It’s often a long road from identifying an issue, creating a consensus and then designing a solution. That seems to be the case with the philosophy called total worker health (TWH). It was created in 2006 by the National Institute for Occupational Safety and Health (NIOSH) to “expand the science, education and training around a more holistic approach to worker well-being.”
“TWH is defined 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,” according to Harvard’s T.H. Chan School of Public Health’s Center for Work, Health & Well-Being, one of the 10 centers of excellence created by NIOSH to implement this doctrine.
Since its creation, many companies have adopted this expanded vision of safety and created programs to address it. By 2023, 58% of small firms and 94% of large companies in the U.S. had a wellness program. It is now so well recognized that Governor Jared Polis declared August 22,2024, as Colorado Day of Total Worker Health.
Chemical giant Dow, which employs 36,000 worldwide, publishes its metrics around TWH. In January 2024, the company proclaimed that based on its Well-Being Portal, which was created in 2022, more than 65% of its employees were enrolled in the program. Dow found that 33% of employees said they felt more productive at work and at home. And 26% reported a reduction in stress levels, a key component of a holistic approach to health.
Smaller companies are following suit in expanding their view of worker health. Jordan Foster Construction, an America Safest Companies winner in 2023 and employer of 700, took this approach 15 years ago. “Having been in the safety business for many years, I have seen the change,” said Tricia Kagerer, the company’s executive vice president, risk management. “The profession started as something where you focus on preventing bodily injury. But the reality is that safety has expanded to deal with the overall person. In construction especially, that means we need to be focused on the mental health of our people.”
Attention to mental health in this sector is critical, as the construction industry has one of the highest rates of suicide in the United States. According to the CDC around 6,000 construction workers died by suicide in 2022, an increase from 2021. To put this in perspective, for every incident related to bodily injury, there are potentially 6 suicides.
Designing Effective Programs
Creating a supportive culture is difficult when you have an industry consisting of workers who are not comfortable discussing mental health. On top of that, industry metrics are a contributing factor to this lack of discussion. “Historically, the industry has rewarded very high challenge, low support environments,” Kagerer explains. “We place people in situations where there are risk factors that multiply the issues. One factor is that sometimes a construction worker doesn’t know where their next job is going to be. So, if you go to where the work is, you’re leaving your support system behind and that can be a challenge.”
Kagerer met that challenge using an approach based on personalization. “We have identified people, not just on our safety team, but those who work in the field to tackle this issue. We wanted to create a better environment by listening to the people that are performing the work. To do that leaders were identified by superintendents or foremen as a person that others naturally gravitate towards when they’re looking for assistance.”
Once identified these leaders attend a year-long class where in addition to learning safety protocols, they also learn communication and leadership skills, and part of that training is related to mental health. Once certified, field safety leaders display mental health certification stickers on their hard hats, which ensures ease of access.
“This program has been a game changer,” Kagerer says. “It sends the message that we’re all in this together. Maybe somebody wouldn’t feel comfortable going to a superintendent, but they do feel comfortable going to someone they consider a peer.”
And this year the company launched the Mind Saver program, created by Asma Bayunus, the company’s EHS operations manager. It adds mental health training to training being given for CPR and first aid.
Reluctance to Ask for Help
Finding programs that workers prefer is essential. For example, it turns out that employees tend not to use the standard EAPs (employee assistance programs) that their companies offer. In a 2024 survey conducted by Firstup, among those employees who do have access to wellness programs, only 28% have taken advantage of them, and 23% say they are unlikely to do so. Kagerer has found that to be true through her own experience.
“I’m very fortunate to be able to speak at national conferences, and I’ve been in a room full of safety professionals and construction professionals, and I flat out asked the question: If you had an employee assistance program and you were having an issue, how many of you would raise your hands and use it? And the room’s silent.”
So, Jordan Foster delivers short safety bytes to employees’ phones on a broad range of issues, including stretch and flex and total worker health. Research from Firstup corroborates that these changes do work. Their survey found that 32% of employees said they would be more likely to use wellness benefits if the information were easier to find.
Along with carefully designing broad-based programs, Jordan Foster monitors changing working conditions. As heat stress increases, the company is cognizant of the working conditions and hours of employees and makes adjustments. Examining working conditions has led the company to institute a standard number of hours employees can work. This is at odds with general industry standards of very long working hours.
How companies view TWH continues to evolve, explains Kagerer. “To use the example of the issue of suicide in our industry, there are so many resources both on an industry level through various associations, and on a company level where people are talking about the issue. Awareness has really increased. In general, I feel the industry has made great strides in TWH as the industry expands our view of safety, but there still is a long way to go.”
