Total Worker Health is a
trademarked
A trademark (also written trade mark or trade-mark) is a type of intellectual property consisting of a recognizable sign, design, or expression that identifies products or services from a particular source and distinguishes them from others. ...
strategy
Strategy (from Greek στρατηγία ''stratēgia'', "art of troop leader; office of general, command, generalship") is a general plan to achieve one or more long-term or overall goals under conditions of uncertainty. In the sense of the "art ...
defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. It was conceived and is funded by the
National Institute for Occupational Safety and Health (NIOSH). Total Worker Health is tested and developed in six Centers of Excellence for Total Worker Health in the United States.
[ ]
Definition
Total Worker Health (TWH) is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.
Traditional
occupational safety and health
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
protection programs have primarily focused on ensuring that work is safe and that workers are protected from the harms that arise from work itself.
TWH builds on this approach through the recognition that work is a
social determinant of health. Job-related factors such as wages, hours of work, workload and stress levels, interactions with coworkers, and access to leave and healthful workplaces all can have an important impact on the well-being of workers, their families, and their communities. TWH explores opportunities to not only protect workers, but also ''advance'' their health and well-being by targeting the conditions of work. Scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to health problems previously considered unrelated to work. For example, there are work-related risk factors for abnormal weight fluctuations, sleep disorders, cardiovascular disease, depression, and other health conditions. In recognition of these emerging relationships, the TWH approach focuses on how environmental, workplace factors can both mitigate and enhance overall worker health beyond traditional occupational safety and health concerns.
The five Defining Elements of TWH are:
* Defining Element of TWH 1: Demonstrate leadership commitment to worker safety and health at all levels of the organization.
* Defining Element of TWH 2: Design work to eliminate or reduce safety and health hazards and promote worker well-being.
* Defining Element of TWH 3: Promote and support worker engagement throughout program design and implementation.
* Defining Element of TWH 4: Ensure confidentiality and privacy of workers.
* Defining Element of TWH 5: Integrate relevant systems to advance worker well-being.
Hierarchy of controls applied to Total Worker Health
![Hierarchy of Controls Applied to Total Worker Health](https://upload.wikimedia.org/wikipedia/commons/a/ac/Hierarchy_of_Controls_Applied_to_Total_Worker_Health.jpg)
The Hierarchy of Controls Applied to NIOSH Total Worker Health is a conceptual model for prioritizing efforts to advance the safety, health, and well-being of all workers. This model applies the framework of ''Total Worker Health'' approaches to the traditional
Hierarchy of Controls used in occupational safety and health. Like the traditional Hierarchy of Controls, strategies are presented in order of expected effectiveness, from top to bottom.
# The first strategy is "Eliminate workplace conditions that threaten worker safety, health, and well-being."
# The second strategy is "Substitute health-enhancing policies, programs, and practices." This suggests replacing unsafe, unhealthy working conditions with policies, programs, and management practices that improve the culture of safety and health in the workplace.
# The third strategy is "Redesign the work environment for safety, health, and well-being."
# The fourth strategy is "Educate for safety and health." This suggests providing safety and health education and resources to enhance individual knowledge for all workers.
# The fifth strategy is "Encourage personal change."
The hierarchy suggests that eliminating or reducing recognized hazards in the workplace is the most effective means of prevention. However, hazards that are difficult or impossible to eliminate can be managed through engineering, administrative, or individual-level interventions. Based on this hierarchy, workplace programs using a TWH approach may emphasize elimination or control of workplace safety and health hazards as the primary goal.
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Issues
![Issues Relevant to Advancing Worker Well-Being Using Total Worker Health Approaches](https://upload.wikimedia.org/wikipedia/commons/0/07/Issues_Relevant_to_Advancing_Worker_Well-Being_Using_Total_Worker_Health_Approaches.png)
The accompanying graphic, “Issues Relevant to Advancing Worker Well-Being Using ''Total Worker Health'' Approaches” illustrates a wide-ranging list of issues that are relevant to advancing worker safety, health, and well-being. Revised in January 2020, this list reflects an expanded focus for TWH that recognizes workplace and work issues such as innovative technologies, working conditions, and emerging forms of employment that present new risks for today’s and tomorrow’s workforce. Additionally, this expanded focus recognizes that there are linkages between health conditions that may not arise from work but that can be adversely affected by work. Understanding, preventing, and reducing these risks are important elements of TWH. A TWH approach advocates for the integration of all organizational policies, programs, and practices that contribute to worker safety, health and well-being, including those relevant to the prevention and control of hazards and exposures, built environment supports, community supports, compensation and benefits, healthy leadership, organization of work, policies, technology, work arrangements, and workforce demographics.
