Total Worker Health in Action: June 2023
Volume 12, Number 2, June 2023
L. CASEY CHOSEWOOD, MD, MPH
I’m excited to share this quarter’s newsletter and highlight the collaborative nature of Total Worker Health® approaches. Working together across disciplines and roles is critical to this holistic approach to worker well-being.
- This edition’s Exclusive highlights our most recent webinar. In it, presenters discuss how staffing companies and host employers must work together to protect temporary workers. We also share a new resource from the National Occupational Research Agenda (NORA) Services Sector Council Contingent Workers Workgroup.
- The Promising Practice section features a country taking Total Worker Health (TWH) to a whole new level that requires national cooperation and collaboration.
- The Featured Affiliates section shows us how working together through professional associations or transdisciplinary research groups can make a greater impact.
New Resource to Help Host Employers Keep Temporary Workers Safe at Work
Editor’s Note: This article features an interview with Brittany Sakata, JD, General Counsel, American Staffing Association; Lauren Menger-Ogle, PhD, Contractor and Social Scientist, National Institute for Occupational Safety and Health; and Michael Foley, MA, Economist, Washington State Department of Labor and Industries
The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
Keeping temporary workers safe can present unique challenges, as host employers and staffing companies must work together to ensure a safe and healthy working environment. On April 11, the NIOSH Total Worker Health (TWH) Webinar Series had the pleasure of hosting “How to Keep Temporary Workers Safe at Work.” We asked the presenters to share some important takeaways from their presentations here.
Within nonstandard work arrangements, what does temporary work refer to?
Temporary, or agency, workers are those employed by a staffing company and assigned to work for a host employer. These include both short- and long-term assignments.
What are some common misconceptions about the staffing industry, and what’s the truth?
Some people assume that U.S. laws do not protect temporary workers. However, that’s not the case. In fact, all workplace safety and equal employment opportunity laws and regulations that apply to traditional employees apply to temporary workers. Staffing companies should work with host employers to promote compliance with those laws.
Are temporary workers at increased risk of injury?
Research looking at workers’ compensation claims suggests temporary workers may be at an increased risk of being injured on the job. For example, a study conducted in Washington State indicated that claim rates for temporary workers were greater than those for non-temporary workers across almost all risk classification categories. This is due, in part, to temporary workers often being new to the job site and unfamiliar with the worksite hazards. Training by both host employers and staffing companies about such hazards is important to ensure good safety and health outcomes.
What role do host employers play in this arrangement?
According to the Occupational Safety and Health Administration (OSHA), host employers and staffing companies are jointly responsible for protecting the safety and health of temporary workers. The OSHA Temporary Worker Initiative issued guidance bulletins on a variety of topics related to the joint safety and health responsibilities of staffing companies and host employers. Because some of this guidance is fairly high level, the National Occupational Research Agenda (NORA) Services Sector Council Contingent Workers Workgroup was inspired to develop more detailed guidance for host employers on best practices (see below).
How can host employers help to protect temporary workers?
A new document entitled Protecting Temporary Workers: Best Practices for Host Employers can help. Host employers can do their part to ensure a safer and healthier workforce by following these best practices and going beyond compliance with OSHA laws and regulations. In the publication, employers will find guidance for these safety and health practices:
- Evaluating and addressing workplace safety and health in a written contract.
- Training for temporary workers and their worksite supervisors.
- Reporting of injury and illness, response, and recordkeeping.
The document includes scenarios of how host employers can begin using the best practices along with checklists that can be printed or completed electronically. A complementary slide deck is also available on the website that staffing companies can use to educate their host employer clients about the best practices.
To learn more and hear from these experts, watch the webinar recording here. Free continuing education is available.
