Total Worker Health®
Laura Punnett, Sc.D., Professor & Co-Director and the CPH-NEW Research Team: Univ. of Massachusetts Lowell Univ. of Connecticut Health Univ. of Connecticut Storrs
CPH-NEW is a NIOSH Center for Excellence in Total Worker Health®
New England AIHA (March 31, 2021) www.uml.edu/cph-new NIOSH “WorkLife Initiative” (2005)
Implement and evaluate strategies for integrating two core public health areas: occupational health/safety (OHS) and workplace health promotion (WHP). Originated (partly) in thinking about socio‐ economic disparities in health: Intersection between community issues and occupational health & safety hazards. [Baron et al., AJIM, 2014]
www.uml.edu/cph-new Traditional Workplace Programs: Separate “silos”
Safety and Health Health/Well-being
Reducing hazards Reducing lifestyle and exposures risk factors at work to to prevent prevent injury disease and illness
www.uml.edu/cph-new NIOSH Total Worker Health® (2012)
• “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 holistic understanding of the factors that contribute to worker well‐being.…. risk factors in the workplace can contribute to health problems previously considered unrelated to work.”
[www.cdc.gov/niosh/twh/totalhealth.html] www.uml.edu/cph-new WHO/OMS on Health Promotion [Ottawa Charter, 1986]
• “Social health promotion” = activities at the community or societal level – Environmental conditions that foster healthy behaviors – Positive human relations at work that foster decision‐making and self‐efficacy Remove obstacles to health Foster positive decision‐making
www.uml.edu/cph-new Do employees need a TWH program?
In 2019, nearly 3 million U.S. workers reported nonfatal workplace injuries and illnesses. (Survey of Occupational Injuries and Illnesses (SOII), U.S. BLS) Nearly 50% of Americans have at least one chronic health condition. The labor force participation rate is expected to increase fastest for the oldest (aged 65 to 74) workers through 2024. (Bureau of Census for U.S. BLS) 44% of Americans reported work as “always” or “often” stressful in 2010.
www.uml.edu/cph-new What issues are present in your workplace?
Aging workforce Workers with disabilities Workers with chronic disease Multigenerational workforce Workplace stress Work/family interference Lack of safe, healthy, affordable housing options
www.uml.edu/cph-new Costs of injury and illness
Stress -> burnout, depression, poor sleep, disengagement, alcohol, obesity, lack of exercise
Direct Costs • Medical claims • Lost wages claims Visible costs
Indirect Costs Non-visible • Lost productivity • Hiring/training Costs replacements • Absenteeism • Presenteeism Indirect costs = 2‐3x direct costs
www.uml.edu/cph-new Total Worker Health®: An integrated approach
www.uml.edu/cph-new Work Organization
“…the way in which work processes are designed and arranged, [and] the broader organizational practices that influence job design.”
Who does When? what?
How often? Work How? Organization
[NIOSH, 2002, The Changing Organization of Work and the Safety and Health of Working People] 10 www.uml.edu/cph-new WorkWork Organization Organization
Who does what? Physical • Effort required • Frequency loading • Duration patterns • (Lack of) variation Work Organization Psycho- • Job demands • Decision making How often? social conditions • Social support When? • Job insecurity How?
11 www.uml.edu/cph-new Total Worker Health®: An integrated approach
www.uml.edu/cph-new Implications of TWH for socio- economic health disparities
• Low‐SES work: lower decision latitude, more physically strenuous, more safety and chemical hazards. • Low‐SES neighborhoods: less access to healthy food, safe places to walk / exercise • WHP programs often have uneven scope, i.e., higher participation and effectiveness among higher‐SES employees.
www.uml.edu/cph-new Obesity and working conditions: Unpacking the relationship
• 8 focus groups of lower‐wage workers – Recruited through 2 community NGO’s – Spanish‐speaking (6 groups) – English‐speaking (2 groups) • Topic: how the workplace affects dietary and/or exercise behaviors • 63 participants – 65% female; 83% Latino / 22% African/Afro‐American – Cleaning, restaurants, construction, manufacturing, health care/human services [Nobrega et al., Health Promotion Practice, 2017] www.uml.edu/cph-new Focus Groups of Low-Wage Workers
• Shift work & irregular shifts: – I used to play football with my friends on Sundays, but now my days off are Tues. and Wed. • Meal breaks: – “At 10:00 a.m., they give me a 15‐minute break. I don’t have time to eat healthy food.” – The mandated 30‐minute break is provided, but divided in two. – I don’t know when during the work shift I will be permitted to take my break.
