Health among those afflicted with diabetes is improving, but obtaining work remains a challenge.
Jack Chapel, assistant professor of health policy and management at the University of Southern California, examines why.
Jack Chapel is an assistant professor (research) of health policy and management at the University of Southern California’s (USC) Price School of Public Policy and a scholar at the USC Schaeffer Institute for Public Policy & Government Service. He is an applied microeconomist specializing in health and labor economics, with a diverse range of research interests unified by the goal of informing public policy decisions that foster societal well-being. His current research focuses on estimating the economic impacts of chronic diseases and quantifying the societal value of chronic disease prevention strategies.
Jack earned his PhD in economics from USC in 2024 and BS in economics from Tulane University in 2015. Prior to his current role, he worked in both academic and government research settings, including at the Centers for Disease Control and Prevention, the Department of Labor, and the Center for Economic and Social Research.
A Diabetes Paradox
A troubling disconnect has emerged in the fight against diabetes, which affects nearly 40 million Americans. Thanks to advances in diagnosis and treatment over the last three decades, people with diabetes have fewer hospitalizations, are less likely to die, and are much less likely to say the condition interrupts their daily lives. Despite these important health gains, my new research found that workforce participation among working age Americans with diabetes has remained stubbornly low.
After adjusting for differences like age, we found that people with diabetes were approximately 10 percentage points less likely to participate in the labor force, and about 5 points more likely to receive disability insurance, compared to peers without the condition. Unlike the trends in health outcomes, these economic gaps haven’t narrowed since the late 1990s.
The findings are puzzling – researchers have long thought health problems and physical limitations caused by diabetes were a major reason why many people with the condition struggle to work. What explains this diabetes paradox? Why haven’t better health outcomes translated into more people working?
One explanation is that many people with diabetes are able and willing to work but increasingly face other employment challenges. Efforts to expand screening have increased diabetes diagnosis, particularly among economically disadvantaged adults. Meanwhile, wealthier people are better able to take steps to avoid developing the disease, shifting the diagnosed population toward those with fewer economic resources. Finally, broader labor-market shifts like automation and outsourcing have disproportionately impacted lower-skilled occupations, precisely the demographic where diabetes diagnoses have risen fastest.
The diabetes paradox adds an important wrinkle to public discussions about reducing the burden of chronic diseases in the US. Better health on its own is important. But to help people with diabetes engage in fulfilling work, it may be just as vital to address the social and economic challenges they’re facing.