History
Background
''Total Worker Health'' originated from the ''Steps to a Healthier US Workforce'' symposium in October 2004, which sought to bring together knowledge and experience of
health protection and
health promotion
Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."
Scope
The WHO's 1986 Ottawa Charter for Healt ...
, in order to stimulate action for the development of programs. The symposium developed around themes of research, practice and policy related to the integration of health protection and health promotion.
By 2005, the initiative was redeveloped from the ''Steps to a Healthier US Workforce'' Symposium and renamed the NIOSH WorkLife Initiative. The WorkLife Initiative supported addressing worker health and
well-being
Well-being, or wellbeing, also known as wellness, prudential value or quality of life, refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimately good ''for'' this person, what is in th ...
in a novel way, by addressing the physical and organizational work environment concurrently with personal health decisions and behaviors of individuals. In September 2007, NIOSH and 35 other sponsors conducted the "WorkLife 2007: Protecting and Promoting Worker Health" symposium. Collaborators at the symposium, which included leaders from labor, business and academic communities provided evidence of work and health benefits from integrated approaches, case studies, and anecdotal reports. The overall consensus was that such integrated work-based programs, if executed and sustained properly, can be good for worker health and business.
[
In 2008, collaborators at NIOSH and the Centers of Excellence developed 10 recommendations, grouped in practice, research and policy, as a long-range strategy for advancing the WorkLife Initiative. These recommendations were based on evidence-based practice and research-to-practice initiatives.] In 2011, a collaborative symposium with other federal agencies culminated in the "Healthier Federal Workers 2011 Symposium", which applied the integrated work health approaches to federal employees.[
]
Expansion
In 2011, NIOSH WorkLife became "Total Worker Health" to better convey the more comprehensive approach to workplace prevention. The year 2012 marked the publication of ''The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012'' presenting the rationale for the TWH approach. These papers noted that a small, but growing body of evidence suggests that integrating occupational safety and health protection program activities with other workplace policies, programs, and practices is more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own. In 2014, NIOSH created the Office for TWH Coordination and Research Support (Office for TWH) to coordinate and advance these extramural and intramural efforts.
The 1st International Symposium to Advance ''Total Worker Health'' was first held October 6–8, 2014 at the National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
Natcher Center. The year 2015 marked developments for the program and Office, including the U.S. Patent and Trademark Office
The United States Patent and Trademark Office (USPTO) is an agency in the U.S. Department of Commerce that serves as the national patent office and trademark registration authority for the United States. The USPTO's headquarters are in Alexa ...
’s granting of the mark “Total Worker Health” as an official registered trademark
A trademark (also written trade mark or trade-mark) is a type of intellectual property consisting of a recognizable sign, design, or expression that identifies products or services from a particular source and distinguishes them from others ...
of the U.S. Department of Health and Human Services; the launch of the first Center within TWH, th
National Center for Productive Aging and Work
and a NIH
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
-cohosted Pathways to Prevention Workshop titled: “Total Worker Health—What’s Work Got to Do with It?”.
In 2016, the NIOSH Office for Total Worker Health released a National Occupational Research Agenda The National Occupational Research Agenda (NORA) is a partnership program developed by the National Institute for Occupational Safety and Health (NIOSH). The program was founded in 1996 to provide a framework for research collaborations among univer ...
(NORA) ''National Total Worker Health Agenda'' to define and prioritize activities for 2016–2026, and published ''Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being''. That same year, NIOSH funded six Centers of Excellence to conduct research on the concepts of ''Total Worker Health''. In 2017, three universities launched certificate programs for TWH. In 2018, the National Institute for Occupational Safety and Health hosted the 2nd International Symposium to Advance ''Total Worker Health''. The year 2019 marked the first TWH publication, Edited Volume on ''Total Worker Health''.
NIOSH programs
NIOSH has funded ten Centers of Excellence for Total Worker Health in the United States to explore and research concepts of TWH, such as pilot testing policies and programs, building a scientific evidence base developing new solutions, developing and disseminating best practices and tool kits, developing strategies for overcoming barriers to organizational adoption, and applying physiological and biological markers
In biomedical contexts, a biomarker, or biological marker, is a measurable wikt:indicator, indicator of some biological state or condition. Biomarkers are often measured and evaluated using blood, urine, or soft tissues to examine normal biologic ...
of stress, sleep, and depression. The ten NIOSH Centers of Excellence for ''Total Worker Health'' are at the University of California San Francisco
The University of California, San Francisco (UCSF) is a public land-grant research university in San Francisco, California. It is part of the University of California system and is dedicated entirely to health science and life science. It condu ...