L. Casey Chosewood, MD, MPH, Executive Editor
Sarah Mitchell, Managing Editor
Cheryl Hamilton, Copy Editor
Steven Marra, NIOSH Web Developer
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Building Total Worker Health Into National Plans
Editor’s Note: This article features an interview with Ivo Iavicoli, MD, PhD, Full Professor of Occupational Medicine at the University of Naples Federico II, and member of the Advisory Panel of the Society for Total Worker Health.
The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
In the last issue of TWH in Action!, we discussed the work of one company, Novelis, in piloting Total Worker Health (TWH) approaches at two plants in Italy. What would it look like if TWH strategies are adopted at the national level? Italy is taking an innovative approach by incorporating the TWH framework into their National Prevention Plan for 2020–2025. In this plan, they specifically note that the TWH framework can help improve worker well-being across the country. One element that stands out in Italy’s national plan is the role of occupational physicians. Read this article to learn more about the strategic role of the occupational physician. We talked to the lead author, Dr. Iavicoli, to learn more about Italy’s National Plan.
Why do you think Italy incorporated TWH concepts into their National Prevention Plan (NPP)?
The Italian Ministry of Health incorporated TWH concepts with the aim of having a holistic and all-inclusive approach to worker well-being. It captures the value of creating environments in which safe, healthy, and rewarding work can produce better health conditions and opportunities for workers, their families, communities, and economies. Therefore, the adoption of the TWH model is currently considered in Italy as the most appropriate tool for planning policies and interventions to prevent occupational risk factors and simultaneously promote worker health.
How will the TWH framework help advance worker safety, health, and well-being in Italy?
In Italy, the current legislation provides that the protection of workers’ health and safety is pursued through the traditional approach of assessing and managing occupational risks. This includes the mandatory health surveillance carried out by occupational physicians. The NPP tries to take a step further to achieve a working environment that is as free as possible of risks and hazards that may compromise the safety and health of workers, while also having policies, programs, and practices that promote the complete well-being of workers. The TWH model implements a robust culture of safety, worker protection, and greater health opportunity by (1) analyzing occupational and work-related risk factors, personal health conditions, and lifestyle factors, and (2) evaluating the possible interactions and reciprocal influences among all these elements.
Could you please share what you know about TWH-related activities taking place in Italy?
Our efforts are just getting started, and we do not yet have precise data on the current application of the TWH model in our country. However, the Italian Society of Occupational Medicine’s (SIML) Health Promotion Working Group conducted a survey between September and December 2022. The results showed that 40% of surveyed occupational physicians are aware of TWH and its guiding principles [Leso et al. 2023]. In the Italian SIML, we are working to promote an understanding of TWH concepts and their applications among all occupational safety and health professionals. There is also a noteworthy four-year project funded by the Ministry of Health called “Italian Total Worker Health – ITWH: a Management System for the Promotion of Worker Well-being and the Total Worker Health Approach in the Workplace.” This is led by the Lombardy Region (in Italy), and participation includes the occupational medicine unit of the University of Naples Federico II, which I coordinate.
We have seen TWH approaches incorporated into company plans. How do you think companies or nations can get started on implementing a plan?
In my opinion, the use of the NIOSH Worker Well-Being Questionnaire (WellBQ) is crucial, which is why we validated the instrument in the Italian language [Fontana et al. 2023]. The use of this tool makes it possible to evaluate the main issues that may negatively impact workers’ well-being. After appropriate interventions, the tool can also help assess the results. The WellBQ can help highlight differences in working populations that have different social and legislative contexts, such as the differences between the Italian and American workforces.
Italian occupational safety and health professionals have started considering how to put TWH strategies into practice now and in the future. We will continue to check in with our Italian colleagues and look forward to learning how incorporating TWH approaches into a strategic plan at a national level can influence the well-being of a country’s workforce.
Outside of a national setting, there are still many ways to incorporate TWH strategies into your organization. Go to our Let’s Get Started page to find more information, tools, and resources for implementing TWH strategies.
