health-related behaviors, like smoking or excessive alcohol consumption, tend to be more challenging to successfully implement, largely due to influences of multiple individual differences among other factors (e.g., personal motivation, age, gender, income; Richmond et al., 2000; Titus et al., 2019). Efforts to change group norms may be more effective in this domain, as we discuss later. There are a couple of practical points to consider when implementing any type of person-level physical health program. First, participation rates in organizational wellness programs are often low and in some (but not all) cases, it is healthier workers who are more likely to participate (Robroek et al., 2009). An effective program that reaches the entire working population may require a calibrated and customized approach based on knowledge of pertinent individual differences (see Chapter 3). Second, focusing organizational attention on worker physical health can create ethically challenging scenarios. In particular, focusing on physical health issues can lead to discriminatory outcomes (Koruda, 2016; Madison, 2016), given the complex relationships between certain forms of racial, ethnic, socioeconomic, and other demographic individual differences and physical health. Organizational initiatives to promote and protect physical health need to be sensitive to the role played by underlying physical health disparities for certain groups of workers compared to others, and ensure that any program-related incentives or penalties are based on fair criteria that do not disproportionately impact certain groups. In response to these concerns around discrimination and other critiques of wellness programs, many organizations opt to reward healthy behaviors, but avoid penalizing poor health-related behaviors, metrics, or risk profiles. The likelihood of success for any physical health promotion program targeting workers will increase if it is developed with clear objectives and well-aligned strategies, and supported by a culture that promotes worker physical health. Strategies for Groups and Leaders Worker physical health is also affected by group affiliations and social norms surrounding health-related behaviors. Normative alcohol, tobacco, and other drug use are particularly common in certain occupational groups, including food service workers (e.g., Moore et al., 2012). Thankfully, such social and normative pressures can also support good health, encouraging smoking cessation (van den Brand et al., 2019) and discouraging problematic drinking (e.g., Wang et al., 2010). These types of successes suggest that interventions leveraging peer support and supervisor training could be effective at stimulating health-related behavior changes. Social forces within workers’ groups and teams, as well as messages from leaders, can also influence workers’ decisions about reporting and attempting to work through injuries or illnesses. These forces can be counteracted by clear messaging throughout the organization that matches a culture supporting a shared desire for healthy lifestyles, without condemning those who may be perceived as unhealthy. Certain physical health conditions may even be associated with actual or perceived social consequences, experienced as stigma (McGonagle & Barnes-Farrell, 2014). Adding stigma to an “unhealthy” status could motivate some to engage in positive lifestyle habits, but could have the opposite effect on those who wish to avoid situations that are uncomfortable because of the increased attention to that stigmatized identity. Strategies for Organizations Sometimes worker physical health efforts are targeted at the level of the overall organization or broad work environment. Some physical health interventions are aimed at promoting worker physical health at a high level and/or supporting the unique needs of workers with a short-term or long-term illness. There are also a number of modifications that can be made to the work itself to reduce the potential for physical harm, discussed more in Chapters 10 and 11. Typical organization-level efforts to promote and protect worker physical health involve environmental adjustments, general education and policy, and culture-level modifications. For example, organizations can provide practical resources that encourage healthy lifestyle choices among workers, such as on-site dining facilities offering healthy, affordable food options. Flexible workstations are another increasingly used tool for physical health promotion. Sit-stand desks can make a workspace more adaptable and reduce back pain for some workers (Agarwal et al., 2018); treadmills, bikes, and even seated elliptical machines can also be added to desk setups to facilitate worker physical activity even while seated (e.g., Carr et al., 2016). These sorts of practical resources may require a moderate financial investment (e.g., one seated elliptical machine was approximately $600 for Carr et al.), but associated gains in concentration, productivity, and health from increased physical activity are likely to outweigh this level of financial investment over time. A broad organization-wide culture change initiative might further combine the benefits of these tangible resources and other elements together, changing the overall work experience into one that rather holistically or comprehensively supports worker physical health. The scheduling of work can also be a practical point of organization-level intervention to support worker physical health. Offering