October 6, 2020 / Jennifer Cavallari

Practical Considerations on Getting Started with Total Worker Health

This blog post is adapted from Jennifer Cavallari’s presentation of the same name, given at AIHce EXP 2020. It was edited by Abby Roberts, editorial assistant at The Synergist.

On average, employed U.S. adults spend more than half of their waking lives working or engaging in work-related activities. Accordingly, our work has a large impact on how we maintain our health and well-being more broadly. Scientific evidence now shows there are occupational risk factors for sleep disorders, cardiovascular disease, depression, obesity, and other common health conditions.

A Total Worker Health (TWH) approach takes occupational safety and health to the next level to encompass broader workforce health concerns such as stress, chronic diseases, and working and living in old age. TWH integrates workplace safety efforts with a broad spectrum of opportunities and interventions to improve overall worker health and well-being. NIOSH defines TWH as “policies, programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness to advance worker well-being.”

A Total Worker Health approach shifts the IH’s thinking so that, rather than focusing solely on occupational injury and illness prevention, the IH considers workers’ total well-being. A TWH approach addresses disorders influenced by combined workplace and other environment factors, as well as the traditional IH concerns relating to chemical, physical, and biological exposures. Instead of only sending workers home in the same state of health in which they came, TWH aims to improve their health.

TWH Fundamentals

TWH also accounts for factors outside of traditional OHS such as leadership, policy, workforce demographics, new employment patterns, worker compensation and benefits, and community supports for healthy living. These factors influence the IH’s success and ability to advance worker well-being. To address them, NIOSH has formulated fundamental elements that an organization must have to initiate a successful TWH program:

  1. demonstrated leadership commitment by top leadership, managers, and supervisors to worker safety and health—in both words and actions
  2. a priority to design work so that safety and health hazards are reduced, and worker well-being is promoted (NIOSH has adapted the traditional hierarchy of controls to this end, advocating above all that harmful working conditions be eliminated—see Figure 1)
  3. Figure 1.
    Figure 1. The hierarchy of controls adapted to promote worker health. Reprinted from NIOSH. (2018). “Total Worker Health: Let’s Get Started.”
  4. worker engagement in hazard identification and in program design and implementation—workers are experts at their own jobs and on their own well-being
  5. confidentiality and privacy for workers regarding health and other personal data
  6. integration of relevant systems to advance worker well-being (Figure 2)
Figure 2.
Figure 2. A Total Worker Health approach integrates relevant areas of workplace policy. Reprinted from Goetzel, R. Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace. The NIOSH Total Worker Health Program: Seminal Research Papers 2012. DHHS (NIOSH) 2012-146

Worksheets for designing a TWH initiative according to these five fundamentals can be found on the NIOSH website. Some of these fundamental elements may already be a component of your occupational safety and health program while others, such as the integration of relevant systems, may be new. Importantly, a TWH approach emphasizes participatory engagement, and broader assessment and addressing of factors related to worker well-being.

Getting Started with TWH

In practical terms, implementing a TWH program starts with education. Educate your organization’s leaders on what TWH is and its value. Make sure that all relevant leaders are on board, regardless of what department they might be in. Evaluate the organization’s readiness for TWH. Be sure that the first changes you make are small, then work toward larger ones.

One way to start small is by integrating your work with related programs that address worker well-being, such as the ones highlighted in Figure 2. Get to know the program managers and their priorities and look for opportunities to coordinate and cross-promote activities. Start by selecting one or two key areas, and build partnerships over time. Health and safety, health promotion, human resources, workers’ compensation, and Employee Assistance Program managers are useful to recruit.

Upgrade existing programs by adding well-being aspects. The focus will be different depending on the nature of work in your organization, but basically, make sure that health and well-being programs account for the reality of the worker’s experience. For example, upgrade your ergonomics program to also address work organization and arthritis.

Find out what employees think of the new program by running surveys and focus groups. Hold workshops where they can share their ideas and solve problems. Recognize employees who get involved. Report back to them on how their ideas have played out.

AIHA is a NIOSH Total Worker Health affiliate, meaning that it is both involved with and works to advance the TWH program. To learn more about implementing TWH at your organization, visit NIOSH’s web pages on promising TWH practices, training resources, and webinars, and sign up for the TWH newsletter.

Jennifer Cavallari

Jenn Cavallari, ScD, CIH, is an associate professor of Public Health Science at the University of Connecticut School of Medicine. She is a core member of the Center for the Promotion of Health in the New England Workplace (CPH-NEW), a NIOSH Total Worker Health Center of Excellence.


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