Continuing Education Opportunity: Recorded Webinar on Keeping Temporary Workers Safe
A recording of the April TWH webinar is available for free viewing and continuing education. The webinar focused on creating and maintaining a safe and healthy work environment for temporary workers. Speakers presented on best practices for host employers and shared perspectives from the American Staffing Association. Access the recording and learn how to obtain free continuing education on the TWH webinar page.
NIOSH Recognizes National Safety Month
Each June, the National Safety Council (NSC) observes National Safety Month. Worker safety is a critical element of TWH strategies, and the NIOSH and the NIOSH TWH Program joins NSC in recognizing this important observance. Learn more about how safety is built into the TWH approach in this previous newsletter Exclusive.
TWH Team Highlights the Importance of Supportive Leadership
Members of the NIOSH TWH Program are emphasizing the role of supportive leadership, a critical component of a TWH approach. Chia-Chia Chang, MPH, MBA, shared insights with the Society for Human Resource Management to describe how supportive leadership is related to mental health in the workplace. NIOSH Office for TWH Director, L. Casey Chosewood, MD, MPH participated in a podcast, explaining why your leader can be more important than your doctor.
- The California Labor Laboratory host webinars on the fourth Wednesday of each month, 12–1 p.m. (PST). The May 24, webinar is “Supporting Healthy Work: Law & Regulation.” The June 28, webinar is “Fired by an App: Rideshare Drivers’ Experience with Discrimination, Harassment, and Unfair Termination.” Visit the webpage to learn more about the webinars and to register.
- The Center for Health, Work & Environment (CHWE) created a Suicide Prevention in the Workplace online course that is available for individuals at any organization. CHWE is also working with community partners and the Latino Policy and Research Center to develop a TWH training series that will be taught in Spanish to train Hispanic and Latino workforces. The Center also helped establish a new Recovery Friendly Workplace Employer Workgroup of employers across Colorado. The group is part of the Recovery Friendly Workplace Initiative that provides education, training, and resources to help managers and individuals implement workplace practices and support for employees in treatment for substance use disorders, helping move toward and sustain recovery.
- The Center for the Promotion of Health in the New England Workplace (CPH-NEW) published new articles about the impacts of sleep in healthcare and correctional This summer, CPH-New, in partnership with the CHWE and the New York Public Employees Federation, will deliver TWH facilitation training to safety and health consultants in Mexico and to labor leaders in New York.
- The Healthier Workforce Center of the Midwest (HWC) released a new video titled Recruitment and Retention: More Than Just a Paycheck. The video explains how a focus on worker well-being in the workplace connects to recruitment and retention. HWC has also announced the availability of Academic Track Pilot Project Grant funding for new investigators (including students/trainees).
- The Johns Hopkins Psychosocial, Organizational, and Environmental Total Worker Health® Center in Mental Health (POE Center), in collaboration with partners, hosted its second annual National Farmworkers Awareness Week seminar on March 30. The seminar honored farmworkers’ important contributions and raised awareness about the issues they face. The seminar will soon be made available publicly on the event webpage. The Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, the Luv u Project, Johns Hopkins Education and Research Center for Occupational Safety and Health, and POE Center are sponsoring a National Summit on Workplace Mental Health and Wellbeing: A Focus on the Graduate Academic Environment, Tuesday, June 27. The summit is free to attend, but virtual attendance is recommended because seats are limited onsite.
- The Oregon Healthy Workforce Center launched a Pilot Project Program, which is open until July. Researchers within Region 10 (OR, WA, ID, AK) are eligible to apply. Read the latest posts in the Oregon and the Workplace
- The University of Illinois at Chicago Center for Healthy Work recently published a policy brief and case study on workplace violence. The policy brief aims to explicate the ways in which workplace violence in defined, trends in workplace violence, and industry-specific risk. The case study details how the University Illinois Health and Hospital System prevent workplace violence. The Center also released an educational game, In a Year’s Work™, that demonstrates how different workers within the same organization experience the social determinants of health.
