By Dean Ana V. Diez Roux, MD, PhD, MPH

Today, the day I am writing this, is May 1. In many countries around the world May 1 is a major public holiday known as International Workers’ Day. Although not celebrated in the United States, the holiday commemorates the “the Haymarket Affair” a historical event that occurred in Chicago in May of 1886. In that year a strike for the eight-hour workday (yes, it is hard to believe but 16-hour work shifts were not that unusual at the time) began on May 1. On May 4 the police intervened, someone threw a bomb, and the police responded by firing on the workers. This resulted in the deaths of seven police officers and at least four civilians with many more police and civilians injured. Subsequently, hundreds of workers were arrested and four executed after what was later shown to be an unfair trial. Starting in 1890, demonstrations were held in many countries on May 1 to commemorate the event and call for the 8-hour workday. In other countries the holiday has acquired other social justice meanings. For example in South Africa in the 1990s, May 1 became associated with the anti-apartheid movement. It is remarkable how many countries across the world still honor May 1 as a major holiday in remembrance of those who died in struggle for more just working conditions.

It is hard to overstate the importance of work to health. Certainly, the terrible work conditions during the Industrial Revolution spurred social movements that led to major social change. But even today around the world many work under conditions that are a major threat to their physical and mental health in the short and long term. Injuries at work are a major cause of death among middle aged populations in many countries. Many work-related exposures have been shown to cause cancer or have other health consequences. Work has many other sometimes subtle but significant impacts on health as documented by the large body of research on demands and control over the work process and their impact on cardiovascular disease for example.

Some of us are fortunate enough to have jobs that to a large extent are engaging, that allow us to develop personally and professionally, that encourage creativity and give us control over what we do and when we do it, but many, indeed most in the world, do not. The COVID pandemic also illustrated how many countries including the United States lag behind in the protection of workers even in affording workers the minimum social protections of sick leave. It is always surprising to me to see how little attention we pay to work as a social determinants of health and as a major contributor to health inequities even in schools of public health today.

Just recently the Center for Hunger-Free Communities and Staff Coordinating Committee at our School have drawn attention to the lack of paid family leave for staff even at institutions like ours. In a careful review of the literature, they summarized the many links between work leave policies and health. They make a strong case for doing more. This May Day I commend them and thank them for their advocacy. And I hope that we in public health will not forget the impact of work on health and the pervasive way in which it drives health. Together with addressing underlying structural inequities and racism, improving conditions at work is likely one of the most significant ways in which we can improve the health of the public and reduce health inequities.