Proceedings of a Workshop—in Brief

Convened June 9, 2025

Exploring Relevant Policy Domains: Labor and Employment Policy and Population Health
Proceedings of a Workshop—in Brief

INTRODUCTION

Mary Pittman, co-chair of the Roundtable on Population Health Improvement, formerly with the Public Health Institute, and co-founder of For Our Health, an initiative of the American Public Health Association, welcomed attendees to the roundtable’s workshop Exploring Relevant Policy Domains—Labor Policy and Population Health, which was held on June 9, 2025. Pittman acknowledged Ana Diez-Roux, the other cochair of the roundtable from Drexel University, who was unable to attend this workshop. Pittman noted the roundtable’s strategic focus on the structural drivers of population health. One of those drivers is public policy; the 2025 workshop series, Pittman added, would explore three policy domains relevant to health, health equity, and well-being: labor and employment, taxation, and housing policies. Pittman explained that this workshop would examine from a variety of perspectives the ways in which labor and employment policies shape people’s lives and affect health care access, social support, and economic stability.

CONTEXT SETTING TALKS: TRENDS AND IMPLICATIONS OF LABOR POLICY FOR POPULATION HEALTH–THE POLICY ENVIRONMENT FOR U.S. WORKERS AND BUSINESS

Aparna Mathur of the Foundation for Research on Equal Opportunity invited attendees to reflect on how the evolving nature of work is reshaping health and well-being for American workers. She noted that the labor market is in constant flux, driven by emerging technologies like artificial intelligence (AI), the rise of gig and freelance work, and changes in where and how people work. Mathur explained that these shifts raise important questions about how current policies affect worker safety, job stability, and long-term economic security. She framed the first workshop session as an opportunity to move beyond the snapshots of metrics like the monthly jobs report from the Bureau of Labor Statistics and instead take a broader view of labor trends and their implications for population health.¹

Daniel Griswold, Cato Institute, discussed how American workers are generally better off today than they were several decades ago. Drawing from his 2020 research, he argued that real wages—when using updated measures such as the Personal Consumption Expenditures price index—have steadily increased, contradicting claims of wage stagnation (Griswold, 2020). He attributed much of this growth to periods of significant trade liberalization, citing milestones such as the North American Free Trade Agreement, the Uruguay Round, and China’s reentry into the global economy.

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Griswold also pointed to structural economic shifts, including a decline of approximately five million manufacturing jobs over the last 25–35 years,² attributing this trend more to technological advances and automation than to trade liberalization. Griswold suggested that while these shifts have transformed the labor market, they have occurred alongside broader improvements in worker and societal well-being. These include reductions in workplace injury and fatality rates, increased educational attainment among women, and gains in life expectancy, and infant health. He noted that the United States has added nearly 20 million net new jobs in higher-paying service sectors during the same period, such as health care, professional services, and education. However, he acknowledged that many Americans have not shared in this progress. While causes vary, he noted issues such as educational barriers, addiction, and stigma after incarceration.

Griswold argued that instead of limiting economic freedom or slowing technological progress, policy makers should focus on targeted, practical reforms or “micro-policies.” He highlighted several areas for action such as strengthening K-12 and vocational education, easing restrictive occupational licensing laws, tackling mental health and substance use disorders, and reassessing income support programs that might unintentionally discourage work. Griswold emphasized that openness and innovation have been key drivers of prosperity and argued that reform efforts should focus on expanding access to those gains, rather than retreating from them.

Gregory Wagner, Harvard T.H. Chan School of Public Health, presented on the bidirectional relationship between work and health at both individual and population levels. He emphasized that while work can provide income, purpose, social connection, and access to health care, it can also expose people to a range of occupational and social risks, including health hazards, income instability, and poor working conditions, many of which are preventable. However, certain groups of workers are more profoundly affected, particularly those in lower-wage or higher-risk jobs. He said traditional occupational risks, such as on-the-job exposure to chemicals, radiation, and infectious agents, continue to contribute significantly to common chronic conditions, including cardiovascular disease, cancer, and asthma. He noted the growing attention to work-related psychosocial stressors, including workplace violence, bullying, burnout, sleep disruption, job insecurity, and physical stressors such as heat exposure. Wagner said that a misalignment between work demands and workers’ ability to meet them is a key driver of poor physical and mental health outcomes, in addition to economic and social harms. Work-related injuries and illnesses, Wagner explained, have ripple effects. For workers, the consequences include long-term income loss and restricted employment opportunities. For employers, the costs manifest in reduced productivity, higher turnover, and greater disengagement. He also highlighted how injuries can be a gateway to opioid use and suicidal ideation and behavior—especially in physically demanding sectors such as construction and mining.

Wagner described a systems framework where worker well-being is shaped by a combination of individual characteristics (e.g., training and health status), workplace conditions (e.g., physical hazards and organizational structures), and broader policy environments. He pointed to the Occupational Safety and Health Act³ as a foundational public policy tool, directing employers to provide workplaces that are free from recognized hazards. He presented the hierarchy of controls as a model for managing risk, starting with hazard elimination, followed by substitution, engineering controls, administrative policies, and personal protective equipment—ranked in descending order of effectiveness. Wagner advocated for upstream prevention strategies that anticipate and mitigate risks before harm occurs.

