>> Hello, and welcome to the second installment of the 2020 Expanding Research Partnerships Webinar Series. Today's webinar topic is on the Future of Work and Implications for Aging Workers. My name is Peter Grandello and it is a pleasure to serve as the moderator for today's webinar. This webinar we'll be conducting using Adobe Connect software.
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At the conclusion of the meeting, we are kindly asking all participants to evaluate the webinar through the SurveyMonkey. The link can be found in the window notes for attendees. Please copy and paste the link into your preferred browser. Now, I would like to introduce Dr. Sarah Felknor,
the Associate Director for Research Integration in the Office of Research Integration. Hello, Sarah. >> Thank you, Pete. Good morning, good afternoon, everyone and welcome to our June webinar on the Aging Worker and the Future of Work. We are pleased to co-host this webinar with the NIOSH Total Worker Health Program and we thank them for their support. We have an exciting panel of speakers today and I'd like to introduce them to you now so we can just go from one presentation to the next and I'll introduce them in the order in which they're speaking.
Dr. Casey Chosewood is the Director of the NIOSH Office of Total Worker Health where he promotes the protection and improvement of safety, health, and well-being of workers around the world. Dr. Chosewood is a physician,
and since 2018 has coordinated NIOSH's response to the opioid epidemic in the United States. Prior to coming to NIOSH, Dr. Chosewood served as medical director of CDC's Occupational Health Clinics. Dr. Jim Grosch is a Senior Research Psychologist
and Co-Director of the Center for Productive Aging and Work at NIOSH. Dr. Grosch's work focuses on better understanding of how behavioral and work organization factors can affect worker's safety and health.
His recent work has looked at changes in physical and mental health outcomes of workers as they age, characteristics of age-friendly workplaces, and the impact of job transitions such as retirement or being laid off. And Dr. Martin Cherniack is the Co-Director of the Center for the Promotion of Health in the New England Workplace or CPH-NEW. Dr. Cherniack is an Occupational Medicine Physician, Researcher,
and Professor of Medicine at the University of Connecticut Health Center. Dr. Cherniack is well known for his work on occupational muscular skeletal diseases and management of chronic disease in the working population. He is principal director of a non-funded longitudinal study directed to aging and work. And Dr. Jennifer Garza is Assistant Professor
in the Division of Occupational Environmental Medicine at the University of Connecticut Health Center. Her research interests include ergonomics, muscular skeletal health, and occupational exposure assessment. She's been the Co-PI on the University of Connecticut Project Center since 2017 and is principally working on wearable instrumentation for assessing activity demands in and out of work. And I'd like to provide a reminder of our disclaimer that the findings and conclusions in these presentations are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health Centers for Disease Control and Prevention. And now, it is my pleasure to invite Dr. Casey Chosewood to our virtual podium.
Casey. >> Thanks, Sarah. Good day, everyone. It's great to see you.
It's my job, really today, to start us off by sharing some opening remarks related to, I think, a fascinating topic that you're going to enjoy. And I'm really pleased to be joined by my other three colleagues, Dr. Grosch, Cherniack, and Dr. Garza. Folks, these are some of the nation's leading voices on the topic of aging and work. So, it's a real treat to have them with us today.
It's really impossible to talk about these three topics: aging, worker well-being, and the future of work without mentioning the other two because these things are tightly linked, inextricably linked. And when you impact one of these things, it automatically impacts the other two. So, I'm going to begin by throwing out some road signs, some caution lights, some speed bumps along this important intersection, if you will, of the future of work, aging, and this concept of worker well-being.
So, let's get started with a few essential truths, the current lay of the land, if you will. All of us, and that means yes, even you, are aging. So, this really topic is germane to all of us whether you're age 25 or 75.
And there are five active generations in today's workforce, if you didn't know it. And each and every one of those people in those generations is getting older. The future work will bring lots of new jobs, that is certain.
But we're going to keep a lot of the jobs that we have today as well. And unfortunately, some of those jobs that we're going to keep have hazards associated with them that are going to persist as well. It's also true that all jobs are going to change. And one of the basic strategies for helping workers deal with the future way that we work and that jobs are conducted is really to give them the skills they need in order to be able to adapt quickly to a changing workplace environment.
I'll also, in my short time with you today, make the argument that organizations that will navigate this intersection well and do it successfully are those that are going to take a comprehensive integrated approach to look at what we term total worker health strategies. And I'll give you more details about that as we move ahead. So, the bullets here lay out a strong basis for an argument that work, that employment, that a job or lack thereof are all very, very strong determinants, social determinants of health. The challenges that lie at the intersection of home and work overlap and interact continually.
Work is also important in that it takes a considerable amount of our time. There are only 24 hours in a day and many of us spend a significant portion of that waking time actually engaged in work. A job, even in the best of times, can be a time sink.
But for some workers, those with multiple jobs, low-wage workers who have to piece together a number of jobs in order to make an income, the time sink is especially difficult. These workers are not only face economic poverty, but also time poverty that robs them from time to invest in health-producing activities. With work, really so central to life itself having such influence, it's really no surprise that when the nature of our work changes as it's going to be very constant as the future work arrives, everything else in our lives will have to shift too. The ripple effect, the down streaming effect, if you will, is going to be quite profound. So, given all that, you can see why work is so darn important. For the most part, all of these questions here are rhetorical.
