Total Worker Health in Action: December 2020

Volume 9 Number 4  December 2020

Update on the Coronavirus Disease 2019 (COVID-19) Response
You can stay up to date on the COVID-19 response in real time on the COVID-19 webpage or sign up for the COVID-19 newsletter.

Director’s Buzz


This has been a difficult and challenging year for many of us. Work as we know it will likely never be quite the same. This year, despite gains in safety and health over the last few decades, work has become more hazardous, instead of less so, for many. The pace of change in how and where we work, and under what conditions we work, is likely to become a “new normal.”  Moving forward we will need continued support from our leaders and managers, new ways to connect with each other and to engage in our work, and innovative ways to fit work into the rest of our lives, as an unprecedented blend of the two taxes our well-being.

medical mask and hand disinfectant and woman talking on phone

Keeping workers safe is the foundation of a Total Worker Health (TWH) approach. Organizations of all kinds are finding ways to engage and support workers, in and outside of the workplace, and NIOSH continues to identify ways to support and guide these efforts. One example of this is an exciting initiative currently underway to develop a voluntary management standard for TWH. This standard would help organizations that wish to broaden their approach to identifying and addressing workplace risk. As we continue to confront new and emerging hazards, the NIOSH TWH program will continue to provide resources, build partnerships, and promote safer and healthier workplaces.

Total Worker Health Exclusive

American Society of Safety Professionals Guides Development of Voluntary TWH Management Standard

This July, the American Society of Safety Professionals (ASSP), with the support of the American National Standards Institute (ANSI), initiated an effort to develop a voluntary management standard for Total Worker Health (TWH).


Voluntary consensus standards are guidelines that safety-minded organizations choose to implement because of their merit. The consensus process brings together diverse viewpoints from all levels of public and private sectors. The collective technical expertise ensures that a standard considers best practices and state-of-the-art technologies while addressing gaps where no regulatory standard exists.

When complete the TWH management standard will act as a road map for organizations to broaden their approach to identifying and addressing workplace risks and responding to them comprehensively. It will address worker well-being while maintaining a strong focus on organizational safety management. The popular ANSI/ASSP Z10 standard, which guides implementation of safety and health management systems in all industries, is being used as a model in the development process.


L. Casey Chosewood, MD, MPH, Executive Editor

Emily Norton, Managing Editor

Sarah Mitchell, Associate Editor

Seleen Collins, Copy Editor

Tonya White, NIOSH Web Developer

Steve Leonard, NIOSH Web Publisher

Please send your comments and suggestions to us at

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ASSP and ANSI issued calls for participants in the standard development committee, organized into a steering committee/writing group and a larger canvass committee/editing group. The resulting committee consists of many experienced occupational safety and health professionals, vital in developing the consensus standard. Several members have implemented TWH principles and established best practices for improving worker well-being. Significant input from representatives of labor organizations is another critical part of the comprehensive process.

The standard-development committee’s first step in the process is to write a draft of the standard, a phase that will continue into 2021. It involves determining the standard’s purpose, scope, applicability, resources, and initial content. Following that, according to ANSI-accredited procedures, will be

  1. a broad-based public review and comment period,
  2. written responses that resolve submitted remarks, and
  3. the right to appeal by any committee member who believes due process was not sufficiently carried out.

Transparency is a key component. Producing a new ANSI/ASSP voluntary consensus standard of this magnitude can take up to two years or longer.

Additional contributors will likely be added as the committee proceeds with development. Interested individuals are encouraged to contact ASSP’s Lauren Bauerschmidt at to obtain information and an application.

Promising Practice

The NIOSH Office of TWH developed this article in collaboration with Meghan Krause, Erica Scott, Isaac Michalski, Claire Fleming, and Joel Spoonheim.

Rested, Resilient, and Active: The HealthPartners Be Well Program

HealthPartners, a NIOSH TWH Affiliate, is a 26,000-person healthcare payer, provider, and research organization serving six states through 16 single, separate employers. Building on a 30-year history of employee well-being, HealthPartners established Be Well in 2010. Be Well is a system-wide well-being program that helps colleagues be more rested, resilient, and active.