Wagner noted that not all workers have equal access to opportunities for health. He emphasized the need for internal workplace policies that support health, such as providing flexibility, promoting employee voice, and ensuring physical and psychological safety. Wagner also highlighted the importance of data in guiding interventions, identifying problems, and understanding the distribution of risks and benefits across different worker groups. He concluded that thriving workers benefit not only from health and safety protections but also from

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intentional systems designed to support well-being—reinforcing that “healthy workers are good for business.”

Tami Simon, who provides human resources and employee benefits consulting, focused her remarks on the business case for investing in employee well-being, highlighting its measurable return on investment (ROI) for organizations and society. She began with a series of facts, noting that nearly 222,000 layoffs had occurred in early 2025, which is the highest since 2009.⁴ Despite this, employers continued to cite attracting and retaining talent as a top priority for the fifth consecutive year, while workers reported increasing difficulty finding jobs and growing levels of burnout. Simon added that over half of workers report being distracted at work due to financial stress, noting that 75 percent of U.S. employees report experiencing burnout at least occasionally, and one in four say it occurs very often or always. She described these challenges as interconnected, using the phrase, “money to brain to body,” to illustrate how financial distress can cascade into mental and physical health issues.

To help navigate these challenges, Simon called for a holistic approach to workforce well-being by encompassing physical and mental health, financial security, safe and stable working conditions, environmental factors like commuting, and social connections built on trust and transparency. Simon described the U.S. system of employer-sponsored benefits as unique compared to other advanced economies, likening the U.S. system to a “three-legged stool” supported by individuals, employers, and government. She explained that each plays a distinct role: individuals are responsible for maintaining their own well-being; employers offer benefits and shape workplace policies; and the government sets the broader public policy framework.

Simon highlighted that investing in employee well-being can yield strong returns. For example, companies that adopted best practices in workplace health promotion⁵ saw their stock value rise by 235 percent, compared to 159 percent for the S&P 500—a common benchmark index of large U.S. companies over the same period (Grossmeier et al., 2016). She added that investments in holistic well-being is a comprehensive strategy not only for business performance but also for national economic resilience. Simon concluded by encouraging employers to use data tools like the Health Enhancement Research Organization Scorecard⁶ to assess their well-being strategies.

Mathur asked panelists how they see the nature of work changing over the next few decades, particularly in light of evolving technologies like AI and shifting workforce demands. Wagner acknowledged the unpredictability of technological change and raised the issue of how work is increasingly “fissured,” referring to trends such as subcontracting and gig work, which make it more difficult to determine who is responsible for worker well-being. Simon agreed that AI and technology would continue to reshape the workforce but argued that demand for human cognitive skills (e.g., creativity, memory) remains strong. She warned that attention spans and cognitive focus are diminishing, potentially due to societal and technological shifts, and highlighted the World Economic Forum’s⁷ emphasis on these cognitive capacities in future labor markets. Griswold pointed to the “reinstatement effect,” where emerging technologies generate entirely new categories of work. Griswold stressed the importance of micro-policy interventions—such as enhancing trade schools and improving literacy—to equip workers for a service-based, tech-enabled economy, rather than resisting technological progress.

During the audience Q&A, roundtable member Robert Kaplan (Stanford University) expressed concern over workforce reductions at the National Institute for Occupational Safety and Health (NIOSH), and the potential weakening of its role. Wagner, who worked at NIOSH earlier in his career, echoed that concern and reflected on NIOSH’s contributions to occupational health research and policy guidance. He described it as a small agency with an outsized impact. Audience member Lisa Fitzpatrick from Grapevine Health asked about the lack of systemic support for prevention efforts aimed at protecting workers’ health and well-being. Wagner noted that public and private systems often fail to anticipate and address workplace

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hazards proactively. Simon added that one reason prevention is underfunded is because employers often question the return on investment (ROI) for proactive measures, including health insurance coverage for preventative services, workplace wellness programs, and environmental or organizational interventions that could reduce stress, injury, or burnout. She encouraged a systems-thinking mindset, urging stakeholders to recognize the interconnected nature of the workforce and to shift from reactive to proactive approaches in workforce well-being.

LABOR POLICY PERTAINING TO BROADER RISKS TO HEALTH

John August, Cornell University, opened the session by framing labor and employment policy as critical to shaping population health. He encouraged participants to consider how evolving work structures, such as technology, climate change, and economic shifts, affect not only job security but also health and well-being. August underscored the importance of cross-sector collaboration to allow labor policies to support a healthier, more resilient workforce.

Alina Schnake-Mahl, Drexel University, provided an overview of current research on labor policy as a structural determinant of population health, emphasizing both recent advancements and remaining opportunities to build the evidence base. She focused on labor policies, such as paid sick leave, minimum wage laws, and scheduling protections that shape health outcomes, particularly in the context of broader systemic risks like pandemics and climate change. Since the COVID-19 pandemic, Schnake-Mahl noted, an increasing number of studies are evaluating the health impacts of labor policy. She emphasized that these policies are shaped at multiple levels of government, creating opportunities for comparative analysis but also posing challenges. As an example, she referenced Texas’s House Bill 2127 (2023), which restricts local authority to regulate business, including labor conditions.

