March 18, 2021

NIOSH Researchers Identify Essential Worker Categories Lacking Access to Healthcare Services

In a new study published March 9 in the online journal Public Health Reports, NIOSH researchers have identified several occupations considered “essential” during the COVID-19 pandemic that lacked regular access to healthcare services in the years 2017–2018. Using the most recently available data from the Behavioral Risk Factor Surveillance System, researchers analyzed workers aged 18–64 in 31 U.S. states according to four metrics: health insurance status, ability to afford to see a doctor when needed, access to a personal care provider, and having received a routine checkup within the previous year.

Of all occupations studied, workers in farming, fishing, and forestry were most likely to lack health insurance, personal care aides were least likely to be able to see a doctor when needed due to cost, and construction workers were least likely to have a personal healthcare provider or to have had a routine physical checkup within the past year. Workers in three broad occupational groups—food preparation and serving, building and grounds cleaning and maintenance, and construction trades—had significantly lower levels of healthcare access compared to the general working population, according to all four metrics.

The occupations discussed in the study were labeled “essential” when the pandemic reached the U.S. in early 2020 and were required to continue reporting to the workplace, rather than work remotely, and interact closely with patients, the public, or coworkers. However, the lack of health insurance and underinsurance common among these workers decreased their access to medical testing, necessary care, and treatment for underlying conditions—making them more vulnerable to COVID-19 but less able to protect themselves. Multiple reports in 2020 found large numbers of COVID-19 cases among essential workers, including some of the occupations in this study.

“This study used data from before the start of the COVID-19 pandemic, so it provides a baseline to understand what kind of healthcare access was in place for essential workers,” said Winifred L. Boal, MPH, a research epidemiologist and the lead author of the study. “Improving access to healthcare for all workers, including essential workers, is critical to ensure workers’ health and work force stability.”

For more information, refer to NIOSH’s news release covering the study or read the study’s abstract in Public Health Reports. Access to the full study is available with a Public Health Records account and through some institutions.

Related: The April 2019 Synergist article “Protecting Home Healthcare Aides: Challenges and Opportunities for Safe Patient Handling and Mobility,” by James D. McGlothlin and Colin J. Brigham, further covers personal care aides’ difficulties with accessing healthcare before the pandemic.