The National Institute for Occupational Safety and Health Total Worker Health® Program

The Third Decade

CME Learning Objectives

• After completing this enduring educational activity, the learner will be better able to:

• Discuss current and future goals of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health® Program.
• Explain how its four program pillars of research, practice, policy, and capacity building prepares employers and workers for an evolving economy, demanding technologies, remote work, and precarious employment.
• Outline the successes, past and current, of the NIOSH Total Worker Health® Program.

In 2023, the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health^® (TWH) Program will mark two decades since its inception as a simple, yet paradigm-shifting, concept that all work should both be safe and enhance the health and well-being of workers. Since its founding, the NIOSH TWH Program has strived to be evergreen, listening avidly to its partners and continually evolving to be responsive to the needs of workers. The NIOSH is now positioned to make new contributions to the well-being of the nation’s workforce. Supported by the four programmatic pillars of research, practice, policy, and capacity building, the third decade is full of promise for the TWH approach to worker safety, health, and well-being.

The past and current successes of TWH science and practice have been rooted in the fundamental principle that work and working conditions should be safe and healthful. It is unacceptable to trade a worker’s health for wages, and protections should extend to all workers regardless of industry, occupation, job title, individual or social factors, demographics, or employment arrangement. However, the purpose and promise of the TWH approach move beyond the basic tenet of avoiding harm for workers. It embeds the conviction that work should be an ongoing, enriching environment for worker well-being, and a source of well-being for their families, their communities, the nation, and the whole of society.

The first two decades have been witness to many examples of the staying power of TWH approaches. For example, promising practices continue to arise from employers, industry, and organizations as they adapt TWH principles to their unique environments. The NIOSH regularly highlights real-world examples of how organizations see positive results using comprehensive workplace policies, programs, and practices. These practices are featured in an ongoing series of reports featured in the Total Worker Health in Action! eNewsletter. Improvements in workplace culture, work design, mental health and substance use disorder interventions, and injury prevention have been highlighted in manufacturing, healthcare, construction, government settings, and academia.¹

However, today the well-being of workers faces an unparalleled assault as the pace of transformation in our society and economy quickens and as new demands of working conditions and threats to workers’ well-being emerge. Many workers will be unable to adapt as quickly as technology and cultural shifts demand. A simplistic emphasis on individual resilience building will be inadequate to prepare workers for the anticipated, sizeable, and relentless nature of these challenges. Among others, these challenges include physical and mental fatigue; gaps in skills necessary for modern work; isolation and loneliness due to telework and remote work; harmful substance use and dependency; long work hours; sleep disruption; gender-based, racial, ethnic, and socioeconomic disparities; and chronic diseases and associated disability and cost. Furthermore, a host of novel realities in a post–COVID-19 pandemic world will demand evidence-based solutions if we are to improve the well-being of workers. Meeting these challenges will require a renewed focus on understanding the pathways of workplace stress and their connection with workplace physical and psychosocial stressors and worker well-being.

As the TWH research portfolio continues to grow and evolve over the next decade, and a greater number of evidence-based interventions for physical and mental health find their way into workplace practice, we will disseminate integrated TWH safety and health concepts as rapidly and as widely as possible. We believe that the TWH-focused research of today and tomorrow will play a critical role in readying employers and workers to take on the challenges of a rapidly evolving economy, innovative but demanding technologies, remote work, and precarious employment. Critical in this regard is to ensure that workers have a significant voice and influence over their own work and its connection to well-being. The TWH approach can play a crucial role in assisting them to find a better fit between their roles at work and in their communities, helping reveal the sweet spot between finding joy in daily living and engaging in work that provides security and meaning. The overall practice of the TWH approach can ensure that work does not diminish quality of life and instead can lead to a better reality where work enhances daily life and contributes to physical, mental, and emotional health.

Recognizing the need for a widely accepted definition and measurement tool for worker well-being, in the second decade of TWH NIOSH partnered with an expert panel to develop a framework for worker well-being and based on the framework, the NIOSH Worker Well-Being Questionnaire (WellBQ).^2,3 This unique contribution to the literature provided a comprehensive, integrated framework and a validated survey tool freely available to the public. Since its publication in 2018, the framework article has been cited more than 100 times. Since the release of the questionnaire in 2021, partners have translated it into Spanish and Italian and it has been used by researchers and practitioners. In the third decade of TWH, the NIOSH will continue to enhance the usefulness of the NIOSH WellBQ and to facilitate the accumulation of knowledge about worker well-being.

The third decade of TWH research, practice, policy, and capacity building is also the time to better define, measure, and operationalize the concept of well-being in the context of work and to optimize the multiple roles that workers hold on the job, within families, and in social and community settings. The WellBQ will help identify workplace (no matter where work is done) and work elements that diminish (or enhance) health, leading to even better interventions to address these factors. Over the next decade, it is anticipated that the NIOSH WellBQ will evolve as its application expands to workplaces worldwide and the data it generates inform our understanding of worker well-being.