The answer is overwhelmingly yes to each of them. In general, it's a rule that we all underestimate the connection between the quality of our work, the demands of our work, the hazards and the constraints that employment brings with it, and our overall health and well-being. Work is a powerful influencer here.
Getting it right is going to be essential, especially for workers and organizations as they navigate some pretty big challenges like the current pandemic that we're in, where unemployment, and working conditions, and working demands are changing so rapidly. In fact, the economic survival of our nation in many ways, how we weather these storms is going to depend on how we navigate the quality of work and how people can actually get through it. You know, it's also imperative that we search every single day to find ways to better understand the connection between work and health outcomes and by extension, how we adapt jobs, how we design them, or redesign them. Or create them from the beginning as future work demands so that we can eke out of every single hour of employment, any potential health benefit that can come our way as a result of that job itself. Old hazards, like, silicosis that you see here on the left, risk for that.
Coal workers pneumoconiosis still persist, as I mentioned before. But I will also draw your attention to perhaps a more dramatically emerging hazard facing workers and that's the risk of substance use disorder and subsequent drug overdose death. Sarah mentioned that our team is leading the NIOSH effort in that space.
And we're learning quite a bit about how this important, new, what I will term workplace hazard is reshaping the nation's workforce, unfortunately. While there are no age boundaries when it comes to substance use disorder, some of the earliest increases in overdose deaths were actually in middle-aged to older white men who are losing jobs in the last economic downturn. So, think Appalachia losing coal mining jobs or manufacturing in the rust belt going away. But now, we see the epidemic of overdose deaths much more pervasive across all age ranges.
Some jobs, however, like construction, like agriculture, like fishing, some service and healthcare jobs, and mining are more strongly impacted by this epidemic than others. It seems that injury risk is a big, obviously, initiator in some work forces for the first use of pain medication and can increase the risk for misuse and substance use disorder. Insecure work appears to be associated as well. And certainly we see that in some industries more than others. Lack of certain benefits, like, paid sick leave, high job demands, tough jobs that lead to pain or early disability.
Those all appear to be strongly associated with increased risk for overdose death. Sadly, construction workers in this country tend to have an opioid overdose risk that's five to seven times the rate of all other workers. It's also true that many workers have jobs that continue to carry high risks likely to expose workers to physical and chemical hazards, violence, punishing shifts and schedules, and other threats. We also know that work associated stress in many occupations continues to grow. So, just how do we design work -- both today's work and work to come in the future -- with comprehensive health outcomes in mind? Let's take an example. New job design, even if done for reasons to improve health can be quite controversial.
If you look closely, this long-haul truck driver is not actually driving the truck. This is a health study underway and the road safety study underway. Sorry about that interruption. This truck driver actually is looking at an iPad, perhaps watching a YouTube video or a movie.
The truck is semiautonomous and a long stretch is, basically, on a long stretch of highway, the truck is basically driving itself. The driver is there in case something goes wrong or to maneuver the truck in tight city spaces. Early results show the stress level on long-haul truck drivers goes down if they have moments of rest.
Stress diminishes if they are not under the chronic toll, if you will, of constant vigilance of driving. And while this may sound like great news for truckers, would it surprise you to know that some truckers are actually protesting this shift from driver actually controlled to autonomous control. Just in Washington DC a couple weeks ago, there was a large protest of truckers decrying some of this new technology worried about job displacement and job loss. So, the future of work is going to require debate, if you will, between the health benefits of certain interventions and certain negative aspects of new work, like, job loss or displacement. As the future work comes along, there's one group of workers that we really need to pay a special amount of attention to.
And this is the group of workers which, unfortunately, has faced challenges throughout our history. Low-wage workers have many occupational risk factors, including the increased risk for injury, like, a social risk effort, reward imbalance to other overt things like discrimination and an increased risk of violence on the job. Low-wage workers face an uphill battle when it comes to securing greater work and well-being opportunities, both in the past, current, and I also fear in future work as well. So, this is going to be a special group that's going to require attention. Low-wage work has inherent risks, some that are overt that we talked about and others that are hidden. So, all interventions that are aimed at improving worker's safety, health, and well-being should be weighted to address the needs of low work wage workers first.
I think it's going to be an important takeaway message, especially, as the future of work continues to come at an increasing pace. You may have heard the quote, "That my father had one job in his life, I've had six in my life, and my kids will have six at the same time." Even though that statement is about five years old now, it's increasingly true for many people. No longer do people mostly have one job for a lifetime and then retire with a pension.
That is just not the case any longer. The future of work is going to change some essential truths about the way we're employed. And our research shows that the some of these issues here that are going to come as part of the future of work are going to have a strong influence on health outcomes. And it's true that some people will benefit from this new cycling of jobs, especially with constant up scaling when that occurs. But others, unfortunately, are going to become generic laborers, largely a commodity, you know, where their value will increase very slowly or not at all. And this is a significant risk that we'll have to pay attention to.
