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Introduction

WORKSHOP THEMES

For some time, research has shown that trends in health and disability in the working-age population (25–64) have been less encouraging than those for older age groups, where declines in the prevalence of chronic disabilities have been observed. A recent report on High and Rising Mortality Rates Among Working-Age Adults (National Academies of Sciences, Engineering, and Medicine [National Academies], 2021) reinforced the observation that worsening mortality among working-age adults is a significant concern in the United States. Because rising mortality is an indicator of deteriorating population health among adults, it is important to investigate the underlying causes and their implications. In introducing the workshop, planning committee chair Emily Agree highlighted the key themes outlined in the workshop statement of task (see Box 1-1) to be addressed during the two-day event. She emphasized the point that increases in working-age disability, and disparities therein, have important implications for labor force participation and a range of public disability, health, and income benefit programs.

One motivation for this workshop is that health and disability trends among working-age populations have been less encouraging than those at older ages. Increases in working-age disability and related morbidity and disparities therein may have important implications for labor force participation and a range of public disability, health, and income benefit programs in the coming decades. These trends also have important interactions with labor markets and changing occupational distributions for accessibility and work capacity. The COVID-19 pandemic’s impact on working condi-

tions (e.g., remote work) also presents opportunities to consider the role of organizational factors including those associated with the workplace. Employment is an important channel for understanding changes in disability over time as well as for potentially intervening to improve functional capacity and welfare. Discussion of research opportunities to inform such interventions, as well as social safety net policies that consider functional capacity and work capacity, will be a key feature of the workshop.

With this backdrop, the National Institute on Aging asked the Committee on Population (CPOP) within the National Academies to convene a workshop of experts to examine what is currently known about trends in disability and disabling morbidity, with the goal for helping to set a research agenda and data priorities. To guide planning of the workshop, a committee of seven experts (listed in the Appendix) was selected and charged with designing an agenda for a 1.5-day workshop and selecting and inviting appropriate experts to speak on the topic. The agenda included sessions on defining, conceptualizing, and measuring disability; examining health and medical drivers of period and cohort trends in disabling morbidity; reviewing population disparities; considering policy influences on morbidity and disability; discussing workforce and workplace trends in disability and disability policy; and then synthesizing the discussions (see Appendix for the complete workshop agenda). The committee then invited 16 experts from relevant fields to participate in a workshop and discuss the current state of the research and the research needs.

Dr. Malay Majmundar, director of CPOP, welcomed participants to the workshop and described the role of the committee in developing the

event, the motivation behind the work, and the planned products from the workshop. Dr. Kriti Jain of the National Institute on Aging provided an overview of her agency’s motivation for initiating the project and goals for the discussion. The institute seeks to understand health as it unfolds over the life course, not just for a single age group. The workshop comes out of a concern that Americans are facing shorter life expectancies compared with the past and with comparable countries.

An earlier CPOP report (National Academies, 2021) found that the working-age population (those ages 25–64) has experienced increased mortality due to what are colloquially termed deaths of despair—drug- and alcohol-related causes of death and suicide—and also from adverse outcomes associated with cardiometabolic issues. Other concerning issues, according to Jain, are high rates of obesity, poor mental health, and wide socioeconomic, racial, and ethnic inequalities. Jain added that, alongside these other factors, disability and related morbidity may have important implications not only for labor force participation but also for various public benefit programs including disability, health, and income benefit programs.

Agree followed up with the observation that, with the documentation of rising mortality, there is a need to better understand the underlying causes, not just of acute crises like the deaths of despair, but of chronic diseases and disabilities, and to understand the disparities in who experiences these health threats.

The workshop was held in Washington, DC, on October 15 and 16, 2024. This report provides a summary of what the speakers presented and the dialogue that followed. As a workshop, no attempt was made to develop a set of recommendations coming from the committee as a whole. Rather, all conclusions and recommendations in this report can be attributed only to the individuals who spoke, and they should not be interpreted as presenting the opinions of the committee, the National Academies, or the National Institute on Aging.

ORGANIZATION OF THE PROCEEDINGS

The organization of this volume follows the general structure of the workshop as a factual summary of what was stated. However, some material has been reorganized to place related concepts together (particularly placing much of the discussion that occurred at the end of each session in the context of the original presentation).

The first session of the workshop—focused on how to improve the measurement of disability, how to strengthen the underlying data infrastructure, and how to define and conceptualize the key underlying concepts—is summarized in Chapter 2. This first session established the foundation for the workshop, which includes measuring the extent to which early life dis-

advantages are expressed in the likelihood of cognitive decline at later ages. Chapter 3 summarizes the discussion of the health and medical factors that drive trends and disparities in disability and disabling morbidity. Chapter 4 examines population disparities, including how and why the timing, types, and severity of disability and disabling morbidity differ across populations and what pathways lead to disparities in health outcomes. Chapter 5 summarizes discussions of the policy landscape across the federal, state, and local governments, considering topics such as the extent of variation and the degree to which such variation enables natural experiments to measure the impacts of the various policies. Chapter 6 focuses on workforce and workplace trends in disability and disability policy. Chapter 7 synthesizes the key takeaways that emerged from the workshop—focusing especially on identifying research gaps, data and measurement needs, and policy directions that may be helpful to the National Institute on Aging in guiding its funding decisions in these areas.