Not sure what Total Worker Health is?
Well, the interview below may be just what you’re looking for. Because we went directly to the source–Dr. Casey Chosewood, the Director of the Office of Total Worker Health, which is part of NIOSH and the Centers for Disease Control and Prevention.
Dr. Chosewood gave us a great introduction to Total Worker Health and we’d like to thank him and invite him to come back again to tell us more.
Go ahead and watch/listen to the video below. We’re also going to create a transcript of this discussion and put that below the video, but to honest, we’ve been quite busy lately at the Convergence Training blog and our delivery of extra video transcription elves is late in arriving, so if you bear with us, we’ll get around to the transcription soonish.
Thanks again to Dr. Chosewood and we hope you enjoy this introduction to Total Worker Health.
Below is the transcript of our interview.
Hi everybody and welcome. This is Jeff Dalto of Convergence Training and Vector Solutions, back with another one of our pod-audio-webcast series. Today we’re in the world of Occupational Safety and Health, and in particular, Total Worker Health, and we’ve got an exciting guest. We’re happy to have Dr. Casey Chosewood. Dr. Chosewood is the Director for the Office for Total Worker Health with NIOSH. As many of you may know, that’s part of the Centers for Disease Control and Prevention.
Dr. Chosewood what how’re you doing today? Thanks for coming on.
Hi, Jeff. Thanks a lot for having me today. It’s good to be with you.
Yeah, I’m excited. Before we jump in and start learning more about Total Worker Health, I wonder if you can just tell people a little bit about yourself, who you are and, what your role is in Total Worker Health and what your interest is?
Sure. Well, I’ve been at CDC almost for two decades now, much of that time as a practicing physician, as the Director of Health and Safety for our own workforce here at CDC. I was the Director of Health and Safety for a few years and the Medical Director of our CDC clinics.
But for the last eight or nine years, I have led an office within NIOSH, the National Institute for Occupational Safety and Health, to think more broadly about the health and well-being of workers. So Total Worker Health really is sort of applying some of my clinical medicine with some additional public health background to really find those, you know, the sweet spot, if you will, of how you can make work not only a living but really enjoyable and engaging, and how work can be well designed to produce health at the end of the day. Not just a risky place where you can get ill or injured. So it’s really an exciting part of this space.
All right, cool. And so, with that, let’s dive in and start learning about Total Worker Health. I’ve got to say, it’s a topic that you see come up more and more. I go to conferences and there’s a lot of interest in it and you see people writing about it.
I wonder if you could start off by telling us, you know, what is Total Worker Health? How does it intertwine with workplace safety programs and culture? And any thoughts along those lines you might have?
Yeah. Great question, Jeff, and you’re right. We are seeing more and more uptake in this sort of holistic, comprehensive approach to taking care of workers on the job.
I think one of the important aspects of this work is that with Total Worker Health, we see workers sort of in the context of their life in full, you know, workers are not a home self and a work self, they are really oneself and it and we don’t disintegrate our lives into away from work and at work. And perhaps that’s even more true today with smart devices that keep us tethered, you know, to work responsibilities around the clock oftentimes.
So I think it’s important for us to view Total Worker Health is really a comprehensive, holistic approach to not only keeping workers safe, because that’s sort of the bedrock, and that’s how it really ties in strongly with the traditional role of safety and health professionals around the world. But that’s sort of the floor, if you will, the required, you know, mandated sort of drive that safety and health professionals have to keep workers safe. We feel that’s an important baseline, but it’s not really enough.
And there are opportunities to use the workplace and use the relationship between employer and worker to go much further to introduce policies, practices, programs that really can grow health, not just keeping people at the same level of health that they come in with each day.
So really, there’s three components to the formal definition of Total Worker Health.
First, keep workers safe. Second, build upon that safe workplace to add in policies, programs, and practices, the three P’s of Total Worker Health that really grow and expand health and opportunities for workers. And the outcome that we’re interested in, yes, we’re interested in fewer injuries and illness. Yes, we’re interested in healthier workers that have a much more enriched, fulfilling longer working life if they choose, a life that allows them to enjoy time with family and friends and do the things they want to accomplish in life in addition to their work. So we’ve come up with this sort of health outcome this summative, really dreamy, if you will, goal to have workers grow their overall well-being as a result of a well-designed job, one that’s safe, one that’s has adequate wages, one that’s fulfilling, so that they go home at the end of the day, not just with the same level of health that they came with, but an increased level of health.
