Total Worker Health® - an integrated approach to a healthier workplace

January 2020

Contributed by Jennifer Cavalari, ScD, CIH, UConn Health and Suzanne Nobrega, MS, University of Massachusetts Lowell

Issue #64

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On average, employed US adults spend more than half of their waking lives working on engaging in related activities (BLS, 2018). Scientific evidence now shows there are occupational risk factors for sleep disorders, cardiovascular disease, depression, obesity, and other common health conditions (NIOSH, 2018). Likewise, our work has a large impact on how we maintain our health. That's why worker well-being is relevant for workers and employers, and why Total Worker Health® can set the stage for worker safety, health and well-being on and off the job.

What is "Total Worker Health®?"

Total Worker Health (TWH) is an emerging program concept that takes occupational safety and health to the next level to include other workforce health concerns such as stress, chronic diseases, and working and living well into older age. TWH is not a wellness program with a new name. Keeping workers safe is the foundation upon which a TWH approach is built. TWH integrates workplace safety efforts with a broad spectrum of opportunities and interventions to improve overall worker health and well-being, as shown in Figure 1.

A TWH approach to workplace well-being focuses on making work organization and the working environment conducive to health. Worker well-being is affected by factors such as the physical and chemical work environment, psychosocial conditions in the workplace, the home and community environment, and personal health behaviors. Therefore, a TWH approach address both the conditions of work and the symptoms of poor health as part of an integrated well-being strategy.

An inverted triangle showing the 5 levels of hazard control strategies with greatest impact (elimination) to least (PPE) impacts using the TWH.

Figure 1: Hierarchy of Controls applied to NIOSH TWH

Examples of an integrated, Total Worker Health Approach to Workplace Safety

Health & Safety ConcernTotal Worker Health Approach
Respiratory Illnesses from poor workplace air quality can be more serious for smokersImprove air quality AND help employees quit smoking
Job Stress increases the risk factors for heart diseases such as high blood pressure, smoking, low physical activity, and anxiety/ depression.Reduce work-related stressors AND Help employees develop skills and habits for exercise, eating well, and managing stress
Physically demanding work can lead to feeling too fatigued to exercise or to prepare healthy mealsProvide equipment to reduce bodily forces AND Plan work schedules to allow for rest and recovery

Simple ways to introduce a Total Worker Health approach

NIOSH outlines essential elements of a Total Worker Health Program (NIOSH, 2017). The examples below outline a few simple steps to begin adopting these elements.

Design for healthier work

  • Re-organize work to minimize repetitive motion, excessive force, and awkward postures.
  • Plan shift schedules that allow workers to have sufficient sleep quality and quantity.
Engage workers in assessment and program implementation activities
  • Involve employees in assessing work and non-work sources of health concerns.
  • Empower employees to identify and solve problems that impact their well-being.
  • Get employee feedback on workplace changes before rolling them out.
Integrate relevant systems to advance worker well-being
  • Encourage coordinated goal-setting and cooperation between health and safety, wellness, benefits, training, and employee assistance programs.
Selected resources from TWH Centers for Excellence 
Selected research resources from NIOSH Total Worker Office
TWH professional development resources

  1. US Bureau of Labor Statistics (2018). American Time Use Survey,
  2. CDC, NIOSH Total Worker Health (2020)
  3. CDC, NIOSH Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being,
Jennifer Cavallari is an Associate Professor of Public Health Sciences at UConn Health. Suzanne Nobrega is CPH-NEW Outreach Director.

CPH-NEW is a Center for Excellence to Promote a Healthier Workforce of the National Institute for Occupational Safety and Health. CPH-News & Views is a semi-monthly column written by Center researchers on emerging topics related to healthy workplaces. These comments reflect thoughts of the individual researchers and do not represent conclusive research summaries, nor do they necessarily reflect a consensus among all Center personnel. We welcome your responses and discussion. Please send all questions and comments to
CPH News and Views Issue 64                                                                                       January 2020
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