Priority Areas and Emerging Issues

To address evolving challenges and opportunities related to worker safety, health, and well-being, the Total Worker Health® program highlights critical priority areas and emerging issues that are currently relevant to advancing worker well-being. The identified priority areas provide supplementary guidance for both short- and long-term Total Worker Health (TWH) efforts, in addition to the program’s latest research interests and needs. Note that these are not meant to be exhaustive, imply a hierarchy of importance, or be mutually exclusive.

Opioid and Other Substance Use Disorders in the Workplace
Substance use can be both an occupational and personal risk factor for worker injury and illness and can contribute to hazards for all workers [NIOSH 2019]. By using Total Worker Health (TWH) principles, NIOSH has developed a four-part framework for addressing the opioid crisis in the workplace, including identifying workplace conditions, determining risk factors, protecting workers and responders, and developing methods for detection and decontamination [NIOSH 2018a].  NIOSH has also identified critical research areas and funds extramural and intramural research on opioids in the workplace [NIOSH 2018b].

framework infographic

TWH Outreach, Education, and Training  
NIOSH seeks to develop new and strengthen existing partnerships and collaborations with State Health Departments, TWH Affiliates, and NIOSH-funded Centers (e.g. Education and Research Centers (ERCs), Training Project Grants (TPGs), Centers of Excellence for TWH, Agricultural Centers, Construction Center) and create regional networks and partnerships across the Nation for the purpose of disseminating and implementing TWH programs, policies, and practices throughout workplaces and providing TWH education and training.

Measuring Worker Well-Being
NIOSH has developed a conceptual framework and associated survey instrument for the assessment and measurement of worker well-being [Chari et al 2018]. The current goal is to undertake efforts to characterize worker well-being at organizational, industry, occupational, or national levels in collaboration with a range of partners including the Centers of Excellence for TWH.

Future of Work
The NIOSH Future of Work Initiative applies the Total Worker Health framework by encouraging collaboration across the spectrum of organizational policies, programs, and practices. It is a collaborative effort of multidisciplinary research, communication, and partnerships throughout NIOSH, other agencies, and organizations that aims to identify novel research solutions, practical approaches, and partnership opportunities to address the future of work [NIOSH 2020]. Goals include: 1) performing, compiling, and synthesizing studies on the future of work; 2) featuring current research and raising awareness about research projects related to the future of work; 3) promoting research among new industries, technologies, organizational designs, job arrangements, automations, ways to control risk, and other workplaces;  and 4) monitoring changes and connecting trends in the workplace, work, and workforce to prepare for the future of occupational safety and health.

Venn Diagrams for the Future of Work

Healthy Work Design and Well-Being
The TWH approach emphasizes the fundamental role that high-quality work and healthy work design play in safer, healthier workers.  The goal of the NIOSH Healthy Work Design and Well-Being Program is to improve the design of work, management practices, and the physical and psychosocial environment of the work environment. The program emphasizes collaboration among labor, trade, and other industry associations, along with professional associations and occupational safety and health researchers. Current priorities include: occupational stress, working hours and fatigue, and non-standard work arrangements (such as temporary agency, contract, and gig arrangements).

Mental Health in the Workplace
Mental health is a crucial part of worker well-being, and both are affected by the quality of working conditions. Psychosocial risks, or risks to mental health, come from work that includes heavy workloads, unclear or conflicting demands, lack of involvement in decisions or input in how the work is done, and poor communication. It may also come from lack of support from managers and co-workers, poorly managed organizational change, job insecurity, and harassment or mistreatment. Mental health worsens with chronic exposure to occupational stress. In the context of non-stop demands, continually changing work processes, and job insecurity, worker mental health and well-being are increasingly at risk. To fully support the comprehensive well-being of workers, it is critical to ensure they have safe working conditions that protect their physical and psychological health. Ensuring a psychosocially safe and healthy workplace is key to a Total Worker Health approach. NIOSH aims to increase awareness of the role of mental health in worker well-being; develop workplace policies, programs, and practices that support mental health; and provide training and resources to organizations to ensure psychosocially safe and healthy workplaces.

Issues Relevant to Advancing Worker Well-Being Using Total Worker Health Approaches

The following graphic, “Issues Relevant to Advancing Worker Well-Being Using Total Worker Health® Approaches” illustrates a wide-ranging list of issues that are relevant to advancing worker safety, health, and well-being. Revised in January 2020, this list reflects an expanded focus for TWH that recognizes workplace and work issues such as innovative technologies, working conditions, and emerging forms of employment that present new risks for today’s and tomorrow’s workforce. Additionally, this expanded focus recognizes that there are linkages between health conditions that may not arise from work but that can be adversely affected by work. Understanding, preventing, and reducing these risks are important elements of TWH. A TWH approach advocates for the integration of all organizational policies, programs, and practices that contribute to worker safety, health and well-being, including those relevant to the prevention and control of hazards and exposures, built environment supports, community supports, compensation and benefits, healthy leadership, organization of work, policies, technology, work arrangements, and workforce demographics.


  1. NIOSH [2019]. New NIOSH study describes drug overdoses at work. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
  2. NIOSH [2018a]. NIOSH confronts the opioid crisis. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
  3. NIOSH [2018b]. NIOSH opioids in the workplace: research. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
  4. Chari R, Chang CC, Sauter SL, Petrun Sayers EL, Cerully JL, Schulte P, Schill AL, Uscher-Pines L [2018]. Expanding the Paradigm of Occupational Safety and Health: A New Framework for Worker Well-Being. Journal article. J Occup Environ Med 60(7): 589-593, electronic medium. icon.
  5. NIOSH [2020]. Future of work initiative. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,