User:James Hare (NIOSH)/Total Worker Health

Total Worker Health is a trademarked strategy integrating protection from occupational hazards and injury and illness prevention. It was conceived and funded by the National Institute for Occupational Safety and Health (NIOSH). Total Worker Health is tested and developed in four "Centers of Excellence" in the United States. It takes a holistic approach to workers' health at home and at work, because occupational hazards can affect health conditions otherwise unrelated to the workplace.

History
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, in order to stimulate action for the development of programs. By 2005, it was renamed the NIOSH WorkLife Initiative, which supported addressing worker health and well-being by addressing the physical and organizational work environment concurrently with personal health decisions and behaviors of individuals.

In 2008, collaborators at NIOSH and the Centers of Excellence developed 10 recommendations for practice, research, and policy. In 2011, the program was renamed Total Worker Health to better reflect its approach. The 10th International Conference on Occupational Stress and Health, known as Work, Stress and Health 2013 was organized by NIOSH along with the American Psychological Association and the Society for Occupational Health Psychology and centered on Total Worker Health.

Proposed provisions to the Affordable Care Act for 2014 onwards, made by President Obama’s administration, include a rule allowing employers to increase incentives awarded to employees participating in workplace well-being programs.

Relevant issues
The following graphic Issues Relevant to Advancing Worker Well-being Through Total Worker Health® illustrates a wide-ranging list of issues that are relevant to advancing worker well-being through a Total Worker Health approach. The list of issues relevant to Total Worker Health was revised, retitled and published in November 2015 with input from stakeholders. This updated list reflects an expanded focus for TWH that recognizes that new technologies, new working conditions, and new emerging forms of employment present new risks to worker safety, health and well-being. Understanding and reducing those risks are important elements of TWH. 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. A Total Worker Health 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 control of hazards and exposures, the organization of work, compensation and benefits, built environment supports, leadership, changing workforce demographics, policy issues, and community supports.

Centers of Excellence
NIOSH has funded four Centers of Excellence in the United States to explore and research concepts of Total Worker Health.[18] Some tasks of the Centers of Excellence include: [18]


 * Pilot testing promising workplace policies and programs
 * Developing and disseminating best practices and tool kits
 * Developing strategies for overcoming barriers to organizational acceptance and adoption of comprehensive, coordinated work-based safety, health, and well-being policies, programs, and practices
 * Investigating costs and benefits associated with integrated programs
 * Promoting increased development and application of physiological and biological markers of stress, sleep, and depression and their use for worker protection or improved health outcomes

The four Centers of Excellence are based in five separate universities in the United States. Locations of the Centers are as follows:


 * Center for the Promotion of Health in the New England Workplace - University of Massachusetts Lowell and University of Connecticut at Farmington and Storrs.


 * Harvard T.H. Chan School of Public Health Center for Work, Health and Well-being - Harvard School of Public Health - Boston, Massachusetts
 * Oregon Healthy WorkForce Center - Oregon Institute of Occupational Health Sciences, Oregon Health & Science University - Portland, Oregon
 * University of Iowa Healthier Workforce Center for Excellence - The University of Iowa - Iowa City, Iowa



National Total Worker Health Agenda and NIOSH Response to Summarized Stakeholders’ Comments
In 2016, the NIOSH Office for Total Worker Health released a National Occupational Research Agenda (NORA) National Total Worker Health Agenda (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 (Proposed National TWH Agenda) released by NIOSH’s Office for Total Worker Health in September 2014. NIOSH invited stakeholders to provide comment on this draft agenda related to the top priority research, practice, and policy issues to help advance worker safety, health, and well-being. 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 now present in the published Agenda better reflects the priorities of the program and helps to overcome the equating of TWH with traditional workplace wellness programs that fail to integrate worker protection elements. TWH continues to place priority upon a hazard-free work environment that protects the safety and health of all workers. The National Total Worker Health Agenda and NIOSH Response to Summarized Stakeholders’ Comments can be found here.

Sit-stand workstations
Pilot studies of sit-stand workstations have shown reductions in sedentary time and possible indications of improved health outcomes.

Concerns over the increasingly sedentary lifestyle 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.[20] 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, improved mood outcomes, reduced eye strain, and reduced upper back, neck and shoulder pain.[21][22][23] 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.[23] Further, the study by Pronk et al. showed decreased fatigue and increased vigor among participants.[22] With these findings, NIOSH has begun a pilot program among employees for the Total Worker Health initiative.[24]

Health care workers
Several studies out of the Harvard T.H. Chan School of Public Health Center for Work, Health and Well-being 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, inadequate physical activity, and sleep deprivation) and work context measures.[25] Inadequate physical activity and sleep deficiency were associated, while lower back pain was not significantly related to either stressor.[25] 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.[25]

Aging workforce and the National Center for Productive Aging and Work
Aging in the American workforce, 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.[26] 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.[26] 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.”[26]

The National Center for Productive Aging and Work (NCPAW) promotes lifelong well-being for workers and encourages a productive aging workforce. The Center also strives to improve worker health by integrating traditional occupational safety and health protection techniques with emerging efforts to promote health and prevent disease. The Center is hosted by the NIOSH Office for Total Worker Health®.

Over the past 15 years, the topic of aging and its role in occupational safety and health has received considerable attention. As part of this effort, NIOSH, along with its partners, asked the National Research Council and the Institute of Medicine to turn their attention to the older worker and to the interaction between work and the aging process. The Committee on Health and Safety Needs of Older Workers published their findings in the 2004 report entitled Health and Safety Needs of Older Workers.

The National Academy’s Committee's report summarizes conclusions and presents detailed recommendations pertaining to three major themes that emerge from examination of the health and safety needs of older workers: (1) conducting informative research requires improved databases and data systems necessary to track the health and safety needs of older workers and the programs that address them; (2) research is needed to provide better understanding of the factors that relate to the health and safety needs of older workers; and (3) research is needed to identify and clarify the aspects of policies, programs, and intervention techniques and strategies that are effective and that are not effective in addressing the health and safety needs of older workers.

In the intervening years, NIOSH researchers turned their attention to the issues that arise from the increasing proportion of the American workforce which is "chronologically gifted." Their work greatly advanced knowledge of the health and safety risks for an aging workforce. However, important questions remain, and there exists a considerable gap between what is known about the changes that accompany the aging process and what organizations are actually doing, and should be doing, to address these changes across all age groups.

Organizations with Successful Integrated Safety, Health, and Well-Being Programs [edit]
Various companies have implemented integrated safety, health, and well-being programs successfully, with documented health improvements and cost savings.[27] 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, FedEx, Dow Chemical and Perdue Farms.[27]