♪ [music] ♪ - [Mary] My name is Mary Conquest. I'm your host for "Safety Labs by Slice," the podcast where we explore the human side of safety to support safety professionals. We move past regulations and reportables to talk about the core skills of safety leadership, empathy, influence, trust, rapport, in other words, the soft skills that help you do the hard stuff.
♪ [music] ♪ Hi there. Welcome to "Safety Labs by Slice." When I think of large organizations related to safety in the United States OSHA and the ASSP come to mind, but I hadn't realized that within the Center for Disease Control lies the National Institute for Occupational Safety and Health, commonly referred to as NIOSH.
And if it seems naive, I'm firstly Canadian and also not a safety professional. So, I think I get a pass. Maybe this is common knowledge to all of you safety practitioner listeners out there. Today, I'm joined by NIOSH's Director for the Office of Total Worker Health. What the heck is the Office for Total Worker Health?
That is what we'll be talking about today. Dr. L. Casey Chosewood is a past director of the United States CDC's Office of Health and Safety, serving 15,000 members of the CDC workforce. Previous to that, he served as the medical director of the CDC's three Occupational health clinics, and as the medical director of the tech manufacturing company, Lucent Technologies.
Currently, Dr. Chosewood is the associate director of Strategic Initiatives and Director of the Office for Total Worker Health at the CDC's National Institute for Occupational Safety and Health, which I will be calling NIOSH from now on. He promotes the protection and improvement of the safety, health, and well-being of workers through research, intervention development, and partnerships.
He also coordinates the worker well-being, mental health, and substance use disorder prevention portfolios of the institute and co-leads the NIOSH cross-sector dedicated to healthy work design and well-being. Casey joins me from Atlanta, Georgia. Welcome.
- [Dr. Chosewood] Thank you. It's great to be with you today.
- So, because we have an international audience, our discussion isn't going to get too much into the weeds about U.S.-specific information like governmental structures, but there's a lot to learn about what NIOSH has been working on that I think is applicable and interesting regardless of where you're listening from. Having said that, let's kind of start wide and zoom in so we can bring listeners with us.
So, for listeners who might not know, what is the role of the CDC in the United States?
- Yeah, that's a wonderful question. And CDC, you know, my home for the past 20 years or so, really serves as the public health agency for the United States. And while most of our efforts are focused internally on the health of Americans, we really do see health as a global enterprise, you know, the globe is so well connected these days.
We're all dependent on each other in so many ways, and health risks and opportunities travel across borders so very easily and freely. So, while we do have many domestic programs to improve the health of Americans, we have a very large global health footprint.
We have formal outposts or stations in more than 40 countries. We deploy people all around the world to help solve public health challenges, outbreaks of diseases. We have an active program to help reduce the burden of HIV/AIDS in many countries around the world. We have a Stop Polio program, trying to eradicate polio from the face of the earth, much like with the success of the Smallpox eradication campaign in the '60s and '70s.
So, while this is a U.S. government agency, it really has a global focus.
- I was surprised, and I don't know if I'm the only one, to hear that there's an Occupational Health branch at the CDC. But it's actually quite large, isn't it? Doesn't it...
- It is. Yeah. Roughly 10% of the public health infrastructure at CDC is dedicated to workplace safety and health, and that's within our own national institute. CDC is actually short for Centers for Disease Control, instead of just one center. And one of those centers is our national institute.
Other centers would be environmental health, or chronic disease, or injury prevention, or perhaps we're most well-known for our infectious disease work.
- Yes. Well, I think these days everyone is...that's been on people's minds. So, within NIOSH, we have the Total Worker Health Initiative. Can you tell me a little bit of history about how and why that initiative was developed?
- Yeah, that's a great question. And Total Worker Health is now actually entering its third decade. So, we're really well-established as what I would call an emerging discipline in workplace safety and health beyond just a program or a plug-and-play approach for employers and workplaces to adopt. We really are interested in changing the way that we as professionals practice the field of occupational safety and health.
Seeing it as a much broader enterprise than just keeping people safe at work, but understanding that people at the very heart of their existence, they're not a work-self and a home-self, they're one-self. And the boundaries between work and home are more blurry today than ever before. And the challenges that workers face do not stay with them only in the home. They come with them each and every day in their briefcase or in their lunchpail to the office.
