Combined with the more traditional employer occupational safety and health protection activities are newer employment-based programs to promote better health through helping workers quit smoking, lose weight, reduce stress, or exercise more regularly. In support of these efforts, some employers have made changes in their policies and facilities to support physical activity and healthier eating, and some employers connect with community resources for health education, health fairs, and other services. From company to company, the interest in, resources for, and ability to do more for employee health and well-being vary. Employees’ interest in, needs for, and priorities for these types of programs also vary.
This diverse array of activities most typically has been planned, managed, and assessed—to the extent they exist in the workplace at all—by different, often uncoordinated departments within the business entity. Some employers have reconceptualized their safety, prevention, and promotion initiatives and attempted to bring them together into a coherent whole. The National Institute for Occupational Safety and Health (NIOSH) has supported this integration, defining Total Worker HealthTM2
1The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.
2The National Institute for Occupational Safety and Health asserts common law trademark rights for the term Total Worker Health.
as “a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.”3
In May 2014, with support from NIOSH, the Institute of Medicine (IOM) organized a 1-day workshop on Total Worker Health. Rather than a review of published literature, this workshop sought input from a wide variety of on-the-ground stakeholders regarding their experiences with integrating occupational safety and health protection with health promotion in the workplace. Box 1-1 lists the workshop’s formal statement of task.
Statement of Task
An ad hoc planning committee of the Institute of Medicine will develop and conduct a public workshop focused on identifying prevalent and best practices in programs that integrate occupational safety and health protection with health promotion in small, medium, and large workplaces; employer and employee associations; academia; government agencies; and other stakeholder groups.
The workshop will feature invited presentations and discussions on:
- Best or promising practices associated with the design, implementation, and evaluation of an integrated approach to worker health, including factors associated with successful implementation;
- Barriers to implementing integrated occupational safety and health protection and health promotion programs and ideas for overcoming those barriers; and
- Measures being used or considered for evaluating the effectiveness of programs that integrate occupational safety and health protection with health promotion.
An ad hoc committee, chaired by Glorian Sorensen, Professor of Social and Behavioral Sciences, Harvard School of Public Health, and Vice President for Faculty Development, Dana-Farber Cancer Institute,4 developed the workshop agenda. Effective implementation of good practices was a prime concern of the committee, not only through the identification of implementation barriers, but ways to address and even overcome them. Committee members placed an additional emphasis on the importance of program evaluation. The committee was careful to ensure the agenda offered a range of perspectives, and to include programs operating among employers of different sizes and types of industries. As a result, speakers and panelists represented both blue- and white-collar settings, including government, health care, manufacturing, energy, and chemicals.
A wide range of common approaches is used within worksites to promote and protect worker health. Sorensen noted that, by and large, these can be divided into the following four principal categories:
- Supporting healthy behavior (e.g., health screening, creating a health-promoting environment),
- Preventing work-related illnesses and injuries (e.g., controlling workplace hazards, improved ergonomics),
- Reducing work-related stress (e.g., fostering social support among workers, supporting work-family balance through flexible schedules), and
- Expanding work-related resources and opportunities (e.g., medical benefits, paid sick and personal leave, child and elder care services, job training, adequate wages).
4Dr. Sorensen is also the principal investigator for one of four NIOSH Centers of Excellence for Total Worker Health, which are: the Center for the Promotion of Health in the New England Workplace (at the Universities of Connecticut and Massachusetts); the Oregon Healthy Workforce Center; the University of Iowa Healthier Workforce Center for Excellence; and the Harvard School of Public Health Center for Work, Health, and Well-Being. See more information at http://www.cdc.gov/niosh/twh/centers.html (accessed July 21, 2014).
Typically, these strategies are managed in a very siloed fashion by people with different professional training, she said. For example, illness and injury prevention may be the domain of workplace safety officers trained in industrial hygiene, engineering, or occupational safety. Reducing work-related stress—if it is anyone’s explicit responsibility—may be delegated to frontline managers, while benefits expansion falls within the purview of human resources professionals and departments. Total Worker Health programs, by contrast, attempt to integrate these activities and skills.
The NIOSH Total Worker Health Centers of Excellence focus on melding occupational safety and health protection with health promotion activities, Sorensen said. As a result, instead of assuming that individual workers are responsible for their own health-related behavior—as in traditional health promotion programs—and that management is responsible for safety and health protection, under an integrated approach, the responsibility is shared. This type of rethinking changes many underlying assumptions about planning and implementing potential programmatic innovations for employers.
A range of research has looked at the benefits of integrated approaches, Sorensen said, in terms of behavior change, employee engagement broadly, reductions in occupational injury and disability rates, stronger health and safety programs, and the potential for better health. These improvements, in turn, have the potential to improve the company’s bottom line, by reducing various kinds of costs and increasing worker performance and productivity.
John Howard, Director of NIOSH, described the agency’s history and vision for Total Worker Health. Traditionally, he told workshop participants, public health programs for workers were separated from a community’s other health-related initiatives, effectively partitioning people into parts. Although in occupational safety and health programs, the bedrock purpose is to protect workers from all sorts of workplace hazards—physical, chemical, biological, and radiological—the idea of integrating health promotion with these traditional activities was fundamental to NIOSH’s 2004 program, Steps to a Healthier U.S. Workforce, which has evolved into the Total Worker Health initiative.5
A decade into the program now, NIOSH is considering whether it is on the right track with this initiative, and the extent to which employers—and which kinds of employers—are picking up on the idea. Howard recognized the need to learn from what is happening in workplaces in “the real world,” and said NIOSH has the opportunity to realign efforts. He welcomed “a robust critical dialogue about all of these issues.” Therefore, while the workshop focused on examining best and promising practices in pursuing Total Worker Health, several participants provided critiques of the Total Worker Health initiative overall, citing the need to focus on safety issues first before adding health promotion programs.
This workshop summary is limited to describing the presentations given and general topics discussed during the workshop itself. Overall, each speaker’s presentation and the ensuing discussions are captured in a variety of ways. For panels, remarks made by individual speakers, as well as topics raised and responses given during the discussion periods, are presented by topic area. Remarks are also not necessarily organized in the same order as the actual workshop, but have been rearranged to provide a better flow for the readers of this workshop summary.
Following this introductory chapter, Chapter 2 presents one personal experience of pursuing Total Worker Health in the “real world.” Chapter 3 explores the value in pursuing Total Worker Health, including discussion of how to define success and which metrics to use. Chapter 4 looks at the experiences of larger businesses, while Chapter 5 considers the experiences of small- and medium-sized businesses. Finally, Chapter 6 describes the reflections and reactions of individual speakers and participants to the workshop overall.