- The Utah Center for Promotion of Work Equity Research held a community engagement conference in April, which generated conversations about opportunities to work with our K-12 school districts in Utah to explore TWH among teachers. They are also working with Community Health Workers to develop a toolkit that they can use to create contracts to collaborate with employers.
These are just a few of the updates from the NIOSH Centers of Excellence for TWH. To learn more about each of the Centers, visit their websites.
Society for TWH Reaches New Milestone
In March, the Society for TWH celebrated a membership milestone, reaching 200 society members. The Society for TWH was founded in 2022 to collaboratively advance the field of TWH through sharing knowledge and best practices for the benefit of working people, their families, organizations, and the community. Joining the society provides a valuable and resource rich community of practice to move the field forward.
Welcoming New Affiliates
The NIOSH TWH Program welcomes two new affiliates, the University of California Berkeley (UC Berkeley) and the University of California Santa Cruz (UCSC). UC Berkeley is one of the world’s leading institutions of higher education and one of the leading employers in the San Francisco Bay Area. UCSC is known for making strides in social and environmental justice and is driven to innovate across disciplines and advocate for transformative change. These affiliates join others from the University of California system, UC Davis, and UC Los Angeles. Learn more on the NIOSH TWH Affiliate Program webpage.
Free Toolkit from Mental Health America (MHA)
MHA is excited to announce the release of their highly anticipated 2023 May is Mental Health Month toolkit. The toolkit provides practical resources on how to support your mental health and the health of those in your community. Through fact sheets, worksheets, sample communications materials, and sample social media, they cover the following topics: 1) What is a mentally healthy and safe space? 2) How can I change my surroundings to support my mental health? 3) What if I can’t control or change something unhealthy about my surroundings? You can join in this effort by downloading the toolkit and taking the first step toward improving your mental health and the health of those in your community.
Call for Late-Breaking Poster Proposals for the 2023 Work, Stress, and Health Conference
Share your work with scientists and practitioners from around the world by submitting your late-breaking research proposal for a poster at the 2023 Work, Stress, and Health conference! They are looking for presentations on a range of topics that address the changing nature of work and implications for worker health, safety, and well-being.
This feature was created to introduce our readers to current NIOSH TWH Affiliates. See how the NIOSH TWH Affiliates responded when we asked about their work.
With more than 10,500 members—including distributors, manufacturers, manufacturer representatives, wholesalers, building service contractors, in-house service providers, residential cleaners, and associated service members—ISSA is the world’s leading trade association for the cleaning industry. The association is committed to changing the way the world views cleaning by providing its members with the business tools they need to promote cleaning as an investment in human health and the environment. ISSA strives to be the most widely accepted resource for knowledge and training regarding professional business practices and making the scientific connection between cleaning and health.
The work that ISSA does is very closely aligned with the goals of TWH. We understand that TWH is more than just maintaining a clean and sanitary physical space. Many of our programs, training, and education focuses on how cleaning is just one aspect of a healthy workplace and that other factors such as building design, air quality, mental health, and other encouraging proper hygiene all play a role in worker well-being. For example, ISSA is hosting more than a 20 Cleaning for Health Workshops, thanks to a U.S. Department of Labor Susan Harwood Grant. The free workshops will help train hundreds of frontline employees to close the gaps in current protections and controls for diseases transmissible by contact, droplet, and aerosol, of which frontline cleaners can be particularly vulnerable.
The Miami Occupational Research Group (MORG), at the University of Miami since 2018, is a NIOSH TWH affiliate. The MORG is a long-standing consortium of South Florida academic, government and industry partners, labor unions, and various workers across industries committed to integrating and advancing the workplace health protection and health promotion. Through education, research and community-service initiatives, the MORG has been supporting small-, medium-, and large-sized businesses in learning about the TWH approach.
