Winter 2022-23

Hard Times: How Economic Stability Can Impact Injured Worker Outcomes

Fast Focus

As part of our Social Determinants of Health series, we explore the role that economic stability can have on individual health outcomes, and the complexity this can bring to a claim.

Economic stability, or the lack thereof, can have a significant impact on a person’s health. Studies have proven that economic factors that cause hardship in a person’s life - such as poverty, a lack of adequate housing, and food insecurity - are also detrimental to their overall health, contributing to downstream health impacts such as comorbidities, mental health concerns, and other factors.

When health problems stemming from economic instability accumulate, they can impact the lives of workers’ comp patients, further complicating their course of care. In order to best assist patients, it is of benefit to understand the impact economic instability can have on patients’ lives, care, and health.

Four Facets of Economic Stability

As a social determinant of health (SDoH), economic stability is composed of the four following components:

Employment Status
Housing Stability
Food Security

Employment Impacts

Employment status is directly tied to one’s overall health. First and foremost, unemployed individuals often have less access to healthcare.1 Health concerns that fall outside of workers’ comp may not receive necessary attention, as individuals in need of help lack the insurance and/or finances to pay for medical care.

Second, unemployment can contribute to negative mental health impacts. Individuals lacking structure, a routine, sense of purpose or identity may develop feelings of worthlessness.2 These emotions can be made worse when combined with financial anxieties and can contribute to depression or other mental health concerns.3

Even light duty work has been demonstrated to contribute to more positive workers’ comp outcomes.4 Having something to wake up to is greatly beneficial to overall health, and the social element of work can be good for mental health. Additionally, depending on available light duty opportunities, light duty can function as a form of occupational therapy for workers recovering from a workplace injury. Unemployed individuals do not have the option to incorporate a light duty component in their recovery.

Unemployment can be associated with the development or exacerbation of a range of health issues, any one of which can impact care among injured worker patients, creating a spectrum of cascading health consequences and potential comorbidities.

Health issues associated with unemployment2-3

Anxiety, depression, and other mental health concerns



Physical pain

Heart disease

High blood pressure



High-risk coping with alcohol, tobacco, or substance use

Patients with mental health concerns may find themselves unmotivated to participate in their care, often struggling with feelings of inadequacy, or wondering how they may provide for their families. Helping patients who face mental health concerns can do wonders for their physical condition.

Poverty Impacts

Poverty can affect health by limiting access to proper nutrition and healthy foods, adequate shelter, safe neighborhoods with clean air and water, and other elements that define an individual’s standard of living. Individuals who live in low-income or high-poverty neighborhoods are likely to experience poor health due to a combination of these factors.

of the U.S. population

live in poverty.5 In recent decades, income inequality has increased dramatically in the U.S.6

Identifying patients susceptible to these health risks is of benefit in workers’ compensation claims management as their overall health – and by extension the course of their claim – may be more inclined to take turns for the worse.

For instance, the ongoing or severe financial stress that comes with poverty can cause:7

Sleeplessness and fatigue
Anxiety and depression
Weight gain or weight loss
A weakened immune system and flare-ups of current or chronic medical conditions
High blood pressure and high blood sugar
Tense muscles, which can cause back and shoulder pain

These health concerns can negatively impact both the risk for injury and the ability to recover from injury. In the case of fatigue, lack of sleep, and tense muscles, workers are more likely to get injured. Approximately 13% of workplace injuries are attributable to fatigue, and workers have a 62% higher risk of injury when fatigued.8

Furthermore, low-income individuals are seven times more likely to be in serious psychological distress than higher-income individuals, making them more likely to cope with stress by using alcohol, tobacco, or other substances.9 Such coping can in turn be a detriment to injured worker outcomes.

READ The Triple Threat of Tobacco Use on Employer, Clinical, and Medication Complexity part of our Social Determinants of Health Series.

Additionally, poverty not only contributes to various health problems, but limits one’s ability to manage those health problems, as individuals often cannot afford healthcare. Delaying necessary care creates significant health concerns over time.

Even if an individual has made their way out of poverty, a history of poverty can mean they had health issues that went untreated for years or decades, and the lingering effects of those issues can create health problems that resurface later in workers’ comp claims.

Time and Transportation

Even when impoverished individuals find themselves able to receive care, they may face additional barriers, including a lack of transportation to make doctor’s appointments, the inability to take time off work, especially if working multiple jobs, and larger familial caretaking responsibilities.

Housing Stability Impacts

An inability to afford adequate housing can have serious health effects. Poor quality housing is associated with various negative health outcomes, including chronic disease, injury, and poor mental health.10

Troubling Real Estate Trends

Issues of adequate housing are becoming more widespread as real estate prices continue to rise, putting even the more fortunate at potential risk of inadequate housing down the road.

Average rent prices increased

25% since 2019, with the national average passing

$2,000 a month11

Cities like

have seen rent increase by

House prices went up

 within the last year

the strongest rise in 20 years12

U.S. house prices are expected to rise another

in 202212

If more people are forced to live in low-quality homes, corresponding health impacts may become more prominent.