Drawing from her research, she pointed out that cities with paid sick leave had higher COVID-19 vaccination rates among working-age adults—especially in socially vulnerable neighborhoods, where mandates expanded access for workers who otherwise lacked leave—suggesting that such policies can help reduce barriers to care (Schnake-Mahl et al., 2022). In contrast, she cited a study in Dallas County, where a mandated rest break policy for construction workers showed no measurable impact on injury or illness rates, possibly due to data limitations or the policy’s limited effect on its own (Schinasi et al., 2023). She stressed the importance of publishing null results to improve policy design and better understand what works in real-world settings.

Schnake-Mahl also emphasized the need to study how labor policies interact, noting that jurisdictions often adopt multiple measures—such as paid leave, fair scheduling, and higher minimum wages—together. Isolating the impact of a single policy, she said, requires complex methods and a deep understanding of local contexts. She called for greater collaboration between public health and legal experts, describing this approach as “legal epidemiology,” and urged researchers to tailor work for policy and business audiences by highlighting cost and actionable insights (Schnake-Mahl et al., 2025). She concluded by emphasizing labor policy research should aim to support both health scholarship and real-world decisions that advance health equity and workforce resilience.

Matt Darling, MEF Associates, offered insights into how unemployment insurance (UI) policies influence health outcomes, which in turn affect employment. He explained that UI is a joint federal–state program that provides temporary financial support to eligible unemployed individuals (Darling and Raderman, 2023).⁸ While UI is commonly viewed as an economic safety net, Darling emphasized its broader implications for public health. For example, he referenced a study of Austria’s UI system, which found that extending benefits by just nine weeks was associated with lower rates of opioid and antidepressant use among women, but also a rise in cardiac events among men—showcasing how policy impacts can differ across demographic groups (Ahammer and Packham, 2020). Darling noted that in the United States, higher UI wage replacement rates have been associated with improved birth outcomes, likely due to reduced maternal stress and decreased health risk behaviors (Dettling and Kearney, 2023). He also described the COVID-19 pandemic as a stress test of the UI system, during which

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temporary expansions such as the $600 supplement and Pandemic Unemployment Assistance benefits extended coverage to previously excluded groups (freelance, gig workers). He noted that while these measures demonstrated the potential for expanded access, most were not sustained, leaving structural vulnerabilities in place.

Darling noted that the U.S. UI system was not built to handle large-scale disruptions like those caused by pandemics or rapid technological change. He pointed to recent data showing higher unemployment rates among college graduates than high school graduates,⁹ possibly due to shifts driven by AI, and suggested this trend signals a broader transformation in the labor market that current policies are not equipped to address. He emphasized that employment is a key determinant of health, and UI plays a stabilizing role during economic stress by supporting individual and family well-being. However, he cautioned that the system remains under-resourced and outdated, calling for a more adaptive UI infrastructure capable of responding to future labor market shocks.

David Leathers, Health Action Alliance, described climate change as a growing threat to worker health and a critical, yet often overlooked, component of labor and employment policy. He framed climate-driven risks, such as extreme heat, poor air quality, and severe weather events, not only as public health emergencies but also as business and workforce challenges that are becoming more evident. Leathers noted that only a small fraction of employers (4 percent) have examined how climate risks impact the workforce, even though nearly two-thirds of workers report experiencing a climate-related event in the past two years. He added that these effects are reflected in rising rates of heat-related illness, increased absenteeism, and declining mental health, including stress and anxiety tied to environmental conditions. Leathers referenced data showing that more than 2.5 billion hours of labor have been lost in the United States due to heat exposure in sectors such as agriculture, construction, and manufacturing.¹⁰ Yet, most employers have not integrated climate-readiness into health, benefits, or risk strategies, he added.

Leathers highlighted the work of the National Commission on Climate and Workforce Health,¹¹ which aims to equip employers with tools, evidence, and partnerships to address the health impacts of climate change on workers. He introduced the Climate Health Cost Forecaster,¹² developed with Mercer, which helps employers estimate how climate exposure may drive health care costs based on workforce and industry characteristics. Citing recent national survey data,¹³ he noted that while many workers face moderate or greater climate-related health risks on the job, fewer than half are confident that an employer plan exists to protect them. Leathers urged employers to recognize climate change as an immediate and growing determinant of workforce health. He concluded, “The question is not whether businesses should act, but whether they will lead.”

August asked all panelists how researchers and practitioners can balance the need for rigorous evidence with the urgency to act. Schnake-Mahl responded that although policy often moves faster than research, it is possible to close the gap through real-time collaborations and responsive research designs. She stressed the importance of not only studying the effects of individual policies but also considering how overlapping labor policies interact in practice. Leathers added that employers want clear guidance and actionable solutions. He argued that researchers should work alongside business leaders to develop tools and strategies that are evidence-based, practical, and ready to implement. Darling noted that compelling narratives about how UI and other supports have helped families during economic crises often resonate more with policy makers than quantitative data alone. He suggested that the field should do more to elevate these stories alongside evaluation of policy effects.

