U.S. Surgeon General Highlights the Value of Worker Well-Being and the NIOSH Total Worker Health® Approach

Posted on by Emily Norton, BPH; Donjanea F. Williams, EdD; Chia-Chia Chang, MPH, MBA; and Maria Lioce, MD

In a recent article in Public Health Reports, the U.S. Surgeon General, Vice Admiral (VADM) Jerome Adams, MD, MPH, recognizes the important relationship between employment and health. The article, “The Value of Worker Well-being,” also highlights the efforts of the National Institute for Occupational Safety and Health (NIOSH), the NIOSH Office of Total Worker Health®, the NIOSH-funded Total Worker Health (TWH) Centers of Excellence, and NIOSH TWH affiliates.

The U.S. Surgeon General recommends that employers and companies ensure that worker well-being programs are implemented more broadly and meet the needs of workers, which will lead to better health and business outcomes. To accomplish these goals, NIOSH recommends a TWH approach, which 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. A TWH approach recognizes that work is a social determinant of health and is consistent with recommendations of the American College of Occupational and Environmental Medicine and the American Industrial Hygiene Association.

As the Surgeon General has noted in previous publications, jobs can improve individual and community healthand better community health is linked to economic prosperity. Workers who report being in good physical, mental, and emotional health are more likely to deliver optimal performance in the workplace, as well as to have better health outcomes and lower risk of? injury. The design of job tasks and activities (work design); workplace management practices; and the physical, mental, and social aspects of a job environment ­are all ways in which work can significantly affect a person’s safety, health, and well-being [i]. Workplace conditions can influence workers’ mental health and stress levels. Studies have found differences in health indicators, such as cardiovascular conditions and prevalence of obesity, among occupational groups [ii]. For example, rotating or shift work, along with long work hours, can disrupt sleep and the circadian rhythm, which is our internal biological clock that regulates sleep. Research shows inadequate sleep has a negative effect on one’s mood and thinking and is associated with varied safety and health issues including motor vehicle accidents, obesity, cardiovascular disease, cancer, and musculoskeletal disorders [iii]. Additionally, a recent study estimated that, between 2002 and 2011, more than 120,000 fatalities per year were associated with certain work-related stressors [iv]. These include unemployment, job insecurity (which can include non-standard or irregular and unstable work arrangements), shift work, high job demands, work-family conflict, and limited social support on the job. Job stress and job insecurity are particular concerns as the nature of work is changing through increases in nonstandard work employments and automation.

Examples of Successful TWH approaches

In his article, the U.S. Surgeon General highlights successful research and practice related to worker well-being from the NIOSH Office of TWH and the Centers of Excellence. These included NIOSH partnering with the National Institutes of Health to identify TWH research needs through the 2015 workshop, Pathways to Prevention Workshop: Total Worker Health—What’s Work Got To Do With It?. The article also recognized the Health Improvement Through Training & Employee Control (HITEC) Program, developed by the Connecticut Department of Corrections and the Center for the Promotion of Health in the New England Workplace (CPH-NEW), a NIOSH TWH Center of Excellence. This program provides peer health mentor­ing to new correctional officers to support healthier behavior and improved well-being. HITEC includes health-related interventions designed by workers. CPH-NEW researchers found this type of participatory approach resulted in higher employee participation than programs developed by organizational leaders. According to CPH-NEW, HITEC also led to correctional officers having improved physical and mental health, associated with decreased hypertension, increased muscle mass, and decreased job burnout.

Next Steps for Advancing Worker Well-being

While the U.S. Surgeon General recognizes the above-mentioned initiatives, as well as efforts by NIOSH partners including the National Academy of Medicine and the National Business Group on Health, the article states that more research is needed on workplace well-being interventions across a variety of settings detailing the positive impacts on multiple health, human capital, and financial outcomes. NIOSH has developed a conceptual framework for worker well-being, funds six Centers of Excellence, and supports an Affiliate network to build the scientific evidence base and identify promising practices related to a TWH approach. Through collaborations among public health leaders, employers, and other stakeholders, the U.S. Surgeon General believes we can help workers achieve their highest potential.

