Healthy Work Design and Well-Being Program

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Burden, Need and Impact

NIOSH strives to maximize its impact in occupational safety and health. The Healthy Work Design and Well-Being program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Below are the priority areas for the Healthy Work Design and Well-Being program.


The burden of shift work, irregular or long work hours, and insufficient sleep that is borne by American workers is immense. Almost 15% of full-time workers (or 15 million Americans) work on evening, night, rotating, split or employer-arranged irregular shifts. 1 The 2010 National Health Information Survey showed 18.7% of American workers worked 48 hours or more per week and 7.2% worked 60 hours or more per week.2 Shift work and long work hours may lead to many health and safety risks by disrupting sleep and circadian rhythms. Substantial evidence supports the need for 7 or more hours of good quality sleep each day.3 The percentage of American civilian workers reporting 6 or fewer hours of sleep per day increased from 24% in the 1980s to 30% in the middle 2000s.4Insufficient sleep is associated with a broad range of health and safety risks including premature death, obesity, vehicle crashes, adverse reproductive outcomes, and developing a wide range of chronic illnesses including cardiovascular, gastrointestinal, and musculoskeletal disorders, diabetes mellitus, cancer, Alzheimer’s disease, and disturbances to mood and cognition. RAND reports insufficient sleep could cost the U.S. economy upwards of $411 billion annually (2.28 per cent of its gross domestic product [GDP]), due to a range of negative impacts, reduced productivity, and losses of 1.2 million working days per year.5


Work on this topic is particularly important for workers who provide critical services for society around the clock including those in healthcare, protective services, and utilities. Shift work and long work hours require research on interventions to reduce risks: testing various work scheduling patterns; manipulating light exposure, pharmacology agents, and diet regimes; work organization strategies and efforts to change workplace cultures; workplace interventions including policies, fatigue risk management systems, and education programs; mathematical models to predict risks; and studies of the impact of broader public policy. NIOSH is uniquely positioned for this work. NIOSH scientists across several disciplines and areas of research from surveillance to online training intervention research are recognized experts on this topic.


A wide range of positive outcomes can be expected from research to reduce the risks associated with shift work, long work hours, and related workplace sleep and fatigue issues. The short term goal is that workers and their managers adopt workplace strategies and personal strategies to promote their sleep health and minimize disruption to circadian rhythms that can occur from shift work and long work hours. These improvements will reduce risk for chronic disease and also reduce fatigue-related mistakes that can cause a range of problems to the employer and the community including patient care errors, vehicle crashes, and industrial disasters. An example of recent impact includes the uptake of an online training program: NIOSH training for nurses on shift work and long work hours. In the first year and a half after launch, the training website had 37,000 visits and almost 3000 people obtained continuing education certificates for taking the training. The evaluations showed about 95% agreed or strongly agreed with positive characteristics about the training. At least 45 external websites provide information about the training and a link.


1 McMenamin, T.M. (2007). A time to work: Recent trends in shiftwork and flexible schedules. Monthly Labor Review, 130(12), pp. 3-15.

2 Alterman, T., Luckhaupt, S.E., Dahlhamer, J.M., Ward, B.W., Calvert, G.M. (2013). Prevalence of work organization characteristics among workers in the U.S.: Data from the 2010 National Health Interview Survey. American Journal of Industrial Medicine, 56(6), pp. 647-659.

3 Luyster, F.S., Strollo, Jr., P.J., Zee, P.C., Walsh, J.K. (2012). Sleep: A health imperative. Sleep, 35(6), pp. 727-734.

4 Luckhaupt, S.E., Tak, S., Calvert, G.M. (2010). The prevalence of short sleep duration by industry and occupation in the national health interview survey. Sleep, 33(2), pp. 149-159.

5 Hafner, Marco, Martin Stepanek, Jirka Taylor, Wendy M. Troxel and Christian Van Stolk. Why sleep matters — the economic costs of insufficient sleep: A cross-country comparative analysis. Santa Monica, CA: RAND Corporation, 2016.


Non-standard work arrangements are characterized by temporariness, instability, irregularity, and lack of legal protections and social benefits for workers which, in turn, may affect worker safety, health, and well-being. Several non-standard arrangements involve temporary jobs and insecurity of employment and income, which have been linked to lower levels of health and well-being.1 Insufficient household income, non-standard or irregular hours, and lack of career opportunities are associated with poor mental health.2 Temporary agency workers frequently lack safety and other general training, and suffer from the tendency for newer workers to be at greater risk of injury.3 Workers whose employers contract their services out to another employer may be at higher risk for injury and illness because the responsibility for safety is divided between two employers.

Gig workers perform work intermediated by a digital on-line platform.4 Gig work is thought to represent something new, because of the way these platforms connect workers with customers, handle payments and determine rates of pay, and guide or incentivize their work. A 2016 survey by Pew Research found that 8% of US adults earned money from an on-line job platform in the previous year, and that 29% of these consider this income essential to meeting their basic needs.5 The same concerns arise for these workers as for other workers who may be misclassified as independent contractors and workers with inadequate and unsteady sources of income.


