By Karen O’Hara
In a symbolic move, the National Institute of Occupational Safety and Health (NIOSH) plans to change the name of its WorkLife division to Total Worker Health to better reflect the unit’s objectives, reports L. Casey Chosewood, M.D., WorkLife senior medical officer.
WorkLife/Total Worker Health seeks to eliminate artificial divides between “at work” and “non-work” by examining the intricate web of work and home life, public and personal protection, and overall health and well-being. For example, as workplace conditions affect employee health and well-being at home and in the community, activities, and conditions outside of working hours can substantially determine health, productivity, and responses to exposures during work, NIOSH researchers say.
The concept of Total Worker Health is strategically aligned with the Accountable Care Organization (ACO) and medical home delivery models promoted in the Patient Protection and Affordable Care Act. (An ACO is a collection of local providers held accountable for the cost and quality of care delivered to a particular population. See related article on page 12.)
While some say Total Worker Health threatens to dilute NIOSH’s fundamental purpose “to understand and decrease the risk of injury and illness in the workplace,” Dr. Chosewood said the federal agency’s primary worker protection mission remains unchanged. However, he said NIOSH recognizes the need to create new avenues to better understand and manage other factors affecting worker performance, such as stress, poor diet, limited exercise, smoking, medication and/or alcohol use, and a plethora of other physical, social, cultural and economic conditions.
“Worker protection has to be at the core of any program,” Dr. Chosewood said during a presentation at the recent annual American College of Occupational and Environmental Medicine (ACOEM) conference in Washington, D.C. “The first dollar needs to be spent on decreasing hazards the worker will encounter at work. After you have done that, then it is appropriate to invest in health promotion activities that will produce the end benefit of making the population as a whole healthier and safer.”
Speaking directly to occupational medicine physicians, Dr. Chosewood said: “We think there are missed opportunities in the clinic setting. There is a need for comprehensive health screenings for work-related and non-work-related risks. There also is growing interest in combining occupational health with a work-place-based primary care home model. “You need to do all that you can to increase the percentage of preventive services that are part of the overall delivery model and encourage full integration in clinics, including the incorporation of behavioral health and traditional safety activities. We hope you will come along with us on our journey toward Total Worker Health.”
Best Practices
On a parallel track, Pamela Hymel, M.D., chief medical officer, of Walt Disney Parks and Resorts and ACEOM past president, told physicians the college’s Workplace Health Protection and The Promotion Committee is developing a response to the NIOSH total health program that will highlight best practices in the integration of protection and health promotion.
“We have found that workers with adverse health conditions such as obesity, hearing loss, poor eyesight, and fatigue are more likely to sustain work-related injuries,” she said. At the same time, “there is often an abyss between safety and wellness. It will be important for ACOEM members to begin to build those linkages. At Disney, I have a meeting set up with our vice president of safety to begin conversing on this very issue.”
Dr. Hymel said occupational medicine practitioners can add value to the conversation by:
- reaching out to segments of the population, such as non-insured employees, who may not have easy access to information;
- designing targeted programs for at risk groups in the workplace; and
- working within organizational hierarchies to introduce procedures, practices, and norms.
Dr. Hymel said the ACOEM committee is studying public policy options that support integrated health protection and promotion efforts and incentives. It also is interested in synergies among ACOEM and government and private sector employers, opportunities for strategic alignment with emerging healthcare delivery models and evidence-based medicine, and NIOSH’s WorkLife Center of Excellence program.
In a related action, Dr. Hymel said ACOEM plans to waive the subscription fee for its health and productivity management (HPM) toolkit for college members to encourage greater utilization in the coming months. The toolkit features a collection of educational materials and is intended for use by professionals involved in the implementation of HPM programs. To learn more about the toolkit, visit https://acoem.org/Membership/Special-Interest-Sections/Health-Human-Performance.
