NIOSH Total Worker Health™: Innovative
Approaches for Healthier Employees
USPHS Symposium
June 20, 2012
Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthTM
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
Disclaimers
• The findings and conclusions in this presentation have
not been formally disseminated by the National Institute
for Occupational Safety and Health, and should not be
construed to represent any agency determination or
policy.
• The mention of organizations and commercial entities
and products in this presentation is for illustrative
purposes only and does not represent an endorsement
by NIOSH, CDC or the US Department of Health and
Human Services.
2
OSH Act of 1970
• SEC. (2) (b) . . . to
assure so far as
possible every
working man and
woman in the Nation
safe and healthful
working conditions
and to preserve our
human resources . . .
(emphasis added)
3
Overview
• Explain RATIONALE for
integrating health protection and
health promotion
• Describe PARTNERSHIPS in
building and promoting
integrated programs
• List RESOURCES to launch and
improve a Total Worker HealthTM
Program
4
Every Day . . .
12,712
9,315
new reported cases of nonfatal occupational injuries and
illnesses
workers are treated in emergency departments
258
workers are hospitalized
134
deaths from work-related illness
14
deaths from work-related injuries
Source: MMWR, Vol. 59, No. 15, April 23, 2010
5
Work-Related Illness, Injury and Fatalities
in the US are costly….
Employers and insurers spent $85 Billion on workers’
compensation in 2007, which is
 Only a portion of the costs borne by employers, workers, and
society
 Excludes costs paid by other insurance systems and most of
work-related illness costs
Source: CDC Morbidity and Mortality Weekly Report. Volume 59, Number 15. April
23, 2010
6
Burden of Chronic Health Conditions
• Cancer
• 553,000 deaths, 1.3M new cases/yr
• $89B in medical costs, $130B in lost work days & productivity
• Diabetes
• >23.6M cases, >200,000 deaths/yr
• $116B for medical issues,$58B for lost work & productivity
• CVD
• 80M cases, >870,000 deaths/yr
• $448B a year
• Tobacco-Related
• 438,000 deaths
• $96B in medical costs, $97B in direct costs
Source: National Center for Chronic Disease Prevention and Control [2008]
7
The Future of Work
• Hazards
 Persistent
 Emerging
• Employment
 Shortage of Workers
 Global Competition
 Flexible vs. Precarious
• Workforce




Aging Workers
Health-Related Issues
Obesity
Multi-Generational
8
Traditional Health Protection and
Health Promotion
• Health Protection – Programs that focus
on reducing hazards and exposures at
workplaces to prevent occupational
injury and illness
• Health Promotion - interventions aimed
at reducing lifestyle risk factors by
promoting healthy behaviors and actions
“Traditional Safety and Health Silos
Not Optimal for Workplace Health”
ACEOM, 2011
A Rationale for Integration
• Workers’ risk of disease is increased by exposure to both
occupational hazards and individual risk related behaviors
• Workers at highest risk for exposures to hazardous working
conditions are often most likely to engage in risk-related health
behaviors and live in higher risk communities
• Worker participation in integrated programs is higher than in singleintervention
• Manufacturing: Greater reduced risks - ergonomic, cardiovascular,
job demand and job control risks
• Blue collar: Smoking quit rates in an integrated program more than
doubled relative to a non-integrated program
http://www.cdc.gov/niosh/steps/pdfs/NIOSH-post-symprevision.pdf
Sorensen & Barbeau (2004)
A Rationale for Integration
• Sharing resources across departments and functions can be cost
efficient and result in a lack of duplication in program offering
• Common set of metrics can be used by all programs
• Reduced competition for senior management attention and
scarce resources
• Improvements in employee health will reduce medical care costs
AND enhance worker safety, productivity, and organizational
competitiveness
• Successful coordinated programs can save MORE money than
they cost and achieve significant ROI
http://www.cdc.gov/niosh/worklife/steps/default.html
Goetzel (2005)
Examples of Integrated Approaches
• Respiratory protection programs that address tobacco use and
smoking cessation
• Ergonomics programs that teach joint health and arthritis
management
• Stress management classes that seek to diminish workplace stressors,
personal stressors and build resiliency
• Integrated training and prevention programs (falls, motor vehicle
safety, first aid, hearing conservation, stretching, flexibility and lifting
programs)
• Comprehensive screenings for work and non-work risks
• Occupational health combined with a workplace primary care home
model
• Full integration of: clinics, behavioral health, traditional safety, health
promotion programs, coaching, EAP, nutrition, disability and workers
compensation.
65% of the adult population can be
accessed at workplaces (CDC, 2010)
14
What is Total Worker HealthTM?
