What is Total Worker Health®?

Injuries, Illnesses, and Fatalities at Work

After the Occupational Safety and Health (OSH) Act was passed in 1970 and the Occupational Safety and Health Administration (OSHA) was created, the number of worker injuries and fatalities dropped considerably (see Figure 1 to the right). OSHA mandated standards of protection to protect workers against common work-related illnesses and injuries, like silicosis, bloodborne infectious diseases, occupationally acquired asthma, and others. OSH professionals worked to protect worker health with activities like monitoring the air for dust that could affect the respiratory system, checking noise levels to ensure that hearing damage would not take place, and testing surfaces to determine levels of potential contaminants (among others represented in Figure 2 below). 

a figure that depicts the classical concerns of occupational safety and health, like respiratory protection and physical hazards
Figure 2. A visual representation of "classical" OSH concerns that were the focus of research and practice after the OSH Act of 1970
a figure depicting the drop in worker fatalities since the passage of the 1970 OSH Act
Figure 1. Annual number of worker fatalities since passage of the Occupational Safety and Health Act of 1970

But following that first immediate drop in fatalities, something curious happened. Rather than continuing to go down, the numbers stayed stagnant. Work was safer and healthier, but something was missing. 

Around the same time, new definitions of health like one from the World Health Organization stated that it was no longer enough to consider health the absence of disease or infirmity, but instead “a state of complete physical, mental, and social well-being.” The National Institute for Occupational Safety and Health (NIOSH), which is the research institute created by the OSH Act, funded and conducted research and scholarship dedicated to exploring the role that work could play in supporting this new definition of health.

The Arrival of Total Worker Health

In response to these new understandings and rapidly changing work, in 2011 NIOSH announced a new initiative: Total Worker Health (TWH). A TWH approach did not change the focus of classical occupational health—instead, it defined itself as the "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." Or, in other words, a TWH approach allows us to: 

Expand the relevant outcomes we hope for with workers. It’s not enough to have workers who survive their jobs but go home exhausted—the goal of a TWH approach is to have work that supports well-being and allows everyone to thrive. 

Expand the strategies we use to pursue those outcomes. TWH invites researchers across disciplines to collaborate on new research questions. It also encourages professionals who might otherwise work separately (say, Human Resources and OSH) to work together to support worker well-being. 

Expand targets for change. With a TWH approach, things like compensation, benefits, manageable workloads, rest time, and work-life fit become critical to achieving worker well-being. In the past, an individual worker's behavior (e.g. eating healthily, exercising) seemed the best way to improve their health. While that remains a large part of worker well-being, we now also recognize that the economic needs and social connections of workers, as well as the environment that surrounds them, are also key targets for change (see Figure 3 for a visual representation).

a visual representation of the TWH approach
Figure 3. A visual representation of how the TWH approach expands and builds upon classical OSH