In following the social-ecological model, it is important that integrated health programs include efforts both to create healthy work environments and support individual workers to change health-related behaviors. Accordingly, the effectiveness of occupational health and worksite health promotion programs can be enhanced when coordinated interventions aim to promote worker health through direct education for individuals and their families by building social support and establishing social norms that encourage healthy behaviors, by assuring that policies and management actions provide a healthy workplace, and through linking worksite efforts to broader community and public policy initiatives that promote worker health (Linnan et al., 2001) (see also Figures 3-2 and 4-2).

This model also provides a framework for moving beyond the individual as the locus of intervention and responsibility for health, in recognition of management’s central role in worker health (Sorensen, 2000). Thus, effective programs need to be aimed at and coordinated across multiple levels of influence. The following discussion provides a structure for the specific program information presented below.

Environmental- and organizational-level systems include the organizational context, management, and policy structures that support worker health by providing a healthy and safe work environment. Reducing the potential for hazardous work exposures within the work environment is the first line of defense for ensuring occupational health and safety. These environmental systems can also present both barriers and facilitators to individual worker health choices in the worksite. For example, social norms, availability, and accessibility are strongly influenced by environmental-level systems (Schmid et al., 1995). Management commitment to an integrated worker health program provides a key foundation for success (DeJoy and Southern, 1993; Sorensen, 2000).

Management participation in individual-level programs is essential to their success. Leaders can become role models, uniting the organizational vision for health with its mission, as well as providing support and encouragement for employee participation. Programs at the individual or interpersonal level focus particularly on educating individual workers and building social norms supportive of worker health, through mechanisms such as educational classes or one-on-one training programs (Refer to Chapter 2 for a description of NASA’s preventive health programs, the NASA Occupational Health website, and the NASA Health Promotion