Total Worker Health in Action: September 2021

Volume 10, Number 3, September 2021

Director’s Buzz


In October 2022, the Third International Symposium to Advance Total Worker Health® will bring together safety and health professionals, employers, researchers, policymakers, and the academic community to focus on advancing Total Worker Health research, practice, policies, and programs. This one-of-a-kind symposium examines opportunities to make workplaces safer and to improve the health and well-being of the workforce across the world. We invite you to join us for compelling keynote addresses, expert presentations, and informal workshops emphasizing the latest strategies aligned with a TWH approach. Visit the symposium website to learn more and to join a mailing list for updates.

Hand with pen writing on calendar page closeup

While we look forward to the future, we also pause to remember how far we’ve come. During the 50th anniversary of NIOSH, we reflect on the evolution of the NIOSH Total Worker Health (TWH) Program. NIOSH was established following the Occupational Safety and Health (OSH) Act of 1970 as a separate and independent research program to create objective scientific research findings in the field of OSH. The origins of the NIOSH TWH program can be traced back to 1984. This is when NIOSH published a report concluding that addressing worksite OSH and worksite health promotion simultaneously would foster a synergistic effect for prevention and improve worker safety and health through comprehensive risk reduction. Since then, the effort has evolved, expanded, and made broader contributions toward safer, healthier work.  Discover more about the early steps toward integrating workplace safety and health in this article.

For the latest TWH news, research, and events, follow us on Twitter at @NIOSH_TWH, join our NIOSH Total Worker Health LinkedIn Group, or send us an email at!

Total Worker Health Exclusive

The Future Workforce: Why Productive Aging Matters

The NIOSH National Center for Productive Aging and Work (NCPAW) examines the ways organizations can shape their work environments to promote and support productive aging. Join us as we take a closer look at the aging workforce with NCPAW.

Productive aging – what is it?

Worker standing infront of organzing bins

Productive aging focuses on the positive aspects of aging and how individuals continue to contribute in meaningful ways in workplaces, communities, and society. A cornerstone to productive aging is reframing the way society thinks about aging. Negative views toward aging can develop from a very young age and often are based on unfounded, negative stereotypes about older adults (Posthuma and Campion 2009). It is important to reframe these beliefs because positive stereotypes about aging are generally supported by fact, and holding negative views toward aging can be harmful to a person’s health as they age (Posthuma and Campion 2009; Chang et al. 2020; Levy et al. 2020).

How does an aging workforce impact today’s workplace?

Virtually all of the U.S. workforce face the challenges and opportunities that come with an aging workforce. Challenges include the risk of fatal injuries and the impact of chronic health conditions, both of which become greater with age. Some aging workers who remain in jobs with high physical demands may become increasingly susceptible to the workplace exposures they experience, particularly when job demands exceed declining work capacity.

On the other hand, opportunities include the expertise that workers gain with experience and the tendency of older workers to have fewer non-fatal injuries overall. Older workers have many qualities and characteristics that are attractive to employers, and the extensive experience of older workers makes them valuable assets. For example, older workers tend to be highly skilled, dependable, conscientious, and compliant to safe work practices. There is also evidence that some aging workers can continue to develop new skills and be highly productive with age.

How will the aging workforce impact the future of work, and how can we prepare?

Population aging is a major issue of the 21st century and impacts all aspects of society, including the workforce. In response to increased life expectancy and declining birthrates, nations have raised or are raising the full retirement age. More people are working beyond the once typical retirement age of 65 by choice or necessity. The Bureau of Labor Statistics projects that the labor force will become increasingly older through 2050. The number of workers aged 55 and older is estimated to increase from 19% in 2010 to 24% in 2050, while all other age groups will remain stagnant or decrease (Toossi 2012).

Age diversity in the workforce is also increasing, with varying needs of workers at different life stages. This means that employers cannot ignore workforce aging and must prepare for and respond to the changing needs of workers as they age. Employers must take steps to protect workers’ safety, health, and well-being and to ensure they have enough qualified and skilled workers to fill roles and complete tasks.

Why is an integrated approach important for retaining an aging workforce? 

Productive aging is relevant to workers of all ages, not just older ones. The gradual, complex nature of the aging process suggests that many avenues and levels of influence can be used in advancing the safety, health, and well-being of an aging workforce. A Total Worker Health® perspective in productive aging is crucial because it advocates for a comprehensive, holistic approach to occupational safety and health. From a Total Worker Health (TWH) perspective, this means applying evidence-based work design strategies and occupational safety and health practices. This approach can help employers safeguard the health and well-being of workers at all stages of their careers and create work environments where individuals can thrive (Grosch 2020).

