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Total Worker Health™Total Worker Health™
TWHTWHAn Integrated Approach to Worker Well-BeingAn Integrated Approach to Worker Well-Being
A NIOSH InitiativeA NIOSH Initiativehttp://www.cdc.gov/niosh/twh/totalhealth.html
ByBySally Bardsley, Ed.D, CIHSally Bardsley, Ed.D, CIH
Montana TechMontana TechSafety, Health, and Industrial Hygiene Dept.Safety, Health, and Industrial Hygiene Dept.
March 4, 2015March 4, 2015
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* Info from:* Info from:NIOSH Total Worker Health™: NIOSH Total Worker Health™:
Innovative Approaches for Healthier Innovative Approaches for Healthier EmployeesEmployees
Heidi Hudson, MPH – Co-Coordinator for Total Worker Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthHealthTMTM
National Institute for Occupational Safety and HealthNational Institute for Occupational Safety and Health
Centers for Disease Control and PreventionCenters for Disease Control and Prevention
20122012
What We’ll Talk About . . .What We’ll Talk About . . .
Total Worker Health (TWH)Total Worker Health (TWH)
TWH & Wellness ResearchTWH & Wellness Research
S&H professional’s role re TWHS&H professional’s role re TWH
ResourcesResources
PLEASE share your insights and PLEASE share your insights and experience during this presentation.experience during this presentation.
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TOTAL WORKER HEALTHTOTAL WORKER HEALTH
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NIOSH’s TWH InitiativeNIOSH’s TWH Initiativehttp://www.cdc.gov/niosh/twh/
A strategy integrating A strategy integrating OSH protection OSH protection with with health promotionhealth promotion to to
PreventPrevent worker injury and illness worker injury and illness
Enhance and advance Enhance and advance well-beingwell-being
How does work (place, practices, etc.) How does work (place, practices, etc.) affect life beyond work?affect life beyond work?
How does life beyond work (recreation, How does life beyond work (recreation, home, family) affect work?home, family) affect work?
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To the Boss, TWH Means . . .To the Boss, TWH Means . . .
Ensuring optimum well-being for workersEnsuring optimum well-being for workers through through integration of state-of-the-art protection and promotion that integration of state-of-the-art protection and promotion that has the has the workers’ best interests workers’ best interests as its motivating goal.as its motivating goal.
Promoting worker well-being in all its aspectsPromoting worker well-being in all its aspects, including , including appropriate indemnity and medical care for work injuries appropriate indemnity and medical care for work injuries and illnesses, adequate paid sick and family leave, and illnesses, adequate paid sick and family leave, maternity and paternity leave, adequate vacation time, maternity and paternity leave, adequate vacation time, living wages, comprehensive health care, social pensions, living wages, comprehensive health care, social pensions, along with safe and healthful workplace conditions as along with safe and healthful workplace conditions as required by law.required by law.
John Howard, MD, MPH, JD, LLM, John Howard, MD, MPH, JD, LLM,
Director, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control Director, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC)and Prevention (CDC)
Keynote address at 1st International Symposium to Advance Total Worker HealthKeynote address at 1st International Symposium to Advance Total Worker HealthTMTM October 6, 2014 | October 6, 2014 | Bethesda, MDBethesda, MD
http://www.cdc.gov/niosh/twh/pdfs/KeynoteDrHoward1stInternatSymposiumTWH.pdf 66
Traditionally . . .Traditionally . . .
Awareness of OSH re the worker has Awareness of OSH re the worker has been around for decades, butbeen around for decades, but
These concepts were largely These concepts were largely compartmentalized compartmentalized
HealthHealth ProtectionProtection ProgramsPrograms – Focused on Focused on reducing hazards and exposures reducing hazards and exposures
at workplacesat workplaces to prevent occupational injury to prevent occupational injury and illnessand illness
Health Promotion Programs Health Promotion Programs – Focused onFocused on reducing lifestyle risk factors reducing lifestyle risk factors by by
promoting healthy behaviors and actionspromoting healthy behaviors and actions
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Is TWH a New Concept?Is TWH a New Concept?
