A ÂŇÂ×ÉçÇř researcher calculates that 14.4 million workers face exposure to infection once a week and 26.7 million at least once a month in the workplace, pointing to an important population needing protection as the novel coronavirus disease, COVID-19, continues to break out across the U.S.

, an assistant professor in the UW School of Public Health, based her calculations on research she in the American Journal of Industrial Medicine. In that paper, Baker and co-authors calculated that about 8% of workers in Federal Region X — comprised of Alaska, Washington, Oregon and Idaho — work in jobs where exposure to infection or disease occurs at least once a week at work. Those risks include flu-like illnesses, and other respiratory illnesses, like COVID-19, as well as wound infections.

Using federal employment data, and the same analysis method, Baker and her co-authors :

• 10% (14,425,070) of U.S. workers are employed in occupations where exposure to disease or infection happens at least weekly, based on employee and employer self-report.
• 18.4% (26,669,810) of U.S. workers are employed in occupations where exposure to disease or infection happens at least monthly, based on employee and employer self-report.

Update April 28: The paper was originally posted on the preprint server but has now been peer reviewed and  This release has been edited to reflect that change.

“While healthcare occupations represent the bulk of workers exposed to infection and disease, other occupations that frequently interface with the public and provide essential services are also at increased risk of exposure. Those include police officers, firefighters, childcare workers, and personal care aides,” said Baker, who is also program director of ±«°Â’s program, Department of Environmental & Occupational Health Sciences. “This underscores the importance of all types of occupations developing workplace response plans for infectious disease.”

While those response plans must include how to keep workers safe from exposure at work, Baker added, they must also ensure workers don’t have to show up sick, potentially spreading disease within and outside the workplace.

Some workers who are in higher paying and more secure jobs, often salaried, can work from home or afford more time away from work, but many don’t have these same options, such as workers who participate in the gig economy or are independent contractors and are typically not considered employees. These workers don’t benefit from employee protective policies, such as sick leave, putting them at increased risk of having to work when they or a loved one is sick, despite public health guidance.

Even if a worker does have paid sick leave, and knows how to access it, a variety of other real and perceived pressures — such as an economy that rewards people who are working hard at all times, or pressure to perform work that no one else can perform, encourages workers to come to work sick, a phenomena researchers term “presenteeism.”

“Our findings serve as an important reminder that the workplace should be a focus for public health intervention, especially during disease outbreaks such as COVID-19,” Baker said, adding that researchers produced the new work to help shed light on this fact, and to respond to questions about their 2018 paper and its application to the current, nationwide outbreak. Estimating the burden of U.S. workers exposed to infection or disease is a key factor in containing risk of COVID-19 infection.

“The public health implications from our study,” Baker said, “are that workplaces need to make sure that they are not only protecting their workers at work, but also coming up with contingency plans to make sure that sick workers are not coming to work, and that can be accomplished through training workers to fill in for each other, providing additional paid sick leave during this time and similar measures.”

Co-authors include Trevor Peckham and Noah Seixas, UW Department of Environmental & Occupational Health Sciences, School of Public Health. This research was funded by the National Institute for Occupational Safety and Health (NIOSH).

Learn more about the ±«°Â’s Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.

The terms and conditions of your employment — including your pay, hours, schedule flexibility and job security — influence your overall health as well as your risk of being injured on the job, according to new research from the ÂŇÂ×ÉçÇř.

The analysis takes a comprehensive approach to show that the overall pattern of employment conditions is important for health, beyond any single measure of employment, such as wages or contract type.

“This research is part of a growing body of evidence that the work people do — and the way it is organized and paid for — is fundamental to producing not only wealth, but health,” said senior author , a UW professor of environmental and occupational health.

The was published this month in the Russell Sage Foundation Journal of the Social Sciences.

Technology and other forces are changing the nature of work, researchers said. The traditional model of ongoing, full-time employment with regular hours and job security is rapidly giving way to gig-economy jobs, short-term contracts, nonstandard work hours and flexible employer-worker relationships.

Current models for understanding this work are too simplistic, said first author , a UW doctoral student in environmental and occupational health sciences. Studies of a single aspect of employment may not capture important elements of jobs that influence health.

“Employment relationships are complex. They determine everything from how much you get paid, how much control you have over your work schedule, your opportunities for advancement and how much protection you have against adverse working conditions, like harassment,” said Peckham, also a clinical instructor in UW Health Services.

The researchers used data from the General Social Survey collected between 2002 to 2014 to construct a multidimensional measure of how self-reported health, mental health and occupational injury were associated with employment quality among approximately 6,000 US adults.

“There are many different forms of employment in the modern economy,” Peckham said. “Our study suggests that it is the different combinations of employment characteristics, which workers experience together as a package, that is important for their health.”

Among their findings:

• People employed in “dead-end” jobs (for example, manufacturing assembly line workers who are often well-paid and unionized but with little empowerment or opportunity) and “precarious” job holders (for example, janitors or retail workers who work on short-term contracts and struggle to get full-time hours) were more likely to report poor general and mental health as well as occupational injury compared to people with more traditional forms of employment.
• “Inflexible skilled” workers (such as physicians and military personnel, who have generally high-quality jobs but with long, inflexible hours) and “job-to-job” workers (such as Uber drivers, gig workers or the self-employed doing odd jobs) had worse mental health and increased injury experience compared to those with standard employment.
• One of the most surprising findings: “Optimistic precarious” job holders (including service-sector workers with high empowerment, such as florists) had similar health to those in standard employment, despite having jobs characterized by insecurity, low pay and irregular hours. They report high control over their schedules, opportunities to develop and involvement in decision-making and may be opting in to these types of jobs.

“Our research has direct implications for policy,” said co-author , a UW assistant professor of epidemiology. “As we have seen at the local level, Seattle City Council has been actively promoting policy solutions to improve workers’ lives.”

That includes the , and policies. These approaches show “the interest and appetite for change,” Hajat said.

Researchers and policymakers must continue the dialog with employers “to demonstrate the benefits of increased worker security and stability on employee turnover, productivity and, ultimately, their bottom line,” she said.

“Using policy and legal levers to influence how people are hired and treated at work can have profound effects on improving the health of workers and their communities,” Seixas said.

Other co-authors are , UW associate professor of psychology; and Kaori Fujishiro at the National Institute for Occupational Safety and Health.

The research was funded by National Institute of Minority Health and Health Disparities of the National Institutes of Health.

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For more information, contact Trevor Peckham, tpeckham@uw.edu or 206-221-8601.