Centers of Excellence for Total Worker Health®

This image shows a person standing up in a meeting to speak to the presenter


Traditional occupational safety and health protection programs have primarily concentrated on making sure that work is safe and that workers are protected from harms arising from work itself. Today’s workers face not only traditional risks of chemical, physical, and biological hazards, but also increased risks related to the changing nature of work. Evolving employment patterns and shifting workplace environments can contribute to stress, mental health effects, chronic diseases, and other impacts on population health and well-being. For these reasons, a broader view of workplace health for modern workers is necessary.

The coronavirus disease 2019 (COVID-19) pandemic has also changed the workplace environment. Workers face increased concerns surrounding economic insecurity and their own personal safety, including threats to their mental health and well-being.  Some faced social isolation and shifts to remote work, while essential workers endured the risks and challenges of working and reintegrating back into a rapidly changing workplace. These and other new challenges among the workplace, families, and communities increase the wear and tear of ongoing, daily stress felt by workers. This increase may affect cognitive reserve and resilience, and potentially lead to cognitive decline. Gender, age, and socioeconomic characteristics may affect workers’ sensitivity to these emerging conditions.

NIOSH’s Total Worker Health® Program builds on four decades of scientific knowledge by recognizing that work is a social determinant of health. For example, job-related factors such as wages, hours of work, workload, stress levels, workplace social interactions, and access to paid leave can all have an important impact on the well-being of workers, their families, and communities. Total Worker Health (TWH) 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. This approach prioritizes a hazard-free work environment for all workers and comprehensively integrates workplace systems relevant to the control of hazards and exposures, organization of work, work-life fit, and compensation and benefits. The NIOSH TWH Program supports ground-breaking research and practical applications that address all the implications of today’s changing workplace.


The Centers of Excellence for Total Worker Health are funded by NIOSH via a cooperative agreement to advance the overall safety, health, and well-being of the diverse population of workers in our nation. Centers accomplish this through a broad range of multidisciplinary research activities, including intervention-focused research, outreach and education, and evaluation. The Centers are hubs for TWH-related research and practice that build the scientific evidence base necessary to develop new solutions for complex occupational safety and health problems.

Map of the USA with the dots showing the Centers of Excellence for Total Worker Health across ten states.

Center Descriptions

TWH Centers Focus on Timely COVID-19 Related Research

During fiscal year (FY) 2021, NIOSH provided extramural funding for projects that address challenges related to the COVID-19 pandemic. As part of the American Rescue Plan (ARP) Act of 2021, six of the Centers of Excellence for TWH received funding. This funding supports research addressing mental health conditions and substance use among health workers including medical first responders and public health workers. These six centers are working on the following eight research projects.