So, let's talk about some promising solutions at this intersection now. Remember when I mentioned the total worker health as an important strategy for dealing with some of these challenges? Total worker health at its core is about keeping workers safe. This is the bedrock of total worker health.
And while that's vital and essential, we believe that you leave value on the table if you don't take an additional step and go beyond that. And that addition is establishing workplace policies, programs, and practices that actually grow the health of workers at the end of the day. And the metric that we're interested in measuring, and achieving, and realizing for workers is the ability to create worker well-being. This summative concept of workers that thrive, they do better, they're engaged in their work, they go home at the end of the day with more health than when they arrived. This is sort of, you know, unheard of. Traditionally, we traded health for wages.
This new model really shows the value of high quality work, of safe work that actually has health producing benefits as part of it. It might be pie in the sky, but our research shows that this is possible with well designed, well managed workplaces and good economic employment arrangements. To drill down further, you can see that the total worker health approach broaden our efforts to focus on health risks on and off the job and understand how they interact.
It stresses the power of optimizing the organization of work, both as a strong exposure and as an opportunity to produce health. We're also very much about the evidence based here. And in a second, I'll tell you a little bit more about our six academic centers of research. For those industrial hygienists in the room, the hierarchy of controls is something you're quite associated with. We apply that to the total worker health model, eliminating certain risks, substituting in healthier policies for workplaces, redesigning the workspace and work arrangements, and then putting less emphasis on behavior change or personal change. Work even education initiatives in the work.
It's not that they're not important, but it's impossible to overcome eight, 10, or 12 hours of difficult work with a one hour lunch and learn on diabetes prevention or, you know, a focus on increasing of exercise in the workplace. Getting to the root of working conditions themselves is really where the big value lies. To see more of our portfolio and total worker health, I'll just share a couple of resources.
This is sort of the broad list of things that our portfolio includes, where we see strong opportunity to better influence the health safety and well-being of workers. Also, part of our work is examining the future of work. And you can see that NIOSH's future work portfolio really takes advantage of the total worker health model to look holistically at workers, workplaces, and the content of work itself. I want you to take a look at some of those items that we're prioritizing: how organizational design is going to change, how understanding work arrangements, how understanding artificial intelligence and other technologies is going to be an important part of the question, and also understanding the issue of demographic, economic security, and skills. Here can see that we're applying the total worker health framework within our current look at the future of work initiatives.
We're also very much interested in working across teams and seeing how this all can work together. It's going to be an important part as we explore this moving ahead. I'll just sum up with a few takeaways to set the stage for our next speakers. I believe that worker protections and prevention efforts along the way, not only are beneficial to workers later in life, but those interventions really help workers of all ages. So, if you talk about intervening for an older and aging workforce, you're actually doing things to help every single worker. We believe that holistic integrated solution shows the most promise because risks come from all different spaces, and sizes, and places and they can be addressed comprehensively.
Approaches that focus on flexibility and worker participation. The components of total worker health are going to be especially vital as work changes quickly in the future and as the age of the workforce increases. We believe that companies that weather this changed most successfully will be able to prioritize the success of their workplace. I want you to read more about Total Worker Health by taking a look at the edited volume that we just produced last year. Dr. Grosch and Dr. Cherniack both contributed to this and you can take a deeper dive in all of our efforts.
I mentioned our six centers of excellence and our affiliates. We don't do this alone. We rely on a really great prolific network of people contributing to this space and we're really happy that these folks are along for the ride. And with that, I will turn it back over to Sarah and look forward to our next speakers. >> Thank you very much, Casey. And as Peter Grandello mentioned the beginning, we're going to hold questions until the end so we can move right into our next speaker.
And it's my pleasure to invite Dr. Jim Grosch to our virtual podium. Jim. >> Thank you, Sarah. It's really great to be here and good afternoon, everybody. I'm going to be continuing, I think, with some of the themes that Casey raised in his presentation and build on them maybe just a little bit.
As Co-Director of our Center on Productive Aging, I'll probably be taking a little bit more of an aging perspective as we go through this. But as you can tell from the title, it's a similar kind of focus in talking about aging on the one hand and also the way that the workplace is changing. And quite often, as Casey was saying, we think of those things as being separate and we studied them separately, but in actuality they are occurring at the same time. So, this is our disclaimer. Sarah mentioned this earlier so I won't repeat it. So, just to give you an idea of what I'd like to cover in the approximately twenty minutes I have, we're going to very quickly look at demographics and how safety and health outcomes are expected to change as the workforce aged.
A little bit on the future of work, and Casey touched on a lot of this already, we'll talk a little bit about some of the potential benefits and costs of future of work technologies that we're beginning to see more and more of. I'll mention our center and productive aging. And finally, I'd like to get to a an actual kind of product we're working on as part of a collaboration between NIOSH and the university of Connecticut. This is an eTool for designing age [inaudible] workplaces in manufacturing. It is a kind of a new project and it is intended to kind of provide initial information to an organization in terms of some of these issues around aging and the future of work. Okay. So, let's start with some demographics.
