Total Worker Health

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Total Worker HealthTWHAn Integrated Approach
to Worker Well-BeingA NIOSH Initiativehttp//www
.cdc.gov/niosh/twh/totalhealth.html

• By
• Sally Bardsley, Ed.D, CIH
• Montana Tech
• Safety, Health, and Industrial Hygiene Dept.
• March 4, 2015

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Info fromNIOSH Total Worker Health
Innovative Approaches for Healthier Employees

• Heidi Hudson, MPH Co-Coordinator for Total
  Worker HealthTM
• National Institute for Occupational Safety and
  Health
• Centers for Disease Control and Prevention
• 2012

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What Well Talk About . . .

• Total Worker Health (TWH)
• TWH Wellness Research
• SH professionals role re TWH
• Resources
• PLEASE share your insights and experience during
  this presentation.

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TOTAL WORKER HEALTH
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NIOSHs TWH Initiativehttp//www.cdc.gov/niosh/tw
h/

• A strategy integrating OSH protection with health
  promotion to
• Prevent worker injury and illness
• Enhance and advance well-being
• How does work (place, practices, etc.) affect
  life beyond work?
• How does life beyond work (recreation, home,
  family) affect work?

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To the Boss, TWH Means . . .

• Ensuring optimum well-being for workers through
  integration of state-of-the-art protection and
  promotion that has the workers best interests as
  its motivating goal.
• Promoting worker well-being in all its aspects,
  including appropriate indemnity and medical care
  for work injuries and illnesses, adequate paid
  sick and family leave, maternity and paternity
  leave, adequate vacation time, living wages,
  comprehensive health care, social pensions, along
  with safe and healthful workplace conditions as
  required by law.
• John Howard, MD, MPH, JD, LLM,
• Director, National Institute for Occupational
  Safety and Health (NIOSH), Centers for Disease
  Control and Prevention (CDC)
• Keynote address at 1st International Symposium to
  Advance Total Worker HealthTM October 6, 2014
  Bethesda, MD
• http//www.cdc.gov/niosh/twh/pdfs/KeynoteDrHoward1
  stInternatSymposiumTWH.pdf

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Traditionally . . .

• Awareness of OSH re the worker has been around
  for decades, but
• These concepts were largely compartmentalized
• Health Protection Programs
• Focused on reducing hazards and exposures at
  workplaces to prevent occupational injury and
  illness
• Health Promotion Programs
• Focused on reducing lifestyle risk factors by
  promoting healthy behaviors and actions

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Is TWH a New Concept?

• OSHAct (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 . . .
• Corporate fitness/wellness in the 80s
• Many companies support employee health and
  wellness
• What does your employer do?
• Traditional Safety and Health Silos
• Not Optimal for Workplace Health
• ACEOM, 2011 http//www.acoem.org/

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Now, Integration is Key

• TWH Equation
• TWH OSH protection Health promotion
• Integrate most aspects of the occupational
  environment and the worker
• Holistically address the challenges of each both
  individually and in combination
• Fit the separate puzzle pieces together into a
  comprehensive picture

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What changes have you seen?

• Between OSHAs inception and now in
• The workforce
• The type of work
• What needs to be changed?

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Issues Relevant to TWH

• Employment
• Workplace
• Workers

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• Lets brainstorm all the facets
• of TWH we can think of re . . .

Worker
Workplace
Employment
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TWH WorkersPromoting Worker Health Well-being

• Optimal Well-Being
• Employee Engagement
• Health Well-Being Assessments
• Healthier Behaviors
• Nutrition
• 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 EmploymentPreserving Human Resources

• New Employment Patterns
• Precarious Employment
• Part-time Employment
• Dual Employers
• Changing Demographics
• Increasing 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 Privacy

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TWH the WorkplaceProtecting Worker Safety
Health

• Control of Hazards Exposures
• Chemicals
• Physical Agents
• Biological Agents
• Psychosocial Factors
• Organization of Work
• Prevention of Injuries,
• Illnesses Fatalities

• Promoting Safe Healthy Work
• Management Commitment
• Safety Culture/Climate
• Culture of Health
• Hazard Recognition Training
• Worker Empowerment
• Risk Assessment Control
• Making the Safety Health Case
• Assessing All Risks
• Controlling All Risks
• Root Cause Analysis
• Leading/Lagging Indicators

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TWH and OSHA Standards

• Are there any that consider a workers general
  health?
• Not just focused on prevention of injury or
  illness
• https//www.osha.gov/pls/oshaweb/owadisp.show_docu
  ment?p_tableSTANDARDSp_id9783
• Are there standards that should do so but dont?
• When we consider TWH and integration, should it
  become regulatory?

