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Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthTM

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1 Heidi Hudson, MPH – Co-Coordinator for Total Worker HealthTM
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. First, there are two disclaimers to bring to your attention: 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) The National Institute for Occupational Safety and Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. The mission of NIOSH is to generate new knowledge in the field of occupational safety and health and to transfer that knowledge into practice for the betterment of workers. To accomplish this mission, NIOSH conducts scientific research, develops guidance and authoritative recommendations, disseminates information, and responds to requests for workplace health hazard evaluations NIOSH (and the Occupational Safety and Health Administration or OSHA) were created by the Occupational Safety and Health Act of 1970 – With the mandate “to assure so far as possible every working man and woman in the Nation safe and healthful working conditions.” The less often quoted portion of the mandate is “ and to preserve our human resources.” We believe this entire mandate provides the directive for a focus on both protecting and promoting the health of the working population.

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 HealthTM Program Today I plan to: Explain rationale for integrating health protection and health promotion Describe the value of partnerships in building and promoting integrated programs List resources to launch and improve a Total Worker Health Program My hope is that you’ll have a better understanding of why it is important to integrate efforts to protect and promote the TOTAL health of workers so as to improve worker safety, health, and engagement

5 Every Day . . . 12, new reported cases of nonfatal occupational injuries and illnesses 9, workers are treated in emergency departments workers are hospitalized deaths from work-related illness deaths from work-related injuries Source: MMWR, Vol. 59, No. 15, April 23, 2010 40 years after the OSH Act, the burden of work-related injury and illness remains a challenge. Every day there is an average of: 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 occupational injury deaths

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 In addition to the human toll, work-related illness, injury and death 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 And this figure Excludes the costs paid by other insurance systems and most of the 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] A major issue that’s relevant to the TWH of any workforce is the prevalence of chronic health conditions. This slide lists 4 of the major diseases that impair health, reduce quality of life, and place extreme economic burden on the healthcare system. In 2006, US healthcare spending was reported to be more than $2 trillion and employers on average pay more than one third of this cost. Chronic health conditions are on the rise across all age gropup in the US, and it is expected that in the near future conditions such as diabetes, heart disease, cancer will add an enormous burden to already high costs of healthcare. Employers will be particularly impacted as they provide medical benefits for employees and absorb the costs of absenteeism and long-term and short-term disability claims.

8 The Future of Work Hazards Employment Workforce Persistent Emerging
Shortage of Workers Global Competition Flexible vs. Precarious Workforce Aging Workers Health-Related Issues Obesity Multi-Generational Now , and as we move into the future, we see continuous risks to the safety and health of workers. For example, in terms of Workplace Hazards we see persisting concerns around Fall from Heights Amputations from Unguarded Machinery Trench Collapses Musculoskeletal Disorders Workplace Violence There are also concerns related to Emerging risks in the areas of Nanotechnology Food Flavorings Airborne Transmissible Diseases Green Jobs Another challenge is that workplaces are rapidly evolving resulting in changes to how work is organized for example: There has been a shift in the way we produce goods (from manufacturing to service environments) Challenges stemming from global competition and the economic climate Downsizing, corporate restructuring Increased pressure on remaining workers to do more with less, working longer hours, compressed work weeks Shortage of workers. Increasing use of contingent and precarious work arrangements contribute to a sense of instability while at the same time changes in the psychological contract result in job insecurity And there are also a number of challenges, workplaces contend with that stem from the changing makeup of the available workforce The composition of the US workforce is becoming increasingly diverse Limited availability of workers of all ages Increasing numbers of older workers We’re seeing health challenges in younger workers (e.g., obesity) A number of our workers are in what is called the “sandwich generation” – caring for young & older workers and thus we’re seeing increasing need for flexibility in work arrangements and scheduling. And ever so slowly, there is an increasing awareness that both on-the-job and off-the-job factors contribute to employees’ health and well-being. Thus, we’re seeing the need to address employees’ TOTAL health from a more comprehensive perspective.

9 Traditional Health Protection and Health Promotion
Health Protection – 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 Employers have responsibility to provide a safe and hazard-free workplace. Traditionally, Health Protection is conceived as including Programs that focus on reducing hazards and exposures at workplaces to prevent occupational injury and illness. (they promote collective change); control of many hazards is regulated. Often these programs reside in non-health oriented units. On the other hand, TRADITIONALLY, Health Promotion has included Interventions aimed mainly at reducing lifestyle risk factors by promoting healthy behaviors and actions. These itv’s promote individual change. Often these program are a function of human resources or benefits. Historically, there has been a disconnect between those responsible for health protection and those responsible for health promotion in the workplace. Most health protection programs are separated from workplace health promotin programs. Sometimes, when resources are sparse, the programs can even seem to compete for funding. However - - there is an emerging body of evidence that supports efforts to integrate these approaches as a promising practice to protect and promote the total health of workers.

