The Total Worker Health® approach originates from an earlier initiative called Steps to a Healthier US Workforce Initiative that was developed by NIOSH and modeled after the US Department of Health and Human Services (HHS) initiative Steps to a Healthier US. The initial goals of Steps to a Healthier US Workforce were to protect, support, and enhance the health of workers through comprehensive programs for safe and healthy work, integrated with health-supportive environments and access to adequate health care.

In October 2004, NIOSH sponsored a Steps to a Healthier US Workforce Symposium to bring together current knowledge and experience of health protection and health promotion. In 2005 the name of the initiative was changed from Steps to the NIOSH WorkLife Initiative. The WorkLife Initiative served as the NIOSH response to the 2004 Steps to a Healthier US Workforce Symposium. Symposium participants called on NIOSH to continue to show leadership in promoting research, policy, and practice in the areas of science, economics, and current practices coordinating health protection and health promotion to improve the health of workers.

The WorkLife Initiative sought to improve overall worker health through better work-based programs, policies, practices, and benefits. The WorkLife Initiative supported addressing worker health and well-being in a more comprehensive way, taking into account the physical and organizational work environment while at the same time addressing the personal health-related decisions and behaviors of individuals. The worksite provides an opportunity to implement programs and policies to prevent both work-related risks and chronic illnesses and injuries that are linked to employee choices.

The aims of the WorkLife Initiative were to:

  • Encourage and support rigorous evaluation of integrative approaches to work and health.
  • Promote adoption of policies and practices proven to protect and improve worker health.
  • Motivate trans-disciplinary collaboration among investigators focused on preserving and improving the health of people who work.
  • Overcome the traditional separation of the occupational health and health promotion professional communities.

This worker-centered initiative relied on productive partnerships for research, training and communication of workplace-relevant health protective and enhancing recommendations. The initiative has created opportunities for both the occupational safety and health community and the health promotion community to work collaboratively to develop and implement workplace programs that prevent workplace illness and injury, promote health, and optimize the health of the U.S. workforce.

In September of 2007, NIOSH and over thirty-five co-sponsors and supporters conducted a national symposium called “WorkLife 2007: Protecting and Promoting Worker Health.” More than 450 participants explored the science and economics of integrated work-based programs, policies, and practices that sustain and improve worker health and well-being. National and international leaders from the business, labor, and academic communities provided ample evidence that, in some settings, comprehensive or integrative approaches to work and health are beneficial. Numerous case studies and anecdotal reports provided support for the concepts that workplace conditions can promote worker safety and health, and safe, healthy workers are good for business.

Extramural Centers of Excellence to Promote a Healthier Workforce were established by NIOSH to create new research in this area, effectively demonstrating the impact of improved and integrated approaches to health protection and health promotion on the improvement of worker health and safety and defining critical elements of health-supportive workplaces. Centers were funded at the University of Iowa, the University of Massachusetts at Lowell, the University of Connecticut, Harvard University, Oregon Health & Science University, Portland State University, and the University of Oregon. In 2016, the Centers of Excellence were renamed as NIOSH Centers of Excellence for Total Worker Health and expanded to include 6 centers:

Based on information received from experts and practitioners with experience in industry, academia, labor, government, and the non-profit sector, NIOSH, through its WorkLife Initiative,  developed a list of “Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Well being“. The Essential Elements served as a resource to guide employers and workers interested in improving workforce health and well-being through improved workplace programs and policies. In 2016, the NIOSH Office for Total Worker Health® updated and revised the Essential Elements document into a workbook, Fundamentals of Total Worker Health® Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being,  focused on five Defining Elements of TWH.

In 2008 NIOSH convened a workshop with representatives of the Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. Their recommendations fall into three areas (e.g., practice, research, and policy) and were published in the Journal of Industrial Medicineexternal icon.

NIOSH has also served as a member of a cross-government workgroup launching the Federal Employee Worksite Health and Wellness Initiative though partners at OPM, OMB, GSA and DOI. This project aims to create, implement and evaluate a comprehensive set of worker protection and health promotion programs on Federal workplace campuses around the country.

In 2011, NIOSH, along with the US Office of Personnel Management, the Department of Veterans Affairs, the Centers for Disease Control and Prevention, Federal Occupational Health, the US Department of Health and Human Services, the Health Resources Services Administration, and the Eagleson Institute hosted “Healthier Federal Workers 2011, A New Symposium on the Health, Safety and Wellbeing of the Federal Workforce” in Washington, DC. Also in 2011, NIOSH renamed its efforts focused on integration of occupational safety and health protection and health promotion from WorkLife to the Total Worker Health® Program. In addition to continuing support of the extramural Centers of Excellence, NIOSH also committed to further developing its TWH intramural research program.

The year 2012 marked the publication of The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012 presenting the rationale for the TWH approach. These papers noted that a small, but growing body of evidence suggests that integrating occupational safety and health protection program activities with other workplace policies, programs, and practices is more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own.

In 2014, NIOSH created the Office for TWH Coordination and Research Support (Office for TWH) to coordinate and advance these extramural and intramural efforts. In that same year, the Office for TWH partnered with the Institute of Medicine to host a workshop on “Best and Promising Practices in Total Worker Health”, and also coordinated the 1st International Symposium to Advance Total Worker Health in Bethesda, MD, drawing over 350 live attendees.

The year 2015 marked the advent of a number of exciting developments for the program and Office, including the U.S. Patent and Trademark Office’s granting of the mark “Total Worker Health” as an official registered trademark of the U.S. Department of Health and Human Services; the launch of the first Center within TWH, the National Center for Productive Aging and Work; and a NIH-cohosted Pathways to Prevention Workshop titled: “Total Worker Health®—What’s Work Got to Do with It?”

NIOSH continues to evolve its Total Worker Health program to more comprehensively address the wide range of factors that influence workers’ total health. Please see our Frequently Asked Questions and What is Total Worker Health pages for more information.