scheduling flexibility, where possible, can make it easier for workers to make time to be physically active, manage doctor appointments, and choose to stay home when physically unwell. Attendance expectations, as well as the overall workload, are both significant correlates with presenteeism (Miraglia & Johns, 2016). Organizations also set the tone for physical health through formal policies and procedures around health risks. For example, organizations with outdoor workers can provide sun protection education and resources (e.g., policies and materials) to protect these workers (e.g., Buller et al., 2018). For work that involves a good deal of physical exertion, workplace stretching programs have shown some degree of success in reducing injuries and musculoskeletal complaints (for a review, see Hess & Hecker, 2003) and can be easily added to a typical workday or included as an educational component of onboarding. Workers returning to work after an injury, working with an injury, or actively managing a physical health condition may require accommodations to do their work well. This is another way in which organizations can support worker physical health. Quality return-to-work support might involve an experienced case manager (Shaw et al., 2008) or well-trained supervisors who know how to modify work to support workers as-needed. Evaluating Physical Health Interventions Regardless of the type of physical health intervention, there are a few essential principles to think about when it comes to evaluation (discussed more in Chapter 2). As we noted earlier, assessing physical health is best done with multiple indicators, ideally gathered over time to allow you to show change associated with your intervention efforts. Think about what your desired outcome truly is (e.g., changes in physical health indicators; changes in health-related attitudes; ROI) and about the time it reasonably takes to see a change in your available indicators. Some measures we have mentioned will work well for shorter-term impact evaluations (e.g., self-efficacy perceptions) while other indicators may only reflect change over an extended period of time (e.g., weight loss, sick day trends). You may need to track data for several years to see small, yet meaningful bottom-line impacts on things like workers compensation claims or absenteeism (Anger et al., 2015). Monitoring a variety of physical health indicators and health-related attitudes will also help you understand the process and impact of your intervention, and even to see if there were any, potentially unexpected, benefits of your intervention. Sometimes, even if an intervention does not hit its original target (e.g., reducing absences), it can lead to other positive effects (e.g., improving workers’ feelings of confidence at work). Something like this happened in an ergonomic intervention among kitchen workers, where workers perceived improvements to their health and workload, even though there was no significant change in the primary outcome of interest, musculoskeletal pain (Haukka et al., 2008; Pehkonen et al., 2009). Other studies find that physical health interventions impact concentration or productivity, even though changes in more objective health data are modest (e.g., Carr et al., 2016). Finally, because so many factors can influence worker physical health, our ability to evaluate these types of interventions is dramatically improved if we can use evaluation methodologies and designs that strengthen the quality of our inferences, such as randomized control group or quasi-experimental designs (Anger et al., 2015). Some evaluations of physical health interventions randomly assign individuals to groups (Carr et al., 2016), while others may randomly assign entire organizations or workgroups to specific conditions for study (Buller et al., 2018; Haukka et al., 2008). Regardless of the level of assignment, gathering data from a comparison group allows us to more convincingly demonstrate effects of an intervention compared to a non-intervention or simpler alternative. Data from these types of evaluations create a strong argument for investing in a particular intervention, especially if the evaluation period spans enough time to document the longevity and stability of an intervention’s effects. Concluding Thoughts and Reality Check Many aspects of work and our work environment can affect our physical health. Being physically healthy is an important resource for effectively carrying out daily work. Influencing worker physical health is not an easy task for organizations, but ignoring the importance of physical health can be tremendously costly and challenging. Organizations can rarely control workers’ health and health-related behaviors with direct mandates (at least, not without triggering serious backlash). Instead, organizations can provide resources that make achieving and maintaining physical health easier. Often these resources are as simple as allowing sufficient breaks and flexible scheduling so workers can eat nutritiously and get some physical activity during their work period, or even creating an environment where it is ok to miss work when sick or make time for regular doctor visits. Organizations have a prime opportunity to structure and design work in ways that limit damage to worker physical health, while also facilitating maintenance and improvement of physical health. Workers, organizations, and society as a whole benefit when we can create and sustain physically healthy workforces.