Total Worker Health

Making the Business Case

At a glance

Total Worker Health® approaches benefit workers and organizations. Businesses and employers can use helpful approaches, like flexible work and supportive supervision, to benefit workers and the bottom line. Avoid harmful work factors, like unpredictable, demanding schedules.

two people sitting in front of a table with a laptop and notebook


Today's employers face new, complex challenges in addition to well-known workplace safety and health concerns. Leading health conditions contributing to medical costs and lost productivity for U.S. employers include:

  • Depression
  • Musculoskeletal disorders
  • Other chronic diseases1

Chronic diseases and injuries cost U.S. employers more than half a trillion dollars in lost productivity each year.2 The economic impact of preventable workplace injuries in 2018 alone was an estimated 170.8 billion dollars.3

Comprehensive efforts to promote worker well-being and reduce safety risks can reduce costs and improve productivity and performance indicators.45 Approaches that improve workplace policies, programs, and practices can lead to better retention rates and improved productivity. Examples of these approaches are described below.

Helpful approaches

Comprehensive programs

L.L. Bean is an outdoor clothing, shoe, and equipment company. They reported a positive return on investment in a comprehensive worker well-being program. Results ranged from $1.70 to $5.30 saved for every dollar invested.6

Flexible work

A study of workers showed that more time-flexible work policies were associated with multiple positive outcomes. Workers reported an increase in loyalty to their employer and fewer stress symptoms. Policies were also associated with lower costs to employers, as workers were more present and missed fewer deadlines.7

Paid sick leave

A NIOSH study found that workers with paid sick leave were 28% less likely to get nonfatal injuries on the job than those without.8 Another study found that providing paid sick leave could have saved employers $0.63 to $1.88 billion in reduced absenteeism costs per year.9

Supportive supervision

Workers with supportive supervisors report less pain, more sleep, and have lower risk of cardiovascular disease.1011 A NIOSH study found that supervisor support might help prevent reduced engagement resulting from job insecurity. Supervisor support increased the odds of engagement among workers with job insecurity by 13%.12

Supporting work-family needs

Workers in an intervention that increased control over work and improved supervisors' support for work and family reported:

  • Better sleep
  • More time with their children
  • Better mental well-being for caregivers
  • Improved schedule control
  • Reduced cigarette smoking
  • Lower work-family conflict6

Harmful work factors

High work stress

Research shows that high stress levels can lead to high blood pressure, heart disease, and diabetes. This is especially true over prolonged periods of time. Workers who report stressors like high job demands, with low levels of decision-making power have an increased frequency of heart disease.13 Work-related stress can also lead to depression. Depression contributes to absenteeism, workers going to work sick, disability, and unemployment, which lead to higher costs for employers.14

Job insecurity

Studies show that downsizing and job insecurity are associated with:

  • Poor physical and mental health
  • Absences due to sickness
  • Increased use of disability pensions1415

A NIOSH study found that job insecurity decreased the odds of engagement of workers by 37%.12 A NIOSH Science Blog highlights more ways economic security affects worker well-being. This includes the link between economic factors, like job insecurity, and negative health and psychological outcomes.16

Unpredictable, demanding schedules

When job demands exceed the time available to complete job tasks, it can result in increased anxiety, fatigue, burnout, and depression. It can also lead to decreased job and family satisfaction, lower organizational commitment, and higher absenteeism.17 Having control over one's work (how, where, and when people work) is beneficial for work-family balance and worker well-being.18

How to measure success

Studies evaluating comprehensive workplace health initiatives have shifted their focus from return on investment to value of investment.1920 Value of investment looks at outcomes like workplace program participation rates, higher worker morale, lower turnover, and injury risk.21

One Minneapolis-based company, TURCK, measures success through turnover, employee satisfaction, and engagement.6 Since 2010, turnover rates at TURCK have stayed around 1% to 4%. This is much lower than industry averages of 11% to 13%. When surveyed, 93% of employees strongly agreed with the statement: "I give my best effort every day."

