Total Worker Health in Action: June 2023

Volume 12, Number 2, June 2023

Director’s Buzz


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.

To stay up to date with the latest news, research, and events, follow us on Twitter at @NIOSH_TWH, visit our website, or send us an email at

Total Worker Health Exclusive

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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Promising Practice

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.

News from NIOSH

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.

News From the NIOSH Centers of Excellence for TWH

  • 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.

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.

News From NIOSH TWH Affiliates and Partners

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.

Featured Affiliates: Get to Know the NIOSH TWH Affiliates

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.

New Publications and Resources

From CDC and NIOSH

From Our Partners

Conferences, Webinars, and Training


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.

Find more events on the NIOSH Conferences, Meetings, Webinars, and Events webpage and the Society for TWH Events page.

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.