And you know, that’s obviously good for the worker is good for their family. It’s good for their income, it allows them to work longer with less chance of disability. But the secret also is that they wake up the next day with that higher level of health and they bring it back to work. The enterprise benefits the organization has a more productive, more engaged worker, they have fewer injuries and illnesses. So that benefits the bottom line of the organization. So really, we’re after the win/win for workers and organizations as well.
Great. Those are two good points.
I wonder if you mind before we move on to the next kind of previously prepared question. You sparked a couple ideas of my own if I might be able to run a couple ideas past you.
So you’re talking about Total Worker Health as being more than just reducing incidents, for example. And I wonder if you’re curious in safety, in particular, some fields called, “new safety,’ or “safety 2,” and “safety differently,” how people are starting to look at not just the importance of not focusing on lagging indicators or incidents, but creating success, and it seems like Total Worker Health would be part of that new definition of safety and health. Does that seem right?
Yeah, absolutely. I mean, we really are trying to be ahead of the curve so that you really are designing jobs from the beginning to produce fewer injuries and illnesses to have fewer hazards associated with the work, to better understand that, you know, the workforce is increasingly diverse.
So one approach is sort of prescriptive, you know, a cookbook approach to safety is not going to work. Really putting the worker at the center of decision making is critical, especially to the new way we work.
We also have, you know, with the increasing turnover, people are not on one job for decades and decades anymore. So it can’t really follow the trajectory of their health at one institution, one organization, one workplace. It really is incumbent upon us to keep the focus on that worker on a personal level. Take their health with them where they go, so our safety programs have to be much more agile, much more flexible, much more willing to work with a variety of incoming, if you will, workers with a huge amount of variety to their background skill sets and health challenges oftentimes.
Great, great. My second thought was, another big thing in safety recently is an emphasis on systems thinking and systemic safety. And, your point made a lot of sense in that context to me as well. Like, why should we focus just on the health and safety of a worker at work? And the fact that this is larger system that the employee is working in as well, at home and life in general?
Side note: read more about systems thinking at work here.
Right, couldn’t agree more.
You know, you don’t turn off those exposures at home, they don’t stay at home, you bring them with you at work. And that might be you know, something like a stressful commute that makes its way into an argument with an coworker and vice versa. If you have a really bad experience at work you may, go off on the first person you see kick the dog as you’d come in the door, that sort of thing.
So that sharing of exposures back and forth is a critical underpinning of why we thought that concept of Total Worker Health was so important. We don’t leave those hazards at home. We don’t leave them at work. There is tremendous spillover between those two. And that really argues for a more holistic, comprehensive approach to looking at the health and safety of workers.
I also think your point about systems approaches is an important one. We tend to talk about total worker interventions at the systemic level as opposed to the individual level. Traditional workplace health programs generally focused on behavior change, so help people exercise more, help them stop smoking, help them eat more nutritious meals. We really think that it’s very difficult to change health outcomes just by focusing on end items around personal behavior change.
We would much rather take a system approach, a policy-level approach, a work-design approach, to effect the change that we’re after. It’s almost impossible to overcome 8, 10, 12 hours a day of poor working conditions with a lunch and learn on diabetes—it’s just not possible. That’s not the way you’re going to get better health outcomes. You really have to think about what is the pervasive exposure? The big exposure is the work itself, that has to be optimized so that you have the benefit of that, prolonged amount of time that people spend on the job.
Good, good answer. That turned out to be a deep vein. Thanks for digging into deeper after I just scratched on it.
So, with that intro in place, maybe you could tell everybody, including myself, what exactly does Total Worker Health look like in practice?
Yeah, it’s quite an interesting question. And, you know, one of the things I’ll do is sort of give a plug to our website where you can see more than a dozen sort of promising practice videos. That’s where we have really showcase some of the best examples that we’re aware of, where people have integrated this health protection and really efforts to prevent, you know, non-work related health conditions as well.
