November 12, 2020 / Chris Laszcz-Davis, Kirk Phillips, Jenn Sahmel, Deborah Nelson, and Abby Roberts

The Role of the NextGen IH in TWH, TWE, and TEH

This blog post is adapted from the presentation of the same name, given by Chris Laszcz-Davis, Kirk Phillips, Jenn Sahmel, and Deborah Nelson at AIHce EXP 2020, and from a conversation with Chris Laszcz-Davis taking place on August 24, 2020. It is intended as a sequel to the October 13, 2020 blog “Total Exposure Health: The Role of the IH in the Future of Exposure Management.”

Total Worker Exposure (TWE)

The October 13 blog, based off a presentation given by Kirk Phillips, John Suter, Larry Sloan, and Ben Kollmeyer, covered both Total Exposure Health (TEH) and the way it fits into Total Worker Health (TWH). Today’s blog elaborates on that topic by introducing a subset of both TWH and TEH: Total Worker Exposure (TWE). TWE assesses worker exposures in and beyond the workplace—it addresses the exposures that cause negative health effects in the working population. TWE is the intersection in which the worker’s environment and lifestyle meet the IH and workplace’s support with regards to reducing worker exposure and improving worker well-being.

As work patterns and environments change, the lines drawn between the workplace, home, and community blur. This enables workplace organizations to offer programs and policies that influence worker exposures both in the traditional workplace and outside of it. Often, doing so requires data collection from workers outside of work hours, which brings up ethical and privacy concerns. A successful TWE program creates ethical contracts for participation and ensures data accuracy and privacy before recruiting volunteers into data collection. The practice and ethics of collecting data from workers will be discussed further in a future blog post.

Both TWE and TEH include exposure assessment, monitoring, and control, but perhaps more importantly, require organization-wide implementation of policies, programs, and practices which integrate robust injury and illness prevention efforts. All relevant departments cooperate for an integrated program, meaning that IH and safety professionals work together.

The Safety Professional’s Role in Total Worker Health (TWH)

The American Society of Safety Professionals (ASSP) has recently examined how to best position Total Worker Health for the safety professional, whose role is anchored on an adapted version of the hierarchy of controls as shown in Jennifer Cavallari's Oct. 6 TWH blog post (Figure 1).

Figure 1.
Figure 1. The hierarchy of controls adapted to promote worker health. Reprinted from NIOSH. (2018). “Total Worker Health: Let’s Get Started.”

The broadest category of intervention in the hierarchy, and the one which IHs should try to implement first, is eliminating working conditions or behaviors that threaten safety, health, and well-being. In order of decreasing scope and priority, the hierarchy also suggests modifying or substituting traditional existing policies, programs, and practices with those that promote worker health and safety; redesigning the work environment to mitigate risk and promote injury and illness prevention efforts; educating or training workers to optimize safety and health conditions and practices; and finally, encouraging workers to adjust their personal lifestyle habits to optimize overall health and well-being. This new hierarchy of controls is a lens through which IHs can influence TWH implementation in an entire organization, analogous to how traditional IH reduces harmful exposures.

The primary difference between integrated and traditional approaches can be illustrated using the example of worker musculoskeletal health. Employing the traditional hierarchy of controls—which generally aims to prevent exposure—diagnosis of a musculoskeletal disorder would then trigger the workplace health and safety program's remedial features. Then the worker might be given physical support, such as a wrist brace, a few days off, and a few sessions of physical therapy.

But under the modified version of controls, the musculoskeletal problem would be prevented before it occurred as a result of various interventions—work was reorganized to provide breaks and reduce repetitive motions; the workers were provided with ergonomic consultation; and the employer offered self-management strategies such as stretching and rest breaks. For workers who sustain an injury despite the changes, the employer provides for full rehabilitation—rather than viewing the injured workers as potential liabilities or as less capable in fulfilling their job. TWH also incorporates psychosocial considerations when deemed appropriate.

ASSP is concerned with providing members with practical approaches which organizations can use to integrate TWH features into the business of the business. The focus is not necessarily research-oriented but includes operational aspects which allow Total Worker Health to be integrated seamlessly and efficiently. In support of this goal, ASSP also is working with the American National Standards Institute (ANSI) to develop a new standard, ANSI/ASSP Z590.7, defining the requirements for implementing and improving a management system addressing Total Worker Health. Applications for the Z590.7 standard development committee have only recently closed.

“It goes without saying that Total Worker Health should be designed and planned to not only result in the reduction of workplace injuries and illnesses but to promote prevention efforts to advance worker well-being. It’s important that TWH features be practical, understood and attainable,” said Chris Laszcz-Davis, the recent chair of the ASSP Task Force on Total Worker Health.

Two case studies demonstrate TWH strategy in action through the Oregon Institute of Occupational Health Sciences—one addressing the risk of mental illness, heart disease, and workplace injuries in a police department (PDF), and one reducing hazards to public employees of the City of Eugene, Oregon (PDF).

Managing Integrated Programs

Above all, a TWH strategy integrates prevention of multiple determinants of worker health, such as workplace hazards and chronic diseases; different disciplines, such as occupational health and safety, industrial engineering and psychology; and various departments within the same organization, such as Health and Safety and Human Resources programs. An integrated approach brings results—the Journal of Occupational Health Psychology found that in 2015, of 17 TWH interventions, all but one intervention improved risk factors for injuries and chronic diseases, and 4 improved 10 or more risk factors.

Several practices, among many others, that will enable an IH to integrate TWH into an organization, include:

  • Regular joint meetings of safety and health promotion teams.
  • Safety and health promotion workgroups to address specific emphasis areas.
  • Ergonomic consultations and interventions that cover joint health and arthritis management.
  • Stress management efforts that effectively diminish workplace stress and build worker resiliency.
  • Programs addressing safety concerns for both work and community environments.
  • Screening for work-related and other health risks.
  • Coordination of all relevant employee health services.
  • Occupational health combined with a patient-centered home model, delivered in the workplace.

Features of a successfully integrated TWH program include organizational leadership showing commitment to TWH, coordination between health protection and health promotion efforts, and supportive organizational policies, programs, and practices with comprehensive content. The policies, programs, and practices coordinate management and employee engagement, provide incentives for employees to maintain healthy lifestyles, use performance metrics to measure success, confidentially store and collect data, and are implemented by trained, responsible managers, both staff and operational.

Chris Laszcz-Davis, Kirk Phillips, Jenn Sahmel, Deborah Nelson, and Abby Roberts

Chris Laszcz-Davis, MS, CIH, COH, FAIHA, AIC Fellow, is the founder and president of the Environmental Quality Organization. She has also chaired the ASSP Total Worker Health Task Force and is helping develop the ANSI/ASSP Z590.7 standard for Total Worker Health management systems.

Kirk Phillips, MS, is a retired US Air Force colonel and now serves on the ASSP Total Worker Exposure Task Force and AIHA Actions Committee.

Jenn Sahmel, MPH, CIH, CSP, FAIHA, is a managing principle scientist with Insight Exposure and Risk Sciences in Boulder, Colorado.

Deborah Nelson, PhD, CIH, FAIHA, served as president of AIHA for 2017-2018, received the 2007 Smyth Award, and is active on AIHA's Total Worker Health Task Force and Rocky Mountain Local Section.

Abby Roberts is the editorial assistant at The Synergist.


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