Healthy Work Strategies For A “Coronanormal” Society
Addressing Economic Insecurity, Stress, Sleep Deprivation, and Fatigue
Working from Home but Missing Your Synergist? Update Your Address
If you’ve been working from home during the pandemic, please consider updating your address with AIHA. You can change your address by editing your profile through AIHA.org. To ensure uninterrupted delivery of The Synergist, designate your home address as “preferred” on your profile. Update your address now.
The COVID-19 pandemic has led to major alterations in the workplace and work, with notable implications for the well-being of the U.S. workforce. Its effects underscore what NIOSH has recognized for a long time: holistic workplace and work policies, programs, and practices are vital to ensuring the overall welfare of the workforce, as well as the long-term health and continuity of organizations and businesses. Yet even with this knowledge, strategies supported by decades of evidence-based research and advocated for by NIOSH programs, such as Healthy Work Design and Well-Being and Total Worker Health, have not been widely instituted. Implementation of these strategies will help employers prepare their workplaces for a future that will not only include emergency and disaster preparedness and response but also critical and interwoven foci such as changes in workforce demographics, expansion of nonstandard work arrangements, blurring of the work and nonwork interface, and complex human-technology interactions. Over the last several years, the hardships brought on by the COVID-19 pandemic have awakened many people outside the occupational and environmental health and safety profession to the fact that work and the workplace profoundly impact the workforce and have ramifications for the general population. It is vital for the OEHS profession to leverage this momentum with calls to action and contributions from experts and leaders in the field, especially at a time when return-to-office implementation has been underway in the U.S., to finally apply the tangible and widespread changes needed to address age-old but largely preventable issues that present risks to workers. This commentary highlights four long-standing, overlapping, and consequential workforce safety, health, and well-being risk factors: economic insecurity, stress, sleep deprivation, and fatigue. These risks were pervasive before the COVID-19 pandemic, became especially pronounced during the worldwide public health emergency, and are predicted to persist. Evidence-based healthy work design suggestions drawn from NIOSH can help employers better safeguard members of their workforces as they work and live in the new “coronanormal” present. Applying the practices suggested here may alleviate the issues associated with these four risk factors by providing employers with policies, programs, and practices necessary to address and raise awareness of what are often considered to be individual-level factors or responsibilities but which are, in reality, predominantly employer- or organizational-level concerns. ECONOMIC INSECURITY Economic security is multifaceted. Among other elements, it consists of income security, referring to adequate income and benefits; labor market security, referring to opportunities for income-earning activities; employment security through protection of income-earning work; and job security, which allows workers some control over job content and opportunities to build their careers. Economic security also encompasses work security—work conditions that are safe and promote well-being. Unsurprisingly, for most workers and their families, economic security is predominantly, if not exclusively, achieved through maintaining stable work. Economic security drives workers’ emotional and physical health, work engagement, and productivity—all of which benefit workers’ families, employers, communities, and the U.S. economy. Conversely, unemployment, underemployment, and insecure employment lead to economic insecurity, which adversely affects well-being. Although the clinical health consequences brought on by the COVID-19 pandemic have been at the forefront of most individuals’ concerns and collective efforts, the economic repercussions have been almost as significant. Protective measures taken during the COVID-19 pandemic, such as physical or social distancing, stay-at-home orders, and temporary business closures, may have lessened rates of disease exposure and transmission, according to the World Health Organization. However, these same measures have also contributed to the COVID-19 pandemic’s devastating economic effects. The closing of businesses following the declaration of the worldwide public health emergency reduced the supply of goods and services, and the resulting job loss significantly affected employers, workers, and their families. The Bureau of Labor Statistics’ Current Population Survey found that the unemployment rate reached 13 percent in the second quarter of 2020, the highest quarterly average unemployment rate in the survey’s history. Despite government policies and programs implemented to alleviate economic instability and an unemployment rate far lower than its 2020 peak, job uncertainty, labor shortages, and economic insecurity due to the COVID-19 pandemic persist. Possible explanations include continuing SARS-CoV-2 transmission, the resignation of millions of workers, lack of available jobs in some sectors, outdated recruiting practices, childcare or other family needs, and