NIOSH Total Worker Health™: Innovative Approaches for Healthier Employees

1. NIOSH Total Worker Health™: Innovative Approaches for Healthier Employees USPHS Symposium June 20, 2012 Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthTM National Institute for Occupational Safety and Health Centers for Disease Control and Prevention

2. Disclaimers • 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.

3. 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)

4. Overview • 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 HealthTMProgram

5. Every Day . . . 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

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

7. 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]

8. 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

9. Traditional Health Protection and Health Promotion HealthProtection – 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

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

11. 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)

12. 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.html Goetzel (2005)

13. Examples of Integrated Approaches • Respiratory protection programs that address tobacco use and smoking cessation • Ergonomics programsthat 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.

14. 65% of the adult population can be accessed at workplaces (CDC, 2010)

15. 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.

16. Developing Thriving 3 Maturing 1 New

17. NIOSH Total Worker Health ProgramTM Value of our partners

18. TWHTM Partnerships • 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

19. Wellness Is Now: Veterans Health Administration

20. 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 Connecticuthttp://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-healthy-workforce-center/index.cfm

21. Case StudiesExamples Promising Practices for tWHTM

22. 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

23. 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

24. CDC Examples • CDC StairWELL Project • CDC’s Tobacco Free Campus Initiative • Bike Shelter replaces Smoking Shelter • Go Green! Go Healthy! • Garden Markets

25. 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

26. RESOURCES FOR BUILDING A HEALTHIER AND SAFER WORKFORCE

27. 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

28. CDC Workplace Tools and Resources

29. Visit our Website:http://www.cdc.gov/niosh/TWH/

30. Upcoming Events Healthier Federal Workers September 2012 in Washington, DC • 10th Work Stress and Health Conference May 2013 in Los Angeles

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

32. 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

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