The indispensable whole of work and population health: How the working life exposome can advance empirical research, policy, and action

Abstract

OBJECTIVES: The thesis of this paper is that health and safety challenges of working people can only be fully understood by examining them as wholes with interacting parts. This paper unravels this indispensable whole by introducing the working life exposome and elucidating how associated epistemologies and methodologies can enhance empirical research. METHODS: Network and population health scientists have initiated an ongoing discourse on the state of empirical work-health-safety-well-being research. RESULTS: Empirical research has not fully captured the totality and complexity of multiple and interacting work and nonwork factors defining the health of working people over their life course. We challenge the prevailing paradigm by proposing to expand it from narrow work-related exposures and associated monocausal frameworks to the holistic study of work and population health grounded in complexity and exposome sciences. Health challenges of working people are determined by, embedded in, and/or operate as complex systems comprised of multilayered and interdependent components. One can identify many potentially causal factors as sufficient and component causes where removal of one or more of these can impact disease progression. We, therefore, cannot effectively study them by an a priori determination of a set of components and/or properties to be examined separately and then recombine partial approaches, attempting to form a picture of the whole. Instead, we must examine these challenges as wholes from the start, with an emphasis on interactions among their multifactorial components and their emergent properties. Despite various challenges, working-life-exposome-grounded frameworks and associated innovations have the potential to accomplish that. CONCLUSIONS: This emerging paradigm shift can move empirical work-health-safety-well-being research to cutting-edge science and enable more impactful policies and actions.

A blueprint for a new commercial driving epidemiology: An emerging paradigm grounded in integrative exposome and network epistemologies

“…124 Over three decades later, however, integrative WLE-CD/CANoN-based epistemologies and methodologies grounded in multifaceted ongoing scientific and technological breakthroughs allow us a more complete examination of the indispensable whole of health and safety challenges of working people. 5 Differently put, novel integrative WLE-CD/CANoN-based epistemologies and methodologies are promising a more comprehensive, useful look at the indispensable whole of commercial drivers' health and safety challenges.…”

“…Grounded in complex systems frameworks, the 1990s brought about an epistemological transition in population health sciences by highlighting the significance of the overlooked “whole” in explaining health and safety challenges 5 . Accumulated evidence suggests that these challenges can be more fully understood when examining them as “wholes” with interacting parts—that is, with the comprehensive inclusion of all possible contributing domains 5 .…”

“…Grounded in complex systems frameworks, the 1990s brought about an epistemological transition in population health sciences by highlighting the significance of the overlooked “whole” in explaining health and safety challenges 5 . Accumulated evidence suggests that these challenges can be more fully understood when examining them as “wholes” with interacting parts—that is, with the comprehensive inclusion of all possible contributing domains 5 . Overall, drawing upon macrosocial syndemic, 31 lifecourse, 47 and ecosocial 48 theoretical frameworks, and grounded in exposome 49 and network 50 sciences, these epistemologies highlight the health implications of lifetime nongenetic influences (with the genome explaining a small proportion of the phenome 51 ) and that connections (edges in network language) among factors (nodes in network language) define the function of “wholes” (networks/systems, represented as graphs 50 ), respectively.…”

“…Expanding our ongoing work 5 in the context of relevant research from chronic disease, injury, and occupational epidemiology; exposome; and commercial driver health and safety (scan of PubMed 2000-2023), including seminal relevant publications of the National Academies, [57][58][59][60][61][62] we introduce the emerging "working life exposome of commercial driving" (WLE-CD). We define the WLE-CD as the totality of an array of heterogeneous, multifactorial and multilayered, and interdependent work, work-related, and in/directly relevant nonwork exposures and associated biological responses and endogenous processes that concurrently or sequentially impact commercial drivers' wellbeing from conception onwards, throughout and beyond their working lifetime.…”

“…To overcome these stalemates at the nexus of occupational, chronic disease, and injury epidemiology, epistemologies conducive to studying the totality and complexity of working people's lifelong health and safety challenges, by examining them as “wholes” with interacting parts, 5 are quite overdue. Hence, in this paper, we: (a) discuss how epistemologies grounded in integrative exposome and network sciences can enhance understanding of commercial drivers' chronic disease and injury burden by introducing the “working life exposome of commercial driving;” (b) conceptualize commercial drivers' health and safety risks as complex networks and initiate the unpacking of this multilayered structure; and (c) elucidate how integrative exposome‐ and network‐science‐based epistemologies and methodologies can contribute to a better understanding of commercial drivers' chronic disease and injury dynamics.…”