Both the NIOSH TWH and NCPAW programs prioritize a hazard-free work environment, while also addressing other workplace systems. Examples include those relevant to the control of psychosocial hazards and exposures, the organization of work, compensation and benefits, the built environment, and work–life management efforts.

Where can we learn more about this topic?

One resource for additional background information is the chapter “Productive Aging and Work” in the volume Total Worker Health. Stay tuned for a new webinar about productive aging this October and learn more on the NCPAW website.


Chang ES, Kannoth S, Levy S, Wang SY, Lee JE, Levy BR [2020]. Global reach of ageism on older persons’ health: A systematic review. PLoS ONE 15(1): e0220857,

Grosch JW [2020]. Advancing safe and health work for all ages. Editorial. Industrial Health 58:89–90.

Levy BR, Slade MD, Chang ES, Kannoth S, Wang SY [2020]. Ageism amplifies cost and prevalence of health conditions. The Gerontologist 60(1):174–181, doi: 10.1093/geront/gny131.

Posthuma RA, Campion MA [2009]. Age stereotypes in the workplace: Common stereotypes, moderators, and future research directions. Journal of Management 35(1):158–188, doi: 10.1177/0149206308318617.

Toossi M [2012]. Projects of the labor force to 2050: A visual essay. Monthly Labor Review October:1–16,


L. Casey Chosewood, MD, MPH, Executive Editor

Emily Norton, Managing Editor

Sarah Mitchell, Associate Editor

Seleen Collins, Copy Editor

Margaret Bertsch, NIOSH Web Developer

Steve Leonard, NIOSH Web Publisher

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Promising Practice

Editor’s Note: The NIOSH Total Worker Health program developed this article in collaboration with Eskenazi Health.    

Applying Total Worker Health Approaches in a Healthcare Setting

Eskenazi Health, a NIOSH Total Worker Health® Affiliate, is a non-profit healthcare organization that employs workers in various conditions and settings. Organizations may have employees who are working from home, providing direct patient care in 12-hour shifts, or working in different departments, quickly learning new tasks to support patients with varying needs. Following the Total Worker Health (TWH) model, Eskenazi Health focuses on caring for workers by continually addressing and improving their policies, programs, and practices. Over the last year, Eskenazi has developed new practices and revised policies and programs to ensure the well-being of workers.


  • The first defining element of TWH is to demonstrate leadership commitment to worker safety and health at all levels of the organization. Eskenazi leadership recognized the importance of understanding and developing strategies to create an inclusive organization for workers and patients. To demonstrate this commitment, Eskenazi converted their Leadership Development Institute over the last year to focus on understanding and developing actionable ways to redesign their language and culture. This reflects Corporate Social Responsibility, one of the issues relevant to TWH approaches.
  • Although Eskenazi Health regularly reviews how policies affect both workers and business continuity, they reviewed policies to address current challenges. Work-from-home policies were reviewed for equity among the various levels and responsibilities throughout the organization.
Women meditating with idea bubbles floating around


  • Another defining element of TWH is to promote and support worker engagement throughout program design and implementation. To increase access and encourage participation, Eskenazi transitioned wellness offerings to be 100% virtual. New offerings include live online classes, telephonic coaching, and supporting fitness goals through a commercial on-demand app. Lifestyle Programs were also adjusted to a virtual platform. Adjusting employee education programs to be fully virtual resulted in greater attendance, adherence, and personal results for workers.
  • Eskenazi Health trained over 100 employees in stress management education and didactics in “Train-the-Trainer” style offerings. Employees who completed these are now sharing the practices they learned with small employee groups.


  • An additional fundamental element of the NIOSH TWH approach is prioritizing a hazard-free environment. The TWH approach recognizes the relationship between work and nonwork conditions, focusing on how the workplace environment can eliminate or reduce risks and enhance overall worker health. Eskenazi Health took precautions to keep the workforce and patients safe by establishing a symptom tracker to help workers monitor their own health.
  • Eskenazi also shifted focus to recognize hazards posed in the work-from-home environment, focusing on new work-from-home ergonomics assessments and home safety. They placed special emphasis on educating workers about proper work area set-up, stress management techniques, and general home safety issues, including fire safety, noise, and time management.
  • Eskenazi Health supported and recognized departments defining a new normal with variations in work-life balances. While some workers faced challenges posed by picking up extra shifts, others dealt with feelings of isolation and sameness from working at home. A common theme that emerged was the importance of creating a separation between work and personal life by defining a start and end to the workday.

