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Pathways to Prevention (P2P) Program

Total Worker Health®—What’s Work Got To Do With It?


Total Worker Health® (TWH) means policies, programs, and practices that integrate protection from work-related safety and health hazards with efforts to promote health and prevent disease for the advancement of worker well-being. One hundred forty-five million Americans are workers, and most spend at least 50% of their active time at the workplace. Despite improvements in occupational safety and health over the last several decades, workers continue to suffer work-related illnesses, injuries, and deaths. Work-related illness, injury, and death estimates include the following:

  • More than 53,000 deaths could be attributed to work-related illness, and the estimated total cost of occupational injuries, illnesses, and fatalities was $250 billion. 
  • More than 4,500 U.S. workers (PDF) died from work-related injuries, and more than 3 million workers (PDF) had a non-fatal occupational injury or illness. 
  • Approximately 2.8 million workers were treated in emergency departments for occupational injuries and illnesses, and 140,000 workers were hospitalized. 


TWH builds upon a foundation of protecting workers from work-related exposures and hazards by championing a holistic understanding of the myriad of factors that influence safety, health, and well-being. 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. With wide variety in the landscape of the workplace (e.g., workplace culture, organization of work, working conditions, size of the employer) and the workforce (e.g., age, gender, access to preventive health care), this often translates to diversity in the safety and health risks for each industry sector and the need for tailored, comprehensive interventions.

Traditionally, workplace systems addressing worker safety, health, and well-being have operated separately. An integrated approach would address the overall influences that the nature and conditions of the work itself (e.g., stress levels, work schedules, trip or fall hazards) have on worker health. TWH promotes bringing together the diversity of relevant programs, including occupational safety and health, worksite health, disability management, workers’ compensation, and human resource benefits. There is evidence that combining efforts through integrated workplace interventions helps safeguard the well-being of workers.

Although the benefits and synergistic possibilities of an integrated approach may seem obvious, integrated programs have not been sufficiently validated by the current research.

Workshop Goals

The workshop sought to clarify:

  • What studies exist assessing integrated interventions?
  • What are the known benefits and harms of integrated interventions?
  • What are the characteristics of effective integrated/combined interventions and programs?
  • What factors influence the effectiveness of integrated interventions?
  • What are the key evidence gaps?

Sponsoring NIH Institutes, Centers, and Offices

The workshop was co-sponsored by: