Anita L. Schill

The NIOSH Total Worker Health™ program: an overview.

Objective: The objective of this article was to provide an overview of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health™ (TWH™) Program that was launched by the institute in 2011. Methods: This article describes the TWH™ concept, relevant issues, and the NIOSH Program. Examples of the concept are provided. Results: Total Worker Health™ is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. Conclusions: The NIOSH TWH™ Program responds to demands for information and practical solutions to the health, safety, and well-being challenges that workers and their employers face. It also addresses issues related to the nations need to sustain a globally competitive workforce.

Advancing workplace health protection and promotion for an aging workforce.

Objective: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. Methods: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. Results: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. Conclusions: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.

Genetic information in the workplace: Implications for occupational health surveillance

Rapid progress in understanding the human genome has made individual genetic information accessible through genetic testing. Different types of genetic testing may be encountered in the workplace. Genetic screening examines individuals for specific inherited characteristics. Genetic monitoring evaluates individuals for acquired modifications to their genetic material. A recent survey provides evidence that some employers are conducting genetic testing of their employees and using the genetic information they obtain to make employment related decisions. Occupational and environmental health nurses must be prepared to meet the challenges presented by the complex issues related to genetic information in the workplace.

Advancing Well-Being Through Total Worker Health®:

Total Worker Health® (TWH) is a paradigm-shifting approach to safety, health, and well-being in the workplace. It is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The most current TWH concepts are presented, including a description of issues relevant to TWH and introduction of a hierarchy of controls applied to TWH. Total Worker Health advocates for a foundation of safety and health through which work can contribute to higher levels of well-being.

Mental Health in the Workplace: A Call to Action Proceedings From the Mental Health in the Workplace—public Health Summit

Objective: The aim of the study was to declare a call to action to improve mental health in the workplace. Methods: We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers. Results: The Advisory Council narrowed the list of ideas to four priority projects. Conclusions: The recommendations for action include developing a mental health in the workplace (1) “how to” guide, (2) scorecard, (3) recognition program, and (4) executive training.

NIOSH Response to the NIH Pathways to Prevention Workshop Recommendations

The National Institute for Occupational Safety and Health (NIOSH) appreciates the recommendations of the independent panel of the National Institutes of Health (NIH) Pathways to Prevention workshop, Total Worker HealthWhats Work Got to Do With It? (1). The workshop speakers, audience contributors, and panelists provided useful insights (2). The Total Worker Health (TWH) program is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The definition for TWH was updated in 2015 to emphasize that integration from a TWH perspective focuses on the ways work-related and nonwork risk factors interact to cause worker injury and illness. This represents an evolution from an earlier TWH definition when the evidence report was first commissioned. The current definition emphasizes the primacy of health protection and prioritizes work organizational factors over individual behaviors in advancing worker well-being. NIOSH is taking the following actions and looks forward to moving quickly to implement the panels 8 recommendations. Recommendation 1: Convene a meeting of stakeholders to set research priorities for integrated interventions. NIOSH will collaborate with the NIH Office of Disease Prevention and the National Heart, Lung, and Blood Institute (NHLBI) to convene a meeting of federal stakeholders, review the panel report, and identify possible follow-up actions and opportunities for addressing the research gaps (3). The meeting will build on the workshops momentum in developing prevention strategies. Recommendation 2: Develop a consensus-based conceptual framework to guide future intervention research. The final National TWH Agenda, which identifies a framework for identifying priorities in research, practice, policy, and capacity building, was published in April 2016 (4). The draft agenda was posted in the Federal Register for public comment, and comments were also solicited during 2 conferences in 2014. Recommendation 3: Develop a core set of measures and outcomes that are incorporated into all integrated intervention studies. NIOSH is developing a framework for worker well-being, including domains and measures for an instrument to assess well-being, and is convening an invitational research methodology workshop within a year. The workshop will review current methodological approaches to TWH-related research and explore the methods that have the most promise to advance the scientific evidence base for the betterment of worker well-being. Recommendation 4: Use a transdisciplinary and participatory process for intervention development. NIOSH is committed to a transdisciplinary, participatory process for TWH and encourages an integrated approach addressing a wide variety of issues relevant to advancing worker well-being (5). NIOSH researchers have studied compensation and benefits, such as paid sick leave, and have created a working group to examine new employment patterns of the new economy. For all research and practice activities, TWH advocates for tripartite engagement and integration across disciplines. As with all NIOSH initiatives, publicprivate partnerships are critical to intramural and extramural research and translation activities, including partnerships with labor unions, worker safety and health advocacy, and community organizations. Recommendation 5: Ensure that future intervention studies represent an appropriate range of worker populations and settings. To ensure that special exposures and outcomes are considered, NIOSH organizes research by industry categories and continuously develops research on cross-cutting issues, such as new employment patterns. Ongoing research within NIOSH and the TWH Centers of Excellence (6) focuses on vulnerable populations, including workers in small businesses. Changing workforce demographics and diversity will continue to be priorities for NIOSH, as discussed in the 2015 funding opportunity announcement for NIOSH Centers of Excellence for TWH (7). Recommendation 6: Expand research and evaluation design options to include a range of rigorous methodologies. NIOSH has developed a logic model (8) to serve as an evaluation framework for TWH that identifies short-, intermediate-, and long-term outcomes for TWH research. The research methodology workshop will further address this goal. Leading investigators in the field of TWH will collaborate to develop a set of promising research methods to guide the design of future TWH studies. Recommendation 7: Develop effective strategies for timely dissemination of findings to a wide variety of stakeholders. Dissemination and translation of findings are foundational to accomplishing NIOSHs mission. The 21 NIOSH TWH affiliates are groups that provide innovative dissemination of findings to stakeholders and implement TWH in the workplace. For the TWH Centers of Excellence, up to 25% of funds (7) is spent on delivering science-based information through partnerships, particularly to reach high-need groups. NIOSH continually seeks evidence-based, knowledge transfer, and diffusion strategies to ensure uptake and incorporation of research recommendations. Recommendation 8: Make investments in research infrastructure and assets to develop population-based laboratories for TWH research. NIOSH will continue to make investments as shown by the planning and convening of the research methodology workshop. It looks forward to the partners meeting that will be convened by NIH Office of Disease Prevention to collaborate with the NHLBI and other stakeholders to identify opportunities for future research. In conclusion, the Pathways to Prevention workshop on TWH was invaluable in assessing the state of science on TWH and identifying research gaps and future research priorities. NIOSH appreciates the NIH Office of Disease Prevention and the NHLBI for their cosponsorship in this effort. NIOSH has already taken steps to carry out the recommendations of the panel, based on the interim draft report, and welcomes opportunities to collaborate with all stakeholders to make further progress in TWH research and practice to advance the safety, health, and well-being of the nations workers.