In a recent article in Public Health Reports, the U.S. Surgeon General, Vice Admiral (VADM) Jerome Adams, MD, MPH, recognizes the important relationship between employment and health. The article, “The Value of Worker Well-being,” also highlights the efforts of the National Institute for Occupational Safety and Health (NIOSH), the NIOSH Office of Total Worker Health®, the NIOSH-funded Total Worker Health (TWH) Centers of Excellence, and NIOSH TWH affiliates.

The U.S. Surgeon General recommends that employers and companies ensure that worker well-being programs are implemented more broadly and meet the needs of workers, which will lead to better health and business outcomes. To accomplish these goals, NIOSH recommends a TWH approach, which is defined 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. A TWH approach recognizes that work is a social determinant of health and is consistent with recommendations of the American College of Occupational and Environmental Medicine and the American Industrial Hygiene Association.

As the Surgeon General has noted in previous publications, jobs can improve individual and community healthand better community health is linked to economic prosperity. Workers who report being in good physical, mental, and emotional health are more likely to deliver optimal performance in the workplace, as well as to have better health outcomes and lower risk of? injury. The design of job tasks and activities (work design); workplace management practices; and the physical, mental, and social aspects of a job environment ­are all ways in which work can significantly affect a person’s safety, health, and well-being [i]. Workplace conditions can influence workers’ mental health and stress levels. Studies have found differences in health indicators, such as cardiovascular conditions and prevalence of obesity, among occupational groups [ii]. For example, rotating or shift work, along with long work hours, can disrupt sleep and the circadian rhythm, which is our internal biological clock that regulates sleep. Research shows inadequate sleep has a negative effect on one’s mood and thinking and is associated with varied safety and health issues including motor vehicle accidents, obesity, cardiovascular disease, cancer, and musculoskeletal disorders [iii]. Additionally, a recent study estimated that, between 2002 and 2011, more than 120,000 fatalities per year were associated with certain work-related stressors [iv]. These include unemployment, job insecurity (which can include non-standard or irregular and unstable work arrangements), shift work, high job demands, work-family conflict, and limited social support on the job. Job stress and job insecurity are particular concerns as the nature of work is changing through increases in nonstandard work employments and automation.

Examples of successful TWH approaches

In his article, the U.S. Surgeon General highlights successful research and practice related to worker well-being from the NIOSH Office of TWH and the Centers of Excellence. These included NIOSH partnering with the National Institutes of Health to identify TWH research needs through the 2015 workshop, Pathways to Prevention Workshop: Total Worker Health—What’s Work Got To Do With It?. The article also recognized the Health Improvement Through Training & Employee Control (HITEC) Program, developed by the Connecticut Department of Corrections and the Center for the Promotion of Health in the New England Workplace (CPH-NEW), a NIOSH TWH Center of Excellence. This program provides peer health mentor­ing to new correctional officers to support healthier behavior and improved well-being. HITEC includes health-related interventions designed by workers. CPH-NEW researchers found this type of participatory approach resulted in higher employee participation than programs developed by organizational leaders. According to CPH-NEW, HITEC also led to correctional officers having improved physical and mental health, associated with decreased hypertension, increased muscle mass, and decreased job burnout.

Next steps for advancing worker well-being

While the U.S. Surgeon General recognizes the above-mentioned initiatives, as well as efforts by NIOSH partners including the National Academy of Medicine and the National Business Group on Health, the article states that more research is needed on workplace well-being interventions across a variety of settings detailing the positive impacts on multiple health, human capital, and financial outcomes. NIOSH has developed a conceptual framework for worker well-being, funds six Centers of Excellence, and supports an Affiliate network to build the scientific evidence base and identify promising practices related to a TWH approach. Through collaborations among public health leaders, employers, and other stakeholders, the U.S. Surgeon General believes we can help workers achieve their highest potential.

What examples have you seen of successful public-private partnerships to promote worker well-being? Click here to visit the blog post on the NIOSH website and leave comments in the comments section below the post.


[i] Van den Broeck A, Parker SK [2017]. Job and work design. In: Knight BG, eds. Oxford research encyclopedia of psychology. Oxford: Oxford University Press.

[ii] Adams JM [2019]. The value of worker well-being. Public Health Reports134(6):583–586,

[iii] Luyster FS, Strollo Jr. PJ, Zee PC, Walsh JK [2012]. Sleep: A health imperative. Sleep 35(6):727-734.

[iv] Goh J, Pfeffer J, Zenios SA [2015]. The relationship between workplace stressors and mortality and health costs in the United States. Manag Sci 62(2)