AIHA Fellows Debate “The Totals”

By Ed Rutkowski

May 25, 2021—Yesterday at AIHce EXP 2021, members of AIHA’s Fellows Special Interest Group offered varied and at times clashing perspectives on a key issue facing the OEHS profession: to what extent should workplace health protection programs attempt to address health issues outside the workplace? The session continued the annual AIHce tradition of “AIHA Fellow debates” during which recipients of AIHA’s Fellow Award present opposing arguments on controversial topics.

As explained in a brief introductory statement by Fellows SIG Chair Jennifer Sahmel, this year’s debate would address the recent trend in OEHS activities toward engagement with worker health problems that can arise from non-occupational concerns such as diet or smoking as well as psychosocial stressors and issues related to workplace leadership, compensation, benefits, and policies. NIOSH has formalized these concerns in its Total Worker Health (TWH) program, which the agency describes as a “holistic approach to worker well-being.” A related approach known as Total Exposure Health (TEH) draws on sciences such as genomics and data-gathering technologies to attempt to understand the totality of each individual worker’s exposures both at work and at home. TWH and TEH, as well as a narrower approach called Total Worker Exposure (TWE), are collectively known as “the totals” among OEHS professionals who use aspects of these frameworks.

At issue for the debate participants, Sahmel said, was “the width of our swim lane” related to the totals—that is, should OEHS professionals embrace these programs as significant new developments in health protection, or should they proceed cautiously given concerns about the programs’ potentially problematic reliance on personal data?

Arguing for a narrow approach, Zack Mansdorf presented a hypothetical conversation between an occupational health nurse and a worker during which details such as the worker’s body-mass index, personal habits such as smoking and drinking, and even his sexual proclivities are considered relevant to the employer’s “totals” approach. In a darkly comic twist, the nurse informs the worker that because he objects to being assigned to a workplace program, his insurance premiums could rise.

Another speaker skeptical of the totals, Tony Havics, objected to what he characterized as TWH’s focus on “irrelevant” issues such as workers’ eating habits, wage loss, and disability insurance. For Havics, the collection of exposure data outside the workplace is ethically fraught and outside the realm of OEHS.

Proponents of the totals included U.S. Air Force Colonel Kirk Phillips, who has described his efforts on behalf of the totals at previous AIHA conferences and on the SynergistNOW blog. Phillips argued that scientific progress will soon allow people to understand their individual genetic susceptibilities to disease. People will want this information to protect themselves from workplace exposures and will go to other professions if OEHS professionals won’t supply it, Phillips said. He added that workplace OEHS programs protect most, but not all workers; the totals, he said, are an effective way to extend protections to workers who are outliers.

Deborah Nelson implied that opposition to the totals was based on exaggerated fears of employers encroaching on workers’ individual liberty. She commented that the totals represent a natural progression of ideas that have influenced OEHS practice for decades, such as the common understanding that occupational exposure limits for certain chemicals may not be appropriate for workers who have similar exposures outside the workplace. “This is not scary stuff,” Nelson said.

While no judges were present at the debate and no winner was declared, most attendees’ comments in the chat were pro-totals. Still, some commenters expressed unease regarding potential infringements on workers’ privacy and acknowledged that data security is vital to the success of these programs.

For more information on TWH and THE, read Kirk Phillips’ SynergistNOW post and the Synergist articles “A New Approach to the Exposure Sciences: The Promise of Total Exposure Health” and “The Journey to ‘Be Well’: Implementing Total Worker Health in Eugene, Oregon.” More resources on TEH are available from the AIHA website.

Ed Rutkowski is editor in chief of The Synergist.