OSHAct (1970)OSHAct (1970)SEC. (2) (b) . . . to assure so far as possible every SEC. (2) (b) . . . to assure so far as possible every working man and woman in the Nation safe and working man and woman in the Nation safe and healthful working conditions and to preserve our human healthful working conditions and to preserve our human resourcesresources . . . . . .
Corporate fitness/wellness in the 80sCorporate fitness/wellness in the 80s
Many companies support employee health and Many companies support employee health and wellnesswellness
What does your employer do?What does your employer do?
““Traditional Safety and Health Silos Traditional Safety and Health Silos
Not Optimal for Workplace Health” Not Optimal for Workplace Health” ACEOM, 2011 ACEOM, 2011 http://www.acoem.org/
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Now, Integration is KeyNow, Integration is Key
TWH EquationTWH EquationTWH = OSH TWH = OSH protectionprotection + Health + Health promotionpromotion
Integrate most aspectsIntegrate most aspects of the of the occupational environment and occupational environment and the worker the worker
Holistically address the Holistically address the challenges of eachchallenges of each both both individually and in combinationindividually and in combination
Fit the separate puzzle Fit the separate puzzle pieces together into a pieces together into a comprehensive “picture”comprehensive “picture”
What changes have you seen?What changes have you seen?
Between OSHA’s inception and now inBetween OSHA’s inception and now in
The workforce The workforce
The type of workThe type of work
What needs to be changed?What needs to be changed?
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Issues Issues Relevant to Relevant to
TWHTWH
EmploymentEmployment
WorkplaceWorkplace
WorkersWorkers1111
Let’s brainstorm all the facets Let’s brainstorm all the facets
of TWH we can think of re . . .of TWH we can think of re . . .
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Worker Workplace
Employment
TWH & WorkersTWH & WorkersPromoting Worker Health & Well-beingPromoting Worker Health & Well-being
Optimal Well-Being:
Employee Engagement
Health & Well-Being Assessments
Healthier BehaviorsNutrition
Tobacco Use Cessation
Physical Activity
Work/Life Balance
Aging Productively
Preparing for Healthier Retirement
Policy & Built Environment Supports
Workers with Higher Health Risks:
Young Workers
Low-Income Workers
Migrant Workers
Workers New to a Hazardous Job
Differently-Abled Workers
Veterans
Compensation & Disability:
Disability Evaluation
Reasonable Accommodations
Return-to-Work
Social Security Disability Insurance
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TWH & EmploymentTWH & EmploymentPreserving Human ResourcesPreserving Human Resources
New Employment Patterns:
Precarious Employment
Part-time Employment
Dual Employers
Changing DemographicsIncreasing Diversity
Aging Workforce
Multigenerational Workforce
Global Workforce
Health & Productivity:
Leadership Commitment to Health-Supportive Culture
Fitness-for-Duty
Reducing Presenteeism
Reducing Absenteeism
Workplace Wellness Programs
Healthcare & Benefits:
Increasing Costs
Cost Shifting to Workers
Paid Sick Leave
Electronic Health Record
Affordable Care Act
HIPAA† Health Info Privacy1414
TWH & the WorkplaceTWH & the WorkplaceProtecting Worker Safety & Health
Control of Hazards & Exposures:
Chemicals
Physical Agents
Biological Agents
Psychosocial Factors
Organization of Work
Prevention of Injuries,
Illnesses & Fatalities
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Promoting Safe & Healthy Work:Promoting Safe & Healthy Work:
Management CommitmentManagement Commitment
Safety Culture/ClimateSafety Culture/Climate
Culture of HealthCulture of Health
Hazard Recognition TrainingHazard Recognition Training
Worker EmpowermentWorker Empowerment
Risk Assessment & Control:Risk Assessment & Control:
Making the Safety & Health CaseMaking the Safety & Health Case
Assessing All RisksAssessing All Risks
Controlling All RisksControlling All Risks
Root Cause AnalysisRoot Cause Analysis
Leading/Lagging IndicatorsLeading/Lagging Indicators
TWH and OSHA StandardsTWH and OSHA Standards
Are there any that consider a worker’s Are there any that consider a worker’s general health?general health?
Not just focused on prevention of injury or Not just focused on prevention of injury or illnessillnesshttps://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9783
Are there standards that should do so but Are there standards that should do so but don’t?don’t?