So good examples, both in the federal space, some of our partners like NASA, the National Park Service have Total Worker Health programs in place. Some of our academic partners, we have six academic centers that are doing research that have developed a number of great toolkits for employers to get started. They also have their own research underway where they’re looking at specific interventions in real workplaces.
And that’s where our learning comes from, of what’s working and what isn’t. We’re only going to really put out evidence-based findings. If something, you know, is tried and it doesn’t work. We’re not going to recommend it. And that’s one of the criticisms we have with some of the health promotion programs out there is there’s not really a well-respected evidence base behind some of those interventions.
We’ve also got some good Fortune 500 examples. Dow, Johnson and Johnson, Alcoa. Those are some companies, Disney, they have all worked with us on their Total Worker Health interventions in their space. And some of those are described in the promising practices section as well.
And then the other big sort of quick uptake area is in health care. Dartmouth Hitchcock is one of our I would say one of the best examples of really a very comprehensive Total Worker Health program, where they have really identified those hotspots in their organization, both from a physical hazard and bloodborne pathogen hazard or psychosocial hazard in the workplace. And they develop these total worker health teams that go in, find the root of the problem, have employee and worker participation, and then come up with really well-crafted solutions, whether it’s a home challenge or a word challenge.
So, definitely check out the promising practices section of our web home for more details.
Cool, and for people listening to this video, know that there’s also a transcription, you’re probably watching this video inside of an article. We are going to include all those links for people so they can check those programs out.
Right. Thanks for that.
It’s really easy just to Google :Total Worker Health“. You know, we come up with hundreds and hundreds of hits. We are one of the registered trademarks in the federal government. We have a trademark we were able to get through the US Patent and Trade Office. Not to restrict people’s use of it, because we want this far and wide. But really to keep the concept true to its original intent. And that is prioritizing worker safety, growing, and building upon that, to really improve the overall well-being of workers.
Yeah, that’s interesting. I saw that trademark in an email from one of your co-workers and it caught my attention. It’s great that you’re not doing it to restrict but also one benefit of doing it is that somebody else can’t get it and restrict it. So that that’s cool.
I think many people have tried to, but to copy is a sort of a form of flattery and we think we’re really onto something here.
All right, so let’s talk about risk factors.
Can you tell us what we’re talking about when we’re talking about risk factors, and you can explain why it’s important to consider risk factors that people might not consider to be work-related?
Yeah. Perhaps one of the best examples is the current opioid overdose crisis that the nation is facing. You guys may know that they announced it’s more common if you’re an American to die of opioid overdose drug overdose than a motor vehicle accident, man that’s dramatic. We’ve had more deaths in the last half generation or so from opioid overdose than all of the deaths from HIV infection over a period twice as long. So, this is a significant public health issue.
Most people wouldn’t automatically assume that there’s any relationship to work. Our research shows, that’s absolutely not the case. There is a strong connection between the job people have and the working conditions they face. The absence or presence of certain workplace benefits like paid sick leave. The premise of certain jobs to cause increased risk for injury that might lead to first use of opioids.
We know that the sort of introductory drug or the sort of the initial exposure to opioids is not sort of through like a gateway of marijuana or even cocaine, or methamphetamine. Usually, the first gateway drug to opioid use is a prescription. So, there are certainly some jobs like construction, like oil and gas exploration, certain types of transportation and food service, certain healthcare jobs, where you are more prone to unfortunately die of opioid overdose because of the working conditions themselves. Because of the previous disposition of that work to work-related injury, an introduction to pain medicine because of that.
There are also some jobs I mentioned, those without paid sick leave, where people have to go to work if they want to get paid and they have no benefits otherwise. So, they may take pain medication in order to be able to report to work. And, you know, it doesn’t take a genius, to know when you mix painful work, use of opioids and safety-sensitive work like construction, for example, that’s a really difficult mix.
We also know that economic issues, lack of a job, lots of plant closings and and rust belt challenges where some industries are really, hard hit in previous economic downturns. Those were the areas where the opioid epidemic began first. Where we saw high rates of overdose high, you know, unfortunate levels of opioid use disorder directly tied to employment issues and economic issues.
