Center for Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, MA, USA.
Department of Public Health Sciences, UConn School of Medicine, Farmington, CT, USA.
Ann Work Expo Health. 2020 Mar 10;64(3):223-235. doi: 10.1093/annweh/wxaa003.
The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of 'integration' in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as 'Total Worker Health'. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept-i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWH-specific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and non-work exposures; (iii) emphasis on interventions to make the workplace more health-promoting; and (iv) participatory engagement of workers in pivotal ways during intervention prioritization and planning to develop self-efficacy in addressing root causes, skill transfer, building program ownership, empowerment, and continuous improvement. Thus we find that integration requires organizational change, both to engage two managerial functions with different goals, legal responsibilities, and (often) internal incentives & resources, and also to orient the organization toward salutogenesis. Examples from research activity within the Center for the Promotion of Health in the New England Workplace illustrate how these criteria have been applied in practice.
工作条件和工作环境对健康行为和中间健康状况的影响已经得到了证实，因此在预防慢性病的努力中应该考虑到这些关系。然而，传统的健康促进实践通常侧重于个人风险因素和个体行为改变。为了寻找解决美国劳动力面临的众多健康挑战的方法，美国国家职业安全与健康研究所（NIOSH）设立了“全面工人健康”（TWH）计划。该计划最初围绕将传统职业安全与健康保护与工作场所健康促进相结合的模式组织，现已演变为更加注重增强工人安全、健康和福利的工作场所计划。在 TWH 卓越中心和其他地方的 NIOSH 研究人员开展的研究计划和方法中，工作场所干预措施中“整合”的定义差异很大。对于哪些组织或个人成果最突出、工作环境应该强调多少、以及为了符合“全面工人健康”需要哪些计划要素，没有达成共识。对于整合的维度达成共识将有助于比较自我定义为 TWH 的计划和干预措施，尽管它们的内容各不相同。用于定义整合的具体标准应该是该概念所特有的，即与预测或评估工作场所健康计划成功的传统标准不同且是其补充。我们提出了一套针对综合干预措施的四个 TWH 特定指标，这些指标既涉及计划内容又涉及计划过程：（i）跨领域协调和互动工作场所计划；（ii）评估工作和非工作暴露；（iii）强调干预措施以使工作场所更有利于健康；（iv）通过干预措施优先级排序和规划，以解决根本原因、技能转移、建立项目所有权、授权和持续改进为重点，让工人以关键方式参与进来。因此，我们发现整合需要组织变革，既要让两个具有不同目标、法律责任和（通常）内部激励措施和资源的管理职能参与进来，也要使组织朝着健康促进的方向发展。新英格兰工作场所健康促进中心的研究活动中的例子说明了如何在实践中应用这些标准。
