NIOSH Total Worker Health™: Innovative Approaches for Healthier Employees

USPHS SymposiumJune 20, 2012

Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthTM

National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention

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• 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.

• The mention of organizations and commercial entities and products in this presentation is for illustrative purposes only and does not represent an endorsement by NIOSH, CDC or the US Department of Health and Human Services.

Disclaimers

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OSH Act of 1970

• SEC. (2) (b) . . . to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources . . .

(emphasis added)

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• Explain RATIONALE for integrating health protection and health promotion

• Describe PARTNERSHIPS in building and promoting integrated programs

• List RESOURCES to launch and improve a Total Worker HealthTM Program

Overview

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12,712 new reported cases of nonfatal occupational injuries and illnesses

9,315 workers are treated in emergency departments

258 workers are hospitalized

134 deaths from work-related illness

14 deaths from work-related injuries

Source: MMWR, Vol. 59, No. 15, April 23, 2010

Every Day . . .

Work-Related Illness, Injury and Fatalities in the US are costly….

Employers and insurers spent $85 Billion on workers’ compensation in 2007, which is

Only a portion of the costs borne by employers, workers, and society

Excludes costs paid by other insurance systems and most of work-related illness costs

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Source: CDC Morbidity and Mortality Weekly Report. Volume 59, Number 15. April 23, 2010

Burden of Chronic Health Conditions• Cancer

• 553,000 deaths, 1.3M new cases/yr• $89B in medical costs, $130B in lost work days & productivity

• Diabetes• >23.6M cases, >200,000 deaths/yr• $116B for medical issues,$58B for lost work & productivity

• CVD• 80M cases, >870,000 deaths/yr• $448B a year

• Tobacco-Related • 438,000 deaths• $96B in medical costs, $97B in direct costs

Source: National Center for Chronic Disease Prevention and Control [2008]7

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The Future of Work• Hazards

Persistent Emerging

• Employment Shortage of Workers Global Competition Flexible vs. Precarious

• Workforce Aging Workers Health-Related Issues Obesity Multi-Generational

Traditional Health Protection and Health Promotion

• Health Protection – Programs that focus on reducing hazards and exposures at workplaces to prevent occupational injury and illness

• Health Promotion - interventions aimed at reducing lifestyle risk factors by promoting healthy behaviors and actions

“Traditional Safety and Health Silos Not Optimal for Workplace Health” ACEOM, 2011

A Rationale for Integration• Workers’ risk of disease is increased by exposure to both occupational

hazards and individual risk related behaviors

• Workers at highest risk for exposures to hazardous working conditions are often most likely to engage in risk-related health behaviors and live in higher risk communities

• Worker participation in integrated programs is higher than in single-intervention

• Manufacturing: Greater reduced risks - ergonomic, cardiovascular, job demand and job control risks

• Blue collar: Smoking quit rates in an integrated program more than doubled relative to a non-integrated program

http://www.cdc.gov/niosh/steps/pdfs/NIOSH-post-symprevision.pdf Sorensen & Barbeau (2004)

A Rationale for Integration

• Sharing resources across departments and functions can be cost efficient and result in a lack of duplication in program offering

• Common set of metrics can be used by all programs• Reduced competition for senior management attention and scarce

resources• Improvements in employee health will reduce medical care costs AND

enhance worker safety, productivity, and organizational competitiveness• Successful coordinated programs can save MORE money than they cost

and achieve significant ROI

http://www.cdc.gov/niosh/worklife/steps/default.htmlGoetzel (2005)

Examples of Integrated Approaches• Respiratory protection programs that address tobacco use and smoking

cessation• Ergonomics programs that teach joint health and arthritis management • Stress management classes that seek to diminish workplace stressors,

personal stressors and build resiliency• Integrated training and prevention programs (falls, motor vehicle safety,

first aid, hearing conservation, stretching, flexibility and lifting programs)• Comprehensive screenings for work and non-work risks• Occupational health combined with a workplace primary care home model• Full integration of: clinics, behavioral health, traditional safety, health

promotion programs, coaching, EAP, nutrition, disability and workers compensation.

65% of the adult population can be accessed at workplaces (CDC, 2010)

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What is Total Worker HealthTM?

