Making the Business Case

How Total Worker Health Approaches can Benefit Both Your Workers and Your Organization

Today’s employers are challenged not only by well-recognized risks of hazards and injuries—such as traumatic injuries and chemical exposures—but also by complex, emerging issues such as shifting employment relationships, work-related stress disorders, an aging workforce, and chronic diseases. Using Total Worker Health (TWH) strategies in your workplace may have a positive, long-term impact on your workers’ health, safety, and well-being and on your organization’s bottom line.

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. These same strategies to improve workers’ health, such as improving working conditions and providing healthier supervisory practices, can also have business benefits, such as better retention rates and improved productivity.

A study by Leigh [2011], illustrated below, estimates that the economic burden of occupational injuries and illnesses, fatal and nonfatal, in the United States in 2007 alone reached $250 billion. Although these costs are not solely borne by the employer, this suggests a community-wide burden that organizations can help address and reduce. A growing body of evidence demonstrates that comprehensive efforts to promote worker well-being and to reduce worker safety risks can have notable effects on costs, productivity, and performance [Grossmeier et al. 2016; Loeppke 2008]. The following section provides actions that employers of all sizes can take to keep workers safer and healthier, all while improving business productivity and financial performance.

us economic burden of worker injuries and illness graph

[Leigh, 2011]

Dr. John Howard
Dr. John Howard

The director of NIOSH explains the advantage of a TWH approach: "Our experience indicates that healthcare cost savings is often not the sole motivation to adopt Total Worker Health policies, practices, and programs. Often, even in spite of the costs associated with implementing a TWH program, employers tell us they accrue competitive advantages related to recruitment, retention, employee satisfaction, community engagement and reputation, and sustainable workforce culture by emphasizing a TWH focus,” [Howard et al. 2016].

  • Offering paid sick leave for employees may help reduce prevalence of employee nonfatal illness and injury, reducing the economic burden on your organization.
    • Making the Case for Paid Sick Leave: A NIOSH study found that workers with access to paid sick leave were 28% less likely overall to suffer nonfatal occupational injuries [Asfaw et al. 2012].
  • Providing training for supervisors on approaches to reducing stressful working conditions can improve employee health, reduce turnover, and increase employee retention.
    • Research shows that high stress levels, especially for prolonged periods of time, can lead to hypertension, cardiovascular disease, obesity, and diabetes. Work-related stress can also lead to depression, which contributes to absenteeism, presenteeism (workers going to work when they are sick), disability, and unemployment [Schnall et al. 2016]. Further evidence demonstrates that employees who report stressors such as low job control or high job strain have an increased incidence of ischemic heart disease [Theorell et al. 2016].  All of these outcomes have substantial cost implications for both organizations and workers.
    • Employees with supportive managers report less pain, sleep more, and have lower risk of cardiovascular disease [O’Donnell et al. 2012, Berkman et al. 2010].
    • Learn about TWH strategies to reduce worker stress by viewing this NIOSH Total Worker Health webinar: Intervening for Work Stress: Work-life Stress and Total Worker Health Approachesexternal icon
  • Providing walking work stations or implementing active meetings may promote health and lower risk of chronic disease among workers, reducing absenteeism and presenteeism.
    • Nearly 50% of Americans have at least one chronic health condition [Ward et al. 2012]. According to research, 10% to 20% of all causes of deaths related to cardiovascular disease among working-age populations can be attributed to work [The Tokyo Declaration on Prevention and Management of Work-Related Cardiovascular Disorders 2013].
    • To learn more on preventing chronic disease, visit Preventing Chronic Disease in the Workplace: A Workshop Report and Recommendations.external icon
  • Designing and providing ergonomically friendly work environments can promote productive aging and support a healthier, safer, more age-friendly workforce.
  • Organizational and management policies that give workers more flexibility and control over their schedules can remove impediments to well-being, thus leading to healthier, more productive workers.
    • Overly demanding work schedules can lead to “time poverty,” because they limit daily opportunities for sleep, physical activity, and healthier nutrition practices [Venn and Strazdins 2017]. “Lack of control over work can also lead to ischemic heart disease [Theorell et al. 2016].”
    •  Nonstandard work arrangements can be considered unpredictable. Although many employees thrive on flexible schedules, others consider their work precarious, which can have significant health effects. Recent studies have shown that precarious employment, downsizing, and job insecurity are associated with poor physical and mental health, absences due to sickness, and disability pensions [Schnall et al. 2016; Howard 2016].

For those interested in seeing positive examples of how to implement TWH strategies in the workplace, take a look at what other businesses have done through Promising Practices for Total Worker Health. If you’re ready to take the next step to learn how to create policies, programs, and practices that protect and promote worker safety, health, and well-being at the organizational and environmental level, then go to Let’s Get Started. You will find tools such as the workbook Fundamentals of Total Worker Health,® Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-Being pdf icon[NIOSH 2016].