And likewise, the challenges that workers face on the job, they don't stay there either. We bring home those stressors and challenges and frustrations and happiness and positive issues as well. They come with us, and they oftentimes play out in our interactions with our family and our social network. So, the recognition of the strong connection was the origin really of the Total Worker Health program, finding a way to help workers on the job and off the job optimize their well-being.
And the good news is, when that happens, both benefit, our home-self and our work-self benefit. We oftentimes tell the Total Worker Health story using the sort of approach of three different companies. The first company fails to keep workers safe, and basically, workers trade their health for wages.
And obviously, that's not good for anybody, right? Eventually, the business can't be sustained, and obviously, the workforce is depleted. Those workers go home at the end of the day from that first company with less health than when they arrived that morning.
Well, other companies do better. They do keep workers safe, and those workers go home at the end of the day with the same level of health. But the ideal employer, the one that embraces the concept of total worker health, they keep workers safe, but then they also add in programs, practices, policies into the fabric of the job, in the design of the work that actually grows the level of health and well-being of that worker.
And those workers go home at the end of the day with more health than when they arrived that morning. Now, obviously, that's good for the worker, their family, their community, but those workers that went home with more health, they bring that higher level of health back to the workplace the next day. And that translates into greater productivity, fewer absences, less presenteeism, better customer service, better stock market performance according to our research.
So, it's a win-win. People who work their families and society, communities and the organizations that employ them.
- Okay. So absolutely, that's the total in Total Worker Health.
- There you go.
- So, it's been three decades, that's a lot to cover, but what kinds of sort of resources or activities has this initiative created in its time?
- Right. Yeah. We're just beginning that third decade. So we're 20 years in. And I would say some of the most sort of headliner accomplishments include our significant network of research and partnerships. At our very heart, NIOSH, our institute here, part of CDC is a research agency. We, in fact, do a lot of the research that informs the Department of Labor's enforcement of workplace safety.
So, within NIOSH, Total Worker Health is a part, but we also have a National Protective Technologies Laboratory looking at and certifying personal protective equipment that people all over the world use for safe job performance. We have an injury prevention center to keep injury levels low.
We have a motor vehicle safety center. We have an aging worker center. We have a future of work initiative. We have a technology focus in some of our centers. So we're really looking at the broad span of exposures that workers experience. So, research is really in our DNA.
The research at the Total Worker Health Program, though concentrates across 10 academic centers that we fund to do primary research in this connection between work and home, work and the rest of our lives. And these centers are funded with five-year cooperative agreements to enter into, you know, these really challenging workplaces and circumstances and find interventions that actually make a difference in people's overall health and well-being.
We've been providing that funding for the past 20 years. In addition to those 10 funded centers, we've also built a network learning-living Laboratories around the country that we call the Total Worker Health Affiliates. We have 58 now. These are groups that we have signed a memo of understanding with, we don't fund them, but to enter joint cooperative activities to learn from each other.
So, it's a social network of people who are implementing total worker health, as well as serving as learning laboratories, trying out things in their own setting. This integration of health, safety, and well-being interventions in workplaces to improve overall work and work performance.
The other thing I would draw your attention to is now we have six centers who are providing educational credentials, either a certificate program, a master's degree, even a Ph.D. in the field of total worker health. So, we're really trying to improve primary research in this space, build important partnerships, translate that research into practice, and then grow the field so that we can actually have total worker health professionals seated across all workplaces in the country.
That capacity building, that workforce development piece to me is a critical part of our sustainability, and it's going to be a focus in this third decade to come.
- Wow. Okay. That's a lot of material. I have a lot of questions. But one thing that struck me that I hadn't realized was the interface, you were talking about the learning labs.
- Yes.
- If I understand that right, that's really where the Total Worker Health Initiative and the individual or the practitioner come together. Is that correct? So, these labs are happening in real workplaces?
- Exactly. Good example would be one of our earliest affiliates was Dartmouth Hitchcock Medical Center in New Hampshire. It's a very large healthcare system with tens of thousands of employees, and they were one of the first to put in place a total worker health approach to their workplace safety and health programs. Looking at this really integration of keeping workers safe and adding to the quality of their work experience so that at the end of the day, they're happier, healthier, more engaged, more likely to stay on the job, able to work longer if they chose to do so.