www.uml.edu/cph-new Focus Group Findings: Physical & Psychological Conditions
• Physical workload: – “I don’t have the desire to do exercise after standing for 15‐16 hours.” – “You come home and you are so tired that you either don’t want to eat, or you want to eat a lot.” • Time pressure: – “The work that three people used to do is given to one person. That creates more stress and eating more…” • Low control: – “Working in factories, you have to eat fast or get fired.”
www.uml.edu/cph-new ProCare study of nursing home workers: Risk of inactivity, by number of occupational stressors*
# of respondents inside bars
35 <4> 30
25 14 20 34 26 15 22 10 Prevalence (%) 5
0 012345 Number of work organization hazards
* Stressors: low decision latitude, low co‐worker support, night work, work‐family interference, perceived toleration of discrimination. Multi‐variable models adjusted for gender, education, region and age. [Miranda et al., Sci World J, 2015] www.uml.edu/cph-new Change in waist circumference by job iso-strain group
Job iso‐strain = 1.8 High job demands, 1.6 low job control, & 1.4 Low social support 1.2 Low/low 1.0 0.8 Low/high or 0.6 high/low 0.4 High/high 0.2 0.0 Men Women [Ishizaki et al. 2008]
www.uml.edu/cph-new Work environment factors and smoking
• Review of 22 prospective studies, evaluated on methodologic features • Resources at work (including job control) ‐ cigs/day; + cessation; ‐ relapse • High job demands + cigs/day; + cessation; + relapse • Social support ‐ cigs/day; + cessation; ‐ relapse
[Albertsen et al. 2006]
www.uml.edu/cph-new Job Strain, Health Behaviors, and Coronary Heart Disease
The traditional HP behavioral targets (exercise, diet, smoking, obesity, etc.) are affected by work organization (decision latitude, social support)
Neuroendocrine CHD mechanisms 32% of the Psycho‐social effect is Stressors Health mediated Behaviors through HB’s
[Chandola et al., Eur. Heart J, 2008] The “bright line” between the 2 silos is not clear as we used to think
Work‐ Non‐work‐ related related morbidity morbidity
www.uml.edu/cph-new Low decision‐making opportunity at work is a primary risk factor for chronic disease.
Therefore, a workforce health program should aim to enhance worker decision‐making and empowerment.
www.uml.edu/cph-new Hierarchy of Controls for Total Worker Health
https://www.cdc.gov/niosh/twh/letsgetstarted.html www.uml.edu/cph-new Decision-making opportunities follows from how work is organized
• Increase employee autonomy and decision‐making (“job control,” health self‐efficacy) • Encourage participation and creativity in problem‐ solving • Structure healthier schedules • Enhance interpersonal relationships at work • Promote consistent and constructive feedback, fair recognition, and rewards for good work
www.uml.edu/cph-new Why a participatory approach?
…to change behaviors Employee …to change conditions health …to make decisions self- efficacy …to support co-workers …to sustain the program
…to uncover root causes of Knowledge physical, social, mental stress from …to uncover root causes of employees’ unhealthy behaviors experience …to contextualize solutions
25 www.uml.edu/cph-new Integrate relevant systems to advance worker well-being
NIOSH DEFINING ELEMENT
www.uml.edu/cph-new Consider adding new elements to current programs/activities • Comprehensive respiratory protection program that addresses tobacco use • Ergonomic program that accounts for work scheduling, offers arthritis management strategies • Stress management efforts that first seek to diminish workplace stressors, and then work on building worker resiliency • Customize wellness program activities to different occupational groups
www.uml.edu/cph-new Integrate relevant systems to advance worker well-being
NIOSH DEFINING ELEMENT
www.uml.edu/cph-new Center for the Promotion of Health in the New England Workplace (CPH-NEW)
Study interactions between work & non‐work exposures; contributions of work to “other” health outcomes Identify opportunities for & obstacles to healthy living Evaluate strategies for integrated workplace interventions
Key take‐home points: ‐ Work organization as a (preventable) source of risk factors for chronic disease ‐ Participatory intervention processes ‐ The “salutogenic” organization
www.uml.edu/cph-new CPH-NEW Healthy Workplace Participatory Program (HWPP) Steering Committee (incl. Champion) • Forms DT, provides necessary resources •Invites DT to develop and propose interventions • Selects most feasible/desirable interventions •Helps promote & evaluate interventions
Action & Action & Design Team (DT) feedback feedback • Identifies & prioritizes health/safety issues • Conducts root cause analysis •Develops ideas for workplace interventions, selects best ideas to propose to SC •Helps promote & evaluate interventions
www.uml.edu/cph-new Case Study #1 – Facility Maintenance
Total Worker Health Approach
• Engaged workers
• Gathered data
• Identified root causes Real estate maintenance technicians: at risk for falls, injuries, burns, and stress.
