2017 Workshop on Total Worker Health® Exploring new intersections of work and health

Workplace Health and Safety Queensland MSD Symposium Workshop 2017

L. Casey Chosewood, MD, MPH Director, Office for Total Worker Health® National Institute for Occupational Safety and Health

The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health, and should not be construed to represent any agency determination or policy.

3 Source: Dr. Kent Anger, Oregon Health and Science University, 2014.

4

• Leading Cause of Workplace Death • 58% of victims weren’t hired as transportation workers • $25 Billion Price Tag for • Seatbelts, speed, distracted driving, fatigue, long work hours

http://www.cdcfoundation.org/businesspulse/vehicle-safety-infographic Low- Workers

Low wage workers have greater likelihood of: • Effort-Reward Imbalance • Increased risk of stress • Diminished decisional latitude, control, respect • Job insecurity • Forced • Discrimination 7 Shift working men: Less likely to eat vegetables & fruits

Shift working women: More energy intake from saturated fat

Hemiö K, et. al. Food and nutrient intake among workers with different shift systems. Occup Environ Med 2015; 0: 1–8 8 Potential Health Effects of Contingent Work • Uncertainty, interrupted work, reductions in earnings • Lack of many benefits that come from traditional • Negative consequences for the worker and society after injury – Risk for severity of injury and likelihood of disability may be elevated – RTW more challenging – Employer-based is rare in contingent work; costs of treating injuries may be shifted to the worker or the public at large – Employers who not directly pay for workers’ compensation and health insurance may be insulated from premium adjustments based on the cost of workers’ injuries • So, employers of contingent labor escape the financial incentives that drive decisions to eliminate hazards for other workers

• Are contingent workers as protected by government safety and health regulatory enforcement as are non-contingent workers? “Work is central to people's well-being.”

“Decent work sums up the aspirations of people in their working lives.”

--International Labour Organization (ILO)

http://www.ilo.org/global/about-the-ilo/decent-work-agenda/lang--en/index.htm 10 Total Worker Health® Keep Workers Safe

Establish workplace policies, practices and programs that grow health

Create Worker Well-being What is Total Worker Health®

Policies, programs, & practices that integrate protection from work-related safety & health hazards with promotion of injury & illness prevention efforts to advance worker well-being Synergy of Integration Increases Program Participation and Effectiveness

Smoking quit rates: 11.8% Integrated interventions

Single intervention 5.9%

Sorensen G and Barbeau E. Integrating Occupational Health and Safety and Worksite : State of the Science. The NIOSH Total Worker HealthTM Program: Seminal Research Papers 2012. DHHS (NIOSH) 2012-146. 13 TWH Approach for Musculoskeletal Disease

Arthritis self- Reorganizing Ergonomic management work consultations strategies TWH Approach for Sleep and Fatigue Health- Safe Supportive Sleep Staffing Policies Isn’t Behavior Change Enough? “It is unreasonable to expect people to change their behavior when the social, cultural and physical environments around them fully conspire against them….”

Adapted from M. Marmot/Institute of Medicine Report 16 Smoking: Improving the Job

Du J and Leigh JP. Effects of on smoking decisions of current and past smokers. Annals of Epidemiology 2015; 25: 575-582

17 Obesity: Improving the Job

Punnett L and the Center for the Promotion of Health in the New Workplace. Recent trends and research in worker safety and health. February 25, 2014 NIOSH Total Worker Health® Webinar 18 What Total Worker Health Is NOT • TWH is not a “wellness program” that has been implemented without simultaneously providing safe and healthful working conditions • TWH is not an “add-on” collection of health promotion efforts at a workplace where the very way that work is designed contributes to worker injuries and illness. • TWH is not consistent with workplace policies that discriminate against or penalize workers for their health conditions or create disincentives for improving health. • TWH is not a “wellness program” that does not ask employees for their input on their work circumstances

Adapted from Opening Keynote, John Howard, Director of NIOSH, October 2014. Bethesda, MD. November 2015

20 ® Issues Relevant to Advancing Worker Well-being Through Total Worker Health

Control of Hazards and Exposures • Responsible Business Decision-Making Changing Demographics • Meaningful Work and Engagement • Chemicals • Multigenerational and Diverse Workforce • Worker Recognition and Respect • Physical Agents • Aging Workforce and Older Workers • Biological Agents Compensation and Benefits • Vulnerable Worker Populations • Psychosocial Factors • Adequate Wages and Prevention of • Workers with Disabilities • Human Factors • Occupational Health Disparities • Risk Assessment and Risk Management • Equitable Performance Appraisals • Increasing Number of Small Employers • Global and Multinational Workforce Organization of Work and Promotion • Work-Life Programs • Fatigue and Stress Prevention Policy Issues • (Sick, Vacation, Caregiving) • Work Intensification Prevention • Health Information Privacy • Disability Insurance (Short- & Long-Term) • Safe Staffing • Reasonable Accommodations • Workers’ Compensation Benefits • Overtime Management • Return-to-Work • Affordable, Comprehensive Healthcare • Healthier • Equal Employment Opportunity and • Reduction of Risks from Long Work Hours • Family and Medical Leave • Prevention of Cost Shifting between • Flexible Work Arrangements • Elimination of Bullying, Violence, Harassment, and Payers (Workers’ Compensation, • Adequate Meal and Rest Breaks Discrimination Health Insurance) • Prevention of Stressful Job • Planning and Benefits Built Environment Supports Monitoring Practices • Chronic Disease Prevention and • Healthy Air Quality • Worker-Centered Organizational Policies Disease Management • Access to Healthy, Affordable Food Options • Promoting Productive Aging • Access to Confidential, Quality • Safe and Clean Restroom Facilities Healthcare Services • Safe, Clean and Equipped Eating Facilities New Employment Patterns • and Skills Development • Safe Access to the Workplace • Contracting and Subcontracting • Environments Designed to Accommodate Community Supports • Precarious and Contingent Employment Worker Diversity • Multi-Employer Worksites • Healthy Community Design • Organizational Restructuring, Downsizing and Mergers • Safe, Healthy and Affordable Housing Options Leadership • Financial and • Safe and Clean Environm