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Small businesses need help on Total Worker Health efforts, researchers say

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Aurora, CO — Small employers, particularly those with 10 or fewer employees, have less success implementing Total Worker Health initiatives than larger organizations, according to a recent study from the Center for Health, Work and Environment at the Colorado School of Public Health.

TWH seeks to advance worker well-being by integrating occupational safety and health approaches with injury and illness prevention efforts. Researchers analyzed TWH implementation at 382 organizations ranging in size from 200-plus employees (large) to two to 10 employees (microbusinesses). Medium-sized employers were defined as establishments with 51-200 employees, and small employers as establishments with 11-50 employees.

The researchers measured organizational adoption of TWH across six benchmarks – organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation – using an assessment developed for CSPH’s Health Links mentoring program. The organizations were then scored on a 1-100 scale.

The large employers had an average score of 63, the medium-sized and small employers tallied an average of 47, and the microbusinesses averaged 33.

The large employers were most likely to score highest on all six benchmarks of the analysis, which indicates a more systematic and comprehensive approach to addressing health promotion and safety. Meanwhile, the smaller employers were less likely to have organizational supports, methods for assessing worker needs and interests, or integrated health and safety strategies.

“Our results indicate a need for intervention research that specifically targets microbusinesses and small businesses,” lead study author Liliana Tenney said in an Aug. 13 press release, “especially in light of the outsized health and safety risks encountered in these sectors of the economy.”


Tenney offered recommendations to help small employers implement TWH more effectively. First, employers should look through the lens of their workers. “Understand both what they need and what they are interested in,” she told Safety+Health. For workers, “engage leadership to gain buy-in, including their participation in TWH planning and activities.”

Many organizations are trying to institute various safety and health initiatives. Tenney’s advice to them? “Do less, better,” she said. “Tackling too much at one time can wear out champions and dilute motivation and participation.”

The study was published online Aug. 1 in the Journal of Occupational and Environmental Medicine.

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