As we look to the future, our goals for the next decade broaden the scope of the current NIOSH TWH portfolio to address the changing world of work and the legacy and evolving challenges faced by workers. (For more information about the NIOSH TWH Program goals for the next decade, contact us at [email protected].) This expanded focus includes greater attention to the diverse needs of working families, to strategies for inspiring meaningful work, to ensuring that jobs meet the needs of workers throughout the full continuum of their working lives, and to creating tools for understanding how to improve human connections in the face of rapidly changing work schedules and employment arrangements. Exploring ways to optimize performance and productivity across the working lifespan, including preparations for a healthy retirement, represents another dynamic horizon where integrated TWH approaches can increasingly contribute. Productivity and competitiveness—envisioned as a vital, sustaining asset to both workers and their organizations—will be essential in years to come. The new awareness of and increased understanding of the importance of worker well-being that arose during the pandemic offer a rare opportunity to both invest in interventions that enhance worker well-being and promote organizational strategies that advance human and enterprise productivity. Organizations that have set a goal to ensure the safety, health, and well-being of all their workers will be the ones most likely to succeed over the long-term.

In the third decade, there will be opportunities to further expand the TWH concept to incorporate issues that have previously existed on the periphery of occupational safety and health research, practice, and policy and yet play a significant role in worker well-being. These evolving issues include confronting concerns like the ever-increasing wage gap; gender, racial, and ethnic inequalities; invasive monitoring and AI-related losses of workers’ agency and autonomy; employment insecurity; and occupational segregation and oppression, all of which may lead to adverse physical health outcomes as well as raise risks for workplace stress and mental health disorders. Successful organizations that adopt TWH strategies and interventions to deal with these realities will be able to attract and maintain a more innovative and diverse workforce and inspire leadership that is mutually beneficial for their workers and their bottom line.

Addressing the range of upcoming challenges facing the NIOSH TWH Program will not be easy. Fortunately, the success of the TWH concept has always been supported by and sustained with public and private partnerships and these partnerships will be even more indispensable in the years to come. Currently, the TWH Program at the NIOSH funds 10 academic Centers of Excellence for Total Worker Health® and has formal partnerships with more than 50 Total Worker Health® Affiliates. These Centers of Excellence and Affiliates function as national, regional, and state hubs for providing resources and collaborative opportunities.

Toward the end of the first two decades of TWH, the Centers of Excellence and Affiliates created certificate and doctoral programs on TWH approaches to worker well-being. There are now four Certificates in TWH, offered by the Colorado School of Public Health, the Gillings School of Public Health, Northern Kentucky University, and the University of Washington jointly with the Oregon Healthy Workforce Center.⁴ The University of Texas School of Public Health’s Southwest Center for Occupational and Environmental Health offers a TWH track within the doctoral program in Environmental Science. Western Kentucky University offers a Graduate Certificate Program in Workplace Health Promotion which introduces students to TWH principles. As additional public and academic institutions, employers, labor, and other organizations become partners in every element of our work, we will welcome them and eagerly anticipate even greater innovations in and relevance of our research and development of practice guidelines, policy, and capacity-building efforts.

The NIOSH TWH Program plans to continue supporting capacity-building efforts throughout the private and public sector. The edited volume on Total Worker Health,⁵ published by the American Psychological Association in July 2019, is one tool for this support. This volume brings together state-of-the-art research and practice in comprehensive and integrated prevention strategies from the most accomplished scholars and practitioners in the field. The book serves as handbook for practitioners and is used by the 10 NIOSH-funded academic centers; universities, and professional associations to train thousands of professionals responsible for the safety, health, and well-being of workers around the globe. The book has been cited more than 50 times and sold more than 600 copies within 3 years, above average for psychological book sales.

The Society of Total Worker Health® Professionals, a newly created professional society, will serve to connect, convene, and certify TWH professionals, as well as advocate for new policies and form new types of partnerships beyond the NIOSH Program’s capabilities. Future TWH professionals will help build bridges to new partners such as human resources professionals, benefits designers, workplace architects and space planners, mental health and substance use disorder treatment professionals, equity and accessibility specialists, sustainability and business responsibility leaders, complementary and integrative health professionals, and tech-savvy problem solvers of all types. These essential, yet currently absent, influencers represent the newest disciplines of the TWH professional, with the potential to expand and enhance the TWH concept further.

To remain impactful in the years ahead, TWH research, practice, policy, and capacity building must remain relevant and responsive to changing work environments by offering pragmatic solutions. The TWH concept is an iterative one—responsive to evolving needs of work organizations and working people, their families, and society. As the third decade of the TWH Program begins, the NIOSH remains committed to keeping the safety and health needs of workers at the heart of all planning and decision making.

The NIOSH seeks to inspire new ways of organizing work—from harmful to helpful, from energy-draining to invigorating, from demoralizing to meaningful, and from a focus on short-term productivity to a focus on long-term worker and organizational sustainability. The NIOSH welcomes new travelers along the path of TWH’s third decade. If you believe that all work can enhance worker safety, health, and well-being, we invite you to join us on this journey. For more information about TWH or to contact us, visit: https://www.cdc.gov/niosh/twh/.