A three-person Be Well team oversees system-wide programming and collaborates with dedicated employee well-being colleagues at select sites within the system. Together, they constitute an operational committee that drives implementation with support from a 500-person Champion network. The Be Well Steering Committee, composed of executive and managerial leaders, provides strategic oversight.

Be Well uses a program-specific dashboard that captures various population health data insights, including

  • Health Results from health assessments, medical/pharmacy claims, and safety claims
  • Survey Results from the annual engagement survey and satisfaction surveys
  • Engagement Results based on participation and completion rates in Be Well and EAP programming
  • Claims PMPY (per member [worker and spouse] per year) average by condition.

The dashboard results inform Be Well efforts to influence practices, policies, and environmental adaptations for safety, health, and well-being.

Be Well uses parallel communication approaches to serve the system of single, separate employers: one for broad, system-wide promotion and another for site-specific opportunities. Be Well uses several channels to engage participants beyond an internal website, including

  1. Boost: A weekly printable sheet featuring upcoming events and healthy-habit practices (printable materials are critical in healthcare settings where caregivers seldom access email during the workday).
  2. Huddle: A weekly organization-wide update featuring news and a “Be Well” practice.
  3. Brief: A semi-monthly organization-wide email featuring educational resources and self-care tips.
  4. Text: A weekly champion text offering specific calls to action.
  5. Webinars: A monthly series featuring subject matter experts on various topics.

Be Well’s “rested, resilient, and active” framework addresses the greatest workforce opportunities identified through dashboard data, targeting the behaviors most likely to create positive change. In response to recent events, programming has shifted to focus on emotional and physical resilience to ensure safety. Here are some examples:

  1. Wellbeats, an online fitness app, was released to encourage people to be active at home when gyms are closed.
  2. Huddles, incentive programs, communications, and team presentations emphasized resilience practices.
  3. A clinician-specific resource page was created to combat burnout and help clinicians connect with one another.
  4. Webinars addressed caution fatigue (fatigue from hearing messaging about the pandemic), grief, and psychological self-care.
  5. Designed in collaboration with Diversity and Inclusion teams, webinars addressed “Micro-aggressions and Disparities in Health Outcomes,” “How to Be Anti-Racist in Healthcare,” and “Internalized Oppression and Racism.”

“An insight I gained was that it’s okay to talk about this, even (and especially) at work, and [about] resources to assist with the conversation.”

—A participant in the “Micro-aggressions and Disparities in Health Outcomes” webinar

HealthPartners employers who piloted a personalized prescriptive incentive model achieved better than regional trend results in health risk reduction and certain claims. Engagement remains high, with focus on groups at higher risk. Looking ahead, Be Well will continue to help team members navigate the pandemic and social disruption until a new paradigm is clear and innovations arise.

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

eople help and grow together. Business woman and man climbing

A recovery-supportive workplace can help people in recovery stay at work or return to work. New Hampshire’s Recovery Friendly Workplace initiative empowers employers, workers, and communities to collaborate, create positive change, and eliminate barriers for those impacted by substance use. The initiative engages businesses to acquire and maintain official “Recovery Friendly” designation status. To earn that designation, businesses must take these actions:

  • Declare to employees that their workplace is committed to this effort
  • Tell employees about workplace policies and how to access resources and supports
  • Offer trainings to supervisors and employees
  • Connect with community-based public health and recovery organizations.

A recent report outlines the initiative, including its background, program outcomes, and next steps for the future. This report highlights what worked during outreach and engagement, such as providing businesses with a menu of training options to meet their specific needs. Learn more about New Hampshire’s initiative or find resources from NIOSH about Workplace Supported Recovery.

News from NIOSH

Funding Opportunity: Centers of Excellence for TWH
NIOSH recently announced available cooperative agreement funding for the Centers of Excellence for TWH. These Centers aim to advance the overall safety, health, and well-being of workers in our nation through multidisciplinary research, intervention, and outreach focused on concepts of TWH. The application deadline is February 3, 2021.

Management During Difficult Times: Supporting Workers and Families to Prevent Burnout and Promote Well-Being
In October, the NIOSH TWH Program held a webinar on managing during difficult times. Speakers discussed how to support workers to prevent burnout and promote well-being, as many workers are juggling multiple, competing duties in and outside the workplace. Discussion included resources for workers to address work-related stress, how to support team members virtually, and how to recognize workers’ needs. Watch the recording here.

