The nation’s public health goals for the population should include work and full participation in life among the major indicators of health status for all adults ages 18 to 70, including those with chronic conditions and disabilities.
The nation’s public health objectives are embodied in the federal government’s Healthy People initiative. The current version is Healthy People 2020, which has 1,200 objectives in 42 topic areas. The government is now developing a new area of emphasis—Health-Related Quality of Life and Well-being—to recognize the many social determinants of health. Employment is only one of the many new measures the government is evaluating in this area, instead of being singled out as a higher-order determinant. The central role of paid work in well-being should be emphasized because employment creates the means for reducing other social determinants of disease. In addition, Healthy People does not define what “healthy” means for people with disabilities. The government should therefore include the following goal in Healthy People: Each individual in the nation should enjoy his or her own optimal state of well-being and participate in life as fully as possible. For working age-adults, this means earning a living or otherwise contributing to society.