Covid-19 & The Full Workforce
Contributors
Araceli Camargo, MSc Neuroscience (Kings College London)
Elahi Hossain, PhD Candidate in Neuroscience at University College London
Sarah Aliko, PhD Candidate in Neuroscience at University College London
Daniel Akinola-Odusola, MSc Neuroimaging (Kings College London)
INTRODUCTION
Covid-19 has produced a widespread and communally traumatic event that will have trans generational consequences. One of the key consequences will be its toll on long term health, both mental and physical. For more information on the different pathways, please see our work on the Secondary Effects of Covid-19.
Global society was already facing a health emergency with spikes in the rates of non communicable diseases (NCD). For example, in Sub Saharan Africa 22.9 million people experience cardiovascular diseases and 13.6 million experience a mental health disorder and a further 10.4 million experience diabetes (source). Adding Covid-19 to this health emergency, makes our society even more vulnerable to future poor health outcomes. Specifically amongst those who have gone on to experience long-haul Covid-19 and the pandemic’s secondary effects.
The lesson here is that the returning workforce will need full support to re-integrate into a work-life. There will be a need for cross industry collaboration from HR departments, to councils, to health practitioners. It is imperative that we learn the lessons from Covid-19, which are that without health we have nothing; no economy, no society, no culture, and no sense of being.
The Biological Mechanisms Between Work & Health
All roads lead to health and the type of work a person conducts and their entire work environment will not be an exception. To understand the relationship between work and health, first we must understand the overarching biological mechanisms. Firstly, as we now understand the HPA-Axis plays a key role in our adaptation to every environment we encounter, including its experiences. In the case of work, we have to understand how the work environment and the events which happen in said environment burden our stress response. Contextualising worker health within the functionality of the HPA-Axis allows us to understand the relationship between work and non-communicable diseases; diabetes, obesity, depression, anxiety, and cardio-vascular disorders.
It can be said that HPA-Axis activation is agnostic to cause, a stressor is a stressor. For example, in the context of the office worker, their body is continually at odds with a range of physical stressors such as cramped offices with poor ventilation, low access to natural light, low access to green spaces and psychosocial stressors such as wages that may not support a livelihood, corrosive/discriminatory work culture etc that are relatively common in the work environment. This causes chronic activation of their stress-response systems; nervous, endocrine, metabolic and immune, which attempt to adapt and deal with the stressors to no avail. As the body becomes chronically activated through repeated week-day exposure, stress-response systems become dysregulated. Abnormal levels of adaptive meditators e.g. cortisol, adrenaline, cytokines, then create ‘wear and tear’ of physiological systems, increasing the risk of autoimmune, inflammatory, cardiovascular, and mental diseases through a process called allostatic load (source). Similarly, for street hygiene workers, their constant exposure to air pollution (physical stressor) and low wages (psychosocial stressor) will too put a burden on the regulation of their stress response.
As a side note, we are not covering the direct health hazards, such as working with complex machinery or being exposed to toxic chemicals. Whilst direct exposure to hazards does affect health, we are interested in uncovering the more hidden hazards that are often ignored.
Risks to Poor Worker Health
In this section, we will be exploring the key factors that create a systemic burden on our bodies through various stressors. We have divided this section into the different risks, the mechanisms by which each risk pose a systemic dysregulation, and the risk to health they potential pose. It is important to note that health is a multi-factorial and a set of complex systems of processes working together. Therefore, we are highlighting how systemic stressors have a potential impact on non-communicable diseases, rather than contributing to the current oversimplified view of health. If we are to create better health for workers, we have to look at it with a systemic lens.
The Commute
The mode of transport and quality used by a person to access work.
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Systemic and HPA-Axis Dysregulation
An impact on the physiology of our breathing, which then impacts digestion, vagus nerve x HPA-axis function, and cardiovascular function. (1-3)
Risk to Health
Obesity Anxiety Cardio-vascular disorders Digestion disorders
(Sources 1-5)
Workers at most risk
All.
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Systemic and HPA-Axis Dysregulation
Taking away from family and community, which can affect their social infrastructure. This can lead to feelings of loneliness.
It also contributes to time poverty, which in turn can affect their ability to exercise, partake in active transport or other wellbeing activities. In turn this could contribute to more inactivity, which is a complex pathway to immune, endocrine, and inflammatory dysregulation. (Sources 6-8)
Risk to Health
Anxiety Depression Cardio-vascular disorders Digestion disorders (Sources 6-9)
Workers at most risk
Low wage workers living outside city centres and those commuting from out of the city.
