Total Worker Health


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Total Worker Health® integrates protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being.

Total Worker Health

Young woman safety professionals talking to colleaguesSafety professionals must partner with their leadership teams on more than just technical safety issues. Occupational safety and health (OSH) involves much more than managing workplace hazards, injuries and health exposures. Safety professionals must be prepared to oversee the effects of an aging workforce; understand changing employment relationships, such as remote, virtual and gig workforces; know about work-related stress disorders and chronic diseases; and adapt to shifting cultural norms.

Total Worker Health® (TWH) is a system of policies, programs and practices that integrates protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being. Implementing and using TWH strategies may well prepare your organization to address evolving business conditions, create a sustainable benefit to worker safety and health and have a positive effect on your organization’s financial health.

The TWH approach provides a pathway to improve worker creativity, engagement and productivity by providing work and work environments that enhance safety and health. When safety professionals build relationships by understanding their company’s business and delivering more than compliance-based solutions, they demonstrate value as a trusted partner.

Total Worker Health Strategies

The National Institute Occupational Safety and Health (NIOSH) coined the term “total worker health” as an evolution of its strategy to promote a healthier U.S. workforce. NIOSH Director John Howard explains the advantage of this approach:

"Our experience indicates that healthcare cost savings are often not the sole motivation to adopt Total Worker Health policies, practices and programs. Often, even despite the costs associated with implementing a TWH program, employers tell us they accrue competitive advantages related to recruitment, retention, employee satisfaction, community engagement and reputation, and sustainable workforce culture by emphasizing a TWH focus.”

Organizational Focus

TWH employs an organizational focus rather than placing sole responsibility on individual workers. A TWH approach recognizes the connection between work, safety and health systems and the need to integrate them effectively. Many traditional health promotion programs operate in a silo and assign responsibility for change management efforts to the worker. Companies must recognize the internal and external risk connections inherent to their worker populations.

TWH explores opportunities to both protect workers and advance their health and well-being by improving the conditions of work through workplace policies, programs and practices. An emerging body of evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected: risk factors in the workplace can contribute to health problems previously considered unrelated to work.

Worker Engagement

TWH strategies encourage worker involvement in addressing high-risk areas and mitigating hazards. When workers help craft safe work practices, they influence how work will affect their safety and health. People closest to the work are often the best judge of what works most efficiently.

When mitigating hazards, organizations must look beyond the immediacy of risk to identify institutional factors that drive individuals to deviate from expected practices and norms.

Preparing for the Future of the Safety Profession

Two young safety professionals pondering the futureFive significant trends are rapidly changing the world and business and life in general—demographics, technology, institutions, relationships and speed. What does this have to do with TWH?

  • Demographic drivers include the growth of the world population, an aging population and urbanization leading to mega-cities and the associated social issues. These changing dynamics create unique opportunities to enhance employment relationships.
  • Technology and emerging business—increased automation, pace of work, demand for responsiveness, and the rapid rise of distributed manufacturing and micro-factories—have already disrupted work as we know it. We are constantly finding new ways to combine materials (both traditional and advanced) and these new streams of commerce are driving the need for a different type of worker.
  • Traditional institutions—healthcare, education, criminal justice, government, trust in big business and unions—are changing and often fall short of expectations. The need to bridge these gaps remains and points to the need for an integrated approach like TWH.
  • Work relationships have changed, as more people work remotely or as part of a virtual workforce or take temporary or contract work. These changes require that safety professionals and their employers understand how to manage situations that offer diminished levels of direct control.
  • Speed of change demands rapid assimilation of new knowledge and research, responsible development of reliable and reproducible practices, understanding risks not yet identified or quantified, and the development of social and business relationship networks not yet appreciated.

Case Study

The Center for Promotion of Health in the New England Work­force piloted a project on patient handling in the medical/surgical unit of a New Hampshire hospital. A committee of front-line nurses identified root causes of injuries, which ranged from equipment issues and irregular meal breaks to lack of exercise and inadequate sleep.

The committee then proposed three interventions for evaluation by hospital safety and health leaders (who would then fund, support and guide implementation):

  1. Increase the use of patient handling equipment.
  2. Provide adequate staffing and required breaks.
  3. Promote workers’ personal health and well-being.

“We had no clue about the scheduling, the amount of sleep people get—that these guys don’t actually schedule breaks and coverage for breaks. We didn’t know that at all. I mean, that turned out to be the biggest issue we need help with, which was a surprise to everyone.”
— Program Facilitator

Resources and Tools

ASSP's Total Worker Health Task Force has identified a selection of tools and resources, from basic to advanced, to help OSH professionals better understand the TWH approach and how the can work with their organizations to integrate this next-generation approach to worker well-being.

View resources and tools


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