Total Worker Health™ - A strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to enhance well-being.

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Total Worker Health™

Intramural Program Partnerships Centers of

Excellence

Developing Thriving 3 Maturing1 New

VALUE OF OUR PARTNERSNIOSH Total Worker Health ProgramTM

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• Federal Worksite Wellness Pilots– OPM and OMB Federal Employee Worksite Health

& Wellness Initiative (10,000 federal workers)• 3-5 pilots in the next two years to implement and

evaluate optimal interventions

TWHTM Partnerships

Wellness Is Now: Veterans Health Administration

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NIOSH Centers of Excellence for Total Worker HealthTM

University of Iowa Healthier Workforce Center for Excellence http://www.public-health.uiowa.edu/hwce/

Center for the Promotion of Health in the New England Workplace At the University of Massachusetts

http://www.uml.edu/centers/cph-new/ At the University of Connecticut

http://www.oehc.uchc.edu/healthywork/index.asp Harvard School of Public Health Center for Work, Health, & Well-Being

http://centerforworkhealth.sph.harvard.edu/ Oregon Healthy Workforce Center, Oregon Health & Science University

(selected in late 2011) http://www.ohsu.edu/xd/research/centers-institutes/croet/oregon-he

althy-workforce-center/index.cfm

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CASE STUDIES

EXAMPLES

PROMISING PRACTICES FOR TWHTM

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Case Study: NASA• Example of an Integrated

Program in a Federal Government Agency

• IOM Committee Evaluated the Current Program (2005)

• 15 Recommendations for Program Improvement

• http://www.ohp.nasa.gov

Example of Coordination in Practice: NASA

• Goal: Every employee is healthier than the average worker as a result of work with NASA

• Recommendations:– Shift from disease status to health status, treatment to prevention,

population-based health model, multiple-risk interventions, – Integrated management of health programs – More effective, coordinated, data-driven health program policy

• Johnson Space Center– Executive Safety and Health Committee cross-divisional– VP program stimulated broader thinking about health and

behaviors at home and in community

CDC Examples

• CDC StairWELL Project• CDC’s Tobacco Free Campus

Initiative• Bike Shelter replaces Smoking

Shelter• Go Green! Go Healthy!• Garden Markets

Policies to Support Health

• Tobacco-free campus • Flexible work/schedule policies

– Leave, telework, job share, parental/dependent care• Nutritious foods-at-meetings policy• Healthy transportation policies• Smoke-free meetings policy• Time during work hours for wellness activities

– Training or educational opportunities, health fairs, events– Screenings, health coaching, EAP– Physical Activity

RESOURCES FOR BUILDING A HEALTHIER AND SAFER WORKFORCE

Key Total Worker Health™ Reports

• STEPS to a Healthier Workforce• Essential Elements of Effective Workplace Programs

and Policies• ACOEM Guidance on Workplace Health Protection

and Promotion• The Whole Worker: Guidelines for Integrating

Occupational Health and Safety with Workplace Wellness Programs

• Integrating Employee Health: A Model Program for NASA

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CDC Workplace Tools and Resources

Visit our Website:

http://www.cdc.gov/niosh/TWH/

Upcoming EventsHealthier Federal Workers September 2012 in Washington, DC

• 10th Work Stress and Health Conference May 2013 in Los Angeles

Designing Healthier Workplaces Can You Become a “Choice Architect”?

• Choice-making is never neutral • Directing default options toward health can be

powerful• Subtle “nudges” toward healthier choices can

improve health outcomes • Policy interventions provide a strong basis for

better choices• Incentives and spotlights can motivate• Providing structure around complex choices helps

Themes from Thaler R, Sunstein, C: Nudge Improving Decisions About Health, Wealth, and Happiness, 2008.

Workplace’s Built Environment Allow Health to Thrive

• Safe, hazard-free workplace• Welcoming, user-friendly, ergo-appropriate workspaces• Commitment to employee respect, engagement, and

input• Stairs, walkways, paths, trails that are safe and inviting• Onsite food choices that make eating healthier easy• Transportation and parking options that enhance health• Onsite or nearby health clinic or access to healthcare

providers• Fitness facilities or opportunities for physical activity

Thank You!Heidi L. Hudson cvv2@cdc.gov