During the Q&A, Megan Todd from the Philadelphia Department of Public Health asked how researchers can overcome the lack of local data when trying to evaluate labor policies. Schnake-Mahl acknowledged the chal-

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lenge, noting that local health departments often lack access to enforcement or employment data and that partnerships between academics and practitioners are essential to build the infrastructure for more robust policy evaluation. An audience member raised concerns about workers in nontraditional employment such as gig workers and unpaid caregivers, who are excluded from many existing labor protections. Leathers acknowledged that current systems were not built for these labor arrangements and emphasized the need for modernized frameworks that account for today’s diverse workforce experiences.

August closed the panel by reiterating the importance of continued dialogue across sectors. He noted that creating healthy workplaces requires coordination among employers, policymakers, researchers, and workers, and emphasized that addressing structural labor challenges is essential to advancing health equity and economic resilience in all workers.

POLICIES RELATED TO THE BASIC PARAMETERS OF WORK AND EFFECTS ON WORKERS AND FAMILIES

Julie Vogtman, a senior director at the National Women’s Law Center and a workshop planning committee member, moderated the third panel on policies related to basic parameters of work—such as pay and schedule—and their effects on workers and families. Vogtman noted that her work focuses on the role of women in the economy, factors contributing to racial and gender pay disparities, and policies needed to improve women’s job quality. She asked each panelist to share some of the key linkages between workplace conditions and population health.

Jeremy Al-Haj, co-founder and executive director at the Missouri Workers Center, said he works with low-wage workers, whose major concerns include wages that do not keep up with the cost of living, health and safety hazards on the job, and a lack of paid sick leave. He found that Amazon workers are especially vocal about experiencing safety issues and shared that in the November 2024 election, Missouri voters approved a ballot initiative to raise the minimum wage to $15 per hour and guarantee seven days of paid sick leave to workers.

Daniel Schneider, co-director of The Shift Project at Harvard University, spoke next and said the worker experiences that Al-Haj shared resonate on a national level, especially within the large fraction of workers in the service sector. The Shift Project, Schneider said, has surveyed hourly workers at some of the largest firms in the United States (e.g. Amazon, Starbucks, McDonalds) over the past 10 years to understand the multidimensional challenges that workers at these places face. He shared the top issues are those that Al-Haj previously mentioned (paid sick leave and wages), but workers face additional problems. For example, Schneider stated that 25 percent of the fast-food workers surveyed reported having gone hungry at least once in the past month because they could not afford food. Another issue Schneider noted is the work scheduling challenges that particularly affect hourly workers in the service industry. In this sector, companies and managers typically have control over workers’ schedules, he explained, and workers often receive their schedules with short notice, with frequent last-minute changes. Schneider added that schedules are unpredictable and unstable, varying not only from week to week but also day to day. He said his work aims to examine the economic impact of schedule instability on households. This research, Schneider said, has found that for workers, an unpredictable work schedule leads to more significant challenges with paying bills, qualifying for benefits, and experiencing higher levels of psychological stress, including difficulty with sleeping.

Anna Gassman-Pines, Sanford School of Public Policy at Duke University, spoke about her work collecting detailed daily reports from service workers in U.S. cities about their work experience over the course of a month. She noted that co-panelist Elizabeth Ananat of Barnard College, collaborated on this work. Their results were consistent with Schneider’s survey data, which found that unanticipated schedule changes were extremely common. The daily instability, Gassman-Pines observed, is associated with poor emotional well-being, with many workers saying they felt angry, sad, or irritable on days when they had an unexpected schedule change. In addition, Gassman-Pines said, workers often “hold open” twice as many hours in a week than they work to accommodate potential additions to their schedule.

Maureen Perry-Jenkins of the Center for Research on Families at the University of Massachusetts Amherst, introduced her focus on the impact of labor issues on

physical and emotional childhood development. She said her research examines how parents’ work experience impacts their mental health and, subsequently, their parenting style and child’s health. Perry-Jenkins explained how her research follows low-wage women workers from pregnancy through when their child enters first grade, measuring parents’ mental health and child health outcomes. One issue, she said, that prevents the implementation of policies to address poor mental health outcomes is the discomfort that both employers and employees feel when discussing mental health issues. She shared three main takeaways from her work that can inform the creation of supportive work environments: (1) not all low-wage jobs are bad jobs, as some low-wage workers self-report positive aspects such as a sense of autonomy and self-direction; (2) positive work relationships with supervisors and coworkers matter in fostering happiness and well-being; and (3) many low-wage workers are unaware of the paid leave policies that are in place or have difficulties filling out the forms needed to access them.

Vogtman asked Ananat to discuss whether public safety net programs address problems associated with having an unsupportive employer and the instability of low-wage work. Ananat emphasized that income stabilization from safety net programs that provide basic needs is essential in preventing a downward spiral from an inability to pay the bills. However, many existing safety net programs are poorly matched to employment issues, she continued. For example, Ananat noted that the Earned Income Tax Credit and the Child Tax Credit are designed as dependent on income, meaning that taxpayers must earn a certain minimum amount of income to be eligible for these credits, which amplifies the instability arising when low-wage workers lose wages. She said other programs, such as the Supplemental Nutrition Assistance Program (SNAP), work in the opposite way, in which people receive more money as they earn less. Medicaid also provides the benefit if income is below a determined threshold, Ananat said, although she noted the policy may shift under proposed Medicaid work requirements.

