Health and Wellness, Q&A, Safety Culture

Addressing Total Worker Health in Your Safety Culture: A Q&A with L. Casey Chosewood, MD, MPH

We’re less than 1 month away from Safety Culture 2019, and we have a great variety of speakers in store for event attendees. One of those speakers, L. Casey Chosewood, MD, MPH, recently sat down with the EHS Daily Advisor to talk about Total Worker Health® and how it can improve your safety culture and your organization as a whole.

psychosocial healthcare mental health

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Chosewood will be presenting his session, “Stress, Fatigue, and Mental Health: Real-World Culture Building to Improve Worker Safety and Health,” at Safety Culture 2019, taking place September 18–20 in Denver, Colorado.

Q: Tell us a little bit about who you are and what you do in the safety world.

I currently lead the Centers for Disease Control and Prevention’s (CDC) Total Worker Health (TWH) program based at the National Institute for Occupational Safety and Health (NIOSH), a collaborative effort dedicated to protecting, preserving, and improving the safety, health, and well-being of working people. The office coordinates internal research, translation, programming, and resource development with activities in 6 funded academic national Centers of Excellence for Total Worker Health and more than 45 TWH affiliate organizations.

We engage thousands of partners in the public and private entities, labor organizations, and academia. Our research focuses on occupational safety and health; worker protection; work organization; workplace well-being; and implementation of worker-centered policies, practices, and programs for advancing safer, healthier work.

Some of my past duties at the CDC include Medical Director of CDC Occupational Health Clinics from 2002 to 2004 and Director of the Office of Health and Safety for the CDC from 2005 to 2009.

Q: What is Total Worker Health, and how does it intertwine with workplace safety programs and culture?

“Total Worker Health” is defined as policies, programs, and practices that integrate safety at work with prevention opportunities at work and beyond. It’s all about keeping workers safe but also about taking the next step to use work and the workplace to make people healthier.

Simply put, organizations must first protect workers and then take a step further by introducing additional policies, programs, and practices that advance health both on and off the job. The result, if done well, leads to workers with higher levels of well-being. This directly benefits workers and, by extension, positively impacts the organizations in which they work.

Traditional occupational safety and health protection programs have primarily concentrated on ensuring that work is safe and that workers are protected from the harms that arise from work itself. TWH builds on this approach through the recognition that work is a social determinant of health; job-related factors such as wages, hours of work, workload and stress levels, interactions with coworkers and supervisors, access to paid leave, and health-promoting workplaces all can have an important impact on the well-being of workers, their families, and their communities.

A healthy workplace culture is the result of a comprehensive set of steps employers can take to benefit their employees. It’s an ongoing commitment to healthier hiring practices; better job design; attention to working demands and conditions; and adequate wages, benefits, recognition, and reward. Good culture supports engagement and retention. It turns a job into a fulfilling experience that provides both a living and a life.

Q: While attitudes are changing, some still believe that many health and wellness issues, such as stress and mental health, are personal issues to be dealt with outside the workplace. How can we go about changing this mind-set in the workforce?

Workplace stress is an extremely important issue in almost all workplaces. It’s one of the most common concerns we hear about from employers. And today, it’s even more critical that we change this misconception that this discussion doesn’t belong in the workplace, especially because mental health challenges and the opioid overdose and suicide epidemics are devastating many in our workforce. Some occupations and industries, like construction, mining, and transportation, are especially hard-hit.

Mental health conditions are a leading cause of disability and are costly for many employers. Underlying mental health concerns or diagnoses impact productivity day in and day out, and they can often slow the return to work after workers face other injuries and illnesses, whether work-related or not. The quality of the job and the demands of the work are critical to consider here, not just personal risk factors. We know that fast-paced work, high job demands, job insecurity, and low wages in many work settings may increase risks for poor mental health outcomes.

Safety pros and HR professionals should increase their comfort around these issues and be ready to help. Many already have skills to help mitigate or address other challenges workers face, and this should be no different. Most have an understanding of work’s connection to health, but broadening this is helpful. Additional skills around empathy, increased awareness, lessening stigma, providing supportive environments, “soft management,” and better people skills can all contribute to a better workplace for all workers, especially those with mental health concerns.

Q: What are three positive steps that safety managers can take right now to address fatigue, stress, and mental health at their companies?

Only three? I’ll double it. Here are some proven strategies employers and organizations can take to prevent or mitigate workplace stressors:

  1. Maximize day-to-day flexibility offered to workers.
  2. Address job insecurity whenever possible.
  3. Give workers a voice; participatory approaches are critical, especially in times of change.
  4. Healthier supervision—train supervisors to understand the connections between work and health; improve their recognition, reward, and support skills.
  5. Provide meaningful work and the resources to do it well.
  6. Improve the work/life interface.

Fatigue is a serious workplace issue often related to long hours of work, shiftwork, and excessive demands on workers (both from work and from nonwork obligations like caregiving and parenting). This issue has overlap with (but is not equivalent to) workplace stress. You can check out NIOSH resources on fatigue and long hours of work here:

To learn more about improving safety culture and total worker health, join us at Safety Culture 2019 this September in Colorado!

Q: Are there any mistakes that safety managers should avoid when trying to tackle these issues?

Yes. Issues around stress and mental health are heavily stigmatized in many settings, and this stigma must be avoided. Protect workers’ privacy and autonomy. Provide good benefits in this area. Make sure shifts and schedules are designed with health in mind. Employers can train supervisors to be mindful of this, providing training to help them understand the connection to work and working conditions, and help them develop strategies to supervise with health in mind. Consider offering awareness-building and screenings on-site in private settings. Have a high-quality employee assistance program (EAP) in place and referral sources with affordable services available. Know that treatments for all mental health concerns, including substance use disorders, are available and really do work—people can get better and return to work to function fully.

Q: What are your biggest hopes and concerns for the future of worker health and safety?

First, a few concerns. Work is changing rapidly, and employment arrangements are shifting. Uncertainty and insecure employment for many will be a constant head wind. New technologies in the workplace have the capability to help or harm workers. So, it is critical for workers, critical end users of any new tech, to be at the table when these decisions are made.

But there is hope for the future of work. At NIOSH, we believe work can and should be more than just a paycheck—more than just a job. The right kind of work, designed with health and well-being in mind, not only offers adequate wages but also provides for social connections, lifelong learning, and meaningful contribution to the company and society. Companies that want a competitive edge should grow their culture, day in and day out, and stay focused on improving the health and well-being of their workers.

ChosewoodWant to learn more about TWH? Join L. Casey Chosewood, MD, MPH, the Director of the Office for Total Worker Health® at the National Institute for Occupational Safety and Health, at Safety Culture 2019, taking place September 18–20 in Denver, Colorado!

During the conference, Dr. Chosewood will be presenting his session, Stress, Fatigue, and Mental Health: Real-World Culture Building to Improve Worker Safety and Health, where you will learn how to proactively identify safety risks, reduce churn, and eliminate injuries.

Register for Safety Culture 2019 today!

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