, University of Colorado
The University of Colorado (CU) is a system of public universities in Colorado. It consists of four institutions: University of Colorado Boulder, University of Colorado Colorado Springs, University of Colorado Denver, and the University of Co ...
School of Public Health, University of Massachusetts Lowell
The University of Massachusetts Lowell (UMass Lowell and UML) is a public research university in Lowell, Massachusetts, with a satellite campus in Haverhill, Massachusetts. It is the northernmost member of the University of Massachusetts public u ...
and University of Connecticut
The University of Connecticut (UConn) is a public land-grant research university in Storrs, Connecticut, a village in the town of Mansfield. The primary 4,400-acre (17.8 km2) campus is in Storrs, approximately a half hour's drive from Hart ...
jointly, Harvard-T.H. Chan School of Public Health, University of Iowa
The University of Iowa (UI, U of I, UIowa, or simply Iowa) is a public university, public research university in Iowa City, Iowa, United States. Founded in 1847, it is the oldest and largest university in the state. The University of Iowa is org ...
, Johns Hopkins University
Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private university, private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hem ...
, Oregon Institute of Occupational Health Science, University of Illinois-Chicago
The University of Illinois Chicago (UIC) is a public research university in Chicago, Illinois. Its campus is in the Near West Side community area, adjacent to the Chicago Loop. The second campus established under the University of Illinois sy ...
, University of North Carolina at Chapel Hill
A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States ...
, and University of Utah School of Medicine
The University of Utah School of Medicine is located on the upper campus of the University of Utah in Salt Lake City, Utah. It was founded in 1905 and is currently the only MD-granting medical school in the state of Utah.
History
The school began ...
.
NIOSH also runs the Total Worker Health Affiliate Program to foster an integrated approach to protecting and promoting worker well-being through collaborations with academic, labor, nonprofit, and government organizations.
Research
National Total Worker Health Agenda
In 2016, the NIOSH Office for Total Worker Health released a National Occupational Research Agenda The National Occupational Research Agenda (NORA) is a partnership program developed by the National Institute for Occupational Safety and Health (NIOSH). The program was founded in 1996 to provide a framework for research collaborations among univer ...
(NORA) National Total Worker Health Agenda to define and prioritize occupational safety and health research, practice, and prevention activities for 2016–2026. The Agenda, representing the first time a TWH-specific NORA has been created, builds on an earlier draft released in September 2014.
NIOSH invited stakeholders to provide comment on this draft agenda. In 2015, in response to stakeholder input received, the TWH definition was expanded and the TWH approach was more finely focused in the final Agenda. The refined description better reflects the priorities of the program, and helps to overcome the equating of TWH with traditional workplace wellness programs that do not integrate worker protection elements. TWH continues to place priority upon a hazard-free work environment that protects the safety and health of all workers.
Sit-stand workstations
Concerns over the increasingly sedentary lifestyle
Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socia ...
of individuals and the associated health risks lead to this development. A study from a large sample of Australian adults found that prolonged sitting was a risk factor for all-cause mortality, independent of physical activity. Sit-stand workstations are custom-built computer workstations, allowing the user to adjust the height of the workplace envelope and to work while standing. With the implementation of sit-stand workstations, individuals will be able to reduce sedentary time while at work, thereby improving health outcomes, and possibly improving work productivity.
Published research in 2012 on the benefits from implementing sit-stand workstations in the workplace has resulted in the development of some pilot studies for Total Worker Health. While the individual results of the studies varied, the researchers found that sit-stand workstations resulted in an overall improvement in health outcomes of workers who switched to these workstations, in addition to the reduced sitting time. Such health benefits from these pilot studies include increased HDL cholesterol
High-density lipoprotein (HDL) is one of the five major groups of lipoproteins. Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules (lipids) around the body within the water outside cells. They are t ...
, improved mood outcomes, reduced eye strain, and reduced upper back, neck and shoulder pain. Robertson et al. found that the sit-stand workstation users, who were trained to vary their postures at work, exhibited increased productivity at work, compared to those who were not trained so.[ Further, the study by Pronk et al. showed decreased ]fatigue
Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
and increased vigor among participants.[ With these findings, NIOSH has begun a pilot program among employees for the ''Total Worker Health'' initiative.]
Health care workers
Several studies out of the Harvard Center for Work, Health and Wellbeing have focused on the relationships between work context and quality of life measures for health care workers. A survey of over 1500 hospital patient care workers examined the relationships between health outcomes (lower back pain
Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeli ...
