Total Worker Health and Chronic Disease at Work

Summary

The prevalence of chronic disease in younger Americans has risen to unprecedented levels in the past 20 years.1 The number of American adults with multiple chronic health conditions is also increasing.2 Job-related health hazards can worsen pre-existing chronic diseases and lead to new ones. The American Journal of Industrial Medicine recently published a commentary titled "Preventing and Managing Chronic Disease in the Work Environment: Using the Total Worker Health Approach."3 This blog contains highlights from the article. It describes how this unique, holistic approach can help to reduce chronic diseases for workers.

Background

A recently published national study found that chronic disease prevalence in children ages 5–17 has risen from approximately 23% in 1999/2000 to approximately 30% in 2017/2018.1 The number of U.S. adults dealing with multiple chronic health conditions is also increasing.2 Nearly 52% of adults have at least one major chronic disease such as cancer, heart disease, diabetes mellitus, hypertension, asthma, or obesity.45 42% suffer from two or more conditions, and 12% have at least five conditions.67 These findings have broad implications for the workforce. While chronic diseases can be a barrier to employment,8 many Americans with chronic diseases are employed and struggle to manage their conditions in the work environment.9101112

Personal and Occupational Risk Factors

Both personal risk factors (PRFs) and occupational risk factors (ORFs) can cause or worsen chronic diseases. While it is typical to examine effects of PRFs and ORFs separately, doing so may miss potential synergistic effects and cumulative burdens.1213 Therefore, a holistic view of PRFs and ORFs is essential to ensuring chronic disease elimination initiatives are effective.14 The following examples illustrate four types of interactions between PRFs and ORFs.15

• Combined Effects: A chronic disease, such as cardiovascular disease, and occupational exposure to physical factors, such as forceful movements, are both independent risk factors for musculoskeletal disorders. Their combined effect is greater than for either one.16

• Increased Susceptibility: Exposure to a chemical like chromium can increase the risk of developing a skin disease like eczema. In addition, pre-existing skin conditions like psoriasis can modify—and worsen—the health effects from chromium exposure.17

• Take‐Home Exposures: Family living spaces can be contaminated with disease‐causing agents from work, such as lead, that travel to the home on skin, hair, clothes, and shoes.18

• Transgenerational Effects: Parents can be exposed to hazards at work that can lead to reduced fertility, birth defects, and childhood cancers, as well as lifelong chronic diseases in their children. These hazards include chemical, radiological, biological, and psychological exposures—all of which can potentially be controlled with prevention strategies.19

Health Promotion and Health Protection

The increase in working Americans with chronic diseases increases the need for employers to consider workplace-based approaches to support these workers. Promoting healthy behaviors on an individual level ("health promotion")—and protecting workers from occupational hazards ("health protection")—are both critical in preventing and managing chronic disease. Health promotion has been found to be more successful when combined with occupational safety and health protective activities.20

Total Worker Health

The Total Worker Health (TWH) approach encompasses policies, programs, and practices that integrate health protection from work-related hazards with promotion of prevention efforts to advance worker well-being. The TWH approach can be implemented in any workplace using the NIOSH Fundamentals of Total Worker Health Approaches workbook which provides tips, examples, and links to tools. The workbook focuses on five Defining Elements of TWH, which can be adapted to address pre-existing and new-onset chronic diseases.

A critical value of the TWH approach to workforce safety, health, and well-being lies in its adaptability. For example, the TWH approach can support the goals of the U.S. Department of Health and Human Services' Healthy People 2030—a five-decade-long national disease prevention and health promotion initiative. It can also play an important role in new national health initiatives like President Trump's Executive Order 14212 entitled "Establishing the President's Make America Healthy Again Commission (MAHA Commission)." The Executive Order provides that the policy of the federal government is to aggressively combat the critical health challenges facing our citizens... including a focus on reversing chronic disease [sect. 2].

MAHA Assessment Report and Strategy Report

On May 22, 2025, the MAHA Commission released the Make Our Children Healthy Again Assessment Report. Importantly, the Assessment Report noted that "today's children are tomorrow's workforce..." [p. 5]. The Assessment identified four major drivers for the increase in childhood chronic diseases and the early onset of adult diseases that present "the clearest opportunity for progress" [p.5]. These four drivers are: poor diet; chemical exposures; a lack of physical activity; and overmedication.

On September 9, 2025, the Make America Healthy Again Commission published a detailed Strategy Report containing over 100 specific recommendations for action. The Strategy sets forth 23 recommended areas for future research including several that touch on occupational contributors to the development of chronic diseases. For example, assessing cumulative exposure is identified as a critical area for research. Research topics about exposure to microplastics and synthetics, adoption of precision technologies in agriculture, research on electromagnetic radiation, and other critical research topics are highlighted. The Strategy also includes 77 policy reforms, deregulatory actions, and agency restructuring proposals that emphasize a broad list of diet, agricultural, environmental, and healthcare recommendations. The Strategy seeks to increase public awareness about children's exposure to fluoride, pesticides, increased computer or telephone screen time, substances like alcohol and cannabis, and vaping.

One type of partnership mentioned in the report involves education to eliminate the causes of infertility. The Strategy states that it is important to "influence adolescent health through early adoption of lifestyles that help avoid the root cause issues that impact adult fertility in the 20s, 30s and 40s" [p. 18]. In addition to the lifestyle factors mentioned in the Strategy, occupational hazards can adversely affect the reproductive health of young workers, cause developmental risks in their offspring, and should be the subject of comprehensive workplace hazard management using the TWH approach.21

Conclusion

Combating chronic childhood diseases ensures the health of the American workforce, as today's children soon become tomorrow's workers. New initiatives are also important to mitigate the challenges facing young workers who enter the workforce already burdened with chronic diseases and to prevent the occupational risks that lead to the development of new chronic diseases. The TWH approach presents an opportunity to integrate workplace health promotion and protection into existing and new national health initiatives.