COVID-19 vaccine employer mandates. In many ways, the COVID-19 pandemic not only created economic insecurity among U.S. workers but identified and exposed the precariousness that existed well before for many. Employers may consider fostering healthy supervisory practices to promote long-term economic security measures that support workers and managers at all times, especially during times of economic uncertainty. Employers can emphasize workers’ career growth and development and prioritize continual learning, (re)training, and reskilling opportunities that focus not only on workers’ economic security needs but employers’ needs as well, and they may recommend training, tools, and other resources at the levels of both the individual and the organization as a whole. Additional strategies for reducing workers’ economic insecurity include offering affordable, accessible, and comprehensive healthcare practices and extending financial or other assistance for health issues, including appropriate leave policies and substance use disorder programs. Employers can also arrange for time-saving transportation and commuting assistance, provide adequate wages and benefits, and prevent wage theft—that is, failure to pay wages, overtime, annual leave, or other entitlements. Organizations that do not already do so can pledge to provide their workers with job security and stability, reduce precariousness, establish minimum guaranteed hours, provide retirement planning and benefits, and ensure equitable pay, performance appraisals, and promotion potential. Finally, employers should guarantee equal and inclusive employment opportunities. In this changing world, where work is seen as a central construct of well-being, the strategies provided here directly and indirectly enable workers to perform effectively and efficiently. They not only ensure workers’ economic security and well-being but also that of employers and society at large. STRESS Stress is emotional or physical tension arising from an event or thought that can lead to emotional or mental disturbances and severe or long-term physical conditions, especially if left unmanaged. In 2019, the American Psychological Association (APA) Stress in America Survey found that six in 10 U.S. adults identified work and money as their most significant sources of stress. Changes resulting from the COVID-19 pandemic contributed even more to work stress. A survey discussed in CDC’s Morbidity and Mortality Weekly Report in August 2020 found that nearly 41 percent of respondents had experienced at least one adverse mental or behavioral health condition related to stress caused by the COVID-19 pandemic. For some, added work-related stress resulted from job loss, uncertainty, and economic insecurity. For others, such as those who continued reporting to their workplaces in person, work-related stress was often precipitated by anxiety over potential SARS-CoV-2 exposure, transmission, and effects. Those engaged in remote work may have experienced increased stress due to having to adapt to new technologies, juggle work and family commitments, and work longer hours, potentially coupled with an overuse of technology. Indeed, for many, the experience of working from home limited their ability to psychologically detach from work or mentally “switch off.” Even presently, APA’s 2023 Work in America Survey found that 77 percent of respondents had experienced work-related stress in the past month, suggesting that U.S. workers have not yet recovered from the COVID-19 pandemic and are still experiencing elevated levels of stress and symptoms of poor mental health. To limit work-related stress, employers may consider supervisory practices and training that support workers and managers during times of heightened stress. Employers may implement healthy work strategies such as prioritizing flexible options to meet workers’ needs, providing paid time off, and improving workers’ autonomy, independence, and control over how they do their jobs. Developing and promoting mechanisms to support meaningful, engaging, and satisfying work, providing adequate resources and staffing for job tasks, engaging in conflict reduction and resolution, and facilitating coworker and managerial social support are other strategies to reduce work stress. Employers should strive to eliminate bullying, harassment, coercion, threats, retaliation, discrimination, and violence and endeavor to instill organizational justice with fair and transparent practices. Organizations may offer on-site caregiving or off-site assistance to alleviate the stress of childcare. Finally, employers can recommend stress reduction training, tools, and other resources at the organizational and individual levels. Implementation of these suggestions could reduce worker stress and work-life imbalance; improve worker control, engagement, and turnover; and have a beneficial impact on the overall well-being of workers and their families.
The COVID-19 pandemic not only created economic insecurity among U.S. workers but identified and exposed the precariousness that existed well before for many.
SLEEP DEPRIVATION AND FATIGUE Sleep issues are extremely common, precipitated by many causes, and can lead to a number of additional health effects. Fatigue is defined by symptoms such as lack of sleep, sleep disorders, and other physical and mental health symptoms. While nonwork factors contribute to sleep problems and fatigue, a number of work-related factors play important roles in exacerbating these problems as well.
