The Batman of Worker Health

By | July 30, 2017


A superhero of employee health is John Howard, director of the National Institute of Occupational Health and Safety, home of the Total Worker Health® (TWH) program.

I was fortunate enough to attend Dr. Howard’s impassioned opening address at the 1st International Symposium to Advance Total Worker Health, which took place at the National Institutes of Health in 2014. Here are a couple of things he said:

Total Worker Health is promoting worker well-being in all its aspects, including appropriate indemnity and medical care for work injuries and illnesses, adequate paid sick and family leave, maternity and paternity leave, adequate vacation time, living wages, comprehensive health care, social pensions, along with safe and healthful workplace conditions as required by law.

We know that workplaces interested in wellness measures only in order to lower their health insurance costs are not likely to be workplaces that can achieve Total Worker Health.

Under the stewardship of Dr. Howard and his team, TWH is forging an agenda that recognizes the full range of forces at play in worker health.

The TWH website emphatically states what TWH is not:

TWH is not a collection of health promotion efforts implemented in a workplace where the work organization and structure contribute to worker injuries and illnesses. Workplace policies that discriminate against or penalize workers on the basis of health conditions or inadvertently create disincentives for improving health are not consistent with a TWH approach.

That last part is a potshot at the section of the Affordable Care Act that legitimizes using wellness incentives and penalties to discriminate against workers. (Learn more about how ACA wellness provisions promote discrimination against disabled and other workers.)

In remarks at a more recent TWH conference, Dr. Howard declared the essential role of TWH:

Our hypothesis is that work itself plays a significant role in the health of workers, and we fund research based on that hypothesis. What good are all the population health efforts currently the fashion… if significant factors arising from work itself…are ignored, ultimately left unintegrated with the larger and more resourced world of population health?

John Howard is Batman! Imagine an employee well-being strategy that puts the needs of workers first.

L. Casey Chosewood, MD, MPH, Total Worker Health manager, hammered home Dr. Howard’s point, outrightly distancing TWH from our commercialized, behavioral approach to wellness. In a Bloomberg BNA article, Robin…um, I mean Dr. Chosewood…was quoted as saying:

Total Worker Health is not now or never has been synonymous with workplace wellness programs. You cannot counter the negative health effects of 8 or 10 or 12 hours a day in difficult working conditions with a 30-minute health promotion program at the end of the day.

Bam! Take that, Joker!

If we know what TWH is not… Then what is it?

According to the program’s website:

Total Worker Health advocates for integration of  all organizational policies, programs and practices that contribute to worker safety, health and well-being, including those relevant to the control of hazards and exposures, the organization of work, compensation and benefits, built environment supports, leadership, changing workforce demographics, policy issues, and community supports.

Elsewhere on the site, TWH explains:

An integrated approach recognizes that risk factors in the workplace can contribute to many health problems previously considered unrelated to work, including cardiovascular disease, obesity, depression, and sleep disorders.

Total Worker Health is…well…total. It encompasses everything in a worker’s life that interplays with work, as well as (and especially) the work itself. And it considers how these influences interact with all dimensions of well-being.

You can find a draft of TWH’s Comparative Effectiveness Review, conducted by the Agency for Healthcare Research and Quality, in the bat cave (oddly enough, the publicly posted document is stamped “Confidential”). Read carefully and you may be disappointed that the document reports no breakthroughs and no surefire solutions. It is absent lofty promises of return-on-investment. In fact, the findings are strikingly unsensational.

In its discretion, the TWH Effectiveness draft offers all of us involved with employee well-being an important and much-needed lesson in how a genuine pursuit for evidence is conducted: systematically, conservatively, transparently, independently, in a manner that encourages discourse, and as objectively as possible. If the old guard of employee wellness had adopted this approach 30 years ago, we today might be much further along in advancing the well-being of our employees and our society as a whole.

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