Integrative Approaches to Safeguarding the Health and Safety of Workers

In many regions, larger employers oversee a wide array of programs and activities to help manage the health, safety and well-being of workers. Examples of these functions include occupational safety and health programs, disability and return-to-work programs, disease management programs, worker compensation programs, employee assistance and health promotion or wellness programs, and various human resource initiatives such as work-family programs. In a recent guidance statement, however, the American College of Occupational and Environmental Medicine (ACOEM) expressed strong concerns that these programs typically operate independently of one another, thus limiting their effectiveness from both a prevention and cost perspective 1). This fragmentation is perhaps most apparent in the gulf that has existed historically between worksite health promotion or wellness programs that focus on personal lifestyle and behavioral risks, and health protection programs that deal with occupational exposures. Concern about fragmentation of workplace health programs is not new. Two decades ago DeJoy and others 2, 3) argued for ecological or systems approaches to occupational safety and health that acknowledge the multi-causal nature of injury and illness among workers, and deliver packages of interventions that address both personal and occupational risk factors in a coordinated way. The occupational safety and health field is now responding to this challenge. National health organizations in the United States have joined with ACOEM in efforts to dissolve barriers among distinct environmental, health, and safety programs and policies in the workplace. In its 2005 report, Integrating Employee Health 4) , the Institute of Medicine issued recommendations for the design and conduct of a comprehensive, integrated health and safety program in a Federal agency, which serves also as a model for industry at large. More specific guidance for the development of integrated health promotion and health protection programs in the workplace was issued by the Labor Occupational Health Program at the University of California, Berkeley in 2010 5) , and also by Harvard University in 2012 6). In 201l the National Institute for Occupational Safety and Health (NIOSH) coined the expression Total Worker Health TM in reference to integrated workplace prevention strategies, and re-titled its research program on this topic to the Total Worker Health TM Program 7, 8) TM was increased and, on the extramural side, a fourth Center of Excellence to Promote a Healthier Workforce was funded 7, 8). What's behind this fresh enthusiasm for integrated prevention strategies in occupational safety and health? As noted, there has …