A Comprehensive and Integrated Framework

The impact of aging on both individuals and organizations is often complex and influenced by a wide range of work and non-work factors. As a result, attempts to design programs or interventions to improve productive aging need to be both multi-dimensional and well-coordinated. Two examples of such an approach that are directly applicable to productive aging are Work Ability and Total Worker Health®.

The concept of Work Ability originated at the Finnish Institute of Occupational Health and has since been adopted in many other countries, including the U.S. Work Ability refers to a worker’s capacity to continue working in his or her current job, given work demands and available resources. Work demands include aspects of the work environment such as physical characteristics, work organization, and supervision. Resources include health, functional abilities, job skills, and family/community support. Strategies to maintain or improve work ability focus on four basic areas:

  • Working Conditions: ergonomics, industrial hygiene and safety
  • Employee Health:  healthy lifestyles, functional capacity
  • Professional Skills: job-related knowledge and competence
  • Psychosocial Factors: work arrangements and flexibility, social support and culture

A Work Ability approach involves conducting an organizational assessment in each of these areas. Programs or interventions that are developed should simultaneously target several of the above factors and involve careful planning, implementation, and long-term follow-up. In addition, a Work Ability Index is often used to measure this construct and to help determine the impact of workplace intervention programs.

Total Worker Health® (TWH) was developed by National Institute for Occupational Safety and Health. TWH is formally 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. Simply put, the TWH approach integrates workplace interventions that protect workers’ safety and health with activities that advance their overall well-being, on and off the job.

A TWH approach prioritizes a hazard-free work environment for all workers. But it also comprehensively addresses other workplace systems, including those relevant to the control of psychosocial hazards and exposures; the organization of work; compensation and benefits; and work-life management efforts. Total Worker Health® calls for a holistic understanding of the factors that contribute to worker well-being, recognizing that workplace risk factors can contribute to health problems previously considered unrelated to work; these include risks for obesity, sleep disorders, cardiovascular disease, depression, and other health conditions.

The emphasis in TWH on integration reflects the fact that often occupational safety and health programs have traditionally been compartmentalized and/or functioned independently of one another with little coordination. A growing body of research, however, indicates that workplace programs that are integrated and share common objectives are more effective than programs developed in isolation.

Both TWH and Work Ability provide useful frameworks for productive aging. The emphasis rests on developing sustainable, well-coordinated strategies that span several different dimensions of safety and health, including factors outside of the workplace. These strategies are not limited to a specific age group, and are intended to have benefits for workers of all ages.


  1. Ilmarinen J. (1999). Ageing workers in the European Union: Status and promotion of work ability, employability and employment. Finnish Institute of Occupational Health and Ministry of Social Affairs and Health, Helsinki, 274 pages.

  2. Schill, A., & Chosewood, L.C.  (2013).  The NIOSH Total Worker Health TM program: An overview.  Journal of Occupational & Environmental Medicine, 55(suppl):S8-S1.  For additional information, see:
  3. Silverstein, M.  (2008). Meeting the challenges of an aging workforce.  American Journal of Industrial Medicine, 51, 269-280.  
  4. Sorensen G, McLellan D, Dennerlein J, et al. Integration of Health Protection and Health Promotion: Rationale, Indicators, and Metrics. Journal of Occupational and Environmental Medicine December 2013;55 (Suppl):S12-18.
Page last reviewed: September 15, 2015