So, there is a strong connection between that health outcome and work. It is just an example of how things that you might not think have any connection to work. Really, really do. So, we try to examine all public health challenges through the lens of occupation through the lens of injury. And then how can you impact that? How can you come up with recommendations for employers? Recommendations for supervisors and managers to really optimize work, optimize employment arrangements and condition work so that people can experience better health.
All right, good. Good, general point and great example with construction for people listening in. We’ve done an earlier webinar with a guy named Cal Beyer about drug addiction and suicide in construction and the suicide epidemic in that industry, and we will link you to that as well.
So, Dr. Chosewood, while attitudes are changing, some still believe that many health and wellness issues, things like stress and mental health, are just personal issues that people need to deal with outside the workplace. I’m assuming you disagree with that. And I wonder what do you think we can do to go about changing that mindset at work?
Yeah, you know, unfortunately, it is. It is a reality that those are things that people are having to deal with, it’s tough for employers to turn a blind eye to that or for supervisors say, oh, well, that’s not our issue. Unfortunately, it is our issue, it is an employment issue. It is a work-related issue.
Sometimes the mental health and stress challenges can arise from work itself. We know that there are stressors at work. Stress from tough schedules, from shift work, disruptive relationships with coworkers, supervisors, there are epidemic levels, in some industries, at work violence.
So, work in and of itself can be a generator, or an unfortunately, you know, at the route sometimes of people’s stress levels and mental health challenges. So, I’m exactly with you. I think this is something that it really serves no one if we say, well, we are not going to deal with that, or that is not our issue.
And I think there’s also an opportunity for workplaces to be quite proactive here, not only in their policies and in their benefits designed around making sure there’s parity for mental health treatment, offering good educational programs around awareness buildings, de-stigmatization of this issue, on-site screenings that are done privately confidentially. All those are opportunities for us to draw attention to this challenge, whether it is anxiety, depression, you know, situational anxiety, stress that sort of thing, or opioid or other substance use disorders.
Workplaces traditionally have offered programs like employee assistance programs and that sort of intervention. We certainly are strong advocates for those. We also think that getting upstream, not just waiting until somebody symptomatic. Getting upstream and finding out what the pressure points are, the pain points are, in an organization so that you can head off some of these things. Ask questions, give workers like, what are your biggest challenges here at work? What are the biggest causes of stress that you have to deal with each and every day? Then involve them in the process of solving these issues. It’s an extremely valuable approach to give workers a voice, they’re closest to the issues and challenges, they’re probably going to be most useful at coming up with solutions. And if they have a voice in the solution, they’re likely to buy in and participate, right?
It isn’t if we build it, they will come. It is if they build it, they will come. So I think workplace stress and mental health challenges, substance use, those are really hot button issues where workers do need not only resources, but really to have a voice in identifying what might be antecedent, what might be at the root of some of those challenges.
Great. Yeah. I loved your emphasis on being proactive and getting things when they’re small instead of big. I love your correct point about getting the workers involved. Which I think really prioritizes empathy and getting the workers involved in almost like a design thinking approach to that. So that’s cool. And I think I think your earlier point as well makes a lot of sense: Yeah, you should look at this as an employer, you should be concerned about it because it is going to affect outputs. It is going to affect productivity and efficiency and employee retention and turnover and all of that, and morale. If employment is actually one of the things creating these problems, I would argue there’s an ethical responsibility to solve them or help to prevent them.
You know, I think from our standpoint, this opioid use disorder, especially opioid overdose death epidemic that we’re seeing is really impacting so many levels of our society, that it really is going to take all hands on deck, including employers, to do their part.
Not only on the front end, but let’s say they have a, worker who has a substance use disorder. They have a golden opportunity to help that person find treatment, do the warm handoff to appropriate care, and then be ready and willing to accept that worker back through recovery supportive policies that really make it a priority to say, Yes, we will, we will bring you back, we’ll help find work that is appropriate for you. Even if your own medication, assisted medication, based treatment, we can find work that you will be able to do we know that employment is an important step to prolonged abstinence recovery. So, we think employers can play really a role all along that spectrum, from prevention all the way to tertiary intervention for care and return to work.
