10 Things to Know About Total Worker Health

1. Safety, health and well-being of the worker is interconnected

We spend over a third of our waking lives working. In 2019, the Bureau of Labor Statistics found that about 24% of people that were employed took their work home with them. Work and home are interconnected. Work can spillover into our personal lives, as well our personal lives can spill over into our work lives, which can strongly impact our safety, health and well-being. Additionally, COVID-19 has introduced new ways in how we work and how we each balance work-life demands to ensure our families stay healthy, well and safe.

Research has shown that work is related to physical and psychological health. Stress at work has been associated with burnout and anxiety, shift work can increase the risk for sleep disorders, and various work-related risk factors have been linked to injury, musculoskeletal disorders, depression, unhealthy lifestyles and many other chronic diseases. Longer work days can impact family well-being, including one’s time to care for their children or aging parents because of competing work demands.

Traditional occupational health and safety programs have focused primarily on keeping workers safe from workplace hazards such as injury risks and harmful exposures. We have since learned that other factors are important to consider as well. Things like wage, work and home environment, shift work, workload, work stress, co-worker and supervisor support have been shown to affect one’s risk for cardiovascular disease and a number of mental health concerns.

Considering a Total Work Health® approach in the workplace can have lasting impacts on safety, health and well-being. For example, promoting a culture of safety and health, such as supervisor role modeling safe practices at work or supporting flexible work schedules to allow employees to take care of health care or home needs can help improve overall satisfaction with work-home life and decrease turn-over.

2. What is a Total Worker Health® approach to improve safety, health and well-being in the workplace?

Total Worker Health® is defined by the National Institute for Occupational Safety and Health (NIOSH) as “policies, programs, and practices that integrate protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being.”

To simplify NIOSH’s definition, the Total Worker Health (TWH) approach is founded on the importance of improving the safety, health and well-being of workers and recognizing that work is a social determinant of health. TWH at its core looks at injury prevention, as well as health protection and promotion in the workplace and at home and recognizes there must be a holistic approach needed for its workers. This process starts from the organizational culture and leadership level, in order to improve and sustain areas of safety, health and well-being.

TWH applies a preventative approach that begins with a workplace that is hazard-free for its’ employees, they will be safer and healthier. Using the Hierarchy of Controls, a tool many occupational health professionals use to help controls hazards in the workplace and protect is worker. The Hierarchy of Controls is seen as a reverse triangle and starts with the most effective way to control a hazard in the workplace:

1. Eliminating or physically removing the hazard

2. Substituting or replacing the hazard

3. Engineering controls or isolating people from the hazard

4. Administrative controls or changing the way people work

5. Protecting the worker with Personal Protective Equipment (PPE).

3. History of TWH

Taking it back a bit, NIOSH started their efforts to improve safety, health and well-being in 2003 through initiatives that would lead to what the TWH approach is today. These initiatives included the 2003 NIOSH Steps to a Healthier US Workforce Initiative and the WorkLife Initiative. In 2011, NIOSH’s renamed these efforts to the Total Worker Health® program that would focus on integrating occupational safety, health protection and health. Learn more about the history of TWH at NIOSH’s website.

NIOSH has funded six different Centers of Excellence for Total Worker Health®. These centers conduct research, education and outreach and evaluation to improve workplace safety, health and well-being around the U.S. to help build scientific based evidence and provide guidance to partners ranging from government, business, labor and community in TWH policies, programs and practices. These TWH Center of Excellences include:

· Oregon Healthy Workforce Center (OHWC) housed in the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University

· Center for Health and Work Environment at Colorado School of Public Health

· Healthier Workforce Center of the Midwest at University of Iowa

· Center for Healthy Work at University of Illinois Chicago

· Center for the Promotion of Health in the New England Workplace (CPH-NEW) at UMass Lowell

· Center for Work, Health and Well-being at Harvard T.H. Chan School of Public Health

4. Fundamentals of TWH

NIOSH has a great start guide to help organizations interested in implementing a TWH approach. This start guide covers the fundamentals of how to adapt and implement TWH policies, programs and practices in your workplace. This guide covers competencies in education and training for TWH which includes a self-assessment tool for your organization, as well as resources for action planning in TWH.

Step 1: Review Fundamentals of TWH Approaches

Element 1:Demonstrate leadership and commitment to worker safety and health at all levels of the organization

Element 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being

Element 3: Promote and support worker engagement through program design and implementation

Element 4: Ensure confidentiality and privacy of workers

Element 5: Issues relevant to advancing worker well-being through TWH

Step 2: Assess where your organization is on the TWH continuum

Access the TWH Organizational Self Assessment Worksheet

Step 3: Develop an action plan to start implementing TWH

Access the TWH Action Plan

5. Issues Relevant to TWH

NIOSH has put together a list of areas to consider to help advance and improve safety, health, and well-being in the workplace. The “Issues Relevant to Advancing Worker Well-being Using Total Worker Health® Approaches,” list was recently revised in January 2020.