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Systemic and HPA-Axis Dysregulation
Being exposed to illegal levels of air pollution on a daily and sustained basis will have an effect on a person’s health. The effects of AP on every system in the body are now well documented and understood. (Sources 10-11)
Risk to Health
Depression Anxiety Metabolic syndrome Cardiovascular diseases Cancer Dementia Parkinson’s (Sources 10-14)
Workers at most risk
Low wage workers living outside city centres. Especially those relying on various transport modes.
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Sources -
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1843-x?optIn=true
https://core.ac.uk/download/pdf/287763619.pdf#page=61
https://dm5migu4zj3pb.cloudfront.net/manuscripts/103000/103344/cache/103344.1-20201218131355-covered-e0fd13ba177f913fd3156f593ead4cfd.pdf
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.572.6792&rep=rep1&type=pdf
https://academic.oup.com/ije/article/46/6/1797/4093959?login=true
https://www.elsevier.com/about/press-releases/research-and-journals/long-commutes-may-be-hazardous-to-health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318302/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322549/
https://www.sciencedirect.com/science/article/abs/pii/S0966692313000628
https://airqualitynews.com/2019/11/29/air-pollution-on-london-underground-four-times-worse-than-above-ground/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598002/#:~:text=Dysregulation%20of%20the%20HPA%20axis,%2C%20and%20depression%20%5B8%5D
https://pubmed.ncbi.nlm.nih.gov/30775976/
https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1409313?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21632
Low Pay
The salary is the payment a person receives when completing work. However, we are currently living in a system where many jobs do not afford the ability to pay for utilities that contribute to a life with dignity.
This can be through a non living wage salary or the new capitalist trend of zero hour contracts.
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Systemic and HPA-Axis Dysregulation
Poverty can lead to various systemic deprivations; unable to access health, unable to afford an adequate home that insulates from noise, AP, or is overcrowded, unable to access nourishing food, living in areas of high levels of noise, light, and air pollution. The experience of poverty. In turn all of these stressors can dysregulate the HPA-axis alongside other systems such as the immune, endocrine, and metabolic systems. (Sources 1-3)
Risk to Health
Depression, Anxiety, Metabolic syndrome, Cardiovascular diseases, PTSD, Dementia, Parkinson's, (Sources 1-3)
Workers at most risk
Low wage workers and zero hour workers. This includes office workers, essential workers, service industry, and creatives.
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Sources
https://www.thecentriclab.com/using-an-ecological-and-biological-framing-for-an-anti-racist-covid-19-approach
https://www.thecentriclab.com/neuroscience-urban-regeneration-and-urban-health
https://www.thecentriclab.com/ptsd-cities
Urban Footprint
The exposure to urban environmental pollutants a worker has due to working in a city. This is regulated by the nature of their work combined with the culture provided by their employer.
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Excess levels of ambient sounds that are from artificial sources. Cars/construction/machinery/etc
Systemic and HPA-Axis Dysregulation
High decibels of sound can elicit the stress response and contribute to its dysregulation. It can also through different pathways contribute to poor cardiovascular health. (Sources 1-3)
Risk to Health
High Blood Pressure Anxiety Depression (Sources 1-3)
Workers most at risk
Low wage workers with long commutes on congested roads or transport modes.
Neurodiverse workers.
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This is contributed via the urban heat island effect, which is that cities are hotter than rural areas. However, even within cities, there are microclimates. Areas with low green spaces have higher temperatures.
Systemic and HPA-Axis Dysregulation
The main biological pathway for heat is the inability to regulate body temperature after the outdoor temperature reaches a certain point. This can lead to various short and long term problems. It also activates the stress response to help the body adapt to the temperature change - which with long term exposure can contribute to dysregulation. (Sources 4-6)
Risk to Health
Heatstroke, HyperTension (Sources 4-6)
Workers most at risk
Workers who are exposed to long commutes in the summer without proper cooling infrastructure. Or those who cannot access shade during their commute.
Neurodiverse workers
-
Air pollution from traffic, construction, aviation, and industrial plants.