I suspect this is the graph that many of you have seen before or something like it before. This is the percent change in the labor force participation rate between 2008, 2028 or a 20-year period. And as you can see, the percent change is really occurring for those groups 55 years and older and especially for 75 years and older in terms of the increase in the percent of workers in those groups.
So, we have people living longer and we have a lower birth rate as well, which explains the very low rates of growth, or in some cases, negative growth for the younger age groups. And, of course, as many of you know, and it is kind of a tragic event that's occurred over the last number of years, longevity in the United States has actually declined slightly recently, in part because of an increase in opioid overdoses as well as an increase in the suicide rate. And now, with COVID-19, one wonders what this means certainly for this year and into the near future. Whether that will change the labor force participation, things like that, remains to be seen. But it certainly is an issue of concern.
Let me add to this graph, just the labor force participation rate and how that has changed over this 20-year period. And it's a similar pattern, although this is really a different variable. You can see for the younger age groups, it tends to be negative, slightly negative, and starts to increase or workers 55 years and older and especially for 75 years and older, it's increasing, you know, that's about 150% over a 20-year period. And one thing that's of interest to folks is understanding more why people work as they get older. You know, some people can retire. What are the factors that lead people to continue to work with the expectation being that in the future we will need people to work as they get older.
And the reasons are sometimes divided into what you might think of extrinsic reasons, and also intrinsic, or push, or pull factors. And these are some of the ones that surveys that AARP does and other organizations interested in aging. These are some of the ones that get mentioned a lot.
You need the money, maintain health insurance coverage, need to pay for healthcare costs, et cetera. And these are kind of related in many different ways and they kind of revolve around a financial kind of reason. Again, these are extrinsic factors suggesting that people are working, perhaps not because they really want to, but because they have to. And this is something that's referred to as job lock. And we know that people who feel like they have to work often have poorer outcomes in the future. The two that probably get the most focus are the first two.
They need the money and maintain health insurance coverage. You might wonder where COVID-19 falls in this. And you might think, well, you know, the economy is down because of what we're going through now and economic uncertainty. That may be a reason for people to work longer.
However, you might also say, well, for people in jobs where they can't work remotely and they may be exposed to a situation where there might be the virus, then those folks made for safety and health reasons, not work as long. So, I think it remains to be seen exactly what the outcome will be of the situation we're going through now. In any case, there are other reasons that people work and these tend to be more positive reasons. You might think of them as pulling people into work.
And some of these include things like that you enjoy the job, you enjoy working, the job makes you feel useful, it provides a purpose in life, reduces physical demand, safety risks -- and that's been true over the years and a number of jobs now. Interaction with other people, something to do, generally higher levels of education -- which is truer of older workers more so in past generations. So, people have a little bit more mobility, the ones that probably gets the most attention are these: I think people would argue that as we move forward, and we want people to be working, and we need older workers, that there's a lot of things we can do in terms of increasing the intrinsic reasons for working. You know, we can do things about work and as we understand people's motivations and interests as they get older in the workplace, there should be a lot of things that we can do to redesign work.
And we'll come back to that in just a little bit. Casey mentioned the different generations. There are currently up to five generations in the workplace. You can see how this has changed over the years and will continue to change moving forward.
When I got interested in the topic of aging, that was back in probably around the year 2000 and that was the time when boomers, baby boomers, ruled everything pretty much because of the numbers. And these are folks born between 1946-1964. But you can see the numbers have gone down whereas Millennials have raced to the top. Gen-Xers have kind of come into their own and now we have the post-Millennials, the new generation, sometimes called Generation Z, I think, who are increasing and will be doing so rather dramatically in the years ahead. And these generations all have different ways of communicating different preferences when it comes to technology, and work, and safety, and health as well. It's important to keep in mind that within the numbers, the overall numbers of workers, you have these different groups and different approaches to work.
Just one final demographic slide. This is the old age dependency ratio. And it basically shows the number of older adults in our society to the number of younger people.
And it's the younger people, of course, who provide resources, financial resources, for social programs like Medicare and Social Security. In 2000, you can see it was one older adult for every five younger adults. And that's increasing rather dramatically. We're right now at about one to four, so that's about 25% in terms of this ratio and it will be increasing to about one to 2.5 younger adults.
And I put this up here in part just to illustrate that this change in age structure that we're talking about is not going to go away in five or 10 years. It will be with us for the foreseeable future, certainly for our lifespan it will be around as well as those additional generations. So, given that, what can we expect in terms of changes, and safety, and health outcomes that seem to occur with age? I'm going to try and go through this rather quickly. But this is a very quick summary of a large literature that's out there in terms of some of these -- and these are selected outcomes.
I'm not going to include everything but just some of the ones that have been studied in a fair amount of depth. These are ones that we don't expect to change very much. You may get a little bit slower, your memory may not be quite as good, but you may not experience a change in job performance because you know how to perform your job better, and you've learned a lot of things about your job over the years. So, a lot of things may counter themselves in terms of these ones in the middle: absenteeism, ability to learn from training, creativity. You'll notice the last one prevalence of back pain has an asterisk. And that's in part because it depends how you look at this.