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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
• Full integration of clinics, behavioral health,
  traditional safety, health promotion programs,
  coaching, EAP, nutrition, disability and workers
  compensation.

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TWH Advantages

• 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 single-intervention
• 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

• 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

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STATS, RESEARCH
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Every Day . . .

• 12,712 new reported cases of nonfatal
  occupational injuries and illnesses
• 9,315 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

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Costs of Work-Related Incidents and Illnesses

• 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, and
• 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

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Health Stats

• Cancer
• 553,000 deaths, 1.3M new cases/yr
• 89B in medical costs, 130B in lost work days
  productivity
• Diabetes
• gt23.6M cases, gt200,000 deaths/yr
• 116B for medical issues,58B for lost work
  productivity
• CVD
• 80M cases, gt870,000 deaths/yr
• 448B a year
• Tobacco-Related
• 438,000 deaths
• 96B in medical costs, 97B in direct costs
• How do you see these Chronic Health Conditions
  affect your workplace?
• Source National Center for Chronic Disease
  Prevention and Control 2008

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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
SavingsBaicker, 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 Cut Healthcare Costs
- Surveyhttp//usatoday30.usatoday.com/money/stor
y/2012-01-28/cnbc-at-work-wellness/52824820/1

• Of 1,121 wellness program participants surveyed,
• Over half said they are more productive as a
  result
• 40 said wellness programs encourage them to stay
  with their company,
• More than a third said they have missed fewer
  days of work.
• BUT while many/most employers offer online
  wellness information, and educational resources
• Employees want more hands-on, tangible rewards,
  like access to nutritionists and onsite fitness
  facilities

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TWH Research Compendium

• Research papers
• http//www.cdc.gov/niosh/docs/2012-146/pdfs/2012-1
  46.pdf

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The Safety Health Professionals Role Re TWH
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OSH Professionals Role re TWH

• What is the scope/boundary of our influence and
  appropriate intervention?
• Does TWH belong under the umbrella of
  occupational safety and health?
• Would/does your employer encourage and promote
  TWH--workplace WELLNESS as well as occupational
  safety and health?
• Would TWH change the educational
  requirementswould multiple professionals be
  required?
• Do you see any downside to TWH?

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Should We Have a Role Re Employee Health beyond
the Workplace?

• Is it part of our professional duty to address
  the health and fitness of employees?
• Or is this beyond the scope of our jobs?
• We know poor health and fitness affect various
  work aspects and can affect the safety and health
  of others
• The body and mind work together in a synergistic
  fashion.
• NIOSH and other agencies see this
• TWH
• Occupational Health Psychology
• Even Congress recognizes its importance
• Do you think mandates will/should follow?

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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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RESOURCES
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TWH Centers of 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
• At the University of Massachusetts
  http//www.uml.edu/centers/cph-new/
• At the University of Connecticuthttp//www.oehc.u
  chc.edu/healthywork/index.asp
• Harvard School of Public Health Center for Work,
  Health, Well-Being
• http//centerforworkhealth.sph.harvard.edu/
• Oregon Healthy Workforce Center, Oregon Health
  Science University
• 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
• Partnerships
• http//www.cdc.gov/niosh/twh/partner.html
• Newsletter
• http//www.cdc.gov/niosh/TWH/newsletter/

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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

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CDC National Healthy Worksite Program

• FAQ
• http//www.cdc.gov/nationalhealthyworksite/docs/nh
  wp-general-faq.pdf
• Newsletter
• http//www.cdc.gov/nationalhealthyworksite/docs/NH
  WP_June2012Newsletter_508_06.20.12.pdf
• Wellness committees
• http//www.cdc.gov/nccdphp/dnpao/hwi/programdesign
  /wellness_committees.htm

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Food for Thought Misc.

• Alliance with fitness facilities
• Montana Tech OSH and AHSS interns!!
• NIOSH webinars
• http//www.cdc.gov/niosh/TWH/webinar.html
• WHO
• http//www.who.int/occupational_health/publication
  s/global_plan/en/

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Thank You

• Please share your questions, expertise, ideas,
  and comments.