When we consider TWH and integration, When we consider TWH and integration, should it become regulatory?should it become regulatory?
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*Examples of Integrated *Examples of Integrated ApproachesApproaches
• Respiratory protection Respiratory protection programs that address tobacco use and programs that address tobacco use and smoking cessationsmoking cessation
• Ergonomics Ergonomics programsprograms that teach joint health and arthritis that teach joint health and arthritis management management
• Stress management Stress management classes that seek to diminish workplace classes that seek to diminish workplace stressors, personal stressors and build resiliencystressors, personal stressors and build resiliency
• Integrated training and prevention programs Integrated training and prevention programs (falls, motor (falls, motor vehicle safety, first aid, hearing conservation, stretching, vehicle safety, first aid, hearing conservation, stretching, flexibility and lifting programs)flexibility and lifting programs)
• Comprehensive screenings Comprehensive screenings for work and non-work risksfor work and non-work risks• Full integration Full integration of: clinics, behavioral health, traditional safety, of: clinics, behavioral health, traditional safety,
health promotion programs, coaching, EAP, nutrition, disability health promotion programs, coaching, EAP, nutrition, disability and workers compensation.and workers compensation.
*TWH Advantages*TWH AdvantagesWorkers’ Workers’ risk of disease is increased risk of disease is increased by by
exposure to both occupational hazards exposure to both occupational hazards and individual risk related behaviorsand individual risk related behaviors
Workers at highest risk Workers at highest risk for exposures to for exposures to
hazardous working conditions are often hazardous working conditions are often
most likely to engage in risk-related most likely to engage in risk-related
health behaviors and live in higher risk health behaviors and live in higher risk
communitiescommunities
Worker participation in integrated programs Worker participation in integrated programs
is higher is higher than in single-interventionthan in single-intervention
Manufacturing: Manufacturing: Greater reduced risks Greater reduced risks - -
ergonomic, cardiovascular, job demand ergonomic, cardiovascular, job demand
and job control risksand job control risks
Blue collar: Blue collar: Smoking quit rates Smoking quit rates in an in an
integrated program integrated program more than doubledmore than doubled
relative to a non-integrated programrelative to a non-integrated program
Sharing resources across departments Sharing resources across departments and functions can be and functions can be cost efficient cost efficient and and result in a lack of duplication result in a lack of duplication in in program offeringprogram offering
Common set of metrics Common set of metrics can be used by all can be used by all programsprograms
Reduced competition Reduced competition for senior for senior management attention and scarce management attention and scarce resourcesresources
Improvements in employee health will Improvements in employee health will reduce medical care costs AND reduce medical care costs AND enhance worker safety, productivity, enhance worker safety, productivity, and organizational competitivenessand organizational competitiveness
Successful Successful coordinated programs coordinated programs can can save MORE money than they cost save MORE money than they cost and and achieve significant ROIachieve significant ROI
STATS, RESEARCHSTATS, RESEARCH
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*Every Day . . .*Every Day . . .
12,712 12,712 new new reportedreported cases of nonfatal occupational injuries cases of nonfatal occupational injuries
and illnessesand illnesses
9,315 9,315 workers are treated in emergency departmentsworkers are treated in emergency departments
258258 workers are hospitalizedworkers are hospitalized
134134 deaths from work-related illnessdeaths from work-related illness
1414 deaths from work-related injuriesdeaths from work-related injuries
Source: MMWR, Vol. 59, No. 15, April 23, 2010Source: MMWR, Vol. 59, No. 15, April 23, 2010
2020
*Costs of Work-Related Incidents and *Costs of Work-Related Incidents and IllnessesIllnesses
Employers and insurers spent $85 Billion on Employers and insurers spent $85 Billion on workers’ compensation in 2007, which isworkers’ compensation in 2007, which is
– Only a portion of the costs borne by Only a portion of the costs borne by employers, workers, and society, and employers, workers, and society, and
Excludes costs paid by other insurance Excludes costs paid by other insurance systems and most of work-related illness systems and most of work-related illness costs costs
Source: CDC Morbidity and Mortality Weekly Report. Volume 59, Number 15. April 23, 2010Source: CDC Morbidity and Mortality Weekly Report. Volume 59, Number 15. April 23, 2010
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*Health Stats*Health Stats
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CancerCancer
• 553,000 deaths, 1.3M new cases/yr553,000 deaths, 1.3M new cases/yr
• $89B in medical costs, $130B in lost work days & productivity$89B in medical costs, $130B in lost work days & productivity
DiabetesDiabetes
• >23.6M cases, >200,000 deaths/yr>23.6M cases, >200,000 deaths/yr
• $116B for medical issues,$58B for lost work & productivity$116B for medical issues,$58B for lost work & productivity
CVDCVD
• 80M cases, >870,000 deaths/yr80M cases, >870,000 deaths/yr
• $448B a year $448B a year
Tobacco-RelatedTobacco-Related
• 438,000 deaths438,000 deaths
• $96B in medical costs, $97B in direct costs$96B in medical costs, $97B in direct costs
• How do you see these Chronic Health Conditions affect your workplace?How do you see these Chronic Health Conditions affect your workplace?