They're an example of one of those learning-living laboratories, and their leadership has gone on to train so many of the other new affiliates who've joined because of their decades of experience. The affiliates, and I mentioned 58 of them, about a third or so, are other academic institutions who we don't fund, but they're doing research that's well-connected, and they really serve as sort of the professors, if you will, of the affiliate network group, sharing their insights, their expertise.
Many of them are from occupational health psychology programs, industrial hygiene programs, really with a bedrock of knowledge that all of us within the affiliate network can take advantage of. Another third are there, because like you said, they're employers, they're large hospital systems, they're medium-sized businesses that maybe have tens of thousands. Mount Sinai Health system has more than 80,000 employees, and they're putting these practices in place and giving us valuable feedback about what's working, what's challenging, what issues need to be solved.
The other third are member organizations like the American Occupational Health Nurses Association, or the American College of Occupational and Environmental Physicians. So, these are membership organizations that really represent practitioners across the full spectrum of occupational health and safety.
ASSP, AIHA are two other big examples of Total Worker Health Affiliates. They really serve as great conduits of information, both our learnings out to their membership, as well as some of the challenges and trends and issues that their memberships are facing that get fed back to us to help inform our next challenge, our next research portfolio, if you will.
We use this information from the affiliates to then go out and develop the call for proposals for our centers of excellence, so that we can be learning the most important knowledge that will be most immediately applicable to the workers that we're serving.
- That's a lot of different areas of research and a lot of different connections. If I was a listener and wanted to learn from that research, where would you find it? What research questions are addressed? Where are the findings available? Like, I realize it's not just one answer with all these partnerships, but where might be a good place to start?
- Yeah. I actually love that question because it is a very big apple to bite into. So, oftentimes people have a certain issue that they're trying to solve, and maybe that's their entry point into the total worker health portfolio, if you will. And that's perfectly fine to us.
The other good news is that we are so well-networked across all of our institute and other parts of CDC that if we don't have the answer, if we're not the expert, we can find the expert within the field of public health. So, a quick way just to get to know us is just to send us an email, twh@cdc.gov. That's just if you have a quick question, say, "Hey, what do you think we should do about this challenge?"
We're happy to connect you to our resources in that space or to help find someone else who can help you. We have a really robust social media platform as well. So, we would invite people to consider our LinkedIn connections, our Twitter, our Facebook, those are perhaps our most prolific social media platforms.
We also have a quarterly newsletter that goes out, which really summarizes all of the late-breaking research, and it is perhaps the easiest way to stay up-to-date with all of our findings. We call it Total Worker Health in Action. The website itself is also really rich because it has a section that I really love called Promising Practices. And it is probably now 50, 60 case examples of people are using the total worker health approach in their own applied employer setting.
And the learnings that you can get just from reading maybe 25 minutes, many of these promising practices will really get you the flavor and the sort of the underpinnings of what total worker health is all about. Because people can see themselves in those same situations, and they can say, "Wow, that's a really novel approach to solving this issue."
So the Promising Practices' section of our website, the newsletter, our social media feeds, those are really the best ways to stay up-to-date with our most essential total worker health information. We also have toolkits and survey examples and really applicable approaches to, you know, putting in place some of these things.
How can you do a total worker health assessment of your own workforce? How can you measure the well-being of your own workforce? We have great tools to do both those things. And, you know, I mentioned our 10 funded centers. Each of them have a very rich website as well because we fund them not only to do bench research, but to produce communications and products and tools and resources that employers can use.
So, the good news is with the 10 centers, they also have sort of specialty focus. Some focus more of their work in healthcare, others in construction, others in perhaps manufacturing. We have some dedicated to small businesses, some to agriculture. So, we have a variety of specialties within our funded centers doing research across a pretty wide spectrum of topics and challenges.
And because of that variety, people can oftentimes drill down to one center that best reflects their own challenge or need.
- As you're saying this, it's occurring to me that, of course, all of this is freely available on the internet. And so when we're talking about, you know, our listeners are from all over the world, this information is available to them as well.
