What is Total Worker Health?

An overview of the ‘non-siloed’ safety approach


Since NIOSH launched its Total Worker Health initiative in 2011, L. Casey Chosewood has witnessed many of its concepts go “mainstream” – especially within workplace safety and health organizations.

Chosewood, director of the agency’s Office of Total Worker Health, pointed to the formation of the Society for Total Worker Health in 2022 as more evidence of the initiative’s continued momentum.

“We’ve seen rapid expansion of the TWH concept overall, with substantial increases in research and publications by funded and nonfunded partners,” he said. “The TWH affiliates program has grown to 60 partners, and we now fund 10 TWH Centers of Excellence.”

What it is

Total Worker Health – a registered trademark of the Department of Health and Human Services – is a “non-siloed approach to safety,” Chosewood said.

What that means is instead of focusing solely on occupational hazards or workplace task safety (machine guarding or lockout/tagout, for example), employers also need to consider – and mitigate – other factors that could affect workers’ well-being. Examples include fatigue, stress or the negative effects of shift work.

NIOSH says an employer could use TWH concepts to address fatigue by:

  • Providing additional breaks on days with heavier workloads.
  • Moving heavy workloads to a time during the day when employees are more alert.
  • Providing a greater variety of work tasks or body positions via job rotations, to help workers avoid monotony or fatigued muscles.
  • Limiting shifts to eight hours to allow time for rest.
  • Giving employees more control over their schedules, job tasks and other work conditions.

“A key component is to be sure to include workers in the conversation,” said Diane Rohlman, director of the Healthier Workforce Center of the Midwest – a TWH Center of Excellence. “This participatory approach will lead to better buy-in and more innovative solutions.”

The Centers of Excellence are hubs for research and practice that seek to “develop new solutions for complex occupational safety and health problems,” according to NIOSH.

Total Worker Health Centers of Excellence

NIOSH funds 10 academic Centers of Excellence for Total Worker Health. The centers are “hubs for TWH-related research and practice that build the scientific evidence base necessary to develop new solutions for complex occupational safety and health problems.”

The centers:

California Labor Laboratory

Carolina Center for Healthy Work Designand Worker Well-Being

Center for Health, Work & Environment (Colorado School of Public Health)

Center for the Promotion of Health in the New England Workplace

Harvard T.H. Chan School of Public Health Center for Work, Health and Well-being

Healthier Workforce Center of the Midwest

Johns Hopkins P.O.E. Total Worker Health Center in Mental Health

Oregon Healthy Workforce Center

University of Illinois Chicago Center for Healthy Work

Utah Center for Promotion of Work Equity Research

Learn about what each center is working on by visiting the NIOSH website.

Make the business case

Because TWH is intended to operate at an organizational level, it’s vital to get everyone on board, including company leadership.

“Solutions at the organizational level will have greater impact than those targeting individual behaviors,” Rohlman said.

One of the best ways to promote TWH to leadership is to connect worker safety and well-being to the bottom line. That includes links to health care costs, workers’ compensation costs, productivity, and even hiring and employee retention.

“If there is something that’s happening at work, it’s going to impact your health care costs,” said Anjali Rameshbabu, manager of the Oregon Healthy Workforce Center – another TWH Center of Excellence. “It’s going to impact your retention, productivity and how engaged people are.

“All of the things that directly impact worker health and well-being also directly – and indirectly – impact the bottom line of the companies.”

Get started

Once you get the whole organization on board with TWH, what’s the next best step?

Rohlman said to look at your data.

“Are you seeing injuries, low morale, turnover or absenteeism? This is where you need to target your initiatives,” she said. “Remember, the most effective solutions integrate elimination of hazards and changes to the work environment and how work is done.”

It’s also helpful to listen to your employees, Chosewood said.

“Ask regularly how they’re doing. What are their pain points or challenges? How is the job meeting – or not meeting – their needs? Get them involved in both the design of the day-to-day work as well as engaged in designing health and well-being interventions.”

Chosewood added that employers should train all frontline managers in “supportive supervision skills,” including better/active listening, nurturing and people skills.

“These leaders are often where Total Worker Health succeeds or fails. Invest in them regularly.”

More tips:

  • Use a worker-management team to solve difficult issues.
  • Recognize and reward employees systematically and frequently.
  • Use metrics and data sources to track progress and continuously improve.

“This is a long-term pursuit, not an off-the-shelf, vendor-delivered health promotion approach,” Chosewood said. “It’s about changing the culture and tenor of our workplaces.”

Free resources

Want to learn more about Total Worker Health? NIOSH offers a number of resources on its website:

“Promising Practices”: Real-world examples in action

“Making the Business Case for Total Worker Health”: Examples of how TWH can benefit your workers and your organization

Fundamentals of Total Worker Health Approaches: A workbook designed to help you develop new TWH initiatives or better align existing workplace interventions with the TWH approach

Worker Well-Being Questionnaire: Intended to help users assess quality of working life, circumstances outside of work, and worker physical and mental health

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