In a newly published paper in the Journal of Occupational and Environmental Medicine, Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field, our group of experts in the field of Total Worker Health (TWH) have proposed the first set of core competencies for training professionals entering this discipline. Speaking as director of a NIOSH Education and Research Center (Mountain and Plains ERC) and director of one of NIOSH’s six TWH Centers of Excellence, the work has already begun—we are actively integrating TWH into occupational safety and health (OSH) curricula.

Several major universities, including my own, have already implemented graduate level TWH Certificate programs, graduate degree tracks, and professional development opportunities, heightening the need for standardized competencies for trainees.

As a collective representing eight academic, governmental, and private organizations, our goal is to open a broad community dialogue about the training and education needed for this emerging field. This article touches on the major themes and, I hope, piques your interest in commenting on this direction.

The COVID-19 pandemic profoundly illustrates how many of the factors that influence worker safety, health, and well-being transcend traditional OSH paradigms. It illustrates the need for us, as OSH professionals, to be better trained in a transdisciplinary approach to not only continue to address the safety of workers, but to also understand and integrate “capital H” health, and well-being.

Consider, for example, that the solutions to workplace safety during the pandemic require not only attention to the traditional hierarchy of controls, but must take into account issues related to health and sick leave benefits, flexible work hours, impacts on worker stress and behavioral health, work/family conflicts, and other considerations that extend beyond traditional OSH purview.

TWH is a transdisciplinary field with relevance to the changing nature of work and to changes in the workforce itself. It is an approach defined by 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.” As such, TWH professionals will need a broad skill set to meet the needs of employers and employees as we face global pandemics, climate change, changes in demographics, emerging technologies, changing work arrangements and profound alterations to our work and home environments. 

The TWH approach recognizes that both work-related factors, and factors beyond the workplace, contribute to the many safety and health challenges facing workers and employers. TWH offers a timely approach to address the great changes and disruptions in how and where work is done and the occupational and public health hazards we face.

In this paper, we have distilled the results of more than six years of symposia, conferences, and workshops to propose six broad domains of TWH competency: Subject Matter Expertise; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination.

1. Subject Matter Expertise

As TWH is an applied field, subject matter experts should gain knowledge and experience in evidence-based workplace OSH programs, practices and policies which are the bedrock for TWH practice. Proficiency in public health, health promotion, as well as business strategies and management principles, are also essential.

2. Advocacy and Engagement

TWH professionals should be able to advocate on behalf of workers with diverse concerns, needs, perspectives, and life-stages to affect policy and implement integrated TWH programs and policies. Essential to this competency is that TWH professionals, in attempt to advocate, learn how to engage employees and management in TWH solutions. This engagement should be proactive, motivating employers to anticipate and mitigate potential ethical conflicts and concerns before they actually occur.

3. Program Planning, Implementation and Evaluation

There is a particular need for TWH professionals to be proficient in designing, implementing and evaluating programs and policies that build on existing scientific information and best practices, again with a cross-over from OSH programs to be inclusive of programs and policies that influence health and well-being. A TWH professional must be able to develop strategies, and design, implement, and evaluate systems-level programs for TWH improvement and be familiar with the comprehensive planning models that exist.

4. Communications and Dissemination

Another core competency is the ability to communicate TWH principles, theories, research findings, and practical applications to diverse stakeholder groups including workers, employers, labor, government, policymakers, and community organizations. The TWH professional must be able to effectively engage individuals at all levels of health and safety literacy in order to influence organizational policies and practices as well as individual health and safety behaviors.

5. Leadership and Management

TWH professionals should possess leadership and management skills in order to provide direction and vision for organizations, business leaders, workers, and their communities. This involves understanding the importance of social systems at work and the role leaders and managers play in organizational development and organizational culture.

6. Partnership Building and Coordination

To achieve success in implementing TWH policies and practices in the workplace, the TWH professional must be able to bring together the right mix of people and resources and to coordinate the efforts of multiple partners. Due to the transdisciplinary nature of TWH, it is critically important that they bring partners together from across disciplines.

This integrated, inclusive approach to preventing on-the-job illnesses and injuries, while simultaneously promoting worker overall health and well-being, is of increasing importance. To meet emerging needs of the workforce, TWH professionals must have knowledge, skills, and experiences covering an array of subjects that consider the safety and health of the worker, including working conditions, work environment, and the nature of work itself.

We would like your input

Like the TWH approach itself, we consider the ideas shared in this paper to be a work in progress and a launching point for further discussion and action by the broader community. We welcome your feedback on this paper, on the proposed competencies, and on the approach to forging a set of competencies for TWH.

Training Opportunities

I encourage you to explore TWH training opportunities. Several universities, including the Colorado School of Public Health at University of Colorado, Western Kentucky University, University of Texas, and the Gillings School of Public Health at University of North Carolina, have launched TWH undergraduate and graduate certificate and advanced degree programs that are attracting OSH professionals and those new to the field. On our website, you can hear the stories of some of our first TWH Certificate program graduates, including individuals working in industrial hygiene, occupational safety and ergonomics, occupational medicine, nursing, architecture, and other fields. Major professional societies have been leading the way in bringing TWH into the mainstream of OSH through conference symposia, tracks, interest groups, and continuing education. We encourage you to explore any and all of these avenues.