Defining Element 2: Design Work to Eliminate or Reduce Safety and Health Hazards and Promote Worker Well-Being

A Total Worker Health approach prioritizes a hazard-free work environment for all workers. It applies a prevention approach that is consistent with traditional occupational safety and health prevention principles of the Hierarchy of Controls, as outlined in Figure 1. Eliminating or reducing recognized hazards in the workplace first, including those related to the organization of work itself, is the most effective means of prevention [NIOSH 2013] and thus is foundational to all Total Worker Health principles. Although some hazards can be eliminated from the work environment, others (such as shift work) are more difficult to change. These must be managed through various engineering, administrative, or (as the very last resort) individual-level changes. Workplace programs that adopt a TWH approach emphasize elimination or control of workplace hazards and other contributors to poor safety, health, and well-being. This emphasis on addressing environmental determinants of health is a crucial concept for TWH programs.


The Hierarchy of Controls Applied to NIOSH Total Worker Health® provides a conceptual model for prioritizing efforts to advance worker safety, health and well-being. As in the traditional Hierarchy of Controls, controls and strategies are presented in descending order of anticipated effectiveness and protectiveness as suggested by the cascading arrows. The Hierarchy of Controls Applied to NIOSH Total Worker Health expands the traditional hierarchy from occupational safety and health to include controls and strategies that more broadly advance worker well-being. To apply this model:

  • Begin by eliminating workplace conditions that cause or contribute to worker illness and injury, or otherwise negatively impact well-being. This includes factors related to supervision throughout the management chain.
  • Second, replace unsafe, unhealthy working conditions or practices with safer, health-enhancing policies, programs, and management practices that improve the culture of safety and health in the workplace.
  • Next, redesign the work environment, where needed, for safety, health and well-being. Remove impediments to well-being, enhance employer-sponsored benefits, and provide flexible work schedules.
  • Then, provide safety and health education and resources to enhance individual knowledge for all workers.
  • Lastly, encourage personal change for improvements to health, safety and well-being. Assist workers with individual risks and challenges; provide support for healthier choice-making.

Using the Hierarchy of Controls Applied to NIOSH Total Worker Health, a program targeting reductions in musculoskeletal disorders could consist of the following:

  1. Reorganizing or redesigning the work to minimize repetitive movement and awkward postures
  2. Providing ergonomic consultations to workers to improve job and workstation design and interface, along with training in ergonomic principles and opportunities for workers to participate in design efforts
  3. Evaluating the age profile and health needs of the workforce to provide education on self-management strategies (including preventive exercise) for arthritis or other musculoskeletal conditions that impact physical ability

Similarly, a TWH program reducing work-related stress might consider the following:

  1. Implementing organizational and management policies that give workers more flexibility and control over their work and schedules, as well as opportunities to identify and eliminate root causes of stress
  2. Providing training for supervisors on approaches to address stressful working conditions
  3. Providing skill-building interventions for stress reduction for all workers and providing access to Employee Assistance Programs

Relevant Resources

Web page: Hierarchy of Controls Source: National Institute for Occupational Safety and Health

Web page: Stress at Work Source: National Institute for Occupational Safety and Health