Yeah, good point. It’s interesting to hear you say that employment is important in getting off as well. You know, no doubt I think a lot of people are aware of the scope of the opioid epidemic. In my own case, I was unplugged from pop culture. I didn’t have cable TV for years. And some years back, I got my cable and I watched an NFL football game and I felt like 50% of the commercials were about constipation for using opioid and I was like, something’s off.
Yeah, it’s pretty easy. There was this big push, you know that we weren’t, as physicians, we weren’t adequately treating pain. So, when I was training, there’s tremendous emphasis on take care of pain, take care of pain, ask about pain at each visit. And unfortunately, that led to really high utilization of pain meds, and we use far more pain meds per person in this country than any other country on earth. And there was a downside to that. No doubt about it.
Yeah, and you know, not to drag you too far down this rabbit hole, but as you talked about the stigma related to drug use and opioids in particular, but a lot of times people get into it not because you were out smoking weed or using coke but because your doctor prescribe it to you, you know, made it legitimate. Maybe unfortunate but a legitimate prescription because you had a legitimate pain that maybe you got at work because you were schlepping heavy stuff working construction. So, it’s nothing to be ashamed about at all.
Exactly, that’s a really good point. We have quite a bit of research going on using workers compensation datasets, because it’s the one place where you have the constellation of work injury information, occupation and injury, occupation and industry information, and pharmaceutical prescribing and medical diagnosis. So, that’s a really rich data set for us to help unpack and better understand the connection between work injury, prescribing patterns, return to work issues, so it’s really valuable place where NIOSH is doing further research.
All right. I just got a little message here. I got 10 minutes left, before this cancels, on me. So, we’ll go a couple quick questions. What are your first steps in an organization can take to improve the safety and health of its workers?
Yeah, you know, we’ve hinted already on this topic.
But you’ve got to ask workers, what matters to them. Ask them what their challenges are, what their biggest stressors are, what their uphill climbs are each day, and give them a voice in creating the program so that they so that they’re more likely to engage and use it.
So, we have developed, a number of tools that will be valuable in that regard. Some of them are done at the organization level, and some are done at the individual employee level. We like those individual ones because it gives workers the strongest voice. And those tools are available on some of our center of excellence toolkits. And we can give you the link for that. But they really all do start with asking employees, what are your challenges, and then based on that, coming up with the right interventions, we’re also developing a worker well-being metric tool that will be available in February, and we would love to maybe revisit with you in and give you more details about that measurement tool.
Oh, we’d love that. That’d be great. Okay, well get that link in and we’ll contact you in the future about the worker well-being.
What about common mistakes? Any common mistakes safety managers are making or should avoid when they’re trying to address these issues at work?
Yeah, you know, I would say one of the biggest is to say that’s not our problem, like when an employee has a personal issue or a challenging circumstance at home that’s going to find its way into the workplace one way or another. So I think it’s really incumbent on organizations to spend a lot of their money that they might otherwise put in health promotion, or some of the traditional, you know, an on-site gym or that sort of thing. To really use some of those funds to improve the training of their frontline supervisors.
I will make the claim that your frontline supervisor is far more important to your health and well-being than your personal physician will ever be just because of the intensity, the frequency you know, the basicness of that relationship and exposure. So, our supervisors today have a tough job to do. We need to give them more skills, so they have better understanding how to manage people fairly. How to reward and recognize people. How to use better people skills and dealing with adults that, you know, are really their peers in many ways. Having them supervised with health outcomes in mind, not just productivity outcomes, because when you do that productivity will go up as well. So, I would say that’s probably the least under supported health intervention that most organizations do, they don’t place enough emphasis on the training and sort of the care and emphasis on high-quality supervision.
Good call. It’s completely consistent with a lot of like new safety people, and the emphasis on creating a better relationship at work.
All right, last point: Pie in the sky, Dr. Chosewood, what are your biggest hopes and your biggest concern for the future of worker health and safety?
Well, let’s start with a few concerns. Some people are worried about how technology is going to take all our jobs away, right? How we’re not going to, you know, there’s such disruption, such rapid pace of change that that things are going to be difficult for workers in the future. I think that’s an unknown. I think an important takeaway here is th