Why Total Worker Health?

In 2011, NIOSH launched the Total Worker Health®program to help support research geared toward improving and sustaining worker well-being through a central focus on the workplace.

Toward this goal, NIOSH funded research Centers of Excellence, tasked with advancing Total Worker Health knowledge, identifying evidence-based interventions and best practices, and reaching out to regional organizations, stakeholders, partners, and the occupational safety and wellness community to both, inform and disseminate the Total Worker Health interventions.

The four Centers, each located in a different region of the United States, would serve to understand and address the working population needs of the entire country.

Learn more about Total Worker Health and the NIOSH Centers of Excellence.

Why is Total Worker Health Research Important?                               

See NIOSH's TWH priorities & accomplishments

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. This is the role of the NIOSH-funded TWH Centers of Excellence.


    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.