Launched in 2011, Total Worker Health™ (TWH) is an ambitious initiative by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety holistically by eliminating the on-the-job, off-the-job division that has long existed between the two.

There is considerable – and still emerging -- evidence to support the idea that such a separation does little to enhance the well-being of workers. Safety programs generally focus on reducing exposure to risk factors in the work environment. Workplace wellness programs emphasize lifestyle factors.

Through TWH, NIOSH is striving to merge the two by integrating occupational safety and health protection with workplace policies, programs and practices that promote health and prevent disease in order to advance worker safety, health and well-being.

First things first

If you’d like to introduce the TWH concept into your workplace, NIOSH stresses that it must be based on a foundation of worker safety.

 “First-dollar investments must address hazardous working conditions. Only after these safeguards are in place can organizations move their workforce toward a state of total worker health. Employers who opt for wellness programs in the absence of adequate workplace safety and health protections are not applying the principles of Total Worker Health.”1

Resources to use

A good place for safety professionals to get an overview of TWH is on the “Let’s Get Started!”2 webpage, where you’ll find easy-to-follow steps on how to begin; promising practices; assessment tools and guidelines for integrated approaches; and tips on how to make a business case for TWH.

Another aide that can help you convince management of the value of a TWH approach is a downloadable, print-ready brochure entitled, Opportunities for Employers to Create a Safer and Healthier Workforce.3

Short on time? Looking for a visual way to make a compelling argument for TWH? NIOSH offers an infographic, Top Reasons to Create a New Pathway for a Safer and Healthier Workforce.4

Those are just a few of the resources available on how to use TWH principles to maintain and optimize a safe, healthy and productive workforce both on and off the job. With emerging research providing new information and participating companies and industries sharing their experiences, the guidance that employers can access about TWH will continue to expand.

New and traditional risks

TWH itself is far from static – something which is evident in NIOSH’s Issues Relevant to Total Worker Health, a list that is regularly updated and revised in order to better reflect the changing nature of work and the changing needs of the workforce. Issues gaining prominence in recent years – such as preventing workplace violence and dealing with psychosocial hazards – take their place with traditional hazards like chemical and biological hazards.

The list also names management commitment, a safety culture/climate, hazard recognition training and worker empowerment as vital components of TWH.

TWH strategies are as varied as the industries and people that comprise the workforce, and include: the provision of mandated respiratory protection programs that simultaneously and comprehensively address and provide supports for tobacco cessation; ergonomic consultations that discuss work design, joint health and arthritis prevention and management strategies; onsite, comprehensive workplace screenings for work and non-work related health risks; and models that combine occupational health services with workplace primary care.


1. http://www.cdc.gov/niosh/twh/totalhealth.html

2. http://www.cdc.gov/niosh/twh/letsgetstarted.html

3. http://www.cdc.gov/niosh/docs/2015-108/default.html

4. http://www.cdc.gov/niosh/twh/topreasons/infographic.html