Total Worker Health

About the Total Worker Health® Approach

Key points

  • 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.
  • The TWH approach prioritizes a hazard-free work environment for all workers.
smiling woman wearing blue scrubs passing a piece of paper to another person

What it is

The TWH approach brings together all aspects of work in integrated interventions that collectively address worker safety, health, and well-being. This integrated approach:

  • Focuses on how the workplace environment can eliminate or reduce risks and enhance overall worker health.
  • Goes beyond traditional safety and health concerns in recognition of the relationship between work and nonwork conditions.
  • Offers a holistic model for improving workforce safety, health, and well-being.
  • Provides a path to improving worker creativity, innovation, and productivity by creating work environments that are safe, health-enhancing, and fulfilling.

Why it matters

The TWH approach benefits workers, employers, and communities. Employers indicate that, by emphasizing a TWH focus, they accrue competitive advantages related to:

  • Recruitment
  • Retention
  • Employee satisfaction
  • Community engagement and reputation
  • Sustainable workforce culture1

Risk factors in the workplace may contribute to health problems previously considered unrelated to work. For example, there are work-related risk factors that can lead to health conditions like:

  • Obesity23
  • Sleep disorders4
  • Cardiovascular disease5
  • Depression678

The program fosters research to increase understanding of health conditions that may not arise from work but are affected by work. The approach targets the conditions of work to both protect workers from hazards and advance their health and well-being.

Priorities

The approach recognizes emerging work issues that present risks for the workforce. It is important to understand, prevent, and reduce these risks. There is a wide-ranging list of issues relevant to advancing worker safety, health, and well-being, including those relevant to:

  • Prevention and control of hazards and exposures
  • Built environment and community supports
  • Compensation and benefits
  • Healthy leadership and policies
  • Technology
  • Work arrangements and work organization
  • Workforce demographics

Implementation strategies

To start effective workplace programs, investments must address hazardous working conditions. Safeguards must be in place to protect workers and keep workplaces safe.

Fundamentals of Total Worker Health Approaches‎

This workbook is a practical starting point to implement workplace programs aligned with the TWH approach. Employers, workers, labor representatives, and anyone interested in the approach can use the workbook.
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Content Source:
National Institute for Occupational Safety and Health
  1. Howard J, Chosewood LC, Hudson HL [2016]. Letter to the editor: The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative. New Solut 26(3):345–348. https://doi.org/10.1177/1048291116656631
  2. Luckhaupt SE, Cohen MA, Jia L, Calvert GM [2014]. Prevalence of obesity among U.S. workers and associations with occupational factors. Am J Prev Med 46(3):237-248. https://doi.org/10.1016/j.amepre.2013.11.002.
  3. Nobrega S, Champagne N, Abreu M, Goldstein-Gelb M, Montano M, Lopez I, Arevalo J, Bruce S, Laura Punnett L [2015]. Obesity/Overweight and the role of working conditions: A qualitative, participatory investigation. Health Promotion Practice 17(1), 127–136. https://doi.org/10.1177/1524839915602439.
  4. Caruso [2013]. Negative impacts of shiftwork and long work hours. Rehabil Nurs 39(1):16-25. https://doi.org/10.1002/rnj.107
  5. CDC [2014]. Prevalence of coronary heart disease or stroke among workers aged <55 Years — United States, 2008–2012. MMWR 63(30):645-649. https://www.cdc.gov/mmwr/pdf/wk/mm6330.pdf
  6. Arcury TA, Grzywacz JG, Chen H, Mora DC, Quandt SA [2014]. Work organization and health among immigrant women: Latina manual workers in North Carolina. American Journal of Public Health 104(12):2445-2452. https://doi.org/10.2105/AJPH.2013.301587
  7. Rayens MK, Reed DB [2013]. Predictors of depressive symptoms in older rural couples: The impact of work, stress and health. The Journal of Rural Health 30(1):59-68. https://doi.org/10.1111/jrh.12028
  8. Wulsin L, Alterman T, Bushnell PT, Li J, Shen R [2014]. Prevalence rates for depression by industry: A claims database analysis. Soc Psychiatry Psychiatr Epidemiol 49:1805-1821. https://doi.org/10.1007/s00127-014-0891-3