From 2005 to 2015, non-standard work arrangements have accounted for all the net employment growth in the United States.6 These types of work arrangements are understudied and their determinants and health and safety consequences are poorly understood. NIOSH has been assessing quality of work life for a long time and is well-positioned to holistically examine the effects of work arrangements on workers. In addition, since work arrangements are often shaped by industry and occupational context, NIOSH’s longstanding focus on specific industries and occupations can help bring needed focus to research and intervention efforts. Because this is a new and growing area of concern, all types of research are needed. Particularly needed are models to help explain the determinants and effects of work arrangements, efforts to improve their classification and description, and linkage of databases to allow more holistic research.


Reducing the risks associated with non-standard work arrangements would improve safety, health and well-being outcomes for workers and their families, employers and society overall. NIOSH jointly published recommended practices for protecting temporary workersCdc-pdf with the Occupational Safety and Health Administration 2014, and continues to conduct research in this area. Two recent studies point to the importance of examining each type of work arrangement separately and in depth, in order to understand and effectively address gaps in research and practice. The first provided evidence that lack of access to paid sick leave is associated with an increased risk of suffering occupational injury.7A second showed that psychosocial factors like job stress, feeing overworked, and freedom to make decisions varied by work arrangements.8 This means that interventions to address specific gaps in psychosocial conditions by work arrangement would reduce job stress and improve health and productivity among workers in these arrangements.


1 Virtanen, M., Kivimaki, M., Joensuu, M., Virtanen, P., Elovainio, M., Vahtera, J. (2005). Temporary employment and health: a review. International Journal of Epidemiology, 34 (3): 610-622.

2 De Moortel, D., Vandenheede, H., Vanroelen, C. (2014). Contemporary employment arrangements and mental well-being in men and women across Europe: A cross-sectional study. International Journal for Equity in Health, 13(1), 90.

3 Occupational Safety and Health Administration (2014). Recommended practices: Protecting temporary workers. OSHA – 3735-2014.

4 Howard, J. (2017). Nonstandard work arrangements and worker health and safety. Am J Ind Med 60(1):1-10

5 Smith, A. (2016). Gig work, online selling, and home sharing. Pew Research Center:

6 Katz, L. F., Krueger, A. B. (2016). The rise and nature of alternative work arrangements in the United States, 1995-2015. National Bureau of Economic Research Working Paper 22667:

7 Asfaw, A., Pana-Cryan, R., Rosa, R. (2012). Paid sick leave and nonfatal occupational injuries. American Journal of Public Health, 102(9):e59-e64.

8 Ray, T.K., Kenigsberg, T.A., Pana-Cryan, R. (2017). Employment arrangement, job stress, and health-related quality of life. Safety Science, May 2017, Epub:


U.S. workers report significant levels of job stress. More than a third of the respondents in the NIOSH Quality of Work Life (QWL) survey report their jobs to be “often” or “always” stressful.1 Job stress has significant adverse effects across the spectrum of well-being (e.g., physical and mental health, behavior, productivity, social, non-work outcomes), and has been linked with a range of adverse physical, mental, cognitive, behavioral, safety, and performance outcomes. Workers who report high levels of job stress have nearly 50% greater health care expenditures than those reporting low levels of job stress2, and the median absence period for lost-time cases due to job stress is more than four times the median for all other injuries and illnesses.3 Stress is present in all industries and occupations. However, for industries where workers report the most stressful jobs, estimated costs for lost workdays due to workplace stress are substantial: $2.6 billion for transportation, $3.2 billion for wholesale/retail trade, $2.9 billion for manufacturing, and $1 billion for construction.4


Reducing job stress is an important step toward improving worker well-being. There is a critical need to develop effective tools that organizations can use to assess and address sources of job stress. Additionally, there is great interest by organizations in the concept of worker well-being, and in integrative approaches to improve worker well-being. NIOSH expertise in this area, as well unique nationally representative databases on occupational stressors and health and safety outcomes that can guide more focused research and interventions to specific sectors, occupations, and demographic groups. Finally, NIOSH has developed strong partnerships with industry partners to collaborate with NIOSH.


NIOSH has partnered with the American Psychological Association (APA) since 1990 on the Work, Stress, and Health conference seriesExternal, and on the development of the field of Occupational Health Psychology (OHP) within the United States. The conference series and the OHP program have been influential in both shaping work organization and stress research in the U.S., and in the development of OHP specialists that are working with companies to implement stress interventions in the workplace. NIOSH is also developing tools to identify and deal with risk factors for job stress, and associated best practices, training, and informational products. The adoption of healthy work organization structures and practices should reduce worker stress and associated health and safety outcomes. This, in turn, is expected to significantly reduce the economic burden associated with injuries, poor health, and reduced productivity, which will benefit workers, employers, families, and communities/society.


1 Unpublished data from the 2014 NIOSH Quality of Work-Life survey. More information about this survey is available at

2 Goetzel, R.Z., Anderson, D.R., Whitmer, R.W., Ozminkowski, R. J., Dunn, R.L., Wasserman, J., The Health Enhancement Research Organization (HERO) Research Committee (1998). The Relationship Between Modifiable Health Risks and Health Care Expenditures: An Analysis of the Multi-Employer HERO Health Risk and Cost Database. Journal of Occupational and Environmental Medicine, 40(10), 843-854.

3 Webster, T. and Bergman, B. (1999). Occupational stress: Counts and rates. BLS Compensation and Working Conditions, Fall 1999, 38-41.

4 Unpublished NIOSH data from 2016.

Page last reviewed: January 4, 2019