Total Worker Health™ - A strategy
integrating occupational safety and
health protection with health
promotion to prevent worker injury
and illness and to enhance well-being.
Total Worker Health™
Intramural
Program
Developing
Partnerships
Thriving
Centers of
Excellence
3 Maturing
1 New
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NIOSH Total Worker Health ProgramTM
VALUE OF OUR PARTNERS
TM
TWH
Partnerships
• Federal Worksite Wellness Pilots
– OPM and OMB Federal Employee Worksite Health
& Wellness Initiative (10,000 federal workers)
• 3-5 pilots in the next two years to implement and
evaluate optimal interventions
18
Wellness Is Now: Veterans Health
Administration
NIOSH Centers of Excellence
TM
for Total Worker Health
 University of Iowa Healthier Workforce Center for Excellence
 http://www.public-health.uiowa.edu/hwce/
 Center for the Promotion of Health in the New England Workplace
 At the University of Massachusetts
http://www.uml.edu/centers/cph-new/
 At the University of Connecticut
http://www.oehc.uchc.edu/healthywork/index.asp
 Harvard School of Public Health Center for Work, Health, & WellBeing
 http://centerforworkhealth.sph.harvard.edu/
 Oregon Healthy Workforce Center, Oregon Health & Science
University (selected in late 2011)
 http://www.ohsu.edu/xd/research/centersinstitutes/croet/oregon-healthy-workforce-center/index.cfm
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CASE STUDIES
EXAMPLES
PROMISING PRACTICES FOR TWHTM
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Case Study: NASA
• Example of an Integrated
Program in a Federal
Government Agency
• IOM Committee Evaluated
the Current Program (2005)
• 15 Recommendations for
Program Improvement
• http://www.ohp.nasa.gov
22
Example of Coordination in Practice:
NASA
• Goal: Every employee is healthier than the average worker
as a result of work with NASA
• Recommendations:
– Shift from disease status to health status, treatment to
prevention, population-based health model, multiple-risk
interventions,
– Integrated management of health programs
– More effective, coordinated, data-driven health program policy
• Johnson Space Center
– Executive Safety and Health Committee cross-divisional
– VP program stimulated broader thinking about health and
behaviors at home and in community
CDC Examples
• CDC StairWELL Project
• CDC’s Tobacco Free Campus
Initiative
• Bike Shelter replaces Smoking
Shelter
• Go Green! Go Healthy!
• Garden Markets
Policies to Support Health
• Tobacco-free campus
• Flexible work/schedule policies
– Leave, telework, job share, parental/dependent care
•
•
•
•
Nutritious foods-at-meetings policy
Healthy transportation policies
Smoke-free meetings policy
Time during work hours for wellness activities
– Training or educational opportunities, health fairs,
events
– Screenings, health coaching, EAP
– Physical Activity
RESOURCES FOR BUILDING A
HEALTHIER AND SAFER WORKFORCE
Key Total Worker Health™ Reports
• STEPS to a Healthier Workforce
• Essential Elements of Effective Workplace Programs
and Policies
• ACOEM Guidance on Workplace Health Protection
and Promotion
• The Whole Worker: Guidelines for Integrating
Occupational Health and Safety with Workplace
Wellness Programs
• Integrating Employee Health: A Model Program for
NASA
CDC Workplace Tools and Resources
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Visit our Website:
http://www.cdc.gov/niosh/TWH/
Upcoming Events
Healthier Federal Workers
September 2012 in
Washington, DC
• 10th Work Stress and
Health Conference May
2013 in Los Angeles
Designing Healthier Workplaces
Can You Become a “Choice Architect”?
•
•
•
•
•
•
Choice-making is never neutral
Directing default options toward health can be
powerful
Subtle “nudges” toward healthier choices can
improve health outcomes
Policy interventions provide a strong basis for better
choices
Incentives and spotlights can motivate
Providing structure around complex choices helps
Themes from Thaler R, Sunstein, C: Nudge Improving Decisions About Health,
Wealth, and Happiness, 2008.
Workplace’s Built Environment
Allow Health to Thrive
• Safe, hazard-free workplace
• Welcoming, user-friendly, ergo-appropriate workspaces
• Commitment to employee respect, engagement, and
input
• Stairs, walkways, paths, trails that are safe and inviting
• Onsite food choices that make eating healthier easy
• Transportation and parking options that enhance
health
• Onsite or nearby health clinic or access to healthcare
providers
• Fitness facilities or opportunities for physical activity
Thank You!
Heidi L. Hudson cvv2@cdc.gov