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workers of various occupations and ethnicities

What is Total Worker Health®?

Total Worker Health® 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.

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. Total Worker Health (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 access to leave and healthful workplaces all can have an important impact on the well-being of workers, their families, and their communities. TWH explores opportunities to not only protect workers, but also advance their health and well-being by targeting the conditions of work. Scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to health problems previously considered unrelated to work. For example, there are work-related risk factors for abnormal weight fluctuations 1, 2, sleep disorders3, cardiovascular disease4, depression5, 6, 7, and other health conditions. In recognition of these emerging relationships, the TWH approach focuses on how environmental, workplace factors can both mitigate and enhance overall worker health beyond traditional occupational safety and health concerns.

In June 2011, NIOSH launched the Total Worker Health (TWH) Program as an evolution of the NIOSH Steps to a Healthier US. Workforce and the NIOSH WorkLife Initiatives. The TWH Program supports the development and adoption of ground-breaking research and best practices of approaches that emphasize the opportunities to sustain and improve worker safety and health through a primary focus on the workplace. The TWH approach integrates workplace interventions that protect safety and health with activities that advance the overall well-being of workers. Establishing policies, programs, and practices within the workplace that focus on advancing the safety, health and well-being of the workforce may be helpful for individuals, their families, communities, employers and the economy as a whole. The original scientific rationale for expanding research on the benefits of integrated programs to improve worker health and workplace safety was published in 2012 in a research compendium of three seminal papers on the science and practice of integrating health protection and health promotion, The NIOSH Total Worker Health® Program: Seminal Research Papers 2012.

For more on the history of TWH, visit

Keeping Workers Safe is Fundamental to Total Worker Health

With the Congressional mandate "to assure so far as possible every man and woman in the Nation safe and healthful working conditions and to preserve our human resources," NIOSH recognizes keeping workers safe is the foundation upon which Total Worker Health is achieved. Employers and employer-employee partnerships wishing to establish effective workplace programs that sustain and improve worker health must first consider the foundational principles of occupational safety and health that are dedicated to keeping workplaces safe and workers protected. First-dollar investments must address hazardous working conditions. Only after these safeguards are in place can organizations move their workforce toward a state of total worker health. Employers who opt for wellness programs in the absence of adequate workplace safety and health protections are not applying the principles of Total Worker Health.

Published in 2010, the NIOSH Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing identifies twenty components of a comprehensive work-based Total Worker Health program and includes both guiding principles and practical direction for organizations seeking to develop effective workplace programs. After understanding these guiding principles and necessary worker protections, organizations will be better positioned to develop an approach that addresses occupational safety and health, worker health and well-being, and the psychosocial work environment at environmental, organizational, and individual levels, all to move more closely to a safer, healthier and thriving workplace.

The following graphic “Issues Relevant to Advancing Worker Well-being Through Total Worker Health®” illustrates a wide-ranging list of issues that are relevant to advancing worker well-being through a Total Worker Health approach. The list of issues relevant to Total Worker Health was revised, retitled and published in November 2015 with input from stakeholders. This updated list reflects an expanded focus for TWH that recognizes that new technologies, new working conditions, and new emerging forms of employment present new risks to worker safety, health and well-being.  Understanding and reducing those risks are important elements of TWH. Additionally, this expanded focus recognizes that there are linkages between health conditions that may not arise from work but that can be adversely affected by work. A Total Worker Health approach advocates for the integration of all organizational policies, programs and practices that contribute to worker safety, health and well-being, including those relevant to the control of hazards and exposures, the organization of work, compensation and benefits, built environment supports, leadership, changing workforce demographics, policy issues, and community supports.

Issues Relevant to Advancing Worker Well-being Through Total Worker Health

Total Worker Health Issues

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Here are examples of TWH approaches as applied to specific workplace challenges:

  • To prevent risk of musculoskeletal disorders, consider:
    • Reorganizing or redesigning how individuals do their work;
    • Providing ergonomic consultations; and
    • Providing education on arthritis self-management strategies.
  • To reduce work-related stress, consider:
    • Implementing organizational and management policies that give workers more flexibility and control over their schedules;
    • Providing training for supervisors on approaches to reducing stressful working conditions; and
    • Providing skill-building interventions on stress reduction for all workers.

For more about Total Worker Health, visit our Frequently Asked Questions page.

  • Page last reviewed: November 6, 2015
  • Page last updated: November 13, 2015
  • Content source:

    TOTAL WORKER HEALTH ® is a registered trademark of the US Department of Health and Human Services