Vogtman next asked the panelists to share one or two policy solutions relevant to the issues identified so far in this discussion. Al-Haj said it is important for any policy to address the fundamental problem of workers lacking power and choice by including within it the conditions for workers to build permanent, long-term organization mechanisms, such as unions. He shared an example from Kansas City, where the proposed building of a $2 billion stadium prompted low-wage workers and unions to demand the developer to sign a community benefits agreement. Al-Haj stated the agreement mandated the following: that wages be made higher; that workers within that district have a path to unionization; that workers in the old stadium have first access to jobs in the new one, with their collective bargaining agreements maintained; and that affordable housing be made available for workers so they could live in the area they were helping make more profitable. He said the developer did not sign the agreement, so the project did not come to fruition, but he said that if a proposal like that had been successful, it would have led to long-term worker power and improvement of worker well-being in Kansas City. He noted that a similar initiative was successful in Milwaukee, where service workers won a community benefits agreement around the building of the Milwaukee Bucks stadium and the agreement included many of the components mentioned previously and increased the power of Milwaukee low-wage service and hospitality workers to be involved in decisions that impact their daily lives.

Schneider said that labor unions and other channels for worker voice are social determinants of health, and unstable working conditions can either be the catalyst for creating these social determinants or can further impede the ability for workers to organize. For example, he noted that jobs with low wages, high schedule instability, and poor managerial relationships often have high turnover, making effective employee organizing difficult. Schedule instability also weakens relationships with coworkers and prevents the types of connections that are essential for organizing, Schneider continued. He spoke about fair workweek and secure scheduling laws, highlighting their important role in providing employees with advanced scheduling notice and providing compensation for last-minute schedule changes. Speaking about the effects of these laws, Schneider observed that while they have positive effects for workers, their impact is somewhat constrained because the state and local labor agencies responsible for implementation and enforcement are

under-resourced and often rely on workers to know their rights and self-advocate. Gassman-Pines highlighted that one consistent benefit of these laws is improved sleep quality among workers, which is an important aspect of improving health. She also agreed with Schneider that implementation practices could be strengthened. Paid family and medical leave programs are another policy to support workers, but Gassman-Pines explained that they are only available statewide in 13 states, including D.C., despite evidence showing they improve maternal physical and mental health, decrease infant mortality, and help workers transition back to paid work.

Ananat spoke next about the 2021 child tax credit, which she noted was fully refundable, meaning that all low-income families received the full value of the credit. She explained that the tax credit improved family stability by decreasing poverty and food insecurity, and it also did not decrease the amount that parents were working. Although the policy was not renewed at the federal level, Ananat said, child tax credit policies at the state level will yield more findings on their effects in the years to come. Perry-Jenkins further emphasized the importance of paid family leave, given its benefits to child development, and noted how the United States lacks in this regard compared to other countries.

Vogtman said some policy makers might argue that raising wages, providing paid sick leave and paid family and medical leave, and offering more work hours would be too costly for employers. She asked the panelists to share potential responses to those arguments. Al-Haj said there are many examples of these policies getting enacted and businesses remaining successful, such as the minimum wage increase for fast food workers in California. Tami Simon asked the speakers to elaborate on cultural differences and noted that the United States is different from other countries in terms of valuing family leave and having employment and social structures that support those policies. Ananat emphasized the primary argument used in opposition to policies that provide paid family and medical leave is that the costs will be harmful to business, noting this belief as a cultural difference between the United States and other countries that should be addressed. This belief, Ananat said, is not supported by evidence that shows that employers who implement paid family leave report that the change was either positive or neutral for them.

Perry-Jenkins proposed that one key measure of return on investment could be how children of impacted workers are doing in terms of health and well-being. She noted how, in her interaction with employers, she has observed recognition by those who are older (above 60 years old) that it is important for employers to invest in the well-being of families by providing these benefits such as paid family leave. Schneider agreed with Ananat’s earlier point that when policies supporting workers are implemented, it’s beneficial for the employer’s bottom line. He also agreed that this demonstrates the need for cultural change and a shift in management education to help prevent these policies from being consistently reversed, often when company leadership changes. Gassman-Pines added that reframing the notion that “if workers are provided stability while they are away from work, then they will not return to work,” is also critical because she said evidence shows the opposite—that providing stability when workers must be away from work helps them return. Ananat explained that this is true because people really want to work.

An attendee asked panelists to what extent how extensive the constraint of people being unaware of or experiencing challenges with completing the necessary paperwork is a barrier to their ability to access benefits, and how this issue can be addressed. Perry-Jenkins said that familiarizing herself with the process and showing others how to do it is one way she has personally tried to help. Gassman-Pines stated she does not think the administrative burdens are inevitable and noted that, across the United States, there is a lot of variability in how burdensome it is for workers to access these programs. Therefore, there is a research opportunity to better understand which ways of implementation lead to more access, she continued. Another attendee asked about best practices for addressing schedule instability, particularly supporting the needs of both employers and employees. Gassman-Pines said it is important to acknowledge both that employers are responding to customer demand and that employees must make difficult last-minute adjustments when this happens. These things, she continued, are okay if employees get compensated for the change.

