This blog post is adapted in part from the presentation of the same name given at AIHce EXP 2020 by Kirk Phillips, John Suter, Lawrence Sloan, and Ben Kollmeyer, and in part from a conversation between Kirk Phillips and Abby Roberts which took place on July 28, 2020. It was edited by Abby Roberts, editorial assistant at The Synergist, and intended as a sequel to the October 6, 2020 blog “Practical Considerations on Getting Started with Total Worker Health.”

While Jennifer Cavallari’s blog post introduced Total Worker Health, a second, related concept may be useful to IHs in conceptualizing their TWH approaches: Total Exposure Health, or TEH. TWH and TEH are both frameworks—analytical tools for organizing one’s priorities in occupational and environmental health initiatives. While the TWH framework accounts for all impacts on health that are relevant to the workforce, TEH is not limited in its use to workers alone. TEH accounts for physical, chemical, biological, and other factors that have negative impacts on a person’s health and which anyone might encounter in daily life. Topics relevant to the TEH framework include clean drinking water, environmental contamination, and household products free of harmful chemicals.

TEH provides IHs a framework to respond to changes in the nature of the work environment, take advantage of recent developments in exposure monitoring technology, and address the effects of different internal and external exposures at the genetic and molecular biological response levels. It considers exposures from four primary areas—occupational, environmental, lifestyle, and clinical—as it aims to achieve true prevention for exposure-based illness and injury. Like TWH, TEH is a tool that IHs can use to adapt their profession to the realities of the Fourth Industrial Revolution—the ongoing advances in society characterized by rapid developments in medicine, genomics, automation, robotics, and technology. The industrial hygienist is seeing these changes acutely as companies automate traditional industry using smart technology, precision health researchers reveal new insights into exposure, and all things become more connected through the Internet of Things.

TEH and TWH

Although TEH is not necessarily a component of TWH, the two frameworks do have some areas of overlap and may be used in support of each other. Therefore, understanding TEH is useful to IHs who are pursuing a TWH program at their organization.

“To the worker, TEH provides all the exposure-based support that TWH needs,” said Kirk Phillips, creator of TEH, an editor of Total Exposure Health: An Introduction, and a noted expert on the subject.

Both TEH and TWH exist under the umbrella of precision health, or healthcare tailored to the individual’s genetic vulnerabilities. As medical consumers become more aware, and as technology improves, it becomes increasingly obvious that a one-size-fits-all approach does not work for healthcare. Every individual’s genetic code harbors vulnerabilities and resistances to thousands of illnesses and injuries. Some individuals can withstand a significant dose of a typically harmful exposure without any negative health effects. Others begin to show signs of illness after exposure far lower than one that would cause the same health effects in the average person. This idea is illustrated in the dose-response curve (Figure 1).

In addition to the variation in health effects experienced by individuals due to minute differences in their genes, individuals are also subject to differences in environment. Even within the same room, someone working near a window or door, for example, may experience different exposures than another person working on the other side of the room. Exposures also accumulate: a person’s exposures at home or in other environments add on to their workplace exposures. This is the point at which TWH and TEH overlap.

Both TWH and TEH take industrial hygiene into the worker’s environment and lifestyle outside of work, in addition to focusing on workplace health, and both attempt to customize their approach to each worker’s genome with tailored interventions. IHs employing TEH in support of TWH might use Big Data to track exposures and effects, and more powerful sensors to measure a worker’s exposures, more often than they would have without a TEH approach. They will advocate for clinical interventions based on biological changes brought about on the molecular level by exposures (Figure 2). In this way, TEH is another tool IHs can use to adapt to changing work environments and extend their protection of worker health.

TEH at AIHA

The Content Portfolio Advisory Group (CPAG) was created to help AIHA prioritize the content the organization provides to its members and other stakeholders, such as white papers, fact sheets, and publications. CPAG’s primary roles are recommending content priorities and publication content proposals to the AIHA Board of Directors and reviewing existing content. The group maintains a dashboard for each content priority—including TEH—describing AIHA’s visions and initiatives.

The CPAG priorities for TEH are: ensuring that IHs understand how occupational and non-occupational exposures combine to affect worker health; that IHs are recognized as exposure science experts; and that IHs are seen as partners collaborating with other scientific communities on initiatives involving the integration of exposure data with other health determinants. Future initiatives include engaging NIOSH in nanomaterial and mixed-exposure-related projects, launching a social media campaign highlighting IH’s connection to exposure science, and exploring a webinar highlighting TEH. Completed CPAG initiatives include creating a webpage for TEH-related resources, exploring how the IH profession can engage more with non-occupational exposure assessment, assembling thought leadership documents on exposure, and participating in a NIOSH TWH symposium.