Working With Chronic Health Conditions: A Case for More Proactive Support

Approximately 60% of adults in the U.S. have a chronic health condition (CHC), or a health condition lasting more than a year and requiring ongoing management (Centers for Disease Control and Prevention [CDC], 2024). Although CHC prevalence increases with age, CHCs affect people of all ages and often lead to disability (CDC, 2024). Furthermore, CHCs disproportionately affect members of minoritized groups due to social determinants of health (e.g., health care access; CDC, 2024). Thus, it is critical that organizations and managers understand how to support workers with CHCs to help maintain their work ability.

Workers with CHCs face common challenges due to the episodic, unpredictable, progressive, and often non-apparent nature of CHCs (Gignac et al., 2021). Many of these challenges are social in nature. Workers with CHCs often face dilemmas around disclosure, such as whether to disclose and to whom, a problem that may be further complicated by difficulties communicating their needs. These challenges are frequently driven by concerns about CHC-based stigma and discrimination, which may discourage workers from seeking formal and informal accommodations to help them continue working effectively. In addition, work–health management interference (WHMI) may arise when work demands deplete the time or energy needed to manage CHCs, such as attending medical appointments or preparing healthy meals, leading to impaired work ability, burnout, and increased withdrawal from work (McGonagle et al., 2020).

Efforts to support workers with CHCs are often reactive, focusing on preventing the progression of existing problems (secondary interventions) or rehabilitating those who have withdrawn from work due to CHC-related disability (tertiary interventions). Workplace wellness programs, a common secondary approach, promote overall health by supporting healthy lifestyle behaviors (e.g., routine physical activity) but rarely address social or WHMI-related challenges directly. Tertiary approaches, such as return-to-work programs, can help individuals with CHC-related disabilities return to the workforce. However, secondary and tertiary approaches alone have limited efficacy in enhancing work ability among workers with CHCs due to their limited scope and reactive nature.

In addition to these noted secondary and tertiary interventions, it is important for occupational health professionals to proactively create supportive work environments (primary interventions) that empower workers with CHCs to successfully manage their conditions at work while also preventing strains that can worsen CHCs. Often, this requires changes to organizational policies and practices and redesigning work to enhance autonomy, flexibility, and supervisor support. Two key elements that can support these efforts are fostering health-supportive organizational cultures and providing supervisor training. One evidence-based cultural intervention is the Support, Transform, Achieve, Results (STAR) initiative, which is designed to increase work schedule flexibility and supervisor support for work–family balance (Moen et al., 2016). STAR involves 8 hour of participatory training sessions with managers and employees, plus four additional hours of supervisor training. More information on STAR, including intervention manuals, can be found at https://workfamilyhealthnetwork.org/star. Another promising model for supervisor training is the Mental Health Supportive Supervisor Behaviors framework, which includes emotional support, practical support, role modeling, stigma reduction, warning sign recognition, and warning sign response (Hammer et al., 2024). Although originally intended for mental health concerns, these elements can support workers with all types of CHCs.