Magazine article Policy & Practice

Tapping into the Potential of Public Health and Social Services Partnerships: A Framework to Improve Outcomes for Disadvantaged Workers

Magazine article Policy & Practice

Tapping into the Potential of Public Health and Social Services Partnerships: A Framework to Improve Outcomes for Disadvantaged Workers

Article excerpt

Millions of Americans suffer from one or more chronic diseases. Individuals with lower income, lower levels of education, or who are racial or ethnic minorities bear the brunt of chronic disease, posing a great challenge to their workforce engagement and economic well-being. Despite being a very common and difficult barrier to sustainable employment and self-sufficiency, the human services system generally does not sufficiently address clients' chronic health conditions. But evidence shows that partnerships between public health programs and human services programs can lead to better health and employment outcomes.

Chronic Disease in the United States

Annually, $1.3 trillion is spent on chronic disease treatment in the United States. (1) Much of this cost relates to insufficient management of chronic disease conditions and the onset or exacerbation of symptoms that inevitably follow. (2,3,4) Over time, poor disease management and symptom control impairs functioning in key life domains--such as employment. (5) These health-related limitations manifest as employee presenteeism (the practice of coming to work despite illness or injury, often resulting in reduced productivity) and absenteeism--where reduced productivity in the workplace costs U.S. employers $1,685 per employee per year, or $225.8 billion annually. (6) Nearly 48 million Americans report some degree of chronic disease-related functional limitation or disability. (7,8) However, socioeconomically disadvantaged populations account for the greatest productivity and health care system costs, given they have a higher disease prevalence, worse symptom control, and more significant health-related work limitations. (9,10,11,12)

There is a tendency to think of a select few conditions when we hear the term chronic disease. Most often, these are the conditions that are the major causes of U.S. deaths (e.g., heart disease and diabetes), and thus are widely believed to account for most of the individual and societal burdens outlined here. In reality, however, a wide range of health problems meets the criteria of being "chronic health conditions," which are defined as "conditions that are generally not cured, once acquired." (13)

These statistics, and the ways in which chronic health conditions impede securing or maintaining employment, are familiar to this audience and others working in the social services sector. For example, in the Temporary Assistance for Needy Families (TANF) program, health problems have long been recognized as significant barriers to employment. Incentives for screening for mental health, substance abuse, and domestic violence as health-related barriers to employment, for example, were written into the legislation that established TANF in 1996. (14) However, this set of health problems is narrowly defined relative to the wide array of chronic health conditions that can act as barriers to employment.

Health and Employment Outcomes for TANF Clients

A focus on screening for mental health and substance abuse among TANF clients may have encouraged some degree of coordination or integration across the social and health services sectors. What we have learned since 1996 from one of our studies, however, and what is being echoed in the broader health literature, is that a 20-year, policy-driven history of focusing on these chronic health conditions in isolation has blunted the progress that could be made in achieving better outcomes for TANF clients. In a randomized controlled trial sponsored by the National Institute of Nursing Research* that used a community-based approach, (15) the first author (Kneipp) tested the efficacy of a public health nursing screening, referral, and case-management program on improving health and employment outcomes with 432 women receiving TANF. (See details of the intervention at …

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