Individuals employed in varying work contexts may experience sleep disturbances, but work-related fatigue is often associated with nonstandard work schedules, such as shift work and long work hours, and with workers who drive for long periods of time. Poor sleep and fatigue can create safety challenges, omissions, errors, and accidents that lead to health outcomes, including acute and chronic illnesses, injuries, and fatalities, that occur at work or as a result of work design and practices. Since poor sleep and fatigue stem from both work- and nonwork-related factors, these issues are best managed jointly by workers and employers.
The COVID-19 pandemic has been characterized in part by longer work hours and added stressors and has worsened the problems of poor sleep and fatigue for millions of workers. This has been especially true for frontline occupations such as healthcare and emergency response, but workers in “essential” sectors, such as education, social services, and transportation, have also been seriously affected. Frontline and essential workers have reported generalized anxiety due to disease exposure risk, the need to manage work and family, longer work shifts, and economic uncertainty. In turn, these challenges have exacerbated new or existing stress, burnout, and mental health issues, which are linked to sleep disruption, poor sleep quality, and insomnia. Nonessential workers working from home during the COVID-19 pandemic have also reported similar sleep- and fatigue-related outcomes, reinforcing the conclusion that these are commonplace problems across sectors, no matter the circumstances and contexts in which work takes place.
Particularly at times when workers and managers are at heightened risk for sleep problems and fatigue, employers may consider implementing healthy work design and fostering supervisory practices and training that address these factors. These may include ensuring flexible work schedules that meet different sleep needs, as well as providing and normalizing adequate rest breaks. Employers can also restructure and redesign work tasks to reduce long work hours, improve workflows and workloads to prevent overloading, guarantee safe staffing that supports the organization’s workload, enforce limits for overtime and maximum allowable consecutive shifts, and provide paid time off. They may even consider implementing nap and rest areas for use during breaks and off-shift hours. Finally, employers can recommend sleep and fatigue information, training, and other resources for organizational and individual use.
THE “CORONANORMAL” WORKPLACE Debate persists on what precise long-term consequences the COVID-19 pandemic will have for the world of work and the population at large. Impacts will likely continue to manifest for some time in ways not yet fully understood, and there is a profound need to learn from the past to better prepare and equip the workplace, work, and the workforce for the future. This commentary highlights economic insecurity, stress, sleep deprivation, and fatigue not only because these four risk factors were aggravated across occupational sectors during the COVID-19 pandemic but also because they were prevalent prior to it, and especially because they are anticipated to remain so afterwards. Left unaddressed, these intertwined factors will lead to a number of adverse safety and health outcomes detrimental to employers, workers, their families, and society, such as a rise in chronic illnesses, diseases, deaths, and associated healthcare costs, as well as increased absenteeism and presenteeism and reduced retention and productivity. Although some employers have made substantial permanent or temporary efforts to address these risk factors, further mutually beneficial investments are needed. These solutions may require increased front-end costs, resources, and time expended, but employers can no longer afford not to invest in the well-being of their workforces in meaningful and sustained ways.
Fortunately, healthy work design strategies can help reduce the risks discussed in this article. Given the inextricable and cyclical relationships between economic insecurity, stress, sleep deprivation, and fatigue both on and off the job, and the overlap between these and other well-being issues, the success of healthy work design introductions or modifications will be heightened if applied comprehensively rather than in a siloed fashion. This aligns with increased calls for expanded and integrated OEHS approaches, frameworks, and solutions to address workplace and work issues. One such approach coordinated by NIOSH—Total Worker Health—considers work as a social determinant of health and offers evidence-based research, practices, policies, and capacity-building tools, training, and case studies that employers can heed to supplement the suggestions offered in this article.
