Total Worker Health® Frequently Asked Questions

Implementing a TWH approach is an ongoing effort that prioritizes workers' safety, health, and well-being. The aim is to create a robust culture of safety, worker protection, and greater health opportunity. This approach consists of a mix of interventions, policy changes, and practices.

This approach often starts with an organizational focus, assessing challenges to keeping workers safe and healthy. Following that are changes to the built environment, policies, and programs.

Programs aligned with the TWH approach are voluntary and participatory. They give workers a voice in the conditions of their work and a say in workplace offerings. Implementation can be incremental and is best driven by worker input using the participatory approach.

Employers and managers planning to adopt a TWH approach should consider using the Hierarchy of Controls Applied to NIOSH TWH. The hierarchy can help prioritize efforts. The following examples of approaches and interventions aligned with the hierarchy can help support a robust TWH program:

• Control hazards and exposures
• Design work schedules and patterns to reduce stress and increase worker control
• Build safer, healthier environments
• Provide fair compensation and affordable benefits that enhance health
• Cultivate leaders and values that encourage healthy supervision, respect for workers, and responsible business decisions
• Create policies and environments that are inclusive and accepting of workers' differences
• Create safety and health interventions that will also have community impact

Traditional occupational safety and health programs primarily focus on keeping workers safe from harms that come from work. The TWH approach builds on this by recognizing that work is a powerful social determinant of health. The approach considers health influences that arise outside the workplace, including interactions between work and non-work demands and circumstances.

The Hierarchy of Controls Applied to NIOSH TWH expands on the traditional focus to more broadly advance worker well-being. The hierarchy starts at the organizational level and narrows down to the individual, including five elements. These are eliminate, substitute, redesign, educate, and encourage.

The TWH approach is not the same as traditional health promotion programs or employee wellness programs in most settings. The TWH approach requires a strong commitment to better working conditions. Keeping workers safe is the foundation of a TWH program. This approach is not:

• An add-on wellness program implemented without simultaneously providing safe and healthy working conditions.
• A collection of health promotion activities for workplaces where the organization or structure of work contributes to worker injuries and illnesses.

Programs aligned with the TWH approach do often contain elements of health promotion. Examples include efforts to optimize worker well-being through improved environmental and social supports. The approach recommends that employers and workers collaborate to design safe and healthy workplaces. Workplaces should support all workers in their professional and personal health goals, regardless of individual or legal differences. Legal differences might include employees versus contractors, temporary workers, or contingent workers.