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ISSN (Impresso) 1679-4435 - ISSN Online 2447-0147
Acesso aberto Revisado por Pares
Resumos expandidos de apresentaçao de convidados



L. Casey Chosewood

DOI: 10.5327/Z16794435201917S1008

Employers, workers, their families and communities all have a stake in creating healthy jobs and safeguarding the wellbeing of workers. Creating jobs that are inherently safe is the employer’s responsibility and should be a given in any enterprise. Quality employers may also go beyond ensuring the safety of their workers to looking more broadly at the role that work and the workplace can play in advancing worker health and productivity — both on and off the job. This expanded view represents the foundational tenet of the Total Worker Health® (TWH) approach, a broadening of the traditional approaches common in many workplace wellness or workplace health promotion programs to introduce a holistic, integrated approach to worker health and well-being.

The Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH) defines TWH as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.

Prioritizing a foundation of safety first, and then integrating workplace policies, programs, and practices that grow health, creates greater worker well-being and is the cornerstone of the TWH field. Through investments in research and the application of research into practice, TWH efforts seek to protect the safety and health of workers and to advance their well-being by engendering safer and healthier work environments and by addressing employment-related issues.

The TWH approach is not consistent with efforts that place sole responsibility on the worker or that blame or penalize workers for any underlying health conditions1.

The essential elements of the TWH approach include the following2:

• Ensure senior level leadership commitment and front-line supervisory supports for safer worker and better health

• Design work to eliminate hazards and be healthier

• Integration of health protection and health promotion efforts across all organizational components (safety, HR, health promo, benefits, sustainability, clinical services and others)

• Protection of the confidentiality and privacy of workers, to include safeguarding their autonomy; assure program participation is voluntary, inclusive and participatory

• Work to increase engagement/grow culture



Changes in the type of work and in employment patterns is shifting. Economic, societal, and organizational pressures all create far-reaching changes in work conditions across the life-span and widespread transformation of the relationship between workers and employers. This shift has produced a greater emphasis on contracting and subcontracting work, multi-employer worksites, organizational restructuring, mergers, and downsizing, often leading to precarious or contingent work. These job types and associated characteristics can produce more uncertainty due to repeated periods of involuntary unemployment, which may lead to unfavorable health effects that may also carry over to other jobs. The resultant job insecurity has implications for a variety of worker safety, worker training, worker injury risk, health factors, stressors, financial insecurity and other outcomes.

Additionally, work itself is transforming as technology, human growth and development, and globalization both influence workers and how work is accomplished. New organizational designs and novel jobs are influenced by technological advances, including artificial intelligence, automation, robotics, sensors, and digitalization. These transformations offer many opportunities, such as new job creation, sustainable practices, and clean technologies, but they also bring challenges, such as skill and job loss, job displacement, emerging occupational hazards and risks, and worker exclusion. All of these shifts will influence the safety, health, and well-being of the world’s workers.



The demographics of workers within the U.S. population and in many other parts of the world are rapidly changing. These changes influence both the characteristics of the workforce and their challenges or needs. Changes in the distribution of workers include the following: age, gender, sexual orientation, race, ethnicity, country of origin, and preferred language of communication. All of these factors interact with work design, management practices, and physical and psychosocial work environments in ways that may adversely and disproportionately affect worker safety, health, and well-being. Because of the complex nature of these changes, greater attention to work design, worker protection and related policies and programs for improved health are necessary.

Many of the emerging groups bring diversity, a richer workplace culture and new insights. However, some of the demographic groups may face elevated safety and health risks, especially those more likely to have physically demanding, labor-intensive jobs or those who work in unregulated or insecure employment. Some workers with certain demographic characteristics are often more concentrated in work arrangements that are temporary in nature, where exposure to physical and psychosocial risks is common, and where employment-related benefits are few.

The aging of the workforce is occurring in many countries and represents an important change. While older workers are often psychologically healthier, report more positive psychosocial work environments, and have fewer occupational injuries overall than younger workers, the rate of fatalities due to occupational injuries suffered by workers aged 65 and older is nearly three times that of the overall workforce. Older workers also have more chronic health conditions that can affect their ability to stay safe and healthy at work, demonstrating the need to develop and implement age-friendly work design, management practices, and physical and psychosocial work environments to create workplaces that are safe for all workers as they age. Similarly, younger workers, often with less experience need special consideration. In the U.S., the rate for workers aged 20–24 was 1.76 times greater than for workers aged 25 and older. These injuries are often the result of working in high-risk jobs, lack of work experience and safety training, and fear of speaking up about the workplace hazards that they and newly hired workers face.

Racial and ethnic diversity, as well as the number of countries of origin and languages spoken by workers, continues to expand as well. This provides both opportunities and challenges for workplaces.

In many cultures, the number of women in the workplace is also increasing. This change may improve personal and family earnings and access to employee benefits, which can in turn affect the well-being of all family members. However, we have limited understanding of how these changes will affect work-life integration and family life for both women and men. Similarly, we have limited understanding of the safety, health and well-being impacts upon sexual minorities, including gay and transgender workers, who may often face challenges related to work including discrimination and differential treatment, harassment, disparagement, and denials of benefits and promotions based on their sexual minority status.



The changing nature of work and the evolving diversity among workers represent a clarion call for new approaches to protecting the safety and health of workers and increasing their well-being. We propose the Total Worker Health® approach as a promising pathway to achieve these goals.



1. United States of America - USA. National Institute for Occupational Safety and Health - NIOSH. Centers for Disease Control and Prevention – CDC. Department of Health and Human Services - HHS. Total Worker Health. Disponível em: Acesso em 01 abr 2019.

2. Lee MP, Hudson H, Richards R, Chang CC, Chosewood LC, Schill AL. Fundamentals of total worker health approaches: essential elements for advancing worker safety, health, and well-being. Publication No. 2017-112. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2016

3. United States of America - USA. National Institute for Occupational Safety and Health - NIOSH. Centers for Disease Control and Prevention – CDC. Department of Health and Human Services - HHS. National Occupational Research Agenda for Healthy Work Design and Well-being [Docket Number CDC–2019–0018, NIOSH–328]. Disponível em: Acesso em 30 mar 2019.


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