- Right. At no cost as well. There's no charge for any of our services.
- So, you talked about some of the international collaborations and partnerships that the CDC does as a wider body. What are some of the international initiatives, partnerships, collaborations that are more specific to either NIOSH or even Total Worker Health?
- Yeah. We are very fortunate to be able to learn from some of our international partners, because it's really not just a one-way street. It isn't just our exporting our information or expertise to our partners. We actually find that some of our colleagues in Europe and Australia and in Canada are doing a much better job than the U.S. when it comes to the control of some hazards and to some aspects of total worker health.
A good example is psychological safety. The United States does not have a psychological safety standard that's enforceable by our Occupational Safety and Health Administration, the enforcement arm of the Department of Labor. We don't have such a standard on a national level. Unlike the UK, Canada, Australia, many countries in Europe have an enforceable mental health psychosocial safety standard in place.
We're envious of that. So, we're using the learnings from those standards across the country to help better inform our own pursuit of, you know, interventions in workplaces here. Because of that, we've built really some strong relationships with the enforcement folks in the UK, Canada, and in Australia as well.
I've been able to go visit some of them and see firsthand how they're operating these issues and challenges. I'm also really excited about a recent collaboration we've had with the Italian Occupational Medical Physician Society. Because of their interest in total worker health and our collaboration, they've actually introduced language into the law in Italy that every occupational setting will take a total worker health approach to developing their programming.
This is a watershed moment for us to see national legislation actually name the total worker health approach and place it into enforceable laws related to workplace standards for health and safety. So, that is an example of how we've been able to export knowledge and information to other countries to help better inform their own approaches to some of these challenges.
That's brand new. They've just introduced that legislation within the last year. It's enacted as law. We're really looking forward to learning how that goes. We don't have, you know, such personalized language in our own legislative authorities when it comes to this issue.
So, it's really a good opportunity for us to learn, as well as to share. One last thing I'll add, we've just recently with one of our partners developed a new professional society for total worker health professionals, and about a third of the members in that society are international members. So, it represents, I think, the breadth of interest, but also how much we can learn from each other. So, for those interested, the Society for Total Worker Health Professionals has its own website.
It's a very low-cost membership. It's not a government entity, it's a standalone entity. We've licensed to them the ability to use our brands, Total Worker Health, and we are a registered trademark. But it's not because we're trying to be exclusive, it really is because we're trying to protect the meaning of the actual program and preserve it long-term.
- I wanted to get into that actually because you've talked about it, like, at the top of the show about the approach of looking at the totality of the worker, not just at work. But if you were to meet someone, you know, who knows nothing about this or even if you meet safety professionals, what kind of sort of elevator pitch or very short summary would you say describes what total worker health means?
- Yeah. I, you know, actually get the opportunity to do that sometimes. Even though we've been around a while, there are lots of people who still haven't heard our story. So usually, I start by saying something like, you know, your job probably is a lot more important and influential in your life than you think it is. There are very few things in life that will make you, like, pick up and leave your home, your family, all the people you know, move thousands of miles away to set up a new life for yourself.
There are very few forces out there that will do that, but a job will do that. And a job influences not only your income, but so many of the other opportunities that lead to either a good life, a challenging life, or a bad life, right? So, getting the work-life interface right is so vitally important. That's the heart of total worker health research. We are trying to find ways where organizations take the lead in keeping their workforce safe, but taking a step beyond that to really grow their health.
A better life should be a take-home benefit of a good job. And companies that get Total Worker Health right, do that. And you know what? Their workers love it. They love their employer. They're more engaged. They're more productive.
They stay longer. They invite their friends to come work for a company that they respect. And those are the promises of a company who really gets Total Worker Health. And our research shows that this approach works. It's possible, it's sustainable, and it really is, we believe, going to become a differentiator. The company that...especially younger workers who are demanding more and they're looking for this balance, they're going to demand companies that respect them, that have healthy supervision, that give them opportunities for growth and development, and respect that they have a life away from the job.
Those are really at the core of a high-quality Total Worker Health program.