As a health care organization working through a public health emergency, Eskenazi Health had to quickly learn and adapt to keep their workers well. Stay up to date and discover more about Eskenazi’s work on their website.

Spotlight on Opioids in the Workplace

Editor’s note: If you or someone you know needs assistance (in English or Spanish) with mental health concerns and/or substance use disorders, prevention, and recovery, please contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) or visit

Road to Recovery

New Video Introduces Workplace Supported Recovery
NIOSH released a new video to introduce the concept of Workplace Supported Recovery and encourage the adoption of Workplace Supported Recovery principles. The video describes how these principles help employers prevent exposure to workplace factors that could cause or perpetuate substance use disorder while lowering barriers to seeking or receiving care and maintaining recovery.

Employers and workers can learn more about Workplace Supported Recovery on the NIOSH website. Contact if you have questions or would like more information.

News from NIOSH

Mark Your Calendar for the Third International Symposium to Advance Total Worker Health!
The Third International Symposium to Advance Total Worker Health is October 11-14, 2022. This symposium is the only NIOSH-sponsored event focused solely on advancing Total Worker Health (TWH) research, practice, policies, and programs. Bringing together an audience of safety and health professionals, employers, researchers, policymakers, and the academic community, the symposium examines opportunities to make workplaces safer and to improve the health and well-being of the workforce across the world. The Center for Health, Work & Environment, Colorado School of Public Health, in collaboration with the NIOSH Office for Total Worker Health, recently launched a symposium website with more information.

Recorded Webinars
Did you miss the “Workplace Health Disparities: A Total Worker Health Perspective” webinar? View recordings of the NIOSH Total Worker Health Webinar Series on the webinars webpage and earn continuing education credits.

Updates from the National Center for Productive Aging and Work
The National Center for Productive Aging and Work (NCPAW) recently received funding through the NIOSH National Occupational Research Agenda for a project, “Supervisory Training Advancing Age-Inclusive Workplaces in the Hospitality Sector.” The 4-year project begins in fiscal year 2022 and represents a major priority area for NCPAW regarding the aging workforce. Stay up to date with the center’s upcoming activities at the Work, Stress, and Health Conference and on the NCPAW website.

News from the NIOSH Centers of Excellence for Total Worker Health

  • The Center for Health, Work & Environment (CHWE) is continuing the Health Links™ Total Worker Health series with the webinar “Paid Family and Medical Leave for All” on September 22, 2021. CHWE will review and discuss new paid family and medical leave policies and best practices for employers. This webinar will help attendees learn how paid leave public policies benefit working people and their families, employers, and communities; how paid leave impacts workplace culture; and best practices from small and large employers who have strong paid leave policies. On October 28, 2021, CHWE will celebrate its 9th annual event to recognize organizations and individuals for their achievements in applying the Total Worker Health The Health Links™ Annual Event Celebrating Total Worker Health® will host a panel discussion with business leaders, researchers, and health and safety professionals to share best-practices and will offer continuing education workshops.
  • The Center for the Promotion of Health in the New England Workplace (CPH-NEW) released a new resource, the Total Worker Health Mentoring Toolkit For Corrections Personnel. The primary goal of this toolkit is to combat the decline in health found during a correctional worker’s career. Correctional organizations can use the materials to organize a TWH Mentoring Program, recruit and train members, and evaluate the program. CPH-NEW also reported that Co-Director Laura Punnett, ScD, recently shared research on the impact of workplace stress on organizations and effective interventions at the Work, Health, and Stress Educational Series held in Colombia. You can view recordings of the presentations, “The Consequences of Job Stress for Organizations” and “Organizational Strategies to Reduce Job Stress.”
  • Researchers at the Harvard Center for Work, Health and Well-being will present on worker safety, health, and well-being at upcoming conferences. Harvard Center Associate Director Jack Dennerlein will present, as part of a plenary session panel, on Well-Being: What Does It Have to Do With Safety?” at the Safety 2021 Professional Development Conference & Exposition. The event will be hosted by the American Society of Safety Professionals on September 14. He will also present “Global Stories: Innovations to Build a Supportive Culture for Worker Safety, Health, and Well-Being” as part of the virtual XXII World Congress on Safety and Health at Work, taking place September 20–23. The Harvard Center will also participate in the virtual Work, Stress, and Health Conference with a poster presentation, “An Expanded Conceptual Model for Research on Work, Safety, Health, and Well-being.”
  • Investigators at the Healthier Workforce Center of the Midwest (HWC) will present on mental health at upcoming conferences. Diane Rohlman will present on workplace mental health at the Annual Iowa Governor’s Safety and Health Conference, and Brad Evanoff will present on the impact of supervisor behaviors on the mental health of workers during the pandemic at the American Public Health Association Conference. You can find more from HWC, including training materials on priority topics like suicide prevention and opioid awareness, on their website. Find print materials and videos or listen to their latest Workplace Matters
  • Stay up to date with the Oregon Healthy Workforce Center (OHWC) in their blog series, Oregon and the Workplace. Geared toward community outreach and active engagement with stakeholders in the Pacific Northwest, the blog regularly features posts from OHWC members who highlight news, updates, and features on topics relevant to the Total Worker Health approach, while inviting comments and feedback from readers. In case you missed it, OHWC’s podcast episode with NIOSH Director John Howard is now live! Celebrate the 50th anniversary of NIOSH with OHWC and Dr. Howard, with this journey through the history of NIOSH.
  • The University of Illinois (UIC) Center for Healthy Work was featured in the American Industrial Hygiene Association’s docuseries “Healthier Workplaces, A Healthier World.” Center faculty and collaborators discuss the future of work and the value of industrial hygiene, as well as collaboration with community groups, to impact worker safety and health. The UIC Center for Healthy Work, Great Lakes Center for Occupational Health and Safety (GLC-OHS), DePaul University Labor Education Center, and Chicago Federation of Labor (CFL) initiated efforts to relaunch a Chicago Area Committee on Occupational Safety and Health (CA COSH). UIC is hosting facilitated conversations with local unions and worker advocacy organizations to ensure worker health and safety through a coordinated network in Chicago and the surrounding area. If you are in Illinois and interested in getting involved, please contact Rolando Favela at

