This post was originally published on the Health Affairs Blog on October 28, 2020.

It is with good reason that there has been an outpouring of support for essential workers during the COVID-19 pandemic. Essential workers have tended to the sick, responded to emergencies, and kept the food supply intact, thus permitting the rest of society to have continued access to health care and basic necessities, and to remain safe and, for the most part, comfortable.

As has been reported, Black and Latino workers make up a large share of the essential workforce, and these demographic groups have experienced higher rates of COVID-19 infections and deaths. Discrimination, disparate access to health services, higher rates of chronic illness, lower incomes, and deficiencies in housing and other social determinants of health have all contributed to the higher risk of COVID-19–related illness and death among racial and ethnic minorities.

But there is another risk factor common among many essential workers—they are more likely to work shifts. Shift workers are those who regularly work outside of the traditional daytime work hours of 8 a.m. to 6 p.m. Shift work is common in the fields of health care, manufacturing, law enforcement and public safety, and public transportation, all deemed essential during the pandemic.

Health and Cost Impacts of Shift Work

Numerous studies have shown that shift work is associated with higher rates of many chronic illnesses, including diabetes, obesity, cancer, and cardiovascular disorders, and the World Health Organization has identified night shift work as a likely carcinogen, stemming from circadian disruption.  Our study, funded by the Robert Wood Johnson Foundation (RWJF), examined the impacts of shift work on employee health and estimated that, among 2,600 shift workers in a manufacturing company, there are approximately 78 excess cases of diabetes and 97 excess cases of obesity because of shift work. People with these underlying medical conditions are at increased risk of serious illness from COVID-19.

While worker well-being is significantly compromised by shift work, our research also shows that employers pay a high price. Many are large, self-insured organizations, and these firms bear the excess health care costs of chronic illness among their employee populations. Using data from those 2,600 workers at that manufacturing company, we estimated that the company incurs a minimum of $1.4 million in excess health care costs per year because of chronic illnesses engendered by the company’s shift-work policies.

Although $1.4 million in excess health care spending at one company is substantial, it may not be large enough for the manufacturer to consider eliminating shift work. Indeed, for a plant that operates 24/7, moving to daytime-only shifts could mean cutting plant revenues in half. We recognize that shift work is inevitable in manufacturing and many other industries.

What Can Employers Do?

Nevertheless, these results may serve as a “wake up call” to employers that rely on shift workers and may encourage them to invest in prevention and disease management. For example, companies could provide intensive behavioral counseling related to improved nutrition, healthy eating behaviors, and increased physical activity to offset the increased risk of cardiovascular disease in employees who need to work shifts. Additionally, larger employers could incentivize local primary care providers to ensure that patients receive recommended screenings—for example, depression screening and diagnosis, coupled with effective treatment, and appropriate follow-up. This would serve the dual purpose of potentially improving quality of life for employees while reducing health care costs for the company.

With the added stress and health risks of the pandemic affecting the lives of essential workers, timely prevention and disease management interventions may be needed to address a projected exacerbation in chronic illness, likely to manifest in the coming months and year. Also, many businesses continue to experience COVID-19–related disruptions to their operations. A survey of manufacturers, conducted by the National Association of Manufacturers, reported that 53 percent anticipate changes to their operations. Manufacturers are responding to abrupt changes in customer demand, supply chain interruptions, the need to improve workplace cleanliness and physical distancing, and/or unusually high worker absence.

This predicament affords a unique opportunity for companies to experiment with different work schedules that may be less harmful to worker well-being. In particular, permitting workers to move from rotating (day/night) shifts to steady daytime shifts will allow those workers to realign their physiological functions (sleep, metabolism) with the environment. Research will be needed to explore the impact of such shift-work experiments on employee health and associated health care costs.

It has been widely accepted that healthy workers are good for business, but hard evidence demonstrating this link has been elusive. The results of our study should be used by organizations representing workers and by public health leaders to more effectively advocate on behalf of shift workers for targeted health interventions. Furthermore, the results should motivate companies’ leadership to seriously consider the trade-offs of shift work scheduling and larger health care costs.

This study was part of the RWJF’s Policies for Action (P4A) program, the goal of which is to generate actionable evidence about how and how well, laws and policies work to promote population health, well-being, and equity, by providing data and information that can guide legislators and other policy makers.


Copyright © 2020 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

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