Why Total Worker Health Matters for Employers

Investing in a comprehensive worker wellness strategy isn’t just a nice-to-have, it has become a business imperative in modern organizations. One reason is the sheer scale of health-related productivity losses: chronic diseases and injuries cost U.S. employers over half a trillion dollars in lost productivity each year. 

Workplace stress and poor mental health are also major contributors to absenteeism and turnover. Research shows that high job stress (for example, excessive demands with little control) elevates risks of hypertension, heart disease, and depression. This leads to more sick days and disability claims. It’s no surprise, then, that companies with robust wellness and safety programs see tangible benefits. In fact, worksite health programs can save companies money by reducing healthcare and absenteeism costs while improving productivity. 

One CDC study found that introducing comprehensive health promotion efforts was associated with lower healthcare expenditures and fewer missed workdays for employees.

The majority of employers today recognize these advantages. Workplace wellness programs have become mainstream, especially among larger firms. A national survey revealed that by 2017 almost half of all U.S. worksites had some type of health promotion or wellness program in place. This trend has only accelerated. 

By 2023, roughly 58% of small companies and 94% of large companies in the U.S. were offering wellness initiatives to their employees. In other words, most organizations, from mid-size businesses up to Fortune 500 corporations, now provide programs supporting workers’ health (e.g. fitness challenges, screenings, stress management resources). 

Employers emphasize wellness not just to reduce insurance costs, but also to gain a competitive edge in recruitment and retention. Healthier, happier employees tend to be more engaged and productive, creating a virtuous cycle for the company. For example, Gallup estimates that employee burnout and poor well-being account for an estimated $322 billion in lost productivity globally due to turnover and reduced performance. 

On the flip side, organizations that actively support wellness see higher morale and loyalty. Studies have found that employees are far more likely to enjoy their work and plan to stay with the company if they feel their employer truly cares about their well-being. 

In fact, comprehensive efforts to improve safety and health lead to better retention rates and improved productivity, strengthening the business bottom line as well as workforce health.

Best Practices for Implementing a Total Worker Health Program

Adopting the Total Worker Health approach means going beyond isolated wellness perks and instead embedding health & safety into the fabric of your workplace culture. The following best practices are derived from TWH evidence-based guidelines and can help your organization successfully implement a TWH program:

1. Secure Leadership Commitment: Effective TWH initiatives start at the top. Company leadership must demonstrate visible commitment to employees’ safety and health at all levels of the organization. This could mean executives championing wellness campaigns, integrating worker well-being into the company’s mission, and allocating resources to safety and health programs. Management’s active support sets the tone that worker well-being is a core value, not an afterthought. NIOSH identifies leadership commitment as Element #1 of Total Worker Health because it provides the foundation and resources for all other efforts. When leaders prioritize health and lead by example (for instance, taking part in wellness challenges or safety walkthroughs), employees are more likely to engage as well.
   
   
   

2. Prioritize a Safe Work Environment First: A fundamental principle of Total Worker Health is that a hazard-free, safe workplace is the prerequisite for wellness. In practice, this means before rolling out new wellness activities (like step-count contests or yoga classes), ensure you have strong safety protections and ergonomics in place. Eliminate or control workplace hazards at the source whenever possible. Fix unsafe conditions, improve ventilation, reduce noise, design tasks to minimize injury risk, etc. The CDC’s Hierarchy of Controls for Total Worker Health emphasizes addressing root causes and environmental factors ahead of individual behavior change. For example, if long hours and excessive workloads are causing burnout, an organization should adjust schedules or staffing (an organizational change) before simply offering stress management apps to overburdened workers. By designing work to eliminate or reduce safety and health hazards, you create a solid foundation so that health-promotion programs can thrive. In short, fix the workplace factors that make people sick or injured as the first step in any TWH program.
   
   
   

3. Integrate Health Promotion with Safety Policies: Total Worker Health is about integration. Weave health promotion into the normal operations of your business rather than treating it as a separate silo. One best practice is to review existing workplace policies, benefits, and programs and align them with TWH principles. For instance, incorporate wellness goals into your safety committees or add safety considerations into your wellness program planning. Remove any organizational barriers that separate “safety departments” from “human resources or wellness departments.” A truly integrated program might involve cross-functional teams (safety, HR, occupational health) working together on an overall well-being strategy. This ensures consistency and that everyone is working toward common goals of worker well-being. In fact, NIOSH recommends integrating relevant systems (from benefits and EAPs to safety training and facilities design) to advance worker well-being as Element #5 of TWH. One example of integration is offering flexible work policies that simultaneously reduce stress (a wellness benefit) and improve safety by cutting down worker fatigue. Another example is designing health-promoting physical work environments, such as ergonomic workstations, healthy food options on site, and dedicated spaces for breaks or exercise, which tie together safety and wellness goals. The key is to make health part of how work is done, not an extracurricular activity. Organizations that integrate health and safety efforts report stronger overall outcomes, including fewer injuries and a more positive safety culture.
   