  • Carolina Center for Healthy Work Design and Worker Well-Being
    • Project Title and Description
      Rural and Urban Clinician Well-being and Targeted Improvement Interventions during COVID-19
      This basic, etiologic study assesses nurse and physician well-being, including such conditions as burnout, depression, post-traumatic stress disorder, and moral distress. The project uses a composite well-being index, along with work system factors associated with well-being during the COVID-19 pandemic. The study includes four different inpatient settings (academic medical center, two rural community hospitals and a critical access hospital) at two timepoints in two years.
  • Center for the Promotion of Health in the New England Workplace (CPH-NEW)
    • Project Title and Description
      “CPH-NEW IV – Total Worker Health -SHIFT II Large Project”
      Building on its Safety & Health Through Integrated, Facilitated Teams  (SHIFT) Study, CPH-NEW started its SHIFT II research in 2021. SHIFT II uses a multi-phase, participatory approach to address the health, safety, and well-being of healthcare workers. Through the SHIFT II study, the center assesses the effectiveness of its participatory model in the intra/post-pandemic environment and explores approaches for integrating the TWH concept of worker participation into the healthcare infrastructure related to the health and safety of workers. The center aims to create practical models for transforming occupational safety and health practice for our nation’s healthcare workers. This is a group dealing with a wide range of occupational hazards including physically demanding work, job burnout, shiftwork, and organizational instability.
  • Harvard T.H. Chan School of Public Health Center for Work, Health and Well-being
    • Project Title and Description
      “Boston Hospital Workers Health Study”
      The Boston Hospital Workers Health Study (BHWHS) is a data-sharing and intellectual partnership between the study team at the Center for Work, Health and Well-being and two large hospitals within Mass General Brigham — a large health system and Massachusetts’ largest employer. BHWHS consists of multiple long-term sources of administrative data from the two hospitals. The data are linked at the worker level with survey data on emerging and established occupational exposures and experiences. BHWHS currently includes 22,000 nurses and nursing assistants. Over the two-year project period, researchers plan to expand the number of study participants to include nearly all 40,000 workers at the hospitals to create a cohort that is diverse by occupation, race, ethnicity, and income level. In this study, researchers will focus on whether specific policies, working conditions, and exposures act as social determinants of health within the hospital work environment. They will also look at whether policies aimed at improving working conditions have the potential to narrow or widen occupational, racial, and wage gaps in health within the hospital workforce. Through this project, this Center of Excellence strives to broaden the scope of occupational safety and health research and practice in hospitals. It aims to do this by showing the need to analyze how working conditions and policies contribute to disparities in health and well-being in the hospital workforce.
  • Johns Hopkins Psychosocial Organizational, and Environmental (POE) Total Worker Health® Center in Mental Health (POE Center)
    • Project Title and Description
      “Psychosocial, Organizational, and Environmental Stressors for Healthcare Workers”
      As the workplace changes, workers’ concerns increase regarding job security, work-life balance, and exposure to physical and psychosocial threats —all which have been exacerbated by the COVID-19 pandemic.
      The POE Center aims to promote worker mental health and well-being through research, education, outreach, and evaluation activities that combine the psychosocial, organizational, and environmental contexts of worker health. This project, known as HC-WORK, aims to improve the mental health, well-being, physical health, and safety of essential workers in healthcare. This is a workforce burdened with burnout, mental health challenges, and related well-being concerns. Many of these challenges existed before and became worse during the COVID-19 pandemic and will likely continue beyond this time. Researchers aim to address these issues by creating a Psychosocial, Organizational, Environmental Measurement Tool. They will develop other interventions and utilize principles of implementation science to address harmful workplace exposures related to psychosocial, organizational, and environmental factors.
  • Oregon Healthy Workforce Center (OHWC)
    • Project Title and Description
      “A Natural Experiment for the Impact of Work Schedule on Cardiovascular Health and Safety in Firefighters”
      This study examines the link between work schedules and psychosocial determinants of sleep, safety, and cardiovascular (CV) disease risk for firefighters, including paramedics and other medical first responders. Although many fire departments have changed work shift hours to decrease stressors that firefighters face which impact their mental and physical health, there is limited research supporting this move. OHWC scientists are using quasi-experimental research to determine the impact of work schedules on firefighters’ CV health. The center expects this project to influence changes in organizational policy and the design of firefighters’ work schedules. The OHWC plans to share the findings with fire departments nationwide via tailored communication products, which they will create and test to ensure the materials are relevant for this worker population.
    • Project Title and Description
      “Translating an Intervention to Address Chronic Pain Among Home Care Workers”
      The Community of Practice and Safety Support (COMPASS) is an intervention previously developed by OHWC. It uses a peer-led scripted curriculum to organize home care workers (HCWs) into neighborhood-based teams and provide education and social support to improve lifestyle (e.g., diet, exercise) and safety behaviors. HCWs are a rapidly growing and vulnerable worker group that is at an elevated risk for mental and physical health issues. Often lacking strong workplace protections, they experience high rates of chronic pain, functional limitations, and emotional distress. This project adapts the COMPASS intervention to address HCWs with chronic pain. The project includes integrating pain management education and specific strategies for pain self-management. OHWC researchers also focus on strengthening ergonomic protections for HCWs, which can prevent soft tissue injuries and musculoskeletal disorders. Through these efforts, OHWC aims to increase pain and injury prevention behaviors and prevent new injuries and re-injuries. They also strive to reduce pain-related limitations in work and life, emotional distress, and the risk of starting opioid use and misuse.
    • Project Title and Description
      “A Total Worker Health, Supervisor-driven Burnout Intervention”
      Currently, there are few randomized controlled trials looking into organizational drivers of burnout in healthcare. This study fills this gap by using a new approach to assess the effectiveness and process of a supervisor-led intervention to address burnout drivers among workers in primary care clinics. OHWC researchers expect to identify intervention components that users can readily adapt to other healthcare settings. This study is significant because it addresses healthcare workers’ burnout — an urgent priority that has become even more critical during the COVID-19 pandemic.
  • Utah Center for Promotion of Work Equity (U-POWER)
    • Project Title and Description
      “Incorporating Worksite Interventions in Safety and Health (IWISH): Building Capacity for Total Worker Health”
      This project focuses on essential workers and brings attention to infectious disease risks. Using qualitative research, this study investigates formal and informal uses of TWH core competencies to make decisions on how to keep workers safe and businesses open during the COVID-19 pandemic. These approaches include a worker-engaged process. U-POWER researchers will also develop guidelines and training materials to support worker-engaged approaches that mitigate workplace exposure to organisms causing respiratory diseases.

Fiscal Year (FY) Extramural Research Program Highlights

Program achievements featured in the Extramural Research and Training Program Annual Reports

Funding Opportunity Announcements

All cooperative agreement funding opportunity announcements