Source: National Center for Chronic Disease Prevention and Control [2008]Source: National Center for Chronic Disease Prevention and Control [2008]
Ten Modifiable Health Risk Factors Are Linked To More Than One-Fifth Of Employer-
Employee Health Care SpendingGoetzel, et al
Health Aff November 2012 vol. 31 no. 11 2474-2484
Top 7 = Depression, high blood glucose, high blood pressure, obesity, tobacco use, physical inactivity, high stress
strongly related to ↑ health care costs
Need properly targeted employer-sponsored health promotion programs to produce substantial savings
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Workplace Wellness Programs Can Generate Savings
Baicker, et al
Health Aff February 2010 vol. 29 no. 2 304-311
For every dollar spent on wellness programs:
Medical costs fall ~$3.27
Absenteeism costs fall ~$2.73
Such a ROI indicates the financial, health, and productivity benefits of such programs
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Workplace Wellness Programs Workplace Wellness Programs Cut Healthcare Costs - SurveyCut Healthcare Costs - Survey
http://usatoday30.usatoday.com/money/story/2012-01-28/cnbc-at-work-wellness/52824820/1
Of 1,121 wellness program participants surveyed,Of 1,121 wellness program participants surveyed,1.1. Over half said they are Over half said they are more productivemore productive as a result; as a result;
2.2. 40% said wellness programs 40% said wellness programs encourage them to encourage them to stay with their companystay with their company, ,
3.3. More than a third said they have More than a third said they have missed fewer daysmissed fewer days of work.of work.
BUT while many/most employers offer online BUT while many/most employers offer online wellness information, and educational resourceswellness information, and educational resources
Employees want more hands-onEmployees want more hands-on, tangible rewards, , tangible rewards, like access to nutritionists and onsite fitness facilitieslike access to nutritionists and onsite fitness facilities
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TWH Research CompendiumTWH Research Compendium
Research papersResearch papers– http://www.cdc.gov/niosh/docs/2012-146/pdfs/
2012-146.pdf
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The Safety & Health The Safety & Health Professional’s Role Professional’s Role
Re TWHRe TWH
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OSH Professional’s Role re TWHOSH Professional’s Role re TWH
What is the What is the scope/boundary of our influence scope/boundary of our influence and appropriate intervention?and appropriate intervention?
Does TWH belong under the umbrella of Does TWH belong under the umbrella of occupational safety and health?occupational safety and health?
Would/does your employer encourage and Would/does your employer encourage and promote TWH--workplace WELLNESS as well promote TWH--workplace WELLNESS as well as occupational safety and health?as occupational safety and health?
Would TWH change the Would TWH change the educational educational requirementsrequirements—would multiple professionals be —would multiple professionals be required?required?
Do you see any Do you see any downsidedownside to TWH? to TWH?
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ShouldShould We Have a Role Re Employee We Have a Role Re Employee Health beyond the Workplace?Health beyond the Workplace?
• Is it part of our professional duty to address Is it part of our professional duty to address the health and fitness of employees?the health and fitness of employees?
Or is this beyond the scope of our jobs?Or is this beyond the scope of our jobs?