Low-quality housing may also include concerns that directly impact well-being, such as:10,13

The presence of lead, which can affect the brain and nervous system
The presence of asbestos, which can cause cancer
Water leaks, poor ventilation, and pest infestation, which can lead to an increase in mold, mites, and other allergens associated with poor health
Poor insulation which can lead to extreme high or low temperatures, which are associated with poor health
Poor maintenance or construction, which can lead to accidents

Homes and Apartments Are Not Often ADA Compliant

ADA-compliant homes are dwellings built or adjusted to be easily accessible, with features such as open floor plans, wider hallways and entryways, varying height countertops, bathroom handrails, ramps, and more.

Injured workers who are temporarily or permanently disabled may not be able to move freely within their own home if it does not meet these standards.

The limitation of mobility can be detrimental to quality of life, requiring intervention to better assist workers’ comp patients. This can become particularly complex when the timing and costs to make home modifications is significant, or if a patient is renting their home and may not be able to modify their living space.

In addition to the quality of one’s home itself, the neighborhood or location of one’s home can also impact health. A few examples of this include:14

Living in a food desert with little access to fresh produce but high access to fast food can lead to unhealthy diets, obesity, high blood pressure, diabetes, and heart disease

Living in close proximity to high-volume roads can increase the likelihood of respiratory diseases such as asthma and bronchitis, as well as car accidents

Living in high-crime areas increases the likelihood of encountering violence

Living in areas without safe places to exercise – such as a lack of sidewalks and parks, or poor street design – can keep individuals from living healthier lifestyles

Living in racially segregated neighborhoods that have historically been associated with lower allocation of public resources can result in higher rates of death or injury

1 in 5 Americans lives in an impoverished neighborhood15

Food Security Impacts

A healthy diet is paramount to a healthy lifestyle, but the inability to access healthy food – known as food insecurity – is an issue that plagues many Americans.

Food insecurity is a concept defined as the disruption of food intake or eating patterns because of lack of money and other resources.16 Food insecurity impacts 11% of the population,16 but that may rise as the cost of groceries increased 12% from 2021-2022.17

Food insecurity impacts
of the population16

Meanwhile, the cost of groceries increased
from 2021-2022,17 and with rising inflation, many are making tradeoffs with limited income

First and foremost, healthier foods are more expensive than mass-produced, readily available foods that are highly-processed with high sodium or sugar contents. A meta-analysis of 27 studies found that healthy diets cost on average $1.25 more per person per day than less healthy diets.18

It is an unfortunate truth that many would prefer to consume healthier foods but simply cannot afford to do so. Research has shown that the price difference in healthy and unhealthy foods is a significant cause of poor diet in a large proportion of the U.S. population.19

Additionally, individuals may live in food deserts, areas with little access to grocery stores that carry fresh fruit, vegetables, and other healthier foods, though their neighborhood may offer access to many cheap and unhealthy fast food options.

Where Do Food Deserts Appear?

Impoverished neighborhoods

Rural areas

Urban areas

Areas with little-to-no public transportation options

Essentially, when individuals can only afford or access unhealthy food, they are at a significantly higher likelihood to develop chronic conditions that can lead to more complex workers’ comp claims, as claims with comorbidities require additional care, medications, and costs.

Chronic conditions associated with unhealthy diets


High blood pressure

Heart disease


Mental health disorders

Takeaways for Workers’ Comp Claims Management

Visibility into when a patient’s health is impacted by economic instability is a key first step. Here are some health consequences related to economic instability and how they impact workers’ comp populations and claims management.

From an overall health perspective, economic instability can exacerbate outcomes for injured workers overall, but this may be even more pronounced for those who also have comorbidities such as diabetes and heart disease. The inability to afford proper healthcare including medications to treat these comorbidities can lead to complications that may put these injured workers at higher risk of recovering significantly slower from their injury, or not recovering at all.

Ensuring a holistic view into an injured worker’s overall health can be impactful. Medical records should be incorporated into the care of an injured worker to ensure that all factors are appropriately considered and addressed. Leveraging partnerships with other care providers can be valuable. A pharmacy benefit manager can partner with payers to help conduct comprehensive patient reviews, as well as identify and manage patient risk factors and treatment regimen risks that arise from these circumstances.

It is well-established that economic instability factors such as unemployment can be detrimental to mental health. In some cases, psychosocial factors can be even more detrimental to claims outcomes than physiologic factors,20 as depression can be a significant inhibitor of restored function.21 Meanwhile, fear avoidance can lead to higher pain and disability levels in injured workers.22

More and more, the workers’ compensation industry is embracing the need to include avenues for behavioral health services within their programs and claims workflows to support injured workers who can benefit from them.

Fatigue brought on by poverty and economic instability increases the risk for workplace injury. For patients already being treated for a workplace injury, fatigue may be made worse by certain medications commonly prescribed within workers’ compensation, which can include CNS depressants, anticonvulsants, benzodiazepines, hypnotics, and muscle relaxants. The identification of fatigue as a concern can inform alternative medication recommendations that avoid exacerbating this concern.

