Rationale for Coordinating Protective Interventions With Health Promotion

Rather than having regulated workplace hazard-reduction initiatives in one bucket and wellness programs that address workforce lifestyle risks in another, it makes sense to co-mingle them in one pool, says Dr. L. Casey Chosewood, senior medical officer for WorkLife at the National Institute for Occupational Safety and Health (NIOSH).

In addition to the altruistic aspects of taking steps to ensure a safe workplace and a healthy workforce, the financial motivation is clear: employers are responsible for a significant percentage of the nation’s health care expenditures and are looking for ways to control their costs through an integrated approach that encourages employee buy-in.   

In a bellwether report commissioned by NIOSH in 2004, researchers at the Harvard School of Public Health articulated one of the challenges associated with integrating regulated  protection with voluntary wellness programs: 

“The belief that worker health begins with individual behavior change sets in motion a different set of intervention strategies from the legal formulation in the Occupational Safety and Health Act, which starts from the assumption that management bears primary responsibility for worker health and safety on the job. Overcoming the segmentation of these fields ultimately will require an inclusive, comprehensive model of work and health, providing for resolution – or at least understanding – of our differences, assumptions, vocabulary, research methods and intervention approaches.”

While seven years old, the report is still relevant today, and it outlines a number of arguments in favor of integration:

• Workers’ risk of disease is increased by exposure to both occupational hazards and risk-related behaviors.
• Workers at highest risk for exposures to hazardous working conditions also are those most likely to engage in risk-related health behaviors and live in higher-risk communities.
• Integrating occupational safety and health with health promotion may increase program participation and effectiveness for high-risk workers.
• Integrated safety/health and health promotion programs may support broader work organization issues and improve the work environment.

Examples of integrated worker protection-and-health promotion programs include:

• Respiratory protection programs that comprehensively address tobacco use.
• Ergonomic consultations that discuss arthritis management strategies.
• Stress management programs that first seek to diminish workplace stressors, then work to build worker resiliency.
• Integrated training and prevention programs (falls, motor vehicle safety, first aid, hearing conservation, stretching, flexibility, safe-lifting programs).
• Comprehensive screenings for work-related and non-work risks.
• Occupational health combined with a primary care home model.
• Full integration of clinics, behavioral health/employee assistance, traditional safety, health promotion, coaching, nutrition, disability and workers’ compensation programs.

Dr. Chosewood said NIOSH researchers prefer to use the term “workability” as opposed to “productivity,” particularly when referring to employees’ expressed desire for greater control over their work schedules and environment. Studies show that employees who are given some latitude in their work life experience less anxiety and stress, which in turn reduces complaints that result in costly work absence.

Reference: Steps to a Healthier U.S. Workforce: Integrating Occupational Health and Safety and Worksite Health Promotion-State of the Science;  

G Sorensen, E Barbeau, Harvard School of Public Health, 2004.