If you look just at a survey of workers and ask them about back pain, you'll find this is true in the number of national surveys, it's about 30%, roughly, about a third of the population. It doesn't seem to vary that much with age. However, if you look at only those people in physically demanding jobs where, for instance, they do a lot of heavy lifting, then you find the rate of back pain goes up with age.
So, it's not just age, it's age in the context of the exposures that you have in the work environment. And that can often be the case and it's important to keep in mind. These are things that tend to worsen with age: fatal severe injuries, slips, trips, and falls, return to work, chronic conditions, and skills obsolescence.
We could, of course, and these data have become known the last few months, of course, Covid 19, older workers are more susceptible. And we're not completely sure why, whether that's due to these underlying chronic conditions, which contribute at least some part or if there are more normative parts of aging that make people more susceptible. But all these things in this column suggest an increased vulnerability that you find with age to various kinds of health outcomes. And finally, there are things that we should not forget, improve with age. And these are some of the ones that people have studied, things like non-fatal workplace injuries and that excludes, of course, slips, trips, and falls.
But overall, the rate goes down. Job and life satisfaction improve, counterproductive workplace behavior has decreased. presenteeism decreases, diversity of knowledge, and experience increase.
So again, I hope this captures some of the complexities, some of the nuance with aging. There are things that don't change, things that get worse, things that get better. Also, very quick summary impact of aging, gradual complex, workplace exposure matters. Things like physical demands, for example.
Primary prevention. We always say in public health is important, but it really, really matters in aging because you need to prevent something because once it occurs, it can be much worse for people as they're getting older. These are the variables we mentioned of concerned things of promise. Okay. Let's move on to this issue of the future of work. We often hear about the fourth Industrial Revolution, which you can see is what we often talk about when it comes to the topic of future of work.
But we have had revolutions and the way that we work and the way that work is carried out previously. They have also involved a lot of change with people and you know, for instance, if you go back to the 1900s, early 1900s, what you say in your slides is the electricity, but the main change then or one of them at least was the advent of assembly line work and breaking a job into more minute tasks. And although we take that for granted now at the time, obviously, had an enormous impact on how work was divided up and carried out.
Today, you know, we're continuing some of the things about computers but things are more interconnected and more intelligent in terms of how they communicate together. So, factors contributing to the future of work. Obviously, the main one, the driving factor is emerging in the vast technologies but we should also acknowledge that those technologies have resulted in things like globalization.
And the fact that the world tends to be more interconnected than it's been before; new and non-standard forms of employment -- Casey touched on this earlier -- growth of services and information based sectors of the economy; climate-related hazards; and the last one there is possible pandemic. And of, course, I'm referring to COVID-19 and a few months ago, this one would not have been on the list, but it is something that for the future we obviously will be needing to consider. It's been pointed out that what we're going through now, in terms of some of the changes brought on by the Coronavirus pandemic, will accelerate things like emerging and advanced technologies in terms of their adoption and companies relying on it. Globalization is an interesting one that may go the other way.
There may be more desire for independence between countries, at least in the short-term. New and nonstandard forms of employment. You could see that continuing, I think. Continued growth of services and information based sectors.
It's hard to see that that will change. Climate related hazards that may actually decrease in the short term, depending on, you know, whether or not economic activity continues to be reduced compared to in the past. I'm going to focus mainly on the emerging advanced technologies, but when we do talk about the future of work, it's a number of other areas too. So, here are some examples.
You'll see that, you know, there's a lot of these things I'm sure you all have heard about. I've listed 14, I could have listed 40. Some of these are in kind of early stages of development.
Some of these are more advanced. Some are cross sectors. Some pertain mainly to one sector or a couple as opposed to several.
But in any case it's really quite amazing all the things that are developing and the potential that they have to change the way we do work. Some of the potential benefits, if you take kind of an aging perspective, people have often talked about the safety dividend for workers, in which hazards or certain types of manual repetitive activities are reduced. More complex job tests that can better utilize older workers' knowledge expertise and provide more meaningful, less repetitive work, and creation of new jobs, and work roles that allow agent workers to further develop their skills. So, this kind of is a very positive spin on how technology might affect work, but there are potential costs.
People have often noted that it seems like the levels of psychosocial stress seem to increase as our use of technology increases. So, things like work demands, work/family conflict, burnout stress, things like that seem to increase and it may depend how we implement the technology, how we use it, but it does seem to be an increasing concern. Job displacement, long-term unemployment, particularly for older workers -- and this is something Casey was emphasizing -- and low skilled jobs. And, you know, the predictions range enormously as to what percentage of jobs can be replaced by automation. Their ranges maybe on the low side to maybe 10% over the next 10 to 15 years to a high of perhaps 50%. So, we don't really know that there will be a fair amount of job displacement and that is more of a concern for older workers and that it takes them a longer time to find a job once they lose one.
For the sake of time, I will just go through this graph rather quickly. This is just looking at relative aging in different countries and the risk of jobs being automated or workers being displaced. And you can see there are many countries on this graph.
This is generally a positive relationship. So, as aging increases across countries, the risk of being displaced and having jobs automated increases as well. There are also a number of additional factors involving government policy.