[Nobrega et al., Applied Ergo, 2017; Robertson et al., Int J Hum Factors Ergo, 2015] www.uml.edu/cph-new Case Study #1 – Maintenance Technicians
Priority Safety & Health Total Worker Health Concerns: Solutions: Stress from high workload Consolidate work order • Poor communication management • Competing demands Reduce low value • Delayed decisions workload with customer • Low decision control education Implemented recognition Environmental hazards system • Overheating • Tight, hot spaces
www.uml.edu/cph-new Design Team Case Study #1 Perceived changes in company climate
% said improved % said same Morale % said declined Recognition and rewards
Opportunities to share my opinion
Opportunities to meet and plan
)pportunities for decisionmaking
Communication between staff and management
Communication between co-workers
0% 20% 40% 60% 80% 100% www.uml.edu/cph-new Design Team Case Study #1 Qualitative evaluation Design Team Members: • A useful forum / tool for making improvements • Solution‐driven: Made change happen • Interaction‐driven: Improved communication between technicians and management • Felt engaged and invested in the program Management: • More aware of workers’ concerns • Good solutions: resident education materials • Personal development of DT members: problem‐solving, communication skills, accomplishment • Wish to see the program continue
www.uml.edu/cph-new Case Study #2 – Healthcare
Workers attributed musculoskeletal injuries to: Infrequent use of patient lift devices: not in the habit of using lifts, patient lift devices not easily accessible Fatigue: Poor sleep, lack of breaks, poor physical conditioning.
www.uml.edu/cph-new Case Study #2 – Healthcare
Addressed work organization:
Increase lift equipment and usage
Improve staffing schedules
Introduce break schedules Addressed well-being:
• Sleep hygiene education
• Fitness opportunities
Patient handling injury rates (per 100 FTEs)
4 3.5 3 2.5 2 1.5 1 0.5 0 2013 2014 2015 Year www.uml.edu/cph-new Case Study #3, “HearWell” Protecting and Promoting Hearing Health
Workers attributed hearing loss to: Noise exposures: loud equipment, long shifts, specialization of tasks Knowledge gap: lack knowledge of noise level of tasks and equipment, not certain when to use HPD Hearing protection (HPD): hot, uncomfortable, not sure of proper use (how) or replacement, limited options Safety climate: lack of supervisor and coworker support for wearing HPD, reducing noise exposures
www.uml.edu/cph-new “HearWell” Intervention Components
Noise Safety Change in Hazard Leader- Hearing Scheme ship Culture Training
HearWell Pre-work Training Planning
www.uml.edu/cph-new Getting started with TWH
Engage your leadership • Assess organizational readiness • Start with small changes Get to know other program managers and their priorities • Cross-promote related activities • Plan together to support mutual goals Engage employees • Find out what they see as obstacles to health, safety, and well-being • Get employee feedback on changes before rolling them out • Create opportunities for employees to solve problems
See also: www.cdc.gov/niosh/twh/fundamentals.html
www.uml.edu/cph-new www.uml.edu/cph-new HWPP Interactive Tools
Online survey of “organizational readiness”
Worksheets and Quick reference guides for facilitators
41 www.uml.edu/cph-new Contacts & Acknowledgements
University of Massachusetts Lowell University of Connecticut Email: [email protected] UConn Health, Farmington, CT Tel: 978-934-3268 UConn Storrs, Mansfield, CT
CPH-NEW main website: University of Connecticut www.uml.edu/cph-new CPH-NEW website: Healthy Workplace http://h.uconn.edu/cph-new Participatory Program Website: www.uml.edu/cphnewtoolkit Sign up for our newsletter at “Contact Us”
The Center for the Promotion of Health in the New England Workplace is supported by Grant Number 1 U19 OH008857 from the U.S. National Institute for Occupational Safety and Health. This content is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH.
www.uml.edu/cph-new