Effective Interventions to Combat Opioid Misuse: Studies from the Field of Opioid Prescription Management

Join the NIOSH TWH Program and Center for Workers’ Compensation Studies on Thursday, December 10, 2020, at 12:00 pm ET for a webinar with Drs. Kuang-chi Chang from the U.S. Department of Labor, William Shaw from UConn Health, and Yonatan Ben-Shalom of Mathematica. The speakers will share findings from a recent report on the State of the Field in Opioid Prescription Management. Register now!

NIOSH “Future of Work” Webinar Series
NIOSH is starting a new webinar series on the Future of Work. The first webinar will focus on the role of organizational design in the future of work, featuring speakers from NIOSH and the Oregon Institute of Occupational Health Sciences. The webinar, “The Role of Organizational Design in the Future of Work,” will take place on Wednesday, January 27, 2021, at 2:00 pm ET. Register now!

News from the NIOSH Centers of Excellence for TWH

To learn more about how the Centers of Excellence are responding to the emerging public health threat, visit their websites.

  • The Center for Health, Work & Environment (CHWE), through Health Links, has become an official partner with the American Subcontractors Association (ASA). CHWE is partnering with ASA on a national and local chapter level to provide discounted Health Links plans to their members. They will be providing education opportunities to teach their members about TWH, including participation in upcoming speaking engagements. A recent success story featuring an ASA business involved in Health Links highlights services offered to members.
  • The Center for the Promotion of Health in the New England Workplace (CPH-NEW) trains and facilitates worker “Design Teams” as a strategy for implementing TWH within individual workplaces. To promote worker engagement during virtual interaction, CPH-NEW researchers converted their field research protocols to use online communication platforms for virtual coaching of Design Teams. Find information about research and training on remote engagement tools and training. Congratulations to Drs. Mazen El Ghaziriand Lisa Jagers, who were awarded funding from the National Institute of Corrections to explore the latest evidence on responding to staff trauma and organizational stress in prisons and jail settings.
  • The Harvard Center for Work, Health and Well-being published an article on the relationship of occupational injury and use of mental health care. Researchers found that injured workers were more likely to seek mental health care services following injury. Read the article.
  • The Healthier Workforce Center of the Midwest (HWC) at Washington University at St. Louis (WashU) is addressing the safety, health, and well-being of construction apprentices. Working closely with the Association of General Contractors in Missouri (AGCMO), HWC assisted with creating and implementing a suicide prevention campaign. A small group was pulled together to work on the campaign, including union safety professionals, representatives from large contractors, AGCMO safety team members, and the WashU team. The freely accessible campaign materials include medallions, hard hat stickers, posters, and toolbox talk handouts.
  • The Oregon Healthy Workforce Center (OHWC) is relaunching the Safety and Health Improvement Program (SHIP) toolkit. The toolkit provides online training, templates, and guides for supervisors and managers to help improve the safety, health, and well-being of employees. The toolkit has been shown in research studies to (1) reduce stress and work-life conflict, (2) increase team communication and effectiveness, (3) improve employee health and safety, and (4) enhance work processes and practices. Learn more here. The OHWC podcast “What’s Work Got To Do With It?” just turned two! OHWC released a miniseries highlighting the 30 year history of OHWC’s home, the Oregon Institute of Occupational Health Sciences. Learn about the history of the institute and how it has evolved through the years, including highlights from community stakeholders who have played a critical role in crafting its research direction.
  • The University of Illinois (UIC)–Center for Healthy Work will be meeting with Illinois-based TWH Affiliates in December 2020. This meeting aims to expand on previous conversations and collaboration efforts around development of a regional focused agenda for shared research, aligning with the National Occupational Research Agenda (NORA). The UIC Center for Healthy Work has also initiated a research affiliate program to identify other investigators at the University of Illinois who are conducting research related to a variety of worker health and safety topics. This research affiliate program will create a resource hub for emerging and novel research related to worker health and safety.