Schneider added that many employers use management software to create schedules using an algorithm, which he said presents an opportunity to take advantage of the software’s capabilities and input rules to help implement best scheduling practices. Lastly, Ananat said, the government can play a role by providing financial support for businesses trying to make changes that support worker well-being.

EMPLOYEE BENEFITS: THE FUTURE OF EMPLOYMENT-BASED INSURANCE, LEAVE POLICIES, AND IMPLICATIONS OF NONSTANDARD WORK

Matthew Rae, KFF, moderated the fourth panel, which was focused on employment-based insurance, leave policies, and the implications of non-standard work. Rae discussed the survey KFF conducts annually on employer-sponsored health insurance (ESI), which includes as many employers as possible. Consistently, one of the main findings is that health insurance is expensive—for both employers and employees. Despite the expense, he said, ESI accounts for the coverage of 167 million people in the United States. The focus of this discussion, Rae continued, is to examine the challenges around ESI and explore if and how the system could be transformed moving forward.

Anjum Hajat, of the University of Washington School of Public Health, spoke about employment quality and labor market changes. She explained that, historically, there was a standard employment relationship consisting of: permanent ongoing contracts, regularly scheduled and full-time hours, direct employment, adequate wages and benefits, and social and economic protections. However, Hajat noted that this relationship was only available to a small subset of the population and said most people did not have the benefit of this type of employment. As the labor market changed, research focused on how to measure the qualities of a good job and the impact of these qualities on health began to take shape. Hajat highlighted seven domains of employment quality that exist on a continuum: employment stability, material rewards, working time arrangements, workers’ rights, collective organizing, interpersonal power relations, and training and employment opportunities (Hajat et al., 2024). Given the multidimensional aspect of employment quality, she said, improving workers’ health requires multidimensional policy solutions that address among other things secure scheduling, paid family leave, accessible and affordable health insurance, retirement funds, and child care.

Barak Richman of George Washington University, spoke more about ESI. Richman said that, on average, the annual family premium for ESI is $25,000, which is approximately 40 percent of the median income. He also noted that, despite the large amount the United States spends on health and traditional health insurance, the country fares worse than all other Organization for Economic Co-operation and Development nations on every health-related metric (e.g. mortality, morbidity, quality of life, happiness, mobility, maternal health, pediatric deaths). Richman said there is likely a relationship between high spending and poor health outcomes, namely that the spending is not focused on preventive care. Additionally, he spoke about how this is a systemic issue that touches the many ways in which the United States spends on social needs, highlighting that more could be invested in significant predictors of health, such as primary care, education, child care, social networks, environmental health, housing, and improved transportation.

Ben Gitis, from USAFacts, spoke about paid family and medical leave, which typically includes 12 weeks of paid time off to either care for a newborn child or an ill family member—or recover from a personal medical condition. He said this type of leave is associated with a range of health benefits, including decreased postpartum depression, reduced infant mortality, and long-term child developmental benefits. However, Gitis noted, the United States is the only developed country without a mandatory paid family medical leave benefit. He said only 13 states and D.C. have it, and an additional 10 states have authorized the sale of paid family leave as a private insurance product for voluntary purchase. Access to the benefit varies, Gitis continued, with employees with higher wages, those working at a company with over 500 employees, or those in finance and information industries being more likely to receive it. Without a nationwide, mandatory paid family leave benefit, he said, most workers use the Family and Medical Leave Act (FMLA), which guarantees unpaid, job-protected, 12-week leave for certain workers. He shared the results of a survey on FMLA conducted

by the Department of Labor in 2018, which showed that among workers who used FMLA, many combine this with other forms of leave, including sick leave (70 percent of respondents), vacation leave (60 percent), a state paid family leave benefit (8 percent), and temporary disability insurance (30 percent), to help them get paid. Lastly, Gitis acknowledged the limited data available regarding how frequently paid family and medical leave is used and to what extent the data are reported, which he stated limits the understanding needed to design a federal policy.

Rae asked Janis Davis-Street, from Chevron, how large employers are approaching ESI. Davis-Street said that considering the amount of time people spend at work, the workplace can significantly influence health, and she noted that industry cannot reach its goals without a thriving, healthy workforce. At Chevron, she said, the two main influences in their approach toward workforce health and wellness are the NIOSH Total Worker Health framework and the Robert Wood Johnson Culture of Health framework.¹⁴ Davis-Street stated that Chevron is focused on various aspects of workforce health, including the psychological and physical work environment, access to health resources, and community support. She said they aim to create an organizational environment that prioritizes employee well-being through action in four areas: (1) building a community of belonging; (2) policies and benefits that address multidimensions of well-being (e.g. health, education, diversity, work-life balance, mental health); (3) safe operations through occupational health; and (4) social investments targeting health systems building, health capacity, and disease prevention. They focus on health at the individual, team, and organizational level, she said.