So, the more a country spends on its education relative to gross national income, the less automation occurs. The larger the size of the manufacturing sector, the more automation is likely to occur. Pension replacement, legal protections, as these goes up, the risk of automation decreases. So, this suggests that on the national government level, there are things that might be done to affect this kind of relationship. Growing skills gap, you hear about this a lot. Loss of privacy probably affects everybody in one way or another.
When you think of some of the costs that come with automation, and social media, and things like that. Some implications for the design of age-friendly workplaces. Casey mentioned things like re-skilling, up-skilling. This is true for workers of all ages. Focus on lifelong learning, obviously, is important and that is something that should continue throughout the working life and not just wait until people get older. More and more people talk about the need for job designed for an aging workforce.
And going back to the table we had about those intrinsic factors that lead people to work as they get older. There's more and more, I think, that can be done in that that area. Greater focus on programs and practices to address a broad range of psychosocial factors, practical tools, and again this idea of government policy when it comes to things like retirement, when it comes to investment, and education. Those areas are important as well. Let me just describe a tool that we're working on.
This is in the context of our center on productive aging and collaboration with our colleagues at the University of Connecticut. This is a definition of productive aging that has helped guide the center by Robert Butler, who is the founding director of the National Institute on Aging. And basically, you can boil it down to the idea of minimizing the losses that we expect to occur with aging -- going back to that table with the colors -- and maximizing the gains.
These are four kind of attributes of our model of productive aging. Casey had mentioned that total worker health is a comprehensive, integrated, holistic approach to safety and health. And that's very much, our center is very much focused on that as well, recognizing the priorities of both workers and employers. And again, the idea of multigenerational sorts of issues. The e-Tool that we're developing as part of this new collaboration is intended to be based on a checklist developed by the International Labor Organization. They have them for job stress and ergonomics will be developing one for age-friendly workplaces, it will contain a series of action checkpoints and supplementary information will be provided for each action checkpoint, in terms of why it is important health consequences and potential solutions.
This will be a mobile app eventually that will be developed that can be used in a manufacturing plant to better identify age-friendly practices. Just to give you some examples, here's one that talks about the possibility of regulating work, any proposed action, no, yes, priority, and notes. This is just an example, we're in the process of actually developing a long list of these items. Here's another one that's intended to really get into some of the issues around the future of work, and reskilling, upskilling kinds of issues. And the tool once it's developed, and again, we're in the very early stages will involve people kind of defining the area in the manufacturing plant to be evaluated, a walkthrough, a manager, safety health professional completes the checklist, priorities are identified and discuss implementation strategies developed. So, this is intended to help get the conversation going.
It's not a panacea, but it is a way to start thinking about some of these issues with aging, and also direct attention to changes in the future of work that are important to consider as well. So, with all of that, let me just thank you for your attention. I've gone a few minutes over. So, let me hand the baton back to Sarah. >> Thank you very much, Jim.
And as we get ready for our last two speakers, we've lost a couple of the first two questions that were submitted, one of them was addressed to Dr. Chosewood, and one of them appeared to be addressed to either the whole panel or any of the panelists. So, these were the first two questions that were submitted. So, if you would please resubmit those questions while we hear our last speakers, we appreciate it. And so, now it's my pleasure to invite Dr. Cherniack, followed by Dr. Garza to the podium.
Martin. >> Thank you. Can you hear me? >> Yes, I can. Thank you. >> Great. Okay. So, I'm going to talk about what's something unusual in occupational medicine.
We're now in our 12th year longitudinal observation on an aging work cohort, the name of the study was funded by NIOSH, is UCONN-SAM. UCONN I guess is obvious, SAM maybe is obvious, but it's Studies on Aging and Musculoskeletal Disease. And the way we're going to divide this up is that I'm going to give some background material and talk about some of the data which we have accumulated historically. I'm going to turn it over to Jenny Garza, who's been busy analyzing more recent data based on multiple observation points, and she'll be presenting some of that data. And then I'll I will be finishing up with some overall observations. So, I want to talk about three objectives for today's webinar.
First goes back to the original study, and now it's a 2008, 2020 study, which we had in mind, 5 years. And that's the look at the health and work characteristics in a manufacturing cohort. In this case, it was six companies, ones which in many cases we had worked with over the years. And looking at health and work characteristics, we were concerned about musculoskeletal health as it changes over time, also economic wellbeing and social wellbeing. And that, again, we're looking at progressive changes. The second thing we want to talk about, which really was not part of our original focus, but it's changes in the work and future directions of the workplace.
And the reasons that we mentioned that is that we went into look at what were somewhat legacy companies, you could even call them stodgy companies. And yet, the biggest changes we've seen have been in work organization, ownership, management, and production cycles. And they have to be commented upon, because the notion that there would be a stasis in terms of exposure simply was not correct. Finally, we wanted to talk a little bit about COVID-19, and there's a couple of reasons for that. In order to make this study work, we have to work very closely with EH and S personnel, safety, engineering, and so forth.