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

News from NIOSH TWH Affiliates and Partners

Mental Health America: Welcoming a New TWH Affiliate
Founded in 1909 by Clifford W. Beers, Mental Health America (MHA) is a community-based nonprofit dedicated to addressing the needs of those living with mental illness and promoting the overall mental health of all. MHA’s programs and initiatives fulfill its mission of promoting mental health and preventing mental illness through advocacy, education, research, and services. MHA’s workplace initiatives include research that (1) explores the impact of workplace policies and practices on employee mental health and (2) identifies effective evidenced-based interventions that support employee well-being. In addition, MHA creates transformational change in workplaces through collaborations with small and large businesses, public education, research dissemination, and strategic public policy change.

Report on Breastfeeding in Relation to Industry Category
The University of New Hampshire Institute on Disability recently published a report, Analysis of New Hampshire Pregnancy Risk Assessment Monitoring System (PRAMS) to Better Understand Breastfeeding Initiation and Duration by Industry Category. This new publication provides additional information that supplements the institute’s 2017 report. Findings in this report suggest significant associations between industry and duration of breastfeeding among women in New Hampshire. It also illustrates that women with higher incomes and professional jobs are more likely to initiate breastfeeding earlier and breastfeed longer than those with lower incomes and service-oriented jobs.

Results of Work-from-Home Survey
Center for Intelligent Environments (CENTIENTS) conducted a survey study to assess the impacts on health and productivity of working from home, specifically focusing on office workers. The final sample consisted of 988 respondents. Results indicated that the average level of physical and mental well-being decreased in comparison with that before working from home, including decreased overall physical activity and increased overall intake of food (both healthy and junk food). While working from home increased flexibility and control over the temporal and spatial contexts of work, it also created challenges of setting and maintaining boundaries between work and home. Manuscripts that provide detailed results are currently being submitted for publication.

Risk Assessment Technical Report
The American Society of Safety Professionals (ASSP) released a new Risk Assessment Technical Report. The report discusses techniques that can help organizations assess the TWH impact of risks and hazards in their work environments. Learn more about the report.

Updates from UNC Greensboro
UNC Greensboro’s Interdisciplinary Workplace Health continues its partnership with the Wellness Council of America (WELCOA) to study the extent to which organizations are following WELCOA’s quality benchmarks in their employee wellness initiatives. Catch up on their latest research: Association between the characteristics of organizations and their profile of performance against quality benchmarks for workplace health promotion; Tracking changes in U.S. organizations’ workplace health promotion initiatives: A longitudinal analysis of performance against quality benchmarks; and Return on investment of workplace wellness: evidence from a long-term care company.

University of Michigan Publications
The University of Michigan Center for Occupational Health and Safety Engineering, a TWH Affiliate, published new research this quarter focused on hotel workers. Catch up on its latest publications: Occupational exposure and health risks of volatile organic compounds of hotel housekeepers: Field measurements of exposure and health risks and Interventions to promote hotel workers’ health: A scoping review.

Is your organization interested in becoming an affiliate? To learn more about the Total Worker Health Affiliate program, visit

New Publications and Resources

From CDC and NIOSH

From NIOSH Centers of Excellence for TWH

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


9 – The webinar “Ergonomic Tips: Maximize Your Comfort and Performance When Computing Remotely” will feature practical tips for working from home. Join speaker Michelle Robertson, PhD, CPE, from CPH-NEW, a Center of Excellence for TWH, at 2:00 pm ET.

10 – A free NIOSH webinar, “Effective Interventions to Combat Opioid Misuse: Studies from the Field of Opioid Prescription Management,” will be held at 12:00 pm ET. Please register for the event.

11 – The Iowa Local Technical Assistance Program (LTAP) will host a free webinar, “You OK? Suicide Prevention and Stress Management,” at 12:00 pm CT.


25 – Join the Master Builders of Iowa (MBI) Safety Day Conference for breakout presentations, including a focus on mental health.

27 – Join NIOSH for a free webinar, “The Role of Organizational Design in the Future of Work,” at 2:00 pm ET. This event will feature speakers from NIOSH and the Oregon Institute of Occupational Health Sciences.

28 – The Rural PREP Grand Rounds will feature Healthier Workforce Center of the Midwest researcher Diane Rohlman in a presentation on farm safety.

Looking for more events? NIOSH has a new web page that provides a list of publicly available occupational safety and health–related conferences, meetings, webinars, and events. Events are sponsored by NIOSH, other government agencies, and non-government agencies such as universities, professional societies, and organizations.

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.