   
   

4. Engage Employees at Every Step: A hallmark of successful Total Worker Health programs is active worker participation in both design and implementation. Involve employees when assessing workplace health needs, brainstorming solutions, and evaluating what works. Forming a wellness committee or getting input through surveys and focus groups can help tailor programs to actual employee needs and preferences. This bottom-up engagement boosts buy-in and utilization of programs. After all, an initiative will be far more effective if it resonates with workers’ real concerns (whether that’s better mental health support, opportunities for physical activity, or help with work-life balance). Moreover, engaged workers can act as wellness “champions” who encourage coworkers to participate. Confidentiality and privacy are also critical here. Employees must trust that their personal health information or feedback won’t be used against them. Employers should ensure health screenings, surveys, or wearable wellness devices maintain strict confidentiality. By creating a safe space for honest input, you empower employees to take an active role. When workers feel heard and supported, participation rises and health outcomes improve. Notably, one longitudinal study found that smaller businesses achieved higher employee participation rates, and greater health improvements, when they actively involved workers in wellness programs, highlighting the power of engagement in driving results.
   
   
   

Measure, Evaluate, and Refine: Implementing Total Worker Health is an ongoing process of continuous improvement. Set measurable goals for your wellness and safety initiatives (e.g. reduce injury rates by X%, increase health screening uptake by Y%, improve survey scores on work stress). Track key metrics like healthcare costs, absenteeism, employee satisfaction, and productivity indicators to gauge the program’s impact. It’s important to evaluate both health outcomes (such as reductions in obesity, smoking, or stress levels among employees) and business outcomes (such as lower turnover or higher engagement scores). Regularly review this data and gather feedback to identify what’s working and what isn’t. This evidence-based approach will help you refine and adjust your TWH strategies over time. For example, if you find that onsite fitness classes are under-attended but flexible scheduling has reduced burnout rates, you might invest more in schedule flexibility programs. Numerous studies have documented positive returns when wellness programs are well-implemented and evaluated. A famous example is the retailer L.L.Bean, which reported a $1.70 to $5.30 return for every $1 invested in its comprehensive worker well-being program. Many other organizations have seen significant reductions in healthcare claims and absenteeism after introducing integrated health and safety initiatives. By continuously measuring results, you can build the business case for sustaining and expanding Total Worker Health efforts. This creates a virtuous cycle of healthier employees and a stronger organization.

Building a Culture of Health and Safety

Transitioning to a Total Worker Health approach is ultimately about building a culture that values employees as whole people. It requires commitment across the organization, from CEOs to front-line supervisors and workers themselves, to prioritize well-being as a shared responsibility. When safety, health, and wellness are all viewed as interconnected parts of workplace culture, the results speak for themselves. 

Companies experience fewer injuries and illnesses, lower healthcare costs, and higher productivity and engagement. Employees, for their part, feel more supported and motivated, knowing their employer genuinely cares about their health, safety, and work-life balance.

Implementing Total Worker Health is a journey that may involve updating policies, investing in new programs, and breaking down old silos. But the payoff is a more resilient, dynamic workforce and a thriving workplace. 

By following best practices (leadership commitment, safe and healthy work design, integrated programs, employee engagement, and continuous improvement) any organization can move toward a “win-win” scenario where workers and businesses prosper together. In an era when employee well-being is directly linked to organizational success, Total Worker Health offers a proven roadmap to achieve both wellness and performance excellence. 

As the saying goes, “a healthy workforce is a productive workforce”. Embracing Total Worker Health is one of the best investments an employer can make for long-term sustainability and success.

References

1. Centers for Disease Control and Prevention (CDC): “CDC: Half of Workplaces Offer Health/Wellness Programs.” CDC Newsroom Press Release, April 22, 2019. (University of North Carolina/CDC Workplace Health in America Survey 2017 findings)
   
   

2. National Institute for Occupational Safety and Health (NIOSH): “About the Total Worker Health® Approach.” CDC Total Worker Health Program, updated May 31, 2024. (Definition and overview of Total Worker Health approach)
   
   

3. Adrienne Selko: “Total Worker Health is Coming of Age.” EHS Today, Oct. 30, 2024. (Article discussing adoption of TWH and wellness programs; cites 2023 statistics on small vs. large firms offering programs)
   
   

4. NIOSH: Making the Business Case (Total Worker Health). “Making the Business Case for Total Worker Health.” CDC NIOSH Total Worker Health, April 12, 2024. (Discusses costs of poor health, benefits of TWH programs, ROI examples like L.L.Bean, and research on flexible work, supervisor support, etc.)
   
   

5. NIOSH: Hierarchy of Controls (Total Worker Health). “Hierarchy of Controls Applied to NIOSH Total Worker Health.” CDC Total Worker Health Program, May 24, 2024. (Conceptual model prioritizing hazard elimination and organizational interventions for well-being)
   
   

6. Liz Hill et al., Oregon Healthy Workforce Center. “Total Worker Health® 101: Basic Principles.” (NIOSH/OSHA collaborative training material, 2022). PDF via OHSU, slides 30–31. (Outlines the five Elements of Total Worker Health: leadership commitment; design of work to eliminate hazards; worker engagement; confidentiality; integrated systems)
   
   

7. Gallup Workplace Analytics. “What Is the Cost of Poor Wellbeing?” Gallup.com, 2023. (Highlights impact of employee wellbeing on business outcomes; notes 75% of medical costs are due to preventable conditions, and burnout-related global losses of $322 billion)
   
   

8. OpenLoop Health: Employee Wellness Statistics 2025. “25+ Compelling Employee Wellness Statistics.” OpenLoop Blog, Feb. 18, 2025. (Aggregates data from Statista, Deloitte, etc.; notes 62% of employees and 82% of execs would stay at a company with better wellness support, and higher engagement at companies with wellness programs)