We know poor health and fitness affect various work aspects We know poor health and fitness affect various work aspects and can affect the safety and health of othersand can affect the safety and health of others
• The body and mind work together in a The body and mind work together in a synergistic fashion.synergistic fashion.• NIOSH and other agencies see thisNIOSH and other agencies see this
• TWHTWH
• Occupational Health PsychologyOccupational Health Psychology
• Even Congress recognizes its importanceEven Congress recognizes its importance
• Do you think mandates will/should follow?Do you think mandates will/should follow?
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Another Brainstorm!Another Brainstorm!
You are a Safety Director that has been asked to develop a workplace TWH program.– How will you proceed?– How could you
integrate a wellness/TWH culture into your safety culture?
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RESOURCESRESOURCES
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TWH Centers of ExcellenceTWH Centers of Excellence
University of Iowa Healthier Workforce Center for Excellence 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 Center for the Promotion of Health in the New England Workplace At the University of Massachusetts At the University of Massachusetts
http://www.uml.edu/centers/cph-new/ At the University of ConnecticutAt the University of Connecticut
http://www.oehc.uchc.edu/healthywork/index.asp Harvard School of Public Health Center for Work, Health, & Well-Harvard School of Public Health Center for Work, Health, & Well-
BeingBeing http://centerforworkhealth.sph.harvard.edu/
Oregon Healthy Workforce Center, Oregon Health & Science Oregon Healthy Workforce Center, Oregon Health & Science UniversityUniversity http://www.ohsu.edu/xd/research/centers-institutes/croet/oregon-
healthy-workforce-center/index.cfm
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Facets of TWH
Research Perspectives on TWH™– http://www.cdc.gov/niosh/twh/perspectives.html
TWH Program Guidelines– http://www.cdc.gov/niosh/twh/reports.html
PartnershipsPartnerships– http://www.cdc.gov/niosh/twh/partner.html
NewsletterNewsletter– http://www.cdc.gov/niosh/TWH/newsletter/ http://www.cdc.gov/niosh/TWH/newsletter/
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*Key Total Worker Health™ Reports*Key Total Worker Health™ Reports
• STEPS to a Healthier WorkforceSTEPS to a Healthier Workforce• Essential Elements of Effective Workplace Essential Elements of Effective Workplace
Programs and PoliciesPrograms and Policies• ACOEM Guidance on Workplace Health ACOEM Guidance on Workplace Health
Protection and PromotionProtection and Promotion• The Whole Worker: Guidelines for Integrating The Whole Worker: Guidelines for Integrating
Occupational Health and Safety with Workplace Occupational Health and Safety with Workplace Wellness ProgramsWellness Programs
• Integrating Employee Health: A Model Program Integrating Employee Health: A Model Program for NASAfor NASA
CDC CDC National Healthy Worksite Program
• FAQFAQ• http://www.cdc.gov/nationalhealthyworksite/docs/http://www.cdc.gov/nationalhealthyworksite/docs/
nhwp-general-faq.pdf nhwp-general-faq.pdf
• NewsletterNewsletter• http://www.cdc.gov/nationalhealthyworksite/docs/http://www.cdc.gov/nationalhealthyworksite/docs/
NHWP_June2012Newsletter_508_06.20.12.pdfNHWP_June2012Newsletter_508_06.20.12.pdf
• Wellness committeesWellness committees• http://www.cdc.gov/nccdphp/dnpao/hwi/http://www.cdc.gov/nccdphp/dnpao/hwi/
programdesign/wellness_committees.htm programdesign/wellness_committees.htm
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Food for Thought; Misc.Food for Thought; Misc.
• Alliance with fitness facilitiesAlliance with fitness facilities• Montana Tech OSH and AHSS interns!!Montana Tech OSH and AHSS interns!!• NIOSH webinarsNIOSH webinars
• http://www.cdc.gov/niosh/TWH/webinar.htmlhttp://www.cdc.gov/niosh/TWH/webinar.html
• WHOWHO• http://www.who.int/occupational_health/http://www.who.int/occupational_health/
publications/global_plan/en/ publications/global_plan/en/
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Thank YouThank You
Please share your Please share your questions, expertise, ideas, questions, expertise, ideas,
and comments.and comments.
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