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What is Total Worker Health™ ?

Total Worker Health™ integrates occupational safety and health protection with workplace policies, programs and practices that promote health and prevent disease to advance worker safety, health and well-being.

Today, emerging evidence recognizes that both work-related factors and health factors beyond the workplace jointly contribute to many safety and health problems that confront today’s workers and their families. Traditionally, workplace safety and health programs have been compartmentalized. Health protection programs have focused squarely on safety, reducing worker exposures to risk factors arising in the work environment itself. And most workplace health promotion programs have focused exclusively on lifestyle factors off-the-job that place workers at risk. A growing body of science supports the effectiveness of combining these efforts through workplace interventions that integrate health protection and health promotion programs.

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. TWH is defined as a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance worker health and well-being. The TWH Program supports the development and adoption of ground-breaking research and best practices of integrative approaches that address health risk from both the work environment (physical and organizational) and individual behavior. 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.

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 health protection and health promotion 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 integrated approach that addresses occupational safety and health, workplace health promotion, and the psychosocial work environment at environmental, organizational, and individual levels, all to move more closely to a safer, healthier and thriving workplace.

The "Issues Relevant to Total Worker Health™" graphic below is an at-a-glance visual of issues relevant to integrating occupational safety and health protection with health promotion. The lists below are not meant to be exhaustive, but, rather they illustrate the breadth of issues related to work that have the potential to impact health and should be considered as strategies are developed for integration of health protection and health promotion activities.

Issues Relevant to a Total Worker Health™ Perspective*

*Issues in these lists are for illustrative purposes and are not meant to be exhaustive

The integration of health protection and health promotion involves the comprehensive development and implementation of organizational programs, policies and practices that minimize and/or eliminate workplace physical, biological, and psychosocial hazards and risks, promote healthy behaviors, and provide resources for maintaining and optimizing a safe, healthy and productive workforce – both on and off the job.

TWH strategies and interventions include but are not limited to:

  • Provision of mandated respiratory protection programs that simultaneously and comprehensively address and provide supports for tobacco cessation.
  • Ergonomic consultations that discuss work design, joint health and arthritis prevention and management strategies.
  • Provision of onsite, comprehensive workplace screenings for work and non-work related health risks.
  • Models that combine occupational health services with workplace primary care.
  • Regular communication and demonstration of senior leadership and management commitment to support a culture of health of safety and health across the organization.
  • A systems-level approach that coordinates the organizational alignment (i.e., reporting, funding) of traditional safety and environmental health programs, occupational health clinics, behavioral health, workplace health promotion programs, health benefits, and compensation and disability management.

For hands-on guidelines and resources on creating or expanding organizational cultures of safety, health and well-being, visit

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  • Page last reviewed: February 10, 2013
  • Page last updated: July 17, 2015

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