The Role of Work in Health Disparities in the U.S. (R01 Clinical Trials Optional)

The purpose of this Funding Opportunity Announcement (FOA) is to support innovative population-based research that can contribute to identifying and characterizing pathways and mechanisms through which work or occupation influences health outcomes and health status among populations with health and/or health care disparities, and how work functions as a social determinant of health.The main objective of this initiative is to determine the extent and mechanisms by which work as a SDOH both contributes to, and helps ameliorate, health and health care disparities. A recent workshop on September 28-29, 2020 organized by NIMHD (https://www.nimhd.nih.gov/news-events/conferences-events/hd-workshop.html) highlighted key ideas for furthering research on work as a SDOH that include conceptualizing work as a social class marker, as a source of exposures and risk factors, and as a source of beneficial social and economic resources such as income and wealth, neighborhood conditions, health care access, education, and social networks. Some key questions include: What are the specific and modifiable mechanisms by which work explains health disparities? To what extent does work as a social class marker, source of exposures and risk factors and/or source of beneficial social and economic resources explain health disparities? Which health disparities does work as a SDOH explain? Of particular interest are projects designed to examine pathways and mechanisms using conceptual model(s) grounded in minority health and health disparities theories that recognize that health disparities arise by multiple and overlapping contributing factors acting at multiple levels of influence (See the NIMHD Research Framework, https://www.nimhd.nih.gov/about/overview/research-framework.html). Studies must examine NIH-designated U.S. health disparity populations, e.g. racial and ethnic minority populations, sexual and gender minority groups, underserved rural populations, and socioeconomically disadvantaged populations of any race or ethnicity (https://www.nimhd.nih.gov/about/overview/). Studies involving primary data collection with human participants are strongly encouraged to incorporate SDOH measures from the Core and Specialty collections that are available in the Social Determinants of Health Collection of the PhenX Toolkit (www.phenxtoolkit.org). Of interest are intersectional approaches that consider different social identities and the embeddedness of individuals within families, households, and communities. Life course approaches that consider the role of work in shaping cumulative processes and critical transitions including periods of unemployment, under-employment, and unpaid and informal work arrangements, are also encouraged. Also, of interest is considering the role of work at the household level with influences on the health of partners and extended families, and the intergenerational transmission to children and their health. In addition, exploring the role of inequity-generating mechanisms that constrain choices around work and health such as racism and discrimination by sex, age, marital status, immigration status, social class, and other power structures is also encouraged. Additionally, of interest are projects that explore whether work can explain the health or health care disparities seen within diseases or conditions (e.g., COVID-19, opioid use disorder, mental/behavioral health, diabetes, cancer, heart disease, asthma, and maternal and infant health ) as well as disparities in co-morbidities and general indicators of health such as greater global burden of disease, quality of life, and daily functioning. Projects that utilize a syndemics lens (i.e., multiple disease states that are interlinked because of social, environmental, and structural conditions), to examine the role of work in disparities in co-occurring health conditions, are encouraged. Also, of interest are projects that explore how work contributes to health care disparities including but not limited to disparities in access to preventive, specialty, and emergency care, in health insurance coverage, and in quality of health care. Moreover, given the reciprocal relationship between work and health, of interest are projects that examine how health impacts access to different work opportunities, working conditions, and work benefits, and how that varies by different social identities. Projects may involve primary data collection and/or secondary analysis of existing datasets. Projects may utilize observational studies, natural experiments, quasi-experiments, simulation modeling, as well as use of large-scale longitudinal data sets, data mining techniques, registries, surveillance data, and linking to administrative data sets such as the Occupational Information Network (O*NET). Quantitative and mixed methods approaches are encouraged. Investigators are encouraged as appropriate for the research questions posed, to forge research collaborations with community partners and stakeholders in the conceptualization, planning and implementation of the research to generate better-informed hypotheses and enhance the translation of the research results into practice.