, inadequate physical activity
Physical activity is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/ ...
, and sleep deprivation
Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either chronic or acute and may vary ...
) and work context measures. Inadequate physical activity and sleep deficiency were associated, while lower back pain was not significantly related to either stressor.[
Work context measures, such as low supervisor support, harassment at work, job title, and job culture were found to be associated with the quality of life and health outcomes for the hospital care workers.][
]
Aging workforce
Aging in the American workforce
The birth rate of the United States has declined in recent decades. Some demographers project a progressively aging and shrinking population and workforce; a trend already occurring in developed countries around the world. There is debate over th ...
, the rapidly increasing numbers of older workers (ages 55 and above) comprising the workforce in the United States, could have significant impacts to the economy, social security benefits, occupational safety and health, health care, and American society as a whole. Researchers from the American College of Occupational and Environmental Medicine (ACOEM) and NIOSH convened a national Invitational Summit on ‘’Advancing Workplace Health Protection and Promotion in the Context of an Aging Workforce’’ to address several questions and to develop consensus statements and recommendations for a national approach to tackle these issues. These issues included why employers should care about aging in the workplace, how to establish best practices to maximize health and productivity of aging workers, how organizational structures can better approach aging in the workplace, what are the barriers to integrating health protection and promotion programs for aging workers, and what tools, programs, and resources exist to overcome the barriers.[ Some of the consensus statements conceived during this summit include creating a “culture of health” throughout the workplace, creating “age-friendly” programs and policies, increasing the use of incentives to impact change, integrating workforce health as a standard business measures, conducting new research and models to analyze data, and creating a new culture of “shared accountability.”][
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Implementation
Various companies have implemented integrated health protection and health promotion management programs successfully, with documented health improvements and cost savings. Each integrated program varies a bit in focus areas and in implementation, but follow the components of ''Total Worker Health''. Examples of companies that have yielded successful results from their programs include Caterpillar
Caterpillars ( ) are the larval stage of members of the order Lepidoptera (the insect order comprising butterflies and moths).
As with most common names, the application of the word is arbitrary, since the larvae of sawflies (suborder Sym ...
, FedEx
FedEx Corporation, formerly Federal Express Corporation and later FDX Corporation, is an American multinational conglomerate holding company focused on transportation, e-commerce and business services based in Memphis, Tennessee. The name "Fe ...
, Dow Chemical
The Dow Chemical Company, officially Dow Inc., is an American multinational chemical corporation headquartered in Midland, Michigan, United States. The company is among the three largest chemical producers in the world.
Dow manufactures plastics ...
and Perdue Farms
Perdue Farms is the parent company of Perdue Foods and Perdue AgriBusiness, based in Salisbury, Maryland. Perdue Foods is a major chicken, turkey, and pork processing company in the United States. Perdue AgriBusiness ranks among the top United S ...
.[
]
See also
*Health promotion
Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."
Scope
The WHO's 1986 Ottawa Charter for Healt ...
*Lifestyle management programme A lifestyle management programme (also referred to as a health promotion programme, health behaviour change programme, lifestyle improvement programme or wellness programme) is an intervention designed to promote positive lifestyle and behaviour cha ...
*Occupational health psychology
Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers.Schonfeld, I.S., & Chang, C.-H. (2017). ''Occupational health psychology: Work, stress, and health''. New York, ...
*''Occupational Health Science
''Occupational Health Science'' is a quarterly peer-reviewed public health journal that covers research on occupational health including empirical and theoretical articles on psychological and behavioral components of occupational health. Amo ...
''
*Occupational hygiene
Occupational hygiene (United States: industrial hygiene (IH)) is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from hazards at work that may result in injury, illness, or affect the well being of work ...
*Occupational safety and health
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
*Participatory ergonomics Industrial ergonomics programs seek to identify and correct factors that negatively impact the physical health of their workers. Participatory ergonomics programs seek to maximize the involvement of the workers in this process based on the simple fa ...
*Prevention through design
Prevention through design (PtD), also called safety by design usually in Europe, is the concept of applying methods to minimize occupational hazards early in the design process, with an emphasis on optimizing employee health and safety throughout ...
* Workplace health promotion
*Workplace wellness
Workplace wellness, also known as corporate wellbeing outside the United States, is a broad term used to describe activities, programs, and/or organizational policies designed to support healthy behavior in the workplace. This often involves healt ...
References
{{reflist
External links
Official NIOSH webpage for Total Worker Health
Occupational health psychology
Human resource management
Occupational safety and health
Public health in the United States
Workplace