And this is what's on their agenda, in our conversations with them in our workshops, our ongoing interactions, COVID-19 has provoked enormous attention and response, and it's probably on the minds of many people in this group here. And we simply can't talk about aging and work without some addresses to it. And that's difficult. We don't have a lot of data, we have observations. The other thing is we don't have -- we have some changes which are certainly contemporaneous and others which are probably longer term which involves the aging workforce, and we'll try to make a differentiation of the two.
So, this just gives you a basic outline of our project. Again, we've had four observation points between 2008 and 2020. We made a number of assumptions, which were kind of interesting in retrospect. As you can see, the whole project was a buffer between two great events, the recession and COVID-19. So, so much for the ideas about historical stasis in manufacturing and time. These were obviously periods of major change.
We could look at it in one hand and say this is exceptional. Our view is with all the changes in the workplace, the economy, COVID-19, the environment, employment, the stability of the population, its expectations, this is now the norm, and will be the norm, and we will have to adjust research in the future to this level of change. Which is to say that if we look to the past, we're probably going to miss the present as well as the future. The other thing we wanted to say is we had six companies, we based our estimations of retention and numbers on a five-year prehistory of all of the different companies, and we made a couple of assumptions. One was management would be stable, ownership would be stable.
If there were no major reorganizations and layout for plans, and there was limited susceptibility to the fact that global marketplace issues which would lead to major changes in the corporation. The surveys were included ones which are familiar with in terms of demographics, health outcomes, generally the validated surveys, they needed revision. We also did extensive physical testing, particularly things such as submaximal oxygen consumption, cardiovascular function, strength, flexibility, endurance, and those we also have to revise. So, this is what we looked at repeatedly over the time period. Now, the next slide is very busy, and so I don't want you to pay much attention to it, except for a couple of things.
One is that we began with 780 workers. We did some replacement in the course of the evolution of the cohort to maintain that number, and those increases are additions were two people over 55. The other thing is that one of our companies, the largest one in fact, dropped out for some interesting reasons in the past 2 years.
And the final thing I wanted to point out, which is actually quite important, we initially planned this to be 5 years, but we thought about people leaving and replacement and leaving either for turnover or retirement, we made certain estimates. But as we proceed in time, we find that there's a departure between the instruments we have, which really survey people at the individual level, and what happens in the firm of the corporation or the workplace, which is not determined at the individual level. Practically, what that means is we have about 175 people who've been there from the beginning to the end. And those numbers become more and more detached as people move on, and we really are interested in what's happening in the contemporary workplace. The other thing that I would add is that when Jenny Garza presents her data, she's going to divide some of the slides into two.
One is the discrete observational period in each of these four intervals when we look at frequencies, and the second is a longitudinal follow up or before intervals of people who maintain themselves from the start of reception through the life of the cohort. Now, you can see we originally had four aims. We were going to evaluate workplace exposure effects on musculoskeletal health, we wanted to look at work and non-work factors, we wanted to look at gender, and we also wanted to define the factors that would predict people leaving the workforce for a premature leaving the workforce or leaving for disability, or other factors that might interfere with the uninterrupted work life.
So, what did we find between 2008 to 2014? Probably the most dramatic finding was that because of the recession, and we eventually added a significant number of financial questions and economic wellbeing questions to the surveys, people did not retire or leave. They retired or left up to 2014 at 39% of the historic rate. One of the points is by 2014, more than 60% of the workforce indicated that they were delaying or were considering delaying of retirement and work decisions because of their insecurities about the economy. Things we believe changed at that point, at least that's what many of the national survey shows, so we wanted to extend and look at that question. The other thing that is perhaps most important is that we saw major organizational changes at our facilities. And for the companies that changed ownership, one had internationalized, one changed in 2015, 2017 period -- reorganizing and becoming internationalized.
But the point is that was within the lifespan of the study, within slightly more than a decade, we saw companies change from being private equity firms to small multinationals, to small conglomerates, to freestanding and often in the same life cycle. And one of the things that was important, and it's important to study, is that these changes have some profound ramifications for the health and the attitudes of the workforce, and some of the individual changes within companies, within six companies that Jenny Garza will show you, attest to that. The other kind of unexpected finding that we have, which is really due to our colleagues from the aging community, was the extent and the importance of elder care issues for an aging workforce. And increasingly, we've lowered that definition of aging more to the six decades of the 50s. We think that one of the reasons that hasn't appeared to people so much is because it's diluted because we never have more than about 15% of people who are, in fact, provoked in this situation at any one time. But it is continuous, and plays a very large role and is one of the major things on the minds of the active workforce.
Now, the other thing I wanted to mention a little bit about sort of overall changes up to 2014. When we looked at sort of standard measures, JCQ, workability, various MST indices, they look generally pretty stable over the years, but there's a big but, because as you'll see in Jenny's data, in terms of the decisions that go into people's making changes in their work life, these are not irrelevant issues. And we do see differences particularly in whether people retire or stay, even though the cross-sectional changes may look similar. And we also see major differences within companies based in many ways on economic and social events.