These strategies focus on the organizational level, given the workplace and work context of economic insecurity, stress, sleep deprivation, and fatigue. Employers, including executives, upper and middle managers, and supervisors, are instrumental in the well-being of their workforces, especially during times of crisis. However, the active participation of other organizational representatives, such as human resources staff, employee assistance program personnel, designated OEHS or other safety and health champions, and especially workers themselves, is likewise key for employers to develop more tailored and flexible options to suit the diverse and fluctuating needs of all workers. Employers can offer well-being programs to buttress negative effects derived from social, technological, environmental, economic, and political forces that impact worker-level factors, but many have relatively little control and limited resources, making implementing certain proposed suggestions challenging. Because the risk factors and solutions listed previously have far-reaching implications and are impacted by external forces, the participation of other interested partners is fundamental. These include OEHS and allied professionals, practitioners, educators, research institutions, places of learning, professional and trade associations, labor unions, health departments, government, policymakers, and others across local, state, and national levels.
LOOKING FORWARD Since its inception, NIOSH’s mission has been to develop new OEHS knowledge based on the needs of the workplace, work, and the workforce and to transfer that knowledge into practices that support safer and healthier workers, with the assistance of a multitude of partners. Despite uncertainties surrounding the extent of COVID-19 pandemic outcomes, what is evident is the need for renewed focus on enduring workplace and work factors such as those highlighted here, as well as others crucial for worker well-being. Embracing the suggestions conveyed in this article and implementing them comprehensively on a collective scale will help establish sweeping and lasting changes. As the U.S. enters a new world of work and adapts to a “coronanormal” status, there is no better time to help create safer and healthier organizations prepared for whatever the future may hold.
Disclaimer: The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.
SARA L. TAMERS, PhD, MPH, was a health research scientist at NIOSH when contributing to this work. She served as coordinator of the Research Program Development and Collaboration of the Total Worker Health Program, assistant coordinator of the Healthy Work Design and Well-Being Program, and coordinator of the Future of Work Initiative.
TAPAS K. RAY, PhD, is a senior NIOSH economist and assistant coordinator for the NIOSH Healthy Work Design and Well-being program. Additionally, he teaches managerial and health economics at Miami University, Oxford, and is an outcome research consultant at the Cincinnati Children’s Hospital.
JEANNIE A.S. NIGAM, MS, is a research psychologist at NIOSH. She is the co-coordinator of the Healthy Work Design and Well-Being program, an advisor to the Total Worker Health Program, and co-editor of the book Total Worker Health.
Send feedback to The Synergist.
BrianAJackson/Getty Images
APA: “2023 Work in America Survey” (2023).
APA: “Stress in America 2020: Stress in the Time of COVID-19, Volume One” (May 2020).
ASSP: “Women and Safety in the Modern Workplace” (PDF, April 2019).
Bureau of Labor Statistics: “Unemployment Rises in 2020, As the Country Battles the COVID-19 Pandemic” (June 2021).
CDC: “Employees: How to Cope with Job Stress and Build Resilience During the COVID-19 Pandemic” (PDF, May 2020).
CDC: Morbidity and Mortality Weekly Report, “Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic—United States, June 24–30, 2020” (August 2020).
CDC: “Workplace Health Promotion: Workplace Health Resource Center” (February 2020).
Chamber of Commerce: “New – Updated Poll: The COVID-19 Unemployed” (November 2021).
Harvard Business School: “Hidden Workers: Untapped Talent” (October 2021).
McKinsey & Co.: “Women in the Workplace 2022” (October 2022).
MetLife: “Navigating Together: Supporting Employee Well-Being in Uncertain Times” (PDF, 2020).
NIOSH: “Healthy Work Design and Well-Being Program.”
NIOSH: “Reducing Risks Associated with Long Work Hours” (April 2020).
NIOSH: “Total Worker Health Program.”
NIOSH: Work and Fatigue.
NIOSH: Behind the Wheel at Work, “Driver Fatigue” (June 2019).
NIOSH: Science Blog, “COVID-19 Stress Among Your Workers? Healthy Work Design and Well-Being Solutions Are Critical” (June 2020).
NIOSH: Science Blog, “Economic Security During the COVID-19 Pandemic: A Healthy Work Design and Well-Being Perspective” (June 2020).
NSC: “NSC Fatigue Reports.”
World Health Organization: “Overview of Public Health and Social Measures in the Context of COVID-19: Interim Guidance” (PDF, May 2020).