What examples have you seen of successful public-private partnerships to promote worker well-being? Tell us in the comments below.

Emily Norton, BPH, is a Public Health Advisor in the NIOSH Office of Communication and Research to Practice.

Donjanea F. Williams, EdD, is a Health Communication Specialist in the NIOSH Office of Extramural Programs.

Chia-Chia Chang, MPH, MBA, is a Public Health Analyst in the NIOSH Office for Total Worker Health®.

Maria Lioce, MD, is a Scientific Program Officer in the NIOSH Office of Extramural Programs.


The Total Worker Health® Centers of Excellence are supported by NIOSH through a Cooperative Agreement. This blog is part of a series highlighting extramural research funded by NIOSH through the Office of Extramural Programs.



[i] Van den Broeck A, Parker SK [2017]. Job and work design. In: Knight BG, eds. Oxford research encyclopedia of psychology. Oxford: Oxford University Press.

[ii] Adams JM [2019]. The value of worker well-being. Public Health Reports134(6):583–586, https://doi.org/10.1177/0033354919878434

[iii] Luyster FS, Strollo Jr. PJ, Zee PC, Walsh JK [2012]. Sleep: A health imperative. Sleep 35(6):727-734.

[iv] Goh J, Pfeffer J, Zenios SA [2015]. The relationship between workplace stressors and mortality and health costs in the United States. Manag Sci 62(2), https://doi.org/10.1287/mnsc.2014.2115

Posted on by Emily Norton, BPH; Donjanea F. Williams, EdD; Chia-Chia Chang, MPH, MBA; and Maria Lioce, MD

3 comments on “U.S. Surgeon General Highlights the Value of Worker Well-Being and the NIOSH Total Worker Health® Approach”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Thank you for this post. I would like to inquire as to why physicians, who are 85% employed now, are not being protected. We continue to be treated like rats on a treadmill. We are probably one of the most resilient professions in the country, proven by our 13 years of rigorous training required to even begin our careers. And yet, the hospital associations and insurers, which include the US government programs, like Medicare and Medicaid, continue to just pile on the secretarial data input duties of electronic medical records, require volumes of ‘ meaningless use’ documentation so insurers, including the US gov’t, can collect personal data on every citizen. Physicians are committing suicide, averaging 2 a day!!!! Why is that not alarming to NIOSH and the US attorney general? Why our physicians rights to being the experts they have invested into becoming, not being protected? Why are physicians being used and abused to collect data when a secretary could do the same job. I was told by my hospital administrator if I wanted a scribe, since I tracked that 75% of my time was doing EHR input and forms at my occupational medicine job, that I could have one but paid for “out of my own pocket’. Really? Physicians’ toxic workplace is literally killing us. Below is one of many addressing the moral injury, burn out and physician suicide epidemic currently escalating in the United States. Here is an article well written by Dr. Robert Emmons, .Journal of American Physicians and Surgeons Volume 24 Number 4 Winter 2019.

    Thank you for your heartfelt comments about the intense stresses experienced by many physicians and their serious consequences. These real concerns for physicians and other healthcare workers have been formally recognized by many groups, including participants in the National Academies of Medicine Action Collaborative on Clinician Well-Being. NIOSH is committed to supporting this important work, including through efforts to design healthy jobs. In addition to job stress, NIOSH is engaged in a number of efforts in the healthcare sector, including with partners in the National Occupational Research Agenda (NORA) Healthcare and Social Assistance Council.

    I completely concur with Dr. Seaman. I have attended a lecture recently in which the rate of physician suicide was discussed. The presenter is actually working at a hospital and medical school system as the wellness ombudsman given the observations about stress which begins in medical school, moves on to residency and then crescendos in actual practice. In that environment, the presenter meets with all practitioners, whether students, graduated physicians or attending staff to assess for excessive stress and to remediate if possible. The rest of us do not have that benefit and are left to our own devices to hopefully recognize where we are on the stress curve and to seek help before it is too late!

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Page last reviewed: June 25, 2021
Page last updated: June 25, 2021