Why Total Worker Health?

In 2011, NIOSH launched the Total Worker Health® program to support research toward improving and sustaining worker safety, health and well-being. To work toward this goal, NIOSH funded Centers of Excellence to advance Total Worker Health knowledge by supporting the development of evidence-based interventions and best practices, and outreach of regional organizations, stakeholders, partners, and the occupational safety and wellness community to help inform and disseminate the Total Worker Health interventions. Learn more about Total Worker Health and the NIOSH Centers of Excellence.

Why Total Worker Health in the Workplace? A restaurant employee posing for a photo.

Why is Total Worker Health Research Important?   

We spend 1/3 of our life at work, and the work setting and activities strongly affects our safety, health and well-being in many ways.  Research demonstrates that safe and healthy workplaces can protect personal health and reduce health care costs substantially.                                                                                           

  • The economic burden of occupational disease, injury, and death in the US is $250 billion in direct and indirect costs, or 1.8% of the United States' GDPa
  • Health impacts safety
  • Integrated Total Worker Health (TWH) programs improve workplace safety, health risk factors and health conditions, including:
  • Return on Investment (ROI) of $2.05b -$4.61c per dollar invested
  • Reduced Workers Compensation claims and costsc
  • Reduced unsafe practices (over-speeding/hard braking) in truck driversd
  • Reduced weight by 7.8 lbs in overweight drivers; changes were sustainedd
  • Reduced smoking in 11.8% of work groups (more than controls)e
  • Increased exercise in 18% of workers (more than controls)f
  • Reduced worker blood pressure by a clinically significant 6-12.79 mm|Hgb;g;h
  • Total Worker Health is founded on improving workplace safety with the added focus of reducing the burden of occupational injury, workplace stress and chronic illness, and improving the well-being of workers.
  • TWH Intervention programs improve/reduce multiple safety and health problems at the same time. Many have produced sustained changes.

The evidence base is small; additional research is needed to evaluate new programs and disseminate proven programs such as those listed above. To find out more, visit NIOSH's Total Worker Health priorities & accomplishments


aLeigh, P. (2011). Economic burden of occupational injury and illness in the United States. The Milbank Quarterly, 89 (4),728-772.

bBertera EL. The effects of workplace health promotion on absenteeism and employment costs in a large industrial population. American Journal of Public Health September 1990: Vol. 80, No. 9, pp. 1101-1105. doi: 10.2105/AJPH.80.9.1101

cKuehl, K., Elliot, D., Goldberg, L., Moe, E., Perrier, E., &Smith, J. (2013). Economic benefit of the PHLAME wellness programme on firefighter injury. Occupational Medicine, 63, 203-209.

dOlson, R., Anger, K., Elliot, D., Wipfli, B., &Gray, M. (2009). A new health promotion model for lone workers: Results of the Safety &Health Involvement for Truckers (SHIFT) pilot study. Journal of Occupational &Environmental Medicine, 51 (11), 1233-1246.

e Sorensen, G., Stoddard, A., LaMontagne, A.D., Emmons, K., Hunt, M.K., Youngstrom, R. …Christiani, D.C. (2002). A comprehensive worksite cancer prevention intervention: Behavior change results from a randomized controlled trial (United States). Cancer Causes &Control, 13, 493-493-502.

f Sorensen, G., Barbeau, E., Stoddard, A. M., Hunt, M. K., Kaphingst, K., &Wallace, L. (2005). Promoting behavior change among working-class, multiethnic workers: Results of the healthy directions—Small business study. American Journal of Public Health, 95, 1389–1395. http://dx.doi.org/10.2105/AJPH.2004.

g Peters, K. K., &Carlson, J. G. (1999). Worksite stress management with high-risk maintenance workers: A controlled study. International Journal of Stress Management, 6, 21–44. http://dx.doi.org/10.1023/A:1021958219737

h Dalton, B. A., &Harris, J. S. (1991). A comprehensive approach to corporate health management. Journal of Occupational Medicine, 33, 338–347.