The final panelist, Jeff McGuire from Tyson Foods, reiterated the expense of health insurance and said that from an employer perspective, the cost of providing ESI plans increases 7 to 10 percent each year. He explained that it is important for employers to evaluate how to change plan designs to reduce spending and focus more meaningfully on high-quality and low-cost health care through efforts such as narrow network designs and variable copay structures. Speaking about the future of ESI, McGuire also mentioned that employers can serve a key role in advancing other social determinants of health (i.e. paid leave, near-site childcare, access to health care and mental health resources). For example, he said Tyson Foods is piloting onsite or near-site resources, such as clinics and near-site childcare at several of its locations. Additionally, he noted the challenge of navigating compliance with paid leave mandates, especially for multistate employers.

Rae highlighted the challenge of large, multistate employers navigating benefits across a patchwork system and asked the panelists to speak about the tradeoffs between offering benefits using a state-level approach more equipped to address local needs versus navigating benefits with a single, large health plan. Gitis said the state-level approach offers a sort of experimentation to observe what works and what does not. He explained that states can differ in the duration of leave, wage replacement rates, different levels of private sector involvement, or whether employees use the state benefit or have the option to purchase a comparable benefit from a private insurance carrier. Hajat noted that one disadvantage of relying on a state-level approach is the concern regarding inequity in access to benefits being dependent on if a state has a given policy or not. Davis-Street added that Chevron aims to ensure consistency in benefits offered across different states but said state leave laws carry additional administrative complexity. McGuire echoed her thoughts and said many employers offer sick leave that is as generous or more so than what state laws may require, but complications arise if they do not comply with minor administrative requirements.

On the topic of other factors that can support worker health, Richman noted the popularity of employee wellness programs in the United States about a decade ago, but he acknowledged that many of them did not demonstrate an ROI. He said employers can help by providing employees with access to mental health care, primary care, preventive care, and community health. Davis-Street added that employers are still focused on worker well-being but might use different terminology to describe it. Implementing a data-driven approach is

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also important, she continued, to help target interventions toward employees who most need them. McGuire agreed and said the data-centered approach was used at Tyson Foods when deciding to build health care clinics in locations that would increase access for workers in rural areas, who otherwise lacked access to care.

Richman observed that despite conversations regarding employer-investment in worker health, there is a lack of discussion about how employers can reduce the cost of care for their employees. Hajat spoke about the importance of portability of benefits, given the rise of gig work and independent contracting, and said that without it, many employees are being left behind. She said it is important for non-standard workers to be offered the same benefits as traditional employees, including paid leave and unemployment insurance. An attendee asked the speakers about the current challenges using available data to assess the prevalence of gig workers and to what extent this can inform the future structure of insurance. Hajat responded that there are data limitations, and more research is needed to fully understand the breadth of independent contractors and what types of benefits they have.

Moving to audience questions and discussion, Simon shared that, in her experience, she has seen employers be more mindful about the transparency of pricing and increasing the competitiveness of their group health plans. She shared that some employers are discussing pay-for-performance health care models to reduce expenses, and as consumers of health care, it is important for people to understand the true cost of it. McGuire responded to the idea of price transparency, saying it is extremely difficult to find data on prices, and more policies on this would be helpful. He expressed his opinion that litigation will likely be the main driver of progress. Roundtable member Robert Kaplan agreed with McGuire, stating that what makes price transparency so challenging is how difficult it is to understand the data.

An attendee asked about the intersection between policies that require pay-for-performance (i.e. directing employees to health care in places with higher quality metrics) and paid sick leave policies, which employees would need in order to take advantage of their health care benefit.

Hajat agreed that it is critical for employers to consider the impacts of multiple policies simultaneously. Gitis responded that he thinks education for employers at smaller companies would be helpful in creating this multidimensional approach because they might be more focused on keeping the business afloat than understanding the benefits of paid leave for their employees.

Lastly, Pittman asked Rae whether employer survey data has shown if the use of high-deductible health plans has increased or decreased and whether people who are insured by these plans have incurred a large amount of medical debt. Rae said that from 2010 to 2020, there was a general decrease in premiums and an increase in deductibles. However, during the past few years, the increase in deductibles has slowed down because employers are focusing more on affordability. Regarding medical debt, Rae said, it is difficult to measure because the prevalence depends on how medical debt is defined in the surveys (i.e. whether it includes dental debt or credit card debt). However, he noted that no matter how it is defined, most people with medical debt are those with insurance, caused by factors such as out-of-network billing. Richman added that employers can help by providing basic legal services for their employees and assistance with navigating the complexity of medical bills.

TOTAL WORKER HEALTH: A POLICY UMBRELLA FOR THE WORKFORCE

John Howard, director of NIOSH at the Centers for Disease Control and Prevention, provided remarks about Total Worker Health (TWH) during the final session of the workshop. NIOSH, established in 1970 through the Occupational Safety and Health Act, is primarily a research organization and the only federal agency that conducts occupational safety and health research, Howard said. He shared that NIOSH does work and shares research with the Occupational Safety and Health Administration, Department of Labor (Mine Safety and Health Administration, Office of Workers’ Compensation Programs), and worker and employer organizations. Showing the TWH diagram that Wagner spoke about earlier in the day, Howard said it is the foundational approach to addressing workplace issues resulting from exposure to physical, chemical, and biological agents. He shared an extensive list of TWH issues that relate to workers,

the workplace, and all the policies and procedures that impact an individual performing work. Howard said one issue that is important to him is how a worker relates to “non-human identities” in the workplace (i.e. algorithmic managing systems, AI, etc.) and what type of policies could be created to support that relationship.