Understanding the value of using an integrated approach goes beyond the more traditional measurement of Return on Investment (ROI). Recent studies evaluating TWH and other workplace health initiatives have shifted their focus away from ROI to Value of Investment (VOI) [Goetzel et al. 2016, Cherniak 2013]. Value of investment includes outcomes that may not be as easily measured, such as lower turnover and injury risk, greater worker morale, and workplace program participation rates, which impact the success of organizations [Goetzel 2016]. In fact, ROI may not be compatible with demonstrating the impact of integrated and comprehensive health and safety interventions; instead, it might magnify short-term effects and discount long-term impacts like disease and injury prevention [Cherniak 2013]. According to a survey by Aon Hewitt, the National Business Group on Health, and the Futures Company [2014], employees who reported having a strong culture of health at work were more likely to report being happy, less likely to report that stress has a negative impact on their work, and less likely to cite the work environment as an obstacle to health.

Additionally, one study by the World Economic Forum compared employees who reported that their workplaces were active promoters of health to those who reported their organizations did not actively promote health and well-being. Of those who felt supported, 64% intended to stay at least 5 years, and 5% intended to stay for less than one year. The respective figures were 42% and 20% among employees who reported that their organizations did not actively promote health and well-being [World Economic Forum 2010].

The TWH approach requires a more integrated method to employee safety and well-being, by encouraging health and safety improvements starting at the organizational level. Many workplace wellness program have traditionally focused upon efforts to improve health at the individual level, for example, by offering weight management classes or smoking cessation programs. However, these programs can place much of the burden of change on the individual, without addressing the overall influences of working conditions and the environment, which often have a strong effect on worker health outcomes.

Taking a TWH approach means moving beyond a focus on individual-level interventions, by first prioritizing interventions that safeguard the health of workers and then moving toward organizational strategies that promote health. For instance, among low-wage workers, various workplace factors—such as fatigue, injury from physically demanding work, anxiety from job stressors, inadequate and unpredictable meal breaks, and poor meal facilities—all contribute to overweight and obesity [Nobrega et al. 2016]. In order to reduce overweight or obesity among workers, employers can address specific workplace factors such as long work hours, high work stress levels, and lack of access to healthier food options. In conjunction, employers can promote a healthy work environment that allows time and resources for employees to stay healthy [Larson and Story 2009; Conn et al. 2009]. The overarching principle—keeping workers safe—is the foundation upon which a TWH approach is built. Employers and employer–worker partnerships wishing to sustain and improve worker health must make occupational safety and health the priority—the foundation for all other health improvements. For more information on the differences between TWH and workplace wellness programs, take a look at the TWH FAQs section.

  • Aon Hewitt, National Business Group on Health, The Futures Company [2014]. The consumer health mindset, icon.
  • Asfaw A, Pana-Cryan R, Rosa R [2012]. Making the case for paid sick leave. NIOSH Science Blog,
  • 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.
  • Bureau of Labor Statistics [2014]. Labor force participation projected to fall for people under age 55 and rise for older age groups. TED: The Economics Daily, icon.
  • CDC Foundation [2015]. Workplace safety and health: CDC helps U.S. employers protect against costly safety and health threats. Business Pulse, icon.
  • Cherniak M [2013]. Integrated health programs, health outcomes, and return on investment. JOEM 55(12):S38–S45.
  • Conn VS, Hafdahl AR, Cooper PS, Brown LM, Lusk SL [2009]. Metaanalysis of workplace physical activity interventions. Am J Prev Med 37(4):330–339, doi:10.1016/j.amepre.2009.06.008.
  • 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, icon.
  • 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.
  • 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.
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  • Howard J, Chosewood LC, Hudson HL [2016]. Letter to the editor: The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative. New Solutions: A Journal of Environmental and Occupational Health Policy 26(3):345–348, doi: 10.1177/1048291116656631.
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  • Leigh JP [2011]. Economic burden of occupational injury and illness in the United States. The Milbank Quarterly, 89(4): 728-772, doi:10.1111/j.1468-0009.2011.00648.x
  • Loeppke R [2008]. The value of health and the power of prevention. Intl J Workplace Health Mgmt 1(2):95–108.
  • NIOSH [2016]. Fundamentals of Total Worker Health approaches: essential elements for advancing worker safety, health, and well-being. By Lee MP, Hudson H, Richards R, Chang CC, Chosewood LC, Schill AL, on behalf of the NIOSH Office for Total Worker Health. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Con­trol and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2017-112.
  • Nobrega S, Champagne N, Abreu M, Goldstein-Gelb M, Montano M, Lopez I, Arevalo J, Bruce S, Punnett L [2016]. Obesity/overweight and the role of working conditions: a qualitative, participatory investigation. Health Promo Pract 17(1):127–136, doi: 10.1177/1524839915602439.
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  • Schnall P, Dobson M, Landsbergis P [2016]. Globalization, work, and cardiovascular disease. Intl J Health Serv 46(4):1–37.
  • The Tokyo Declaration on Prevention and Management of Work-Related Cardiovascular Disorders [2013]. Adopted by the Plenary of the Sixth ICOH International Conference on Work Environment and Cardiovascular Diseases under the auspices of the ICOH Scientific Committee on Cardiology in Occupational Health, 30 March 2013, Tokyo, Japan.
  • 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 ischaemic heart disease development. Eur J Public Health 26(3):470–477.
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