Systemic and HPA-Axis Dysregulation
Being exposed to illegal levels of air pollution on a daily and sustained basis will have an effect on a person’s health. The effects of AP on every system in the body are now well documented and understood. (Sources 7-11)
Risk to Health
Depression, Anxiety, Metabolic syndrome, Cardiovascular diseases, Cancer, Dementia, Parkinson's (Sources 7-11)
Workers most at risk
Low wage workers with long commutes on congested roads or transport modes.
Neurodiverse workers
-
This comes from night glow, which is from artificial sources such as buildings, street lights, aviation, computers.
Systemic and HPA-Axis Dysregulation
Any light at night plays a role in the dysregulation of the sleep/wake cycle which in turn plays in the dysregulations of the body’s metabolic functions. (Sources 12-14)
Risk to Health
Obesity, Diabetes (Sources 12-14)
Workers most at risk
Those working night shifts or office workers working long hours.
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This is both in terms of parks but also dotted tree canopy.
Systemic and HPA-Axis Dysregulation
Whilst it is widely known that green spaces are great for exercise and lowering air pollution. It also provides a source of nourishment through the microbiome. Green spaces help regulate the function of gut health. Conversely our lack of exposure can deprive us from that essential nourishment - to various consequences. (Sources 15-17)
Risk to Health
Obesity, Diabetes, Anxiety, Depression (Sources 15-17)
Workers most at risk
Low wage workers that are commuting through highly urbanised areas.
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Needing to do more than two commutes per day via one mode of transport.
Systemic and HPA-Axis Dysregulation
The more commutes we are exposed to the more we are exposed to noise, overcrowding, and air pollution. Through this workers can experience a burden on their biological systems, including the stress response. (Sources 1-17)
Risk to Health
Obesity, Diabetes, Depression, Anxiety. (Sources 1-17)
Workers most at risk
Office workers.
Low wage workers needed to use various modes of transport.
Workers that have various commitments such as child care or caregiving responsibilities.
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Sources
https://www.sciencedirect.com/science/article/abs/pii/S1750946716301027
https://www.sciencedirect.com/science/article/abs/pii/S014067361361613X
Thoreau, H.D., THE NEUROLOGIC EFFECTS OF NOISE POLLUTION ON HEALTH. CliniCians, p.55.
https://link.springer.com/article/10.1007/s00484-009-0256-x
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042428/
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413443
https://airqualitynews.com/2019/11/29/air-pollution-on-london-underground-four-times-worse-than-above-ground/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598002/
https://pubmed.ncbi.nlm.nih.gov/30775976/
https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1409313?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21632
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627884/
https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.118-a28
https://www.sciencedirect.com/science/article/abs/pii/S0306987711004762
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290017/
https://www.sciencedirect.com/science/article/pii/S0160412020318365
https://www.preprints.org/manuscript/202102.0088/v1
Work Environment
The work environment is in reference to the place and location people work in. This means the building itself as well as the local area.
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Excess levels of ambient sounds that are from artificial sources such as machinery, human activity, and traffic.
Systemic and HPA-Axis Dysregulation
High decibels of sound can elicit the stress response and contribute to its dysregulation. It can also through different pathways contribute to poor cardiovascular health. (Sources 1-3)
Risk to Health
High Blood Pressure, Anxiety, Depression. (Sources 1-3)
Workers most at risk
Construction, Hospitality, Teachers, Office workers.
Neurodiverse workers
-
This is contributed via the urban heat island effect, which is that cities are hotter than rural areas. However, even within cities, there are microclimates. Areas with low green spaces have higher temperatures. It can also be poorly cooled indoor environments, such as kitchens.
Systemic and HPA-Axis Dysregulation
The main biological pathway for heat is the inability to regulate body temperature after the outdoor temperature reaches a certain point. This can lead to various short and long term problems. It also activates the stress response to help the body adapt to the temperature change - which with long term exposure can contribute to dysregulation. (Sources 4-6)
Risk to Health
Heatstroke, Hyper-Tension. (Sources 4-6)
Workers most at risk
Kitchen staff, Drivers, Transport, Agricultural.
Neurodiverse workers
-
Air pollution from traffic, construction, aviation, and industrial plants. As well as indoor air pollution from carpets, cleaning equipment, printers, machinery, paint, industrial chemicals.
Systemic and HPA-Axis Dysregulation
Being exposed to illegal levels of air pollution on a daily and sustained basis will have an effect on a person’s health. The effects of AP on every system in the body are now well documented and understood. (Sources 7-11)
Risk to Health
Depression, Anxiety, Metabolic syndrome, Cardiovascular diseases, Cancer, Dementia, Parkinson's (Sources 7-11)
Workers most at risk
Office, Factory, Agricultural, Hygiene workers, Drivers, Construction.