These are just a few of the updates from the NIOSH Centers of Excellence for TWH. To learn more about each of the Centers and their response efforts, visit their websites.

News from NIOSH TWH Affiliates and Partners

Featured Affiliates: Get to Know the NIOSH TWH Affiliates

This new feature was created to introduce our readers to the current NIOSH TWH Affiliates. See how two NIOSH TWH Affiliates responded when we asked about their work. If your organization is a NIOSH TWH Affiliate and is interested in being featured, please email

International Brotherhood of Boilermakers (IBB)

What does your organization do?
Organized in 1880, we are one of the oldest unions in North America.  Our members are employed in heavy industry, shipbuilding, manufacturing, railroads, cement, mining, and related industries.

How do you incorporate TWH practices into your work?
We run programs targeting construction pre-apprentices (functional abilities and medical assessments), health and wellness promotion programs throughout the membership, and occupational health protection programs in the field (noise exposure surveys, welding assessments).

What are you most proud of having accomplished as a NIOSH TWH Affiliate?
In 2019, we launched a long-term mental health initiative that has had fantastic uptake by the members and unwavering support of our organization’s leadership. We’ve woven mental health training into our apprenticeship, shop steward, leadership, and standalone courses addressing suicide prevention, stigma, coping strategies, the mental health continuum, and more.

How has being a NIOSH TWH Affiliate helped you in your work?
Using NIOSH’s expertise, support, and insights, we have been successful in nudging our industry’s understanding of all the variables that impact the health of the whole worker (therefore moving the conversation away from placing blame on the worker to fixing the jobsite).

Collaborating with NIOSH and the other affiliates has allowed us to learn, share best practices, and advance the long-term health, well-being, and quality of life for our members.

Learn more about the International Brotherhood of Boilermakers (IBB).

The American College of Preventive Medicine

What does your organization do?
The American College of Preventive Medicine (ACPM) is a professional medical society of more than 2,000 physicians dedicated to improving the health and quality of life of individuals, families, communities, and populations through disease prevention and health promotion. A preventive medicine specialist is a licensed medical doctor (MD) or doctor of osteopathy (DO) who has expertise in a broad range of health care skills, including biostatistics, epidemiology, planning and evaluation of health services, management of health care organizations, research, and the practice of prevention in clinical settings.

ACPM provides our members with a dynamic forum to engage with like-minded public health professionals, learn from cutting edge educational opportunities, and assume leadership roles to advance the practice of prevention.