  1. CDC [2018]. Workplace health strategies. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
  2. IBI [2020]. Cost of poor health infographic. Oakland, CA: Integrated Benefits Institute,
  3. NSC [2020]. Work injury costs. National Safety Council,
  4. Grossmeier J, Fabius R, Flynn JP, Noeldner SP, Fabius D, Goetzel RZ, Anderson DR [2016]. Linking workplace health promotion best practices and organizational financial performance. ACOEM 58(1):16–23.
  5. Loeppke R [2008]. The value of health and the power of prevention. International Journal of Workplace Health Management 1(2): 95-108.
  6. Hudson H, Nigam J, Sauter S, Chosewood CL, Schill A, Howard J [2019]. Total Worker Health. In: Goetzel R, Roemer E, Kent K, and McCleary K, eds. Integration of workplace prevention programs and organizational effectiveness. Washington, DC. American Psychological Association.
  7. Halpern [2005]. How time-flexible work policies can reduce stress, improve health, and save money. Stress and Health, 21: 157-168.
  8. Asfaw A, Pana-Cryan R, Rosa R [2012]. Making the case for paid sick leave. NIOSH Science Blog,
  9. Asfaw A, Rosa R, Pana-Cryan R [2017]. Potential economic benefits of paid sick leave in reducing absenteeism related to the spread of influenza-like illness. J Occup. Environ. Med. 59(9):822-829.
  10. O'Donnell EM, Berkman LF, Subramanian SV [2012]. Manager support for work/family issues and its impact on employee-reported pain in the extended care setting. J Occup Environ Med 54(9): 1142–1149.
  11. Berkman LF, Buxton O, Ertel K, Okechukwu C [2010]. Managers' Practices Related to Work–Family Balance Predict Employee Cardiovascular Risk and Sleep Duration in Extended Care Settings. Journal of Occupational Health Psychology 15(3): 316–329.
  12. Asfaw A and Chang C [2019]. The association between job insecurity and engagement of employees at work. J Workplace Behav. Health 34(2):96-110.
  13. Theorell T, Jood K, Jarvholm S, Vingard E, Perk J, Ostergren PO, Hall C [2016]. A systematic review of studies in the contributions of the work environment to ischemic heart disease development. Eur J Public Health 26(3):470–477.
  14. Schnall P, Dobson M, Landsbergis P [2016]. Globalization, work, and cardiovascular disease. Intl J Health Serv 46(4):1–37.
  15. Howard J [2016]. Nonstandard work arrangements and worker health and safety. Journal article. Am J Indust Med 60(1):1-10, doi: 10.1002/ajim.22669.
  16. Pana-Cryan R, Ray T, Bushnell T, and Quay B [2020]. Economic security during the COVID-19 pandemic: A healthy work design and well-being perspective. NIOSH Science Blog,
  17. Duxbury L, Lyons, S, and Higgins C (2008). Too much to do, and not enough time: An examination of role overload. In K. Korabik, D. S. Lero, and D. L. Whitehead (Eds.) Handbook of work-family integration (pp. 125-140.) Burlington, MA: Academic Press.
  18. Kelly EL and Moen P (2007). Rethinking the clockwork of work: Why schedule control may pay off at work and at home. Advances in Developing Human Resources, 9, 487-506.
  19. Goetzel R, Fabius R, Fabius R, Roemer EC, Thornton N, Kelly RK, Pelletier KR [2016]. The stock performance of C. Everett Koop Award winners compared with the Standard & Poor's 500 Index. JOEM 58(1):9–15.
  20. Cherniak M [2013]. Integrated health programs, health outcomes, and return on investment. JOEM 55(12):S38–S45.
  21. Goetzel R [2016]. The do's and don'ts of workplace health and wellbeing programs: why building a culture of health is a true differentiator. Virgin Pulse,