Some areas include: Prevention and control hazards and exposures, the built environment, community support, compensation and benefits, healthy leadership, organization of work, policies, technology, work arrangements and workforce demographics. Each of these categories include examples of policies and practices in TWH an organization can address.

See the complete list in this PDF provided by NIOSH

Credit NIOSH: Issues Relevant to Advancing Worker Well-Being Using Total Worker Health Approaches

6. Priority areas and emerging issues in safety, health and well-being at work

There are many evolving areas that NIOSH would like to address in regards to the future of work and the safety, health and well-being of the worker. These TWH priority areas include opioids and other substance use disorder in the workplace, TWH outreach, education and training, measuring well-being, the future of work, as well as healthy work design and well-being. These areas are complex and require continuing research, community outreach and education, dissemination of TWH tools and toolkits as well as partner collaboration.

7. Case studies

NIOSH shares many promising practices and case studies of TWH that covers a wide range of industries. These examples of government agencies like the National Park Service and NASA, in addition to police, departments, hospitals to universities.

Small businesses and larger organizations are starting their journey and taking steps towards improving workplace safety, health and well-being. Strategies for some of these workplaces include embedding well-being into the organizational culture, improving safety culture, reducing job stressors, problem solving and team work for an aging workforce and injury prevention training and education just to name a few.

Each quarter, NIOSH publishes a TWH newsletter that includes case studies and examples on how organizations are using TWH approaches. This newsletter gives great insight on TWH research, updates from the NIOSH Centers of Excellence for TWH, as well as helpful resources and educational opportunities.

Photo by Edward Jenner from Pexels.com

8. Not-for-profit and government organizations can join the NIOSH TWH Affiliate Program

There are many opportunities to get your workplace involved. The mission of the NIOSH Total Worker Health® Affiliate Program is to foster an integrated approach to protecting and promoting worker well-being through collaborations with not-for-profit and government organizations.

TWH affiliates include academic institutions, labor organizations, public sector entities, such as federal, state or local government agencies, as well as non-profit associations that area related to occupational safety and health. These affiliates often collaborate in NIOSH TWH activities such as:

  • Conducting joint research
  • Develop programs, interventions and other products
  • Collaborate on seminars, meetings, trainings and educational events
  • Create and disseminate publications and other communication products
  • Cross promote individual and joint activities

9. How can your organization start incorporating TWH?

Start by making the business case and approach your leadership and gain support on how TWH can benefit the organization and employees. Getting leadership support and having a champion in your workplace is important for driving policy change and resources for your program.

Identifying the needs of your organization is important and so are the baby steps into incorporating TWH. This can be done conducting something like an assessment or survey to see what type of current program and policies are already in place. An assessment of current programming can help set priority areas and goals for your workplace.

It is important to plan, assess, and evaluate your efforts to help measure your program impact and success, but it is beyond measuring just the Return of Investment (ROI) or the financial piece of the equation. Measuring areas like participation, as well as mental, social and emotional well-being impacts of programs are just as applicable when it is geared towards understanding the safety, health and well-being needs of your workforce.

10. Where can I find more resources and training on TWH?

There are various places you can access webinars and training on TWH. Some great places to start include:

· NIOSH Total Worker Health Calendar

· Total Worker Health webinar series

· NIOSH recorded Total Worker Health trainings

· NIOSH’s book on Total Worker Health®

· International Symposia to Advance TWH

· Graduate training, certificate and degree programs

· Oregon Healthy Workforce Center Training and Symposia recordings

· What’s Work Got To Do With It? podcast episode on TWH?

· Workplace TWH Toolkits and Tools

We spend much of our waking hours at work. It is inevitable that factors at the workplace contribute to our health and well-being, both at work and at home. There is growing research and evidence in the impacts of Total Worker Health® approaches at work can improve the well-being of the U.S. workforce, as well as protect the safety and health of the worker.

The future of work is bright and will keep changing as technology and the ways we work evolve. It is important for each of us to keep adapting to these changes and collaborate with our leadership and communities to keep our workforce safety, health and well. Tune in for our next article that will share an organizational approach to support workplace safety, health and well-being.

Article by: Helen Schuckers, MPH, Dissemination Specialist and Research Associate at Oregon Healthy Workforce Center and Oregon Institute of Occupational Health Sciences at OHSU

This work was supported by the Oregon Healthy Workforce Center, a National Institute for Occupational Safety and Health (NIOSH) Total Worker Health Center of Excellence [grant number U19OH010154]. This work was also partly supported by the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University via funds from the Division of Consumer and Business Services of the State of Oregon (ORS 656.630).



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