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461:(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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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.
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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.
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438:) 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.
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409:, 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
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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.
55:. 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
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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
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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
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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
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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.
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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,
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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
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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
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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
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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
376:(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.
457:, 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
425:
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
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Loeppke, Ronald R.; Schill, Anita L.; Chosewood, L. Casey; Grosch, James W.; Allweiss, Pamela; Burton, Wayne T.; Barnes-Farrell, Janet L.; Goetzel, Ron Z.; Heinen, LuAnn; Hudson, T. Warner; Hymel, Pamela; Merchant, James; Edington, Dee W.; Konicki, Doris L.; Larson, Paul W. (2013).
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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
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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.
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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
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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
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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.
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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.
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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
42:
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.
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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.
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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
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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
195:, 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.
1097:"Integrated Interventions for Improving Total Worker Health: A Panel Report From the National Institutes of Health Pathways to Prevention Workshop: Total Worker Health—What's Work Got to Do With It?"
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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.
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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
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Robertson, MM; Ciriello, VM; Garabet, AM (2012). "Office ergonomics training and a sit-stand workstation: effects on musculoskeletal and visual symptoms and performance of office workers".
274:. 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
244:
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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.
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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
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used in occupational safety and health. Like the traditional
Hierarchy of Controls, strategies are presented in order of expected effectiveness, from top to bottom.
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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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1036:"CDC – NIOSH Publications and Products – The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012 (2012–146)"
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NIOSH has funded ten Centers of Excellence for Total Worker Health in the United States to explore and research concepts of TWH, such as
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van der Ploeg, HP; Chey, T; Korda, RJ; Banks, E; Bauman, A (2012). "Sitting time and all-cause mortality in 222497 Australian adults".
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Pilot studies of sit-stand workstations have shown reductions in sedentary time and possible indications of improved health outcomes.
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34:. Total Worker Health is tested and developed in six Centers of Excellence for Total Worker Health in the United States.
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Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being
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and increased vigor among participants. With these findings, NIOSH has begun a pilot program among employees for the
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Symposium and renamed the NIOSH WorkLife Initiative. The WorkLife Initiative supported addressing worker health and
1014:"CDC – Total Worker Health WorkLife Transitions to Total Worker Health – NIOSH Workplace Safety and Health Program"
539:
1610:"Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace"
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Cherniack, Martin; Henning, Rob; Merchant, James A.; Punnett, Laura; Sorensen, Laura R.; Wagner, Gregory (2011).
534:
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Sorensen, G; Stoddard, AM; Stoffel, S; Buxton, O; Sembajwe, G; Hashimoto, D; Dennerlein, JT; Hopcia, K (2011).
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The first strategy is "Eliminate workplace conditions that threaten worker safety, health, and well-being."
23:
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255:-cohosted Pathways to Prevention Workshop titled: “Total Worker Health—What’s Work Got to Do with It?”.
943:"CDC – Total Worker Health History of Total Worker Health – NIOSH Workplace Safety and Health Program"
1291:"NIOSH Response to Summarized Stakeholders' Comments on Proposed National Total Worker Health Agenda"
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1389:"Reducing occupational sitting time and improving worker health: The Take-a-Stand Project, 2011"
270:. That same year, NIOSH funded six Centers of Excellence to conduct research on the concepts of
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Demonstrate leadership commitment to worker safety and health at all levels of the organization.
1148:"CDC – Research Program Development & Collaboration – NIOSH Office for Total Worker Health"
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1503:"The Role of the Work Context in Multiple Wellness Outcomes for Hospital Patient Care Workers"
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Natcher Center. The year 2015 marked developments for the program and Office, including the
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The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012
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Design work to eliminate or reduce safety and health hazards and promote worker well-being.
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474:. Examples of companies that have yielded successful results from their programs include
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The third strategy is "Redesign the work environment for safety, health, and well-being."
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symposium in October 2004, which sought to bring together knowledge and experience of
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652:"Prevalence of Obesity Among U.S. Workers and Associations with Occupational Factors"
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Promote and support worker engagement throughout program design and implementation.
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Luckhaupt, Sara E.; Cohen, Martha A.; Li, Jia; Calvert, Geoffrey M. (2014-03-01).
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The accompanying graphic, “Issues Relevant to Advancing Worker Well-Being Using
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1197:"Graduate Training, Certification Programs & Degree Programs | NIOSH | CDC"
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Alkhajah, TA; Reeves, MM; Eakin, EG; Winkler, EA; Owen, N; Healy, GN (2012).
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1558:"Advancing Workplace Health Protection and Promotion for an Aging Workforce"
1344:"Sit-stand workstations: a pilot intervention to reduce office sitting time"
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Seventy-year-old miner emerging from his coal mine in eastern Pennsylvania.
