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Why are they falling in? — Chris Martin

man in shirt, tie, outside

Dr. Chris Martin is researching the reasons people are susceptible to addiction, including what the lack of a "decent job" means in a person's life. 

In the messy matters of public health, the cycle of addiction is both the root and the consequence of other health issues that affect a wide swath of U.S. and, particularly, West Virginia, residents. According to Dr. Chris Martin, there’s a seemingly unlikely connection in the causes of both — a decent job, as defined by The World Health Organization’s International Labor Organization that deals with occupational health. 

Martin likens his work to the public health analogy of continuing to pull people out of a river until finally walking upstream to find out why they’re falling into the water in the first place. 

“Of course, we have to have safe jobs, they have to be secure,” Martin said. “Beyond that, (people) also have to be treated with dignity and respect at work and they have to have appropriate benefits, not only to provide access health care, but time for vacation, sickness or life events. Everybody should be entitled to a decent job.”

Even people who have jobs that don’t hit all those marks may enjoy their work, and while the U.S. uniquely ties health benefits to employment, not all employers offer it. 

Martin volunteers at a free clinic where patients don’t have health insurance, or even Medicaid. One patient, who really liked her work, needed surgery to prevent a stroke. Martin said she was told to quit her job so that she would qualify for Medicaid, meaning she would give up the work that gave her self-sufficiency and that she enjoyed, impoverishing her enough so that she could get health care that would potentially save her life or prevent long-term disability.

Martin’s work centers around what happens to people when they transition to long-term disability from work-related injuries, and in short, the result is “not good.”

“We’ve found that overall death rates, as well as those specifically from opioid overdoses and suicides, increase among people receiving Workers’ Comp(ensation) Disability because of low back pain compared to people with claims for low back pain who are not disabled,” Martin said. 

“We’ve replicated those findings among those with carpal tunnel syndrome claims, as well. We know that when people no longer work, they lose a large component of their feeling self-worth and their social network, so employment is another powerful social determinant of people’s health.” 

That plays into the other causes of death where West Virginia and the Appalachian region rank among the highest in the nation — heart disease, cancer, suicide and opioid-related overdoses. But in this state and others where employment options are bleak, Martin said people look at the disability system as a way to get by because there either aren’t many jobs, they aren’t qualified for available jobs or the jobs are something no one wants to do. 

“At the end of the day, if we don’t start looking at what is starting all of this, it’s like my dog chasing his tail. We’re never going to fully address these problems by responding to them after they’ve fully developed,” Martin said. “If we don’t up come up with primary prevention approaches, we’re never going to get ahead of this.”

Between a Training Project Grant from NIOSH and Physician Training Award in Preventive Medicine from the Health Resources and Services Administration, Martin injects $650,000 each year into the School of Public Health to train resident physicians in occupational medicine dealing with work-related diseases and injuries or in public health responses at levels from local to state and federal.

“These are the only such programs in all of Appalachia,” Martin said. “They are signature programs. The HRSA grant is a difficult one to get, only 17 are awarded in the country, including renewals.”

In addition to long hours that turned into long days and eventually months of working to apply for the grant, Martin said that when the announcement came that the award was indeed coming to West Virginia, it came with a deadline of one year to set up the public health residency program or lose the funding. Successful at setting up the timeline and meeting the accreditation deadline, Martin got word in December 2018 that what seemed impossible —a group of public health professionals actually laughed at the idea it could all be done in a year — was about to be a reality. And although by that time most residents had already chosen locations, but a resident showed up the next July and graduated two years later. 

“When I look back, I don’t know how we did it. Now we have two residency programs that are fully accredited; they do not have a single citation, which is very, very rare in medical residencies,” Martin said. “This is not Johns Hopkins. This is not Harvard or Yale (and it has) many more challenges that arise from being a rural program. We draw from a national applicant pool.”

And, Martin said, that’s important because typically, many residents end up staying where they did their last residency training program. That could help the state reduce the shortfall of doctors to address those ever-growing public health needs.