Patients facing financial difficulty may not have reliable transportation, which can make it difficult for them to show up for doctor’s appointments. The availability of reliable transportation through a worker’s compensation program can help address this significant barrier to access to care in these populations.

Injured worker patients who are partially or fully disabled may lack mobility within low-quality homes. The ability to keep a patient mobile is of great importance to their recovery, and access to home modification solutions through workers’ compensation programs can help patients move about their homes and prevent a detrimental lack of mobility.

Times Are Tough All Over

The health impacts of economic stability are important now more than ever as the U.S. inflation rate has reached a 40-year high.17 More and more individuals are feeling the effects of economic instability as prices for everyday goods and necessities continue to rise:

Gas prices increased
within the last year17

The cost of groceries increased
within the last year17

Rent prices increased
since 2019, averaging $2,000 a month11

Housing prices are up
compared to last year, with an expected rise of 10% this year12

of lower-income adults worry almost daily about paying bills23

of employees earning $100,000 or more say they are living paycheck to paycheck24

The official poverty rate is
far above the 3.6%25 unemployment rate

of workers in the gig economy have a full-time job and are using gig work to supplement their income25


  1. NIOSH study examines relationship between employment status, healthcare access, and health outcomes. National Institute for Occupational Safety and Health (NIOSH). November 18, 2021.
  2. Social determinants of health – Employment. Office of Disease Prevention and Health Promotion. 2020.
  3. Howley EK. Health effects of unemployment. U.S. Health News. July 24, 2020.
  4. Massey PA, Sampognaro G, Fincher P, et al. Earlier return to light duty is associated with successful return to full duty of workers’ compensation patients treated with shoulder arthroscopic surgery. Arthroscopy, Sports Medicine, and Rehabilitation. 2022; (4)3: e927-e933. DOI:
  5. National poverty in America awareness month: January 2022. U.S. Census Bureau.
  6. Khullar D, Chokshi DA. Health, income, & poverty: where we are & what could help. Health Affairs. October 4, 2018.
  7. The effects of stress on your body. Healthline. Last reviewed June 5, 2017.
  8. Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta- analysis. Sleep Medicine Reviews. 18(1), 61–73. Feb 2014. doi: 10.1016/j. smrv.2013.01.004
  9. Cunningham P. Why even health low-income people have greater health risks than higher-income people. The Commonwealth Fund. September 27 2018.
  10. Social determinants of health – Quality of Housing. Office of Disease Prevention and Health Promotion. 2020.
  11. Ellis T. Rental market tracker. Typical U.S. asking rent surpassed $2,000 for first time in May. June 9, 2022.
  12. Kishan H, Ganguly S. U.S. house prices to rise another 10% this year. Reuters. March 2, 2022.
  13. Braverman P, Dekker M, Egerter S, et al. How does housing affect health? Robert Wood Johnson Foundation. May 1, 2011.
  14. Taylor L. Housing and health: an overview of the literature. Health Affairs. June 7, 2018.
  15. Shrider E, Benson C. Share of people living in poverty areas fell by 6.6 percentage points since first half of the decade. U.S. Census Bureau. February 8, 2021.
  16. Coleman-Jensen A, Rabbitt M, Gregory C, Singh A. Household food security in the United States in 2018. United States Department of Agriculture. September 2019.
  17. Rugaber C. U.S. inflation at new 40-year high as price increases spread. AP News. June 10, 2022.
  18. Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 2013;3:e004277.
  19. Kern DM, Auchincloss AH, Stehr MF, et al. Neighborhood prices of healthier and unhealthier foods and associations with diet quality: evidence from the multi-ethnic study of atherosclerosis. Int J Environ Res Public Health. 2017 Nov 16;14(11):1394. doi: 10.3390/ijerph14111394. PMID: 29144387; PMCID: PMC5708033.
  20. oesler ML, Glendon AI, O’Callaghan FV. Recovering from traumatic occupational hand injury following surgery: a biopsychosocial perspective. J Occup Rehabil. 2013;23:536-46. doi: 10.1007/ s10926-013-9422-4
  21. Richmond TS, Amsterdam JD, Guo W, et al. The effect of post-injury depression on return to pre-injury function: a prospective cohort study. Psychol Med. 2009;39:1709-20. doi: 10.1017/ S0033291709005376
  22. Wertli MM, Rasmussen-Barr E, Held U, et al. Fear-avoidance beliefs – a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14:2658-78. doi: 10.1016/j. spinee.2014.02.033
  23. Igielnik R, Parker K. Most Americans say the current economy is helping the rich, hurting the poor and middle class. Pew Research Center. December 11, 2019.
  24. Iacurci G. Amid high inflation, 36% of employees earning $100,000 or more say they are living paycheck to paycheck. CNBC. June 16, 2022.
  25. The employment situation – June 2022. Bureau of Labor Statistics. July 8, 2022.


Since 2010, the semi-annual RxInformer clinical journal has been a trusted source of timely information and guidance for workers’ comp payers on how best to manage the care of injured worker claimants and plan for the challenges that lay ahead. The publication is an important part of Healthesystems’ proactive approach to advocating for quality care of injured workers while managing the costs associated with treatment.