Among the various MORG activities and projects, the Firefighter Cancer Initiative (FCI) leads educational, research, and service activities using the TWH framework. Recently the FCI, along with firefighters and union members, published a commentary article titled “A TWH Approach to Skin Exposure Assessment.” The article describes how fire departments, unions, and individual firefighters can work collaboratively in a TWH framework to reduce carcinogenic skin exposures among firefighting.
We are most proud of hosting, in February, the 2023 International Firefighter Cancer Symposium. The event brought scientists, clinicians, industry, government, firefighter unions, and fire department and professional firefighter organizational leadership together to the discuss the State of the Science in firefighter cancer prevention.
From CDC and NIOSH
- Critical Steps Your Workplace Can Take Today to Prevent Suicide
- Work Conditions and Serious Psychological Distress Among Working Adults Aged 18–64: United States, 2021
- NIOSH TWH Affiliate Program Rapidly Creating New Worker Well-being Opportunities
- Fatalities Involving Substance Use Among U.S. Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014–2019)
- Working Alone and/or in Remote Locations: Opportunities to Prevent the Risk of Fatality From Cardiovascular Events in Oil and Gas Extraction Workers
From Our Partners
- A Cross-sectional Analysis of Work Schedule Notice and Depressive Symptoms in the United States
- A Tutorial on a Marginal Structural Modeling Approach to Mediation Analysis in Occupational Health Research: Investigating Education, Employment Quality, and Mortality
- Building a Thriving Academic Hospitalist Workforce: A Rapid Qualitative Analysis Identifying Key Areas of Focus in the Field
- COMMunity of Practice and Safety Support for Navigating Pain (COMPASS-NP): Study Protocol for a Randomized Controlled Trial With Home Care Workers
- Excellence in TWH and an Interview With Dr Laura Linnan
- The Evaluation of Worker Exposure to Airborne Silica Dust During Five OSHA Table 1 Construction Tasks
- Maternal Precarious Employment and Child Overweight/Obesity in the United States
- Point-of-Care Testing in Chronic Kidney Disease of Non-Traditional Origin: Considerations for Clinical, Epidemiological, and Health Surveillance Research and Practice
- Participatory Design of a Sleep Intervention With Correctional Supervisors Using a Root Causes Approach
- Promise and Perils of Leader-employee Check-ins in Reducing Emotional Exhaustion in Primary Care Clinics: Quasi-experimental and Qualitative Evidence
- Work-family Conflict and Depression Among Healthcare Workers: The Role of Sleep and Decision Latitude
12 – HWC will host a virtual collaborative learning community called The Why and How of Recovery Friendly Workplaces. Featured speakers will provide employer guidance on recruiting, supporting, and retaining workers in recovery and highlight current research and resources.
14 – The CHWE’s Health Links® will host a webinar titled Antiracism 2023: Environmental Justice and the Workplace.
15 – Nonprofit organizations are invited to attend the City of Chicago’s Readiness Summit. The summit is a virtual half-day event designed to build the capacity of small nonprofits to implement equity-based investment strategies that catalyze sustainable economic recovery from the COVID-19 pandemic.
16 – OHWC’s Spring Symposium is a virtual professional development workshop that will examine the intersection of shift work, sleep, and worker health and safety.
27 – The POE Center, with partners, is sponsoring a free National Summit on Workplace Mental Health and Wellbeing: A Focus on the Graduate Academic Environment.
28 – The California Labor Lab is hosting a webinar entitled Fired by an App: Rideshare Drivers’ Experience With Discrimination, Harassment, and Unfair Termination.
19 – CHWE and the University of Colorado’s Center for Bioethics and Humanities will host Ethics & the Future of Work Webinar: Exploring Ethics and Artificial Intelligence in the Workplace.
3–5 – The National Association of Community Health Workers (NACHW) will host the NACHW Unity Conference and Annual Meeting. The event will be in-person and online. Community health workers and allies across the country are invited to submit an abstract, become a sponsor, and attend the event.
Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). 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.