10. Health conditions affect work status.

In much of the research reviewed above, there has been an implicit assumption that workplace conditions affect health and the major causal arrow points from work to health. Relatively few studies have actually used methodologies that allow for assessing causal direction, and in many cases it is plausible to believe that health also influences work status. It is well-documented that individuals with disabilities often have a difficult time finding good employment. In California,76 percent of people ages 18 to 64 are employed, compared with 46 percent for people with disabilities. Work-related health impediments are not always visible. Depression stands out as a significant barrier to employment in a meta-analysis of 20 random assignment welfare-to-work and welfare reform studies in a report to be released by the U.S. Department of Health and Human Services this year.⁵⁰

It is likely that if research methodologies were sophisticated enough to capture the complexity of individuals’ experiences over time, we would find a great deal of interplay between work and health status with causal arrows in both directions. For example, an individual may experience some health impairment that causes him or her to drop back to less than full-time work. This could result in a loss of health insurance that might decrease access to health services that could then result in a further loss of health even leading to disability. Fortunately, analytic strategies are consistently improving to include increased capacity to more thoroughly examine the long-term, complex and reciprocal effects of work and health.