So, let me talk about -- I may be going sufficiently fast, actually -- let me talk a little bit about what we're doing now, because in 2017, after a hiatus, we were refunded. And since I was asked to present something about a study, I'm going to present some material which may be a marginal interest to people who are simply interested in the end results and demographics. One is, as we mentioned, people did not leave work. Now, we looked at health and leaving work as a major endpoint for all of our measurements, whether they be survey measurements or physiologic measurements.
But if there's no change in the constitution of the workforce, there's a great deal of conservatism in our endpoint measures. And so, this was one reason we wanted to continue the study with another observation point, which we've just completed, unfortunately, just before COVID-19 changes. And that was really to see whether many of the changes which we had seen in 2008 to '14, or the lack of change was a function of the economic downturn and how much was transient and presumably altered by what we've been told is a full employment and much more satisfying economy. The other thing is we have to refine some of our testing. So, our physical testings, for example, submaximal exercise testing, some of our measurements of endurance and physical performance, we had based on other literature so that we will be consistent with other international studies.
And what we found is that they didn't work particularly well. They didn't differentiate at the level that we'd expect it and didn't differentiate well enough didn't have high enough variation within the study. But we really wanted to reexamine them to see if it really was worth doing this extensive evaluation of physiologic effort. And so, this phase was done in the laboratory and the changes which were made and are now being put in to the current and timepoint change. Obviously, there was a problem with discontinuing the sequence of previous tests from a longitudinal perspective, but we've done a lot of the tests which were widely used, just not very good.
We also have limitations to our survey, although we redid standard instruments and then spent a great deal of time in its development. And the use of many of the of the stems throughout CPH knew our problem with the help center, we found that there was some real limitations. Certainly, on the elder care issue, there were limitations but we also felt that in terms of life cycle, work, and retirement and decision making, they just were no good instruments. And if we looked at alternatives, like the National Health and Retirement Survey, they're far too detailed for any kind of a cohort or in a workplace setting. So, we've had to really develop some new surveys. And then finally, we have piloted interventions, and Jim Grosch mentioned one, Eldercare is another, we are in the process in our final year, of re-thinking COVID-19 and the type of interventions that may involve.
And I can't say any more now, but maybe if you asked me in 3 months, we all would have something more to say. So, this is the last slide, I'm going to present in the sequence, and it's just to say something about the participation rates, and I want you to keep this in mind as Jenny proceeds. We have very low turnover in the first 6 years of the study; we've had normal turnover in the final years of the study. That can have two meanings. One of them is that our inception cohort is much smaller, but the second is that in the study of workplaces, this retention becomes a very difficult issue once people have left their employment.
So, having said that, I realize we're all a bit over and I'm going to run, turn to Jenny. >> Thanks, everyone. So, for the next few slides, I'm going to be presenting some of the initial observations and findings from the last round of data collection for the UCONN-SAM project. Now, in the next series of slides, you will see two different things. So, on the left hand side of your screen, you're going to see some figures depicting changes in several of our health outcomes over the four time periods of the study, that is from Time 1 in 2008, through Time 4, which was in 2019. Now, this is depicted across all six of the companies that participated in the study.
We averaged the responses for each participant across the six different companies separately, so those are the six different colored lines that you're seeing on the left hand side here. And we are showing the trends in, in this case, the health of the population, across our entire population of 769 participants. So, this question on this slide was the health in general as evaluated through the survey question on the SF12, the single item survey question from the SF12 to analyze the health of the population in general. And as you can see here, we did see some differences in the overall health of participants across the six different companies and later Dr. Cherniak will present some thinking about some administrative changes that may have influenced the health of participants at the different companies. However, what we want you to take away from this slide currently is that if you look across the four different time periods, and across the six different companies, we saw very little change in the health of our study population overall.
So, the Health reported in 2008 was approximately the same as the health reported in 2019. So, now, I'd like to turn your attention over to the right hand side of your screen. And there we're showing some data in a little bit different way. So, again, we're still looking at that same question of health in general of our population.
However, now we're presenting a restricted group of our study population. So, here, we're only looking at those participants who were aged 55 or older, and what we wanted to understand was the difference between participant two remains in our sample between Time 3 and Time 4, compared to those who left our sample between Time 3 and Time 4 due to retirement, to try to understand whether there may be any predictors of retirement amongst our survey questions. So, here, we wanted to know whether there might be differences in the health of the retirees compared to those who remained employed at their study site in 2019. But we took away from this that we really observed no differences in the health across the first three time periods of those participants before they retired. So, now I'm going to move on to the next slide, which has a similar analysis, however, with a different health outcome. So, here we're looking at depression, and this was evaluated again through the survey using the CESD scale.
And again, on the left hand side of the screen, you can look at the data presented across the six different companies and across the four time periods between 2008 and 2019. Again, as we reported in the past slide, you can see some differences by company where there were some companies who the employees on average reported higher depression scores and some reported lower. However, overall, if you look across the six different companies, there seems to be some slight upwards trend in depression over the four time periods so that the depression scores on average reported in 2008 seems to be a little bit lower than the depression scores reported in 2019. And now if you turn your attention to the right hand side of the screen, looking at the depression of a scores reported by the participants who retired between Time 3 and Time 4, compared to those who were present at Time 3 as well as at Time 4, you can
2022-04-24