History of Total Worker Health®
The NIOSH Initiatives That Led to “Total Worker Health”
The Total Worker Health® approach originates from the 2003 NIOSH Steps to a Healthier US Workforce Initiative. The goals of this initiative 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 2004, NIOSH sponsored a Steps to a Healthier US Workforce Symposium, where participants called on NIOSH to continue to show leadership in promoting research, policy, and practice in the areas of science and economics, coordinating health protection and health promotion to improve the health of workers.
In response, NIOSH developed a new NIOSH WorkLife Initiative in 2005, which sought to improve overall worker health through better work-based programs, policies, practices, and benefits. The initiative addressed worker health and well-being in a more comprehensive way, considering the physical and organizational work environment in addition to individual behaviors.
The Evolution of TWH
In 2011, NIOSH renamed “WorkLife” to the Total Worker Health® Program, committed to developing knowledge focused on integration of occupational safety and health protection and health promotion.
The next year, NIOSH published The Research Compendium: The NIOSH Total Worker Health Program: Seminal Research Papers 2012, presenting the rationale for the Total Worker Health (TWH) approach. These papers highlight a growing body of evidence that integrating occupational safety and health protection program activities with other workplace policies, programs, and practices is more effective for worker well-being than either of these activities on their own.
In 2014, the TWH program partnered with the Institute of Medicine to host a workshop on “Best and Promising Practices in Total Worker Health,” and coordinated the 1st International Symposium to Advance Total Worker Health in Bethesda, MD, with attendees from a broad spectrum of fields, including occupational safety and ergonomics, worksite health promotion, occupational medicine, academia, and human resources. Sessions shed light on various aspects of TWH approaches, including the health and safety challenges and opportunities in industry and worker populations, methodological challenges, and innovations related to TWH interventions.
The TWH program has also experienced continued growth within NIOSH, with the launch of the first NIOSH Center within TWH, the National Center for Productive Aging and Work (NCPAW), in 2015. NCPAW was created to address the needs of an aging workforce and identifying interventions and strategies aligned with TWH to support both workers of all age groups and organizations that employ them. Over the years, the TWH program has evolved and become further embedded in other NIOSH efforts, including participation in the Healthy Work Design and Well-being Cross Sector Program and leading the NIOSH Future of Work Initiative. The Future of Work Initiative applies a TWH framework by encouraging collaboration across the spectrum of organizational policies, programs, and practices.
The NIOSH TWH program has also released multiple significant publications more recently, including a workbook for employers and an edited volume. In 2016, the TWH program updated and revised the 2010 Essential Elements document into a workbook. The new workbook, entitled the Fundamentals of Total Worker Health® Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-being, focused on five defining elements of TWH and includes an organizational self-assessment and action plan.
Four years after the 1st International Symposium, NIOSH co-hosted the 2nd International Symposium to Advance Total Worker Health in 2018, focused on the theme “Work & Well-Being: How Safer, Healthier Work Can Enhance Well-Being,” once again bringing together experts from across the globe to advance the evidence base for TWH, with a new emphasis on the whole worker and work design.
In 2019, the American Psychological Association published the first ever edited volume on Total Worker Health. The volume, edited by the NIOSH TWH team, additional authors include researchers from NIOSH, the Centers of Excellence for TWH, and other valued partners.
In 2021, NIOSH published the NIOSH Worker Well-Being Questionnaire (NIOSH WellBQ). The NIOSH WellBQ provides an integrated assessment of worker well-being across multiple spheres, including individuals’ quality of working life, circumstances outside of work, and physical and mental health status.
Recognizing the growing need to focus on protecting and promoting the safety, health, and well-being of our nation’s workforce, the number of Centers of Excellence for TWH nearly doubled in 2021. NIOSH funded 10 centers, welcoming four new Centers of Excellence in California, Maryland, North Carolina, and Utah in addition to six existing Centers in Colorado, Connecticut, Illinois, Iowa, Massachusetts, and Oregon. The increase in Centers includes an expanding regional presence that helps generate new knowledge about the important connections between work and health.
The 3rd International Symposium to Advance TWH is October 11-14, 2022. The symposium will examine opportunities to make workplaces safer and improve the health and well-being of the global workforce.
NIOSH continues to evolve its TWH program to address the wide range of factors that influence workers’ safety, health, and well-being. Find out how the NIOSH TWH Program is preparing for the next 50 years and discover our vision for the future of TWH on the NIOSH Science Blog.
National Institute for Occupational Safety and Health Office of the Director