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Total Worker Health (TWH) is defined by National Institute for Occupational Safety and Health (NIOSH) 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. It is a holistic approach that integrates frameworks and practices from several disciplines to identify and control exposures to hazards that impact workers’ safety, health, and well-being. These exposures may be overt, such as chemical exposures or physical hazards. Alternatively, they may be more insidious, such as exposure to a stressful work environment. TWH also promotes the creation of a healthy work environment, for example, by considering workplace ergonomics and work design, the impact of health care and other organization benefits on worker health and well-being, and factors contributing to a supportive work environment. The goal of TWH is to provide a safe workplace where all workers can also improve their overall health and well-being.

In 2009, the American College of Occupational and Environmental Medicine (ACOEM) issued a guidance statement stating that occupational and environmental medicine (OEM) physicians are prominent players in the field of workforce health and productivity. While they did not use the term TWH in their statement, they did call for more OEM attention and resources for health promotion services, in addition to health protection services, to ensure that our workforce is able to continue working productively. OEM physicians understand the consequences of injuries and illnesses. They also have the medical knowledge to understand the importance of managing chronic illness. They have seen how work-related injuries and illnesses as well as chronic illness can interact during the injury recovery and return to work process. In contrast to conventional worksite wellness programs, the TWH approach prioritizes safety first, followed by organizational and individual behaviors that contribute to overall health.

To address national priorities for the future of TWH, NIOSH published two national agendas. First, the National TWH Agenda (2016–2026) represented the first TWH-focused national effort to coalesce TWH research, practice, policy, and capacity building goals. Second, NIOSH developed its latest National Occupational Research Agenda (NORA) that includes a new cross-sector program called Healthy Work Design and Well-Being (HWD). HWD seeks to improve the design of work, work environments, and management practices to improve worker safety, health, and well-being. For example, their current goal for the construction industry is to reduce the impact that nonstandard work arrangements have on respiratory diseases, musculoskeletal disorders, fatal and nonfatal injuries from falls, and hearing loss. In the construction industry independent contracting, in particular, is a form of temporary work where employers improperly classify workers as sole proprietors. The implications are that workers do not have access to employer-based benefits, such as health care or workers’ compensation insurance, and employers are less accountable to Occupational Safety and Health Administration (OSHA) rules and regulations intended to protect workers.



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