Annual County Health Rankings Report: Developing Indicators on How Work Affects People's Health

Brief Summary
Background: The County Health Rankings program, a joint collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, provides county rankings within states by using population measures of health outcomes and a variety of specific factors that affect people’s health. Within the system, values for each measure for counties can be compared to both state and national benchmarks. Although it is widely recognized that work affects people’s health, some basic indicators of this are lacking within the County Health Rankings program. Scientists from both the CDC’s National Institute for Occupational Safety and Health and the County Health Rankings program aim to correct this gap. Methods: We identify the specific requirements needed, including various performance standards such as coverage and timeliness, for indicators to be incorporated into the County Health Rankings program. We identify the indicator submission and approval process and characterize the alternative approaches for including data that covers the nation or select, participating states. We enumerate the many and varied constructs of how work may affect people’s health, focusing especially on how this occurs at the community or county level. Using our understanding of the requirements of indicators for the County Health Rankings program and knowledge of the existing and accessible data, we identify initial candidates to serve as county-level measures of how work affects people’s health. Results: Initial assessments and discussions with scientists supporting the County Health Rankings program indicate that incorporating one or more indicators of how work affects people’s health appears to be feasible. Indicator proposal and submission processes are relatively straightforward, and mechanisms exist to propose and submit data for counties across the nation or, in some instances, for just one or more states with data available to measure the construct. Our list of risk factors and health outcomes includes measures from both existing occupational health indicators and other measures of how work may affect people’s health. Work in high injury-risk occupations, work in high injury-risk industries and low-wage work appear to be initial candidates to propose for the nation. US Census data for these measures are available from their County Business Patterns, Equal Employment Opportunity Tabulations, and American Community Survey data. Conclusions: Our work suggests that including indicators on how work affects people’s health is feasible and, by using existing data, some initial measures can be included in the County Health Rankings program.