He explained how, over the years, there has been increased attention focused on work-related psychosocial hazards and highlighted some notable ones that pose a risk to health, such as job stress, work schedules, long work hours, and precarious work conditions. Howard said research has shown that anxiety and depression are significant workplace issues, and solutions can come from organizational and management policies rather than relying on individual resilience. He also spoke about the NIOSH Worker Well-Being Questionnaire, a tool used to measure individual worker well-being.

CLOSING DIALOGUE

Pittman invited participants to reflect on themes raised throughout the day and identify opportunities for further inquiry, policy development, and cross-sector collaboration. Simon suggested that legal action could help remove red tape in accessing public benefits. Darling noted that while this approach has been considered before, it is hard to prove intent behind complicated systems. He added that many issues stem from neglect, not malice, and highlighted the difficulty of keeping public materials and websites up to date. Another attendee asked about the public’s general awareness of the Employee Retirement Income Security Act (ERISA), which sets minimum standards for most employee benefit plans, particularly its application to health benefits. In response, Simon and Richman observed that most employees are unaware of their rights under ERISA, often viewing health benefits as discretionary perks rather than earned income. Richman added that this perception gap limits the degree to which workers view legal protections as tools.

Roundtable member Hilary Heishman, Robert Wood Johnson Foundation asked panelists to name specific policy gaps where meaningful protections or infrastructure are lacking. Simon pointed to ongoing implementation challenges, noting that even when good policies exist, they are often not applied consistently or effectively. Richman emphasized the lack of coordination between sectors, particularly in how labor and health policies interact. Leathers noted that current frameworks may overlook the needs of low-wage and non-traditional workers, creating gaps in support. Schnake-Mahl highlighted data limitations, including the absence of disaggregated, local-level information used to evaluate and improve labor-related health outcomes.

In her closing reflections, Pittman acknowledged the range of perspectives shared throughout the workshop and highlighted several recurring themes. These included the uneven distribution of labor market benefits, the growing need for policies that reflect changing work structures, and the importance of designing systems that promote inclusion, flexibility, and worker well-being. She emphasized that implementation matters as much as policy design.

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Darling, M., and W. Raderman. 2023. An unemployment insurance system that works. Niskanen Center. https://www.niskanencenter.org/wp-content/uploads/2023/09/A-UI-System-That-Works-Final.pdf (accessed July 28, 2025).

Dettling, L. J., and M. S. Kearney. 2023. The cyclicality of births and babies’ health, revisited: Evidence from unemployment insurance. NBER Working Paper No. 30937. National Bureau of Economic Research.

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Schinasi, L. H., A. Williams, and A. Schnake-Mahl. 2024. Mandated rest breaks and occupational injuries and illnesses in Dallas County, Texas construction workers: A quasi-experimental, comparative interrupted time series study. Journal of Occupational and Environmental Medicine 66(9):731-736. https://doi.org/10.1097/JOM.0000000000003144.

Schnake-Mahl, A. S., G. O’Leary, P. H. Mullachery, A. Skinner, A. V. Diez Roux, J. R. Raifman, and U. Bilal. 2022. Higher COVID-19 vaccination and narrower disparities in US cities with paid sick leave compared to those without. Health Affairs 41(11):1565–1574. https://doi.org/10.1377/hlthaff.2022.00779.

Schnake-Mahl, A., A. V. Diez Roux, U. Bilal, G. Schwartz, and S. Burris. 2025. Rigorous policy measurement: Causal inference challenges and opportunities. American Journal of Epidemiology kwae468. https://doi.org/10.1093/aje/kwae468.

DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Alexandra Andrada Silver and Stephanie Puwalski as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE Mary Pittman (Chair), Public Health Institute; Carla Alvarado, Association of American Medical Colleges Center for Health Justice; John August, Scheinman Institute at Cornell University; Chia-Chia Chang; Sanne Magnan, HealthPartners Institute; Aparna Mathur, Harvard Kennedy School’s Mossavar-Rahmani Center; Julie Vogtman, National Women’s Law Center. The National Academies’ planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Amy B. Monahan, University of Minnesota. Leslie Sim, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS This workshop was partially supported by Association of American Medical Colleges, Blue Shield of California Foundation, Fannie E. Rippel Foundation, Nemours, NYU Langone Health, Robert Wood Johnson Foundation, The Kresge Foundation, and Thomas Jefferson University. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

STAFF Maggie Anderson, Research Assistant; Alexandra Andrada Silver, Program Officer; Alina Baciu, Roundtable Director, and Stephanie Puwalski, Research Associate.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2025. Exploring Relevant Policy Domains: Labor and Employment Policy and Population Health: Proceedings of a Workshop—in Brief. Washington, DC: National Academies Press. https://doi.org/10.17226/29281.

For additional information regarding the workshop, visit https://www.nationalacademies.org/event/45002_06-2025_structural-drivers-of-population-health-exploring-relevant-policy-domains-exploring-labor-policy-and-population-health-a-workshop.

Health and Medicine Division Copyright 2025 by the National Academy of Sciences. All rights reserved.