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of stress, sleep, and depression. The ten NIOSH Centers of Excellence for
903:"Hierarchy of Controls Applied to NIOSH Total Worker Health | NIOSH | CDC"
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Issues Relevant to Advancing Worker Well-Being Through Total Worker Health
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239:’s granting of the mark “Total Worker Health” as an official registered
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developed by the National Institute for Occupational Safety and Health
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278:. The year 2019 marked the first TWH publication, Edited Volume on
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This article incorporates text from this source, which is in the
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This article incorporates text from this source, which is in the
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This article incorporates text from this source, which is in the
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to define and prioritize activities for 2016–2026, and published
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1267:"CDC – Total Worker Health Topics – NIOSH Total Worker Health"
372:
In 2016, the NIOSH Office for Total Worker Health released a
258:
In 2016, the NIOSH Office for Total Worker Health released a
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National Institute for Occupational Safety and Health (NIOSH)
1175:"CDC – NIOSH Centers of Excellence for Total Worker Health"
860:"NIOSH Publication Page for Fundamentals of TWH Approaches"
459:
American College of Occupational and Environmental Medicine
94:
Integrate relevant systems to advance worker well-being.
1095:; Ortega, Alexander N.; Curry, Susan J. (2016-08-16).
99:
Hierarchy of controls applied to Total Worker Health
1562:Journal of Occupational and Environmental Medicine
1507:Journal of Occupational and Environmental Medicine
1387:Pronk, NP; Katz, AS; Lowry, M; Payfer, JR (2012).
141:The fifth strategy is "Encourage personal change."
572:"Total Worker Health: Frequently Asked Questions"
247:; the launch of the first Center within TWH, the
198:By 2005, the initiative was redeveloped from the
1475:"CDC – NIOSH Science Blog – NIOSH Takes a Stand"
627:"WHO | What are social determinants of health?"
333:Oregon Institute of Occupational Health Science
1641:Official NIOSH webpage for Total Worker Health
88:Ensure confidentiality and privacy of workers.
839:"Fundamentals of TWH Approaches Workbook PDF"
249:National Center for Productive Aging and Work
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245:U.S. Department of Health and Human Services
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966:"Statement on National WorkLife Priorities"
341:University of North Carolina at Chapel Hill
227:The 1st International Symposium to Advance
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321:Harvard-T.H. Chan School of Public Health
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231:was first held October 6–8, 2014 at the
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16:Management strategy for worker wellbeing
1091:Bradley, Cathy J.; Grossman, David C.;
970:American Journal of Industrial Medicine
812:"NIOSHTIC-2 Search Results – Full View"
788:"NIOSHTIC-2 Search Results – Full View"
764:"NIOSHTIC-2 Search Results – Full View"
740:"NIOSHTIC-2 Search Results – Full View"
716:"NIOSHTIC-2 Search Results – Full View"
692:"NIOSHTIC-2 Search Results – Full View"
656:American Journal of Preventive Medicine
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63:The five Defining Elements of TWH are:
1242:"Edited Volume on Total Worker Health"
305:University of California San Francisco
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515:Occupational Health Science (journal)
374:National Occupational Research Agenda
345:University of Utah School of Medicine
260:National Occupational Research Agenda
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1070:"TWH Symposium on NIOSH TWH Website"
368:National Total Worker Health Agenda
360:National Total Worker Health Agenda
264:National Total Worker Health Agenda
1676:Public health in the United States
313:University of Massachusetts Lowell
14:
1222:"A Total Worker Health Symposium"
603:"CDC – NIOSH Total Worker Health"
200:Steps to a Healthier US Workforce
185:Steps to a Healthier US Workforce
107:Hierarchy of Controls Applied to
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237:U.S. Patent and Trademark Office
1321:10.1001/archinternmed.2011.2174
455:Aging in the American workforce
396:Concerns over the increasingly
1671:Occupational safety and health
1661:Occupational health psychology
525:Occupational safety and health
510:Occupational health psychology
505:Lifestyle management programme
337:University of Illinois-Chicago
120:approaches to the traditional
48:occupational safety and health
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574:. Centers for Disease Control
233:National Institutes of Health
1575:10.1097/jom.0b013e31829613a4
1519:10.1097/JOM.0b013e318226a74a
1453:10.1016/j.apergo.2012.05.001
1363:10.1016/j.amepre.2012.05.027
669:10.1016/j.amepre.2013.11.002
53:social determinant of health
1101:Annals of Internal Medicine
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540:Workplace health promotion
92:Defining Element of TWH 5:
86:Defining Element of TWH 4:
80:Defining Element of TWH 3:
74:Defining Element of TWH 2:
68:Defining Element of TWH 1:
1666:Human resource management
535:Prevention through design
317:University of Connecticut
311:School of Public Health,
1608:Goetzel, Ron Z. (2005).
1049:10.26616/NIOSHPUB2012146
873:10.26616/NIOSHPUB2017112
530:Participatory ergonomics
329:Johns Hopkins University
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309:University of Colorado
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122:Hierarchy of Controls
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1072:. September 14, 2017
520:Occupational hygiene
183:originated from the
1405:10.5888/pcd9.110323
1093:Hubbard, Rebecca A.
472:Total Worker Health
421:Health care workers
415:Total Worker Health
398:sedentary lifestyle
301:Total Worker Health
280:Total Worker Health
276:Total Worker Health
272:Total Worker Health
229:Total Worker Health
181:Total Worker Health
164:Total Worker Health
118:Total Worker Health
109:Total Worker Health
20:Total Worker Health
982:10.1002/ajim.20900
545:Workplace wellness
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325:University of Iowa
297:biological markers
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436:sleep deprivation
432:physical activity
189:health protection
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