10 “Traditional Safety and Health Silos Not Optimal for Workplace Health” ACEOM, 2011
The evidence clearly shoes that the health of workforce is inextricably linked to the productivity of the workforce and the health of the nation’s economy. Few employers have truly integrated programs .

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 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 Goetzel (2005) A growing body of research demonstrates the connection between improved health and functional status. Good physical condition, absence of chronic illness, and good mental health are factors that have been scientifically observed to be associated with low injury rates

13 Examples of Integrated Approaches
Respiratory protection programs that address tobacco use and smoking cessation Ergonomics programs that 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)
Whether or not an illness or injury is work-related, the workplace is an ideal setting for safety, health protection and health promotion activities: There are 143M full- and part-time workers – CDC Estimates that 65% of the adult population can be accessed through worksites. Employees spend more than 1/3 of their day at the workplace Employers have a financial interest since they provide health insurance coverage Employers pay for 36% of the nation’s healthcare expenditures And we’ve talked about how chronic health conditions are expensive not only for the healthcare system overall but also impinge upon employees’ abilities to be healthy, productive and engaged at work. [57% of employers with >500 employees offer some sort of wellness program]

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. NIOSH coined the term Total Worker Health in 2011 and defines it as: the strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to enhance worker well-being

16 Total Worker Health™ Intramural Program Partnerships
Centers of Excellence NIOSH has chosen to assume a leadership position in addressing these issues through our Total Worker Health™ program. We see the concept of the TWH™ program as an umbrella for 3 specific components: Our developing intramural research program Our thriving partnerships, e.g, OPM, GSA, DOI federal worksite wellness pilot, VA Wellness is Now program Our Centers of Excellence – 3 maturing (recently refunded) and 1 new in 2011 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 We have a number of active partnerships with Federal Agencies and have participated in a cross-govt workgroup with the OPM and OMB that is launching the Federal Employee Worksite Health and Wellness Initiative. OSH interventions, evidence-based health promotion strategies Integrated health, safety and wellness content Clinical and clinical preventive services Built environment interventions HRA’s and chronic disease management strategies Inventory of OSH and health promotion activities throughout the federal workforce nationwide Assistance with vendor and evaluation provider selection Exploring new potential for data collection, claims awareness, EHR’s and incentives Improved benefits for prevention We have also been actively involved with helping the Veteran’s Administration design their WIN – Wellness Is Now program. NIOSH has had input into the program’s content, training design and promotion. We have engaged in partnerships to Co sponsor and collaborate on conferences We co-sponsored Healthier Federal Workers 2011: A new symposium on the health, safety and wellbeing of the federal workforce. And in response to overwhelming requests for a follow-up, we are hosting another Healthier Feds conference in 2012. We are also working with the American Psychological Association and the Society for Occupational Health Psychology to organize the upcoming WSH conference for which the theme will be “Protecting and Promoting Total Worker Health”

19 Wellness Is Now: Veterans Health Administration
"Wellness is Now – VA” pilot launched 2 years ago NIOSH engaged with program content, training, and promotion Data collection for program effectiveness evaluation including measures of: Employee satisfaction Administrative data Sick leave Lost time injuries Workers' compensation costs VHA is planning a national health promotion survey as part of its periodic work organization surveys Large network of VA health promotion providers now active Collaborating on 2011 Health of the Federal Worker Symposium

20 NIOSH Centers of Excellence for Total Worker HealthTM
University of Iowa Healthier Workforce Center for Excellence Center for the Promotion of Health in the New England Workplace At the University of Massachusetts At the University of Connecticut Harvard School of Public Health Center for Work, Health, & Well-Being Oregon Healthy Workforce Center, Oregon Health & Science University (selected in late 2011) This slide lists the 4 NIOSH Centers of Excellence: The University of Iowa Healthier Workforce Center for Excellence The Center for the Promotion of Health in the New England Workplace At the U Mass Lowell and U Conn Harvard School of Public Health Center for Work, Health and Well-being The Oregon Healthy Workforce Center at the Oregon Health and Science University – newly funded in 2011 These centers are engaged in exciting research that will help us to understand how the integration of health protection and health promotion in the workplace can benefit individual workers, employers, our communities, and our nation.

21 Case Studies Examples 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

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
Refer to handout

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 Here are a fe key report covering the concept of Total Worker Health. All of these reports a listed and linked to the source on our website.

28 CDC Workplace Tools and Resources

29 Visit our Website: http://www.cdc.gov/niosh/TWH/
This is a screen shot of our TWH™ website, along with the website link. Much of the information I’ve provided today is available on our website, along with lots of great resources for additional information. I encourage you to take a look!

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

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

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


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