-
This comes from night glow, which is from artificial sources such as buildings, street lights, aviation, computer screens, indoor lighting.
Systemic and HPA-Axis Dysregulation
Any light at night plays a role in the dysregulation of the sleep/wake cycle which in turn plays in the dysregulations of the body’s metabolic functions. (Sources 12-14)
Risk to Health
Obesity, Diabetes. (Sources 12-14)
Workers most at risk
Those working night shifts or office workers working long hours.
-
Nature provides us with various health affordances, including microbes that are essential to gut health. We are meant to be exposed to nature for 4-8hrs per day.
Systemic and HPA-Axis Dysregulation
Whilst it is widely known that green spaces are great for exercise and lowering air pollution. It also provides a source of nourishment through the microbiome. Green spaces help regulate the function of gut health. Conversely our lack of exposure can deprive us from that essential nourishment - to various consequences. (Sources 15-17)
Risk to Health
Obesity, Diabetes, Anxiety, Depression. (Sources 15-17)
Workers most at risk
Low wage workers that are commuting through highly urbanised areas.
-
https://www.sciencedirect.com/science/article/abs/pii/S1750946716301027
https://www.sciencedirect.com/science/article/abs/pii/S014067361361613X
Thoreau, H.D., THE NEUROLOGIC EFFECTS OF NOISE POLLUTION ON HEALTH. CliniCians, p.55.
https://link.springer.com/article/10.1007/s00484-009-0256-x
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042428/
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413443
https://airqualitynews.com/2019/11/29/air-pollution-on-london-underground-four-times-worse-than-above-ground/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598002/
https://pubmed.ncbi.nlm.nih.gov/30775976/
https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1409313?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21632
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627884/
https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.118-a28
https://www.sciencedirect.com/science/article/abs/pii/S0306987711004762
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290017/
https://www.sciencedirect.com/science/article/pii/S0160412020318365
https://www.preprints.org/manuscript/202102.0088/v1
WORKER HEALTH AND COVID-19
This section will cover how worker health has been affected by the pandemic, this is an additional layer to consider when looking at the systemic aspects of worker health.
The pandemic has added another set of stressors that will affect their health for decades to come. It is also important to acknowledge that the debate of bringing back the workforce has to go beyond the current binary argument of “working from home” or not.
The transition back has to consider past (those above) and current health risks to ensure there is an equitable and safe transition to normative work patterns.
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A person who works within transport this includes attendants or ticketing. Drivers are in the above category.
COVID Risk Factors
Over-exposure to the virus.
Sedentary activity.
Exposure to illegal air pollution.
Disrupted sleep due to shift work.
Exposure to acute heat exposure during heatwaves.
Noise pollution.
Psychological stress of working during a pandemic & contaminating a loved one.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
Asthma.
Fatigue.
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A person that spends their work life driving this includes delivery, bus drivers, taxi, or lorry drivers.
COVID Risk Factors
Reduced pay/financial worry.
Exposure to illegal air pollution.
Disrupted sleep due to shift work.
Complex family dynamics due to pandemic.
Psychological stress of working during a pandemic.
Contaminating a loved one.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
Asthma.
Fatigue.
Diabetes.
Obesity.
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These are workers that spend the majority of their time working outdoors; construction, gardeners, street hygiene workers, bike messengers/deliveries or farmers.
COVID Risk Factors
Over-exposure to the virus.
Disrupted sleep due to shift work.
Exposure to toxic chemicals.
Air pollution.
Reduced pay/financial worry.
Heat exposure during heatwaves.
Noise Pollution.
Complex family dynamics due to pandemic.
Psychological stress of working during a pandemic.
Contaminating a loved one.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
Asthma.
Skin conditions.
Fatigue.
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A person working on the hygiene and maintenance of a building across all industries.
COVID Risk Factors
Over-exposure to the virus.
Disrupted sleep due to shift work.
Exposure to toxic chemicals.
Indoor Air pollution.
Complex family dynamics due to pandemic.
Psychological stress of working during a pandemic.
Contaminating a loved one.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
Asthma.
Fatigue.
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A person working within care homes, including administration, doctors, care-givers, nurses.
