Two essential health-related activities that are central to effective workplace health programs are: the protection of worker health to avoid illness, injury, and disability; and the promotion of health among workers to maintain and improve health, function, and well-being. Both activities contribute to the advancement of overall health and productivity, personal health, population health, and health of the company. Unfortunately, for too long, worker health protection and worksite health promotion have operated separate and independent of each other in the workplace — separate activities performed as if they were “ships passing in the night.”
Worker health protection traditionally has been under the auspices of the safety and health committee of an organization. Health protection includes activities such as compliance with the Occupational Safety and Health Administration regulations, safety training, work organization and ergonomics issues, and introduction and training related to the use of protective gear, blood-borne pathogens, respiratory protection, laboratory safety, and radiation safety. On the other hand, worksite health promotion typically has focused on maintaining and improving the health of workers through individual behavior change, team- or group-based activities that promote health, and changes in organizational policies and protocols to reduce health risk factors through environmental changes (physical and psychosocial). Arguably, and supported by emerging scientific evidence, the merging of these two essential activities will generate synergy and alignment resulting in more efficient and effective methods to create a safer, healthier, and more resilient workforce that is prepared to address daily challenges in the workplace.
A NEW APPROACH
An integrated approach to worker health is a coordinated and comprehensive approach that includes programs and policies that address the physical and organizational work environment and promotes personal health among individual workers and their families. It uses multiple levels of intervention including the individual, the organization, and the environment. This integrated approach addresses exposure to potentially harmful environmental factors on the job, the social context of work, and workers’ individual health and safety behaviors. It does so by linking and coordinating policies, practices, and access to resources across these different areas. Integrated programs recognize the roles of the organization, the leadership, the management, and the individual employees. The Figure depicts this new approach designed to integrate occupational safety, health, and worksite health promotion.
The emerging move toward integration of worker health protection and promotion is driven largely by work conducted under the leadership and vision set forth by the National Institute for Occupational Safety and Health (NIOSH), as part of the Total Worker Health program, which was and formerly called the WorkLife program (6). NIOSH defines its Total Worker Health program as “a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being” (6). The program recognizes that the workplace represents an environment with a strong connection to worker health and safety and that this relationship extends beyond the workplace into nonwork activities and settings. On the one hand, diminished health, injury, and disability whether incurred at work or outside the workplace reduces health, quality of life, and opportunity for career advancement or increased income for workers and their families. On the other hand, when workplaces reduce the likelihood for injury and disability and optimize the likelihood for workers to be healthy, the workforce is more likely to be fully productive, reduce waste, and recognize the company as a good place to work.
Separately, worker safety and health promotion each contribute unique and important improvements to the overall health and well-being of workers and companies. Together, they may lead to synergistic outcomes in overall health and productivity. Reasons for the integration of these two activities include the need to address health issues of the American workforce that affect worker health and work performance, recognition that certain health risks may affect work-related safety, and the notion that safe and healthy work environments will provide potential to create cultures of health that spill over into family and community life. A short list of examples of factors and reasons to integrate include:
- Chronic conditions such as obesity, low back pain, and diabetes are highly prevalent across the population. Nearly 50% of all Americans live with a chronic condition, and among those, about one half has multiple chronic diseases.
- The latest data from the U.S. Centers for Disease Control and Prevention indicate that across the United States, not a single state has obesity prevalence below 20%. A total of 36 states had a prevalence equal to or greater than 25%; 12 of these states had a prevalence equal to or greater than 30% (2).
- During the last 50 years in the United States, work-related energy expenditure has decreased by more than 100 calories day−1, and this reduction in caloric expenditure accounts for a significant portion of the increase in body weights among workers (3).
- As the number of health risks among workers increases, so do the annual medical claims they incur. In fact, medical claims for people with five or more health risks were double compared with those of people with two or fewer health risks (4).
- The workforce is aging. By 2015, projections are that one in five workers will be aged 55 years or older.
- Obesity affects work performance and productivity. It may even be a reason for not meeting job requirements. For example, obesity is the leading medical reason why many young men and women fail to qualify for military service (1). Hence, obesity may be a factor that impacts our national security.
- An estimated 15% to 35% of cardiovascular disease is attributed to workplace factors such as psychosocial stressors (e.g., work schedules, high-demand‐low-control work situation, and organizational injustice) (7).
Integration of worker health protection and promotion can support a more efficient and effective method of improving the overall health and well-being of the workforce as chronic conditions increase as a result of increasing numbers of modifiable health risk factors and drive a disproportionate share of the total cost of care for populations. Conversely, slowing the increase in health risks also will affect a reduction in the rise in cost of care. Safety and ergonomic programs increasingly need to consider the sedentary nature of many work tasks, especially considering those among knowledge workers; such that integration of safety design into health promotion programs can be an effective method of maintaining health and preventing injuries. For example, the use of sit-to-stand devices to reduce prolonged sitting time among office workers appears to be an effective means to reduce back pain and improve mood states, thereby improving worker health and overall productivity (5, 8).
DOES INTEGRATION WORK?
To answer the question if improvements in worker health can improve safety and if safety improvements can promote health, NIOSH has supported a research agendum that has led to the introduction of several WorkLife Centers of Excellence around the United States (6). Currently, NIOSH funds three centers to integrate worker health promotion and protection efforts and connect the workplace to home life as well as the local community. The centers are focused on multidisciplinary research, training and education, and dissemination of best practices. The Table presents an overview of the three WorkLife Centers of Excellence.
Early research findings and summaries from studies conducted in this area of inquiry indicate that this new approach — integrated workplace health — may be more effective than using either worksite health promotion or occupational health and safety alone. For example, there is evidence that blue collar workers are more likely to make health behavior changes when worksite health promotion programs are coupled with workplace hazard assessments and changes in the work environment. Although research is devoted to exploring the link between the physical and psychosocial conditions of work and a range of musculoskeletal, cardiovascular, and mental health outcomes, more is still needed. Work-family conflicts have been shown to result in decreased organizational commitment and job satisfaction, higher work and family stress, substance abuse, decreased healthy eating behaviors, absenteeism, and increased intentions to leave the job (9).
The integration of worker health protection and health promotion is an idea whose time has come. To advance this agendum, many companies can take action today by bringing together their safety and wellness committees, already charged with activities related to their representative areas. New research and information arising from the projects of the Worklife Centers of Excellence will be able to inform companies on what works and what does not, based on best practices, as well as highlight successful approaches and experiences from individual companies. Creating a larger group of employees all focused and committed to a broad common agendum that is aimed at a safe and healthy work environment will create a stronger foundation with deep roots, all of which positions a company to benefit from a sustained worker health initiative.
Disclosure: Author declares no conflicts of interest.
3. Church TS, Thomas DM, Tudor-Locke C, et al
. (2011) Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS ONE
. 6(5):e19657. doi:10.1371/journal.pone.0019657.
4. Edington DW. Emerging research: a view from one research center. Am J Health Promot
7. Olsen O, Kristensen TS. Impact of work environment on cardiovascular disease in Denmark. J Epidemiol Community Health.
8. Pronk, NP. The problem with too much sitting. A workplace conundrum. ACSM’s Health Fitness J
9. Sorensen G, Landsbergis P, Hammer L, et al
., and the Workshop Working Group on Worksite Chronic Disease Prevention. Preventing chronic disease at the workplace: A workshop report and recommendations. Am J Public Health
. [Online ahead of print Jul 21, 2011. DOI: 10.2105/AJPH.2010.300075. (Dec 2011, Vol 101, No. S1).