What Is Total Worker Health®?

Total Worker Health is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness-prevention efforts to advance worker well-being.

The Total Worker Health (TWH) approach prioritizes a hazard-free work environment for all workers. It also brings together all aspects of work in integrated interventions that collectively address worker safety, health, and well-being. Traditional occupational safety and health protection programs have primarily concentrated on ensuring that work is safe and that workers are protected from the harms that arise from work itself. TWH builds on this approach through the recognition that work is a social determinant of health. Job-related factors such as wages, work hours, workload, interactions with coworkers and supervisors, and access to paid leave impact the well-being of workers, their families, and their communities. The long-term vision of the TWH program is to protect the safety and health of workers and advance their well-being by creating safer and healthier work.

Keeping workers safe

NIOSH was created by the Occupational Safety and Health Act of 1970, which mandates “to assure so far as possible every man and woman in the Nation safe and healthful working conditions and to preserve our human resources.” Keeping workers safe is the foundation upon which Total Worker Health is achieved. The TWH approach offers a holistic model for improving workforce safety, health, and well-being. It does so through an integrated approach that prioritizes safety while simultaneously engaging in other workplace efforts (e.g., healthy work design, employee training and development, injury and illness prevention efforts) to advance the overall well-being of workers.

Those wishing to start effective workplace programs must first consider the principles of occupational safety and health that are dedicated to keeping workplaces safe and workers protected. First-dollar investments must address hazardous working conditions. These safeguards must be in place for organizations to adopt a Total Worker Health approach.

Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-Being is a practical starting point for employers, workers, labor representatives, and other professionals interested in implementing workplace safety and health programs aligned with the TWH approach. Published in 2016, this workbook prioritizes a hazard-free work environment for all workers. The workbook applies a modern prevention approach—consistent with traditional occupational safety and health prevention principles—that recognizes that job-related factors can have an important impact on the well-being of workers, their families, and their communities.

Benefits for workers

At its core, the TWH program aims to benefit workers and enhance worker well-being by informing the design of work and employment conditions in a way that will prioritize safety and improve physical and psychological outcomes. Evidence suggests that risk factors in the workplace can contribute to health problems previously considered unrelated to work. For example, there are work-related risk factors for obesity [Luckhaupt et al. 2014; Nobrega et al. 2015], sleep disorders [Caruso 2013], cardiovascular disease [CDC 2014], depression [Arcury et al. 2014; Rayens and Reed 2013; Wulsin et al. 2014], and other health conditions. In recognition of these relationships, some newly observed, and others based on established scientific evidence, the TWH approach explores opportunities to both protect workers from hazards and advance their health and well-being by targeting the conditions of work. This includes protecting and enhancing the health of workers across the life-span, from their first job through retirement. The National Center for Productive Aging and Work, hosted by the TWH program, advances lifelong well-being for workers of all ages and supports a productive aging across the working life.

Benefits for employers and communities

Research on the Total Worker Health approach provides a scientific evidence base that can help businesses and communities reduce the impact and cost of injuries and illness, thereby helping to control healthcare costs and disruption to family and community life. The TWH approach promotes research into patterns of work organization and emerging forms of employment, recognizing that both occupational and non-occupational exposures can act together to produce worker illness and injury. By integrating the traditional focus on work-specific factors with attention to health conditions and the quality of working life, the TWH approach provides a pathway to improve worker creativity, innovation, and productivity by creating work and work environments that are safe, health-enhancing, meaningful and fulfilling.

Employers indicate that, by emphasizing a TWH focus, they accrue competitive advantages related to recruitment, retention, employee satisfaction, community engagement and reputation, and sustainable workforce culture [Howard et al. 2016].

Science at work for people at work

NIOSH-funded research provides the evidence to address the challenges workers and employers find in the workplace, as well as the practical solutions needed for workers to remain safe and for employers to retain a productive workforce. To build the scientific evidence needed to develop innovative solutions for complex problems, NIOSH funds the Centers of Excellence for Total Worker Health. These Centers are hubs of TWH-related research and practice. The research conducted at these Centers generates new knowledge and informs novel approaches for addressing challenges faced by employers today.

Related Resources
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Find answers to Frequently Asked Questions (FAQs) about Total Worker Health!

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Learn more about the Priority Areas and Emerging Issues relevant to TWH.

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Discover how the approach has evolved with the “History of Total Worker Health


Arcury TA, Grzywacz JG, Chen H, Mora DC, Quandt SA [2014]. Work organization and health among immigrant women: Latina manual workers in North Carolina. American Journal of Public Health 104(12):2445-2452. https://doi.org/10.2105/AJPH.2013.301587.

Caruso [2013]. Negative impacts of shiftwork and long work hours. Rehabil Nurs 39(1):16-25. https://doi.org/10.1002/rnj.107.

Howard J, Chosewood LC, Hudson HL [2016]. Letter to the editor: The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative. New Solut 26(3):345–348. https://doi.org/10.1177/1048291116656631.

CDC [2014]. Prevalence of coronary heart disease or stroke among workers aged <55 Years — United States, 2008–2012. MMWR 63(30):645-649.  https://www.cdc.gov/mmwr/pdf/wk/mm6330.pdf.

Luckhaupt SE, Cohen MA, Jia L, Calvert GM [2014]. Prevalence of obesity among U.S. workers and associations with occupational factors. Am J Prev Med 46(3):237-248. https://doi.org/10.1016/j.amepre.2013.11.002.

Nobrega S, Champagne N, Abreu M, Goldstein-Gelb M, Montano M, Lopez I, Arevalo J, Bruce S, Laura Punnett L [2015]. Obesity/Overweight and the role of working conditions: A qualitative, participatory investigation. Health Promotion Practice 17(1), 127–136. https://doi.org/10.1177/1524839915602439.

Rayens MK, Reed DB [2013]. Predictors of depressive symptoms in older rural couples: The impact of work, stress and health. The Journal of Rural Health 30(1):59-68. https://doi.org/10.1111/jrh.12028.

Wulsin L, Alterman T, Bushnell PT, Li J, Shen R [2014]. Prevalence rates for depression by industry: A claims database analysis. Soc Psychiatry Psychiatr Epidemiol 49:1805-1821. https://doi.org/10.1007/s00127-014-0891-3.

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