Working through pain? You’re not alone.

Nicole Maestas.

Niles Singer/Harvard Staff Photographer

Work & Economy
Working through pain? You’re not alone.

Researchers use Dutch tool to pursue full scale of functional limitations in U.S. labor force

Alvin Powell

Harvard Staff

August 5, 2025 3 min read

A new study of functional abilities in the U.S. labor market reveals a workforce both vulnerable and resilient, with a large majority of workers reporting multiple limitations even as they fulfill their job duties, according to researchers at Harvard Medical School.

Nicole Maestas, head of the Medical School’s Department of Health Care Policy, said that the findings reflect worrying nationwide trends.

“Prior research finds that people in midlife are less healthy than people who are older now were at midlife,” said Maestas, the John D. MacArthur Professor of Economics and Health Care Policy. “And it’s even true that younger people are less healthy than the midlife people were when they were younger.”

The study, published in June in the Proceedings of the National Academy of Sciences, employed a tool developed in the Netherlands to assess disability claims. The Dutch tool measures 97 job-related functional abilities, providing a far more granular picture of American workers than the U.S. government’s disability measure, which considers six domains.

“We haven’t seen a detailed portrait like this of the American workforce,” Maestas said. “It’s not that we’re measuring it better, it’s that we’re measuring it for the first time.”

“We haven’t seen a detailed portrait like this of the American workforce.”
Nicole Maestas

The study of 3,396 working adults age 22 and older found that three-fourths faced at least one functional limitation. It also indicated that U.S. workers average more than five functional limitations each. The most prevalent limitations are upper-body strength and range of motion of one’s torso. Also common are limitations related to sensitivity to the ambient environment — hot weather, for example — and to knee function. Other limitations include problems linked to the immune system, head and neck movements, emotional regulation, and cognition.

The researchers also asked workers about underlying medical issues. The conditions that cause the greatest number of functional limitations are mental illness, joint conditions such as arthritis, substance use disorder, and asthma and chronic obstructive pulmonary disease.

The data was collected in 2019. The National Institute on Aging grant supporting the project has been canceled, but Maestas said that researchers managed to collect additional data early this year for a follow-up study that she hopes will identify targets for intervention.

While the employment of people with functional limitations is a success of the U.S. labor market, the new paper highlights the vulnerability of the workforce and, by extension, the national economy, Maestas said. The highest levels of functional limitations were seen in jobs that involve constant physical labor, as well as clerical, service, and sales positions. Many of these roles are essential. The upshot is a workforce less equipped for the impact of a pandemic or some other major disruption.

“The fact that so many people with functional limitations are working is a success,” Maestas said. “It also reveals points of vulnerability when you’re thinking about the country’s broader economic performance. The backdrop of this study is the fact that the U.S. population is aging at its most rapid clip ever. We knew this was coming but you have more people retiring than are coming into the workforce. We need workers in order to keep our economy growing.”