How do you incorporate TWH practices into your work?
ACPM is proud to be a NIOSH Total Worker Health affiliate and to help connect our members with resources and strategies for integrating the TWH approach into their practices. A few months ago, ACPM hosted Dr. Casey Chosewood for a member-exclusive webinar discussing TWH and its focus on meeting growing workplace challenges with innovative approaches that promote a balance of a living wage and positive health outcomes. This webinar is now available on-demand, and ACPM is looking forward to continuing to advance TWH and workplace wellbeing with our members.

Learn more about the American College of Preventive Medicine.

Affiliate Updates

Hazard Alerts: New Reports from the Kentucky Fatality Assessment and Control Evaluation (FACE) Program
The Kentucky FACE Program is an occupational fatality surveillance program of the Kentucky Injury Prevention and Research Center. The program recently released two hazard alerts: Intentional Self-Harm in the Workplace and Pedestrian Fatalities. You can also learn more about the work of the program in the 2020 FACE Annual Report.

National Safety Council: Safety Congress and Expo and Webinar Recording

Registration for the National Safety Council Safety Congress and Expo is now open! Stay current on workplace safety solutions while networking with your peers and learning from safety experts. You can view a preliminary program and register online. The Work to Zero program at the National Safety Council held a free webinar, “Proximity Sensors for a Safer Workplace,” in July. The webinar is now available for on-demand viewing.

Save the Date for the Ex4OSH 2021 International Conference
The Ex4OSH 2021 International Conference—brought to you by the Southwest Center for Occupational and Environmental Health at UTHealth School of Public Health and NIOSH is scheduled for December 9–11, 2021. The conference will address three critical areas for the future of occupational safety and health: research, training, and policy. NIOSH Director John Howard, MD, and CHP-NEW Co-Director Laura Punnett, ScD, will present.

To learn more about the Total Worker Health Affiliate program, visit

New Publications and Resources

From CDC and NIOSH

Making the Business Case for TWH

Mission Possible: Measuring Worker Well-Being

Work and Well-being: The Changing Face of Occupational Safety and Health

The Importance of Psychological Contracts for Safe Work During Pandemics

The Role of Artificial Intelligence in the Future of Work

Universities Can Facilitate Collaboration to Address Precarious Work

From NIOSH Centers of Excellence for Total Worker Health

A Classification Approach to Estimating Human Circadian Phase under Circadian Alignment from Actigraphy and Photometry Data

A Mixed-Method Approach to Tailor the Implementation of a Participatory Total Worker Health® Program

Can Supervisor Support Improve Daily Employee Well-being? Evidence of Supervisor Training Effectiveness in a Study of Veteran Employee Moods

Evaluation of a Total Worker Health® Leadership Development Program for Small Business

Feasibility of Virtual Focus Groups in Program Impact Evaluation

How to Ask: Surveying Nursing Directors of Nursing Homes

Profiles of Total Worker Health® in United States Small Businesses

The Key Role of Supervisors for Supporting Veterans in the Workplace (Military veteran employment—your competitive advantage: A business guide for the data-driven leader) 

Thriving from Work: Conceptualization and Measurement

Tungsten Linked with Chronic Kidney Disease

Validation of the Workplace Integrated Safety and Health (WISH) Assessment in a Sample of Nursing Homes Using Item Response Theory (IRT) Methods

Workplace Discrimination and Short Sleep among Healthcare Workers: The Buffering Effect of People-Oriented Culture

Conferences, Webinars, and Training in Support of NIOSH Total Worker Health


  • 14–15 – Hear from the NIOSH Total Worker Health team and the Centers of Excellence for TWH at the Work, Stress, and Health conference, September 14–15 and continuing in November.
  • 20 – Join CHWE presenters Miranda Dally, Dr. Tenney, and Dr. Schwatka during the World Congress on Safety and Health at Work on September 20.
  • 30 – In partnership with the Heartland Center for Occupational Health and Safety, the Hawkeye on Safety Annual Conference on September 30 provides essential training to professionals responsible for workplace health and safety.



  • 1-4 – The Work, Stress, and Health conference continues November 1–4. Learn more and register today! Join to hear TWH Director Dr. L. Casey Chosewood speak on the panel “International Perspectives on Work, Stress, and Health.”

Find more events on the NIOSH Conferences, Meetings, Webinars, and Events webpage.

This newsletter is published quarterly via email by the National Institute for Occupational Safety and Health Total Worker Health® Program to inform members of the public health community as well as interested members of the general public of program-related news, new publications, and updates on existing activities and initiatives.

Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in this document were accessible as of the publication date.