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Safety and Health Join Wellness in Total Worker Health

February 09, 2026 | BCSP Staff Guide

Safety and Health Join Wellness in Total Worker Health®

The work we do impacts our lives, and our well-being affects our work performance. The concept of Total Worker Health® recognizes this and seeks to address workplace safety as well as improve work conditions in order to enhance overall health and wellness.

This approach was spearheaded by the National Institute for Occupational Safety and Health (NIOSH) over two decades ago and was registered as Total Worker Health® (TWH) in 2015. According to NIOSH, TWH includes “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.”

TWH has its own Hierarchy of Controls similar to the hierarchy used in safety practice. While it is not the same as a wellness program, it can include the use of a wellness program. It also addresses mental health factors, builds psychological safety, and reduces stress.

The Total Worker Health® Hierarchy of Controls

The TWH Hierarchy of Controls is based on the hierarchy used in safety practice, modified for more general application. It is not intended as a replacement for the original hierarchy, but as an additional model for reference when implementing the TWH approach.

Similar to the Safety Hierarchy of Controls, the TWH hierarchy outlines the priority of actions to control workplace hazards and reduce harm. Primary to both is elimination, followed by substitution:

1. Eliminate: Remove the hazardâ€‹

Eliminating working conditions that threaten safety, health, and well-being is the priority in the TWH hierarchy.

2. Substitute: Replace the hazard

In TWH, this entails substituting old policies, programs, and practices with new ones that enhance worker health.

The concept of elimination is similar, while expanding the scope to include eliminating causes of stress or poor health that may not usually be considered a result of work. Like elimination, substitution in the TWH hierarchy of controls highlights practices to a greater degree than the traditional hierarchy. This might include changes like replacing a hazard reporting system where those making reports are known with an anonymous reporting system to remove fear of reprisal from the process and reduce stress.

The two hierarchies then diverge, with engineering controls, administrative controls, and PPE becoming redesign, educate, and encourage in the TWH hierarchy of controls.

3. Redesign the work environment for safety, health, and well-being

This element of the TWH hierarchy includes providing benefits that enhance your team members’ well-being, such as frequent breaks, paid sick leave, health benefits, and/or a wellness program.

4. Educate for safety and health

Safety professionals and/or human resources can provide training that illustrates the connections between safety and health, like how sleep disorders or poor nutrition can contribute to overexertion and fatigue, and provide resources or review programs that employees might use to improve their lifestyles.

5. Encourage personal change

Team members can be encouraged to make healthy choices through material incentives and encouragement, including demonstration by leadership.

The TWH hierarchy of controls illustrates the similarities and differences between traditional occupational safety and health programs and TWH. The two are complimentary systems with a great amount of overlap. Both require leadership buy-in, required for any modification of workplace practices, and TWH may increase cross-departmental collaboration, especially between EHS and HR professionals. TWH unites safety and health with wellness.

Safety and Wellness

One of the key connections TWH encourages is the link between traditional occupational safety and health practice and employee wellness. This does not make it the same as an employee wellness program, but building an employee wellness program that works with the occupational safety program can go a long way in fulfilling TWH goals.

As risk assessments involve the identification of workplace hazards to find potential areas for improvement, consider how worker health and wellness might contribute to risks. Safety professionals can, and should, include these potential sources of risk in the assessment. In assessing these risks, the case could be made to address them as part of company wellness initiatives.

For example, if it is found that fatigue is having an adverse effect on your workplace’s safety, this may be mitigated by modifications to work scheduling and by providing screenings that can correct sleep issues and disorders, like sleep apnea. You might find that mental health issues undermine individuals’ motivation to keep themselves or others safe from harm. Employee assistance programs (EAPs), access to counseling services, and a supportive work environment that reduces stigma around mental health support both safety and the overall health of your team.

Wellness programs are often offered by insurance companies, as they recognize the connection between health and risk. Consider the TWH approach, assess how health and wellness contribute to risk, and use it to improve safety.

TWH Includes Mental Health

Poor mental health has adverse effects for those suffering from it as well as their workplace colleagues.

Studies have shown a direct relationship between mental health and occupational injury, with workers exhibiting depressive symptoms having a three times greater risk for workplace injury or fatality compared to those without such symptoms, according to research by the National Library of Medicine. The construction industry has the highest overdose death rate and the second-highest suicide death rate of all American industries, as highlighted in a BCSP webinar on the topic.

These statistics highlight the importance of mental health. Providing psychological safety is a key component of TWH. By destigmatizing mental health and promoting psychological safety, an organization can encourage team members to speak up about issues they may be having as well as create an environment where safety is more valued, encouraging hazard reporting and other proactive safety practices.

You may have heard the adage the “hurt people hurt people”—The opposite is also true, that “healthy people help people.”

TWH focuses on mental health as much as it does physical health, as it acknowledges that, by recognizing the importance of workers’ mental well-being, organizations can enhance workers’ overall well-being and positively impact worker safety.

In practice, TWH brings together safety, health, and wellness into a unified approach that acknowledges the full spectrum of factors influencing worker well-being. By combining traditional occupational safety programs, wellness initiatives, and an emphasis on mental health and psychological safety, organizations can address risks more comprehensively. When leadership commits to the TWH approach, the result is not only healthier workers, but safer workplaces, with greater engagement, and a safety culture where team members’ well-being and safety reinforce one another both on and off the job.

Tags: Employee Wellness Mental Health NIOSH Total Worker Health