Health and Wellness

The NIOSH Guide to a Total Worker Health Program

Did you know that workers who are obese are more likely to suffer strains and sprains? So, you may invest a great deal in your ergonomic program, but unless your workforce maintains healthy weight levels, you could still see injuries.

Healthy Worker Lunch

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Did you know that when a worker smokes, workplace exposures that might not cause a problem for nonsmoking workers can lead to serious lung diseases because tobacco smoke and chemical exposures can have synergistic effects? So, your efforts to reduce chemical exposures in the workplace are important, but they’ll be more effective if you can also get workers to give up cigarettes.

When you integrate your occupational safety and health initiatives and worker wellness, both programs—and your bottom line, not to mention your workers—will benefit. For the past 2 years, the National Institute for Occupational Safety and Health (NIOSH) has been developing an online guide ( that employers can use to integrate their worker safety and wellness programs, called Total Worker Health® (TWH). Here’s how you can improve your outcomes by expanding your focus to embrace TWH—and why you should get started right away.

NIOSH Makes the Business Case

Both wellness programs and occupational safety and health programs are often seen by management as expenses, rather than as investments with measureable returns. You may be able to make a case for your occupational safety and health efforts based on regulatory requirements, but wellness programs lack a similar regulatory backing, making it harder to generate support for them. It’s important to know how you can measure a return on this kind of investment.

An integrated safety and wellness program contributes to the bottom line in several ways:

It improves participation in and overall effectiveness of your health programs. A worksite health promotion program that exists in isolation may experience only limited success. When workers see that the employer is doing its part (for example, by reducing chemical exposures that can cause lung damage), their participation in efforts like smoking cessation programs increases, along with their rate of success.

It enhances management’s credibility. When management makes a side-by-side effort to improve workplace conditions and workers’ health behaviors, workers have more faith in the health promotion program. Without a combined effort, workers may feel cynical about management’s commitment to their health.

It addresses synergistic risks. Many hazards have both workplace factors and worker factors. A joint program addresses both.

It reduces sickness. Workers enrolled in an effective health promotion program use less sick time for both short-term health issues (for example, seasonal colds) and chronic illnesses (for example, cardiovascular disease).

It enhances retention and productivity. Healthier workers are less stressed and happier, which makes them both less likely to leave and more productive when they are at work.

Creating a Program

NIOSH offers a number of steps employers can take to establish an effective TWH program, including:

Get everybody together. Different departments may be responsible for different aspects of worker safety and health. Have representatives from your health protection, health promotion, human resources, workers’ compensation, and other departments meet to discuss how they might best work together.

Learn what workers need. Survey employees to find out what is affecting their safety, health, work-life balance, and productivity. Ask them for suggestions for low-cost, feasible solutions. Bear in mind that workers’ concerns about privacy are a common barrier to participation in wellness programs—make sure that you also ask them what you can do.

Ask how your built environment, policies, and work schedules can enhance safety, health, and well-being. Policies, practices, and programs that address these areas can contribute to TWH. Ask:

  • What can be done to make workspaces and job tasks both safer and healthier?
  • Do workers have free onsite access to (and, where applicable, paid time for) healthy food, physical activity, health screenings, stress reduction resources, and health education?
  • Do workers know how to access and use paid family and sick leave and medical benefits?
  • Are staffing levels contributing to stress and hazards?
  • Do workers feel safe from discrimination, harassment, and violence?
  • Could work be organized in a way that enhances health?
  • Do workers receive fair performance appraisals and advancement opportunities?
  • Is attention paid to work/life integration for all employees?
  • Are work factors that can cause chronic conditions addressed?
  • Are older workers receiving support for productive aging?
  • Could the workplace be more flexible, giving workers more control over their schedules?

One More Tip: Lunch-and-learn programs are one way to encourage healthier eating and provide information about workplace efforts and available wellness initiatives.


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