COVID Risk Factors
Over-exposure to the virus.
Disrupted sleep due to shift work.
Over-exposure to acute stress due to pandemic.
Complex family dynamics due to pandemic.
Psychological stress of working during a pandemic.
Contaminating a loved one.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
PTSD.
Fatigue.
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A person working in factories across various industries.
COVID Risk Factors
Over-exposure to the virus.
Disrupted sleep due to shift work.
Reduced pay/financial worry.
Indoor Air pollution.
Complex family dynamics due to pandemic.
Psychological stress of working during a pandemic.
Contaminating a loved one.
Noise Pollution.
Health Risks
Risk of long-haul Covid.
Depression.
Anxiety.
Cardiovascular diseases.
Asthma.
Fatigue.
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A person that works in an office setting. This is across C-suite and office managers
COVID Risk Factors
Poor at home working conditions.
Poor socialisation.
Unable to switch off, which has increased work hours.
Sleep disruption.
Sedentary behaviour.
Noise pollution.
Health Risks
Feelings of loneliness.
Depression.
Anxiety.
Digestion.
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A person working within hospitality from front of house to managers.
COVID Risk Factors
Over-exposure to the virus.
Financial stress due to job loss.
Acute Poverty, including homelessness.
Noise pollution.
Complex family dynamics due to schedule/job loss.
Health Risks
Risk of long-haul Covid.
PTSD.
Anxiety.
Depression.
Fatigue.
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A person working at a hospital; nurses, doctors, administration staff.
COVID Risk Factors
Over-exposure to the virus.
Over-exposure to acute stress due to pandemic.
Disrupted sleep shiftwork and stress.
Disrupted meal schedule.
Noise pollution.
Complex family dynamics due to schedule.
Health Risks
PTSD.
Depression.
Anxiety.
Risk of long-haul Covid.
Cardiovascular diseases.
Fatigue.
SUPPORTING WORKER HEALTH
There are three main learnings from the past sections. The first is worker health has to be contextualised beyond the confines of the workspace. Second, the long term health effects of this pandemic will go way beyond the virus itself. Third, it is clear that worker health was already in a crisis and Covid-19, if not addressed will only make things worse. Centric has deliberately omitted speaking about the economics of worker health, because it diminishes the crisis. We actually have no way of accounting how much it will cost in terms of human potential, societal evolution, innovation, or the ability to ideate. We are all under incredible stress and structural changes are needed.
Support Worker Rights
Covid-19 made it very clear that workers need strong protection offering ethical wages and working conditions. This is across every industry, from a farmer asking for better PPE to protect them against pesticides or a doctor asking for more infrastructure to ease their workload. There also needs to be a consideration for new working from home practices. There are currently no protective laws to regulate how much work life encourages on personal time while working from home or regulations about working conditions while WFH (ergonomics, natural light, noise pollution etc).
An ethical living wage
This pandemic has brought to light how many people live without a proper and ethical living wage; influencing the ability to save, ability to access healthcare, afford wellbeing activities, free time to access self-care, afford a safe and adequate home, afford nourishing food, and the ability to feel financially secure. Providing people with ethical wages can go a very long way in terms of health, reducing the risk of many diseases related to poverty, poor living conditions, and psychological stress of financial insecurity.
Healthcare specialist team
There should be dedicated mental health practitioners with clinical experience working inside each organisation to ensure people transition from this crisis in an equitable and healthy manner.
People will need help adjusting back to old work routines, they will need help integrating into work if they lost their jobs, faced financial hardships, and they will need to heal - this is especially important for those who will be experiencing PTSD, anxiety or depression due to various experiences during the pandemic.
Ideally this would be a government supported initiative rather than a reliance on NHS aftercare and local authority care services which are already at full stretch.
Advocating for better Urban Living
Traditionally, HR departments, CEO’s and those who manage worker wellbeing would not see the use of being involved in planning.
However, the health of an employee is directly related to the health the city. Therefore, advocating for healthy cities should be centred within the worker health conversations and initiatives.
This could come in the form of a new entity akin to the Business Improvement District model that focused on engaging a city’s employers with areas beyond its local postcode.
Out of Work Support
Even when things fully open up, it will still take time to bring everyone who has been furloughed or unemployed to full time employment.
Therefore, there should be government schemes run by public health organisations which focus solely on the mental and physical recovery of COVID-19.
Quiz Exercises
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