- You mentioned a little bit about some of the tools that you've developed that are on the website. And I'm wondering if you could talk about, I don't know, just a few of them and say how the sort of average, I don't think there's an average safety practitioner, but how the safety practitioner out in the field might take advantage of them.
- Yeah. I love that we have an essentials...what I would say is really one of the best starting tools for anyone who's interested in total worker health, either to implement it, but just to learn about it. The Essentials of Total Worker Health really is a nice little workbook. It'll take about 15 to 20 minutes to go through. That helps you assess how your company is doing from a baseline, if you will, total worker health perspective.
The Essentials for Total Worker Health, very readily, easily findable on our website is a super place to start. For the company that's a little bit more organized and ready to go and wants to do an assessment of their current environment, if you will, in a very comprehensive way, we have a new tool that's only been out a few years, it's called the NIOSH WellBQ.
WellBQ stands for Worker Well-being Questionnaire. And you can Google NIOSH WellBQ, W-E-L-L, with the letter B, the letter Q, and you'll be taken to this really valuable tool. It's 68 items, takes about 12 to 15 minutes depending on fast survey taker or a slow survey taker. But it really looks at worker well-being across five domains, including safety climate, including how your relationships are with your supervisors and peers, your well-being as it relates to your family, to community, to society.
Your personal health status. So, it's looking across so many domains that we have validated as all critical pieces of an individual worker's well-being. When you take the survey in a population, all of a sudden you have a very valuable set of guidelines and information about where people are thriving and where they're struggling, and it allows you to prioritize interventions.
Do they need to be on the personal health side? Do they need to be on the relationship side with workers and their supervisor? Is it more home and community? Is it more challenges that they have with peers? Is it more their injury proneness because safety issues have not been well-addressed? This allows companies to use the measure of worker well-being to help prioritize where they invest in improving the workplace environment.
It's validated. We've done it in many settings already. We're also developing a data clearinghouse for the WellBQ, where folks who administer it can submit their de-identified data into a clearinghouse and then compare their results in their organization with others in like industries or demographics.
So, it's going to be a valuable additional way to gauge your progress against those in similar industries or in similar settings.
- Well, and as far as policy, it sounds to me that over time, the accumulation of this kind of data will be fantastic just to see how are things going on a large scale, you know, nationally or industry-wide in terms of these things. Yeah. That'll be some interesting analysis.
- Yeah. You know, I love the fact that you mentioned policy because this is the very kind of tool that will help organizations determine where those policies need improvement. Now, I mentioned that there are really three components when people add health to a job programs, day-in, day-out operations that improve people's knowledge or ability to access services and grow their own health.
Practices, what are we training our frontline supervisors to do because they have so much control and so much power in the day-to-day success or decline of our well-being? And then lastly, policies.
Those are the three P's of Total Worker Health, programs, practices, and policies. Policy is the most powerful. Why? Because they help every single person on the job. A program's only good if people take advantage of it. A good supervisor practice is only good if you have one of those supervisors who knows those healthy practices. Policies set the stage for everybody in the organization to benefit, and they're the most powerful lever that organizations have.
They set the tone, the climate, the culture of an organization. We recommend investing a lot of effort in getting policies right, followed by practices, making sure those policies are put into action. And then lastly, developing programs that help sustain some of these changes.
- I'm going to switch gears a little bit here because although I said we wouldn't get too much in the weeds, I don't think this is in the weeds, but it's interesting to me that OSHA, which is the regulatory body in the U.S., it also develops resources and information for OHS practitioners. You mentioned when we spoke before that both entities were created with the same legislation, but were purposely developed as separate entities.
So, can you explain some of the thinking behind that?
- Yeah, we both arose from the Occupational Safety and Health Act of 1970. So, we've been around now maybe, what is that? Like, 50, 53 years, something like that. We just celebrated our 50th anniversary not long ago. And you're right, the legislation called for the establishment of the Occupational Safety and Health Administration, the enforcement arm of health and safety in U.S.
workplaces within the Department of Labor. But purposefully, NIOSH, the National Institute for Occupational Safety and Health was formulated to go into the Department of Health and Human Services. So, we are sister organizations, if you will, closely partner on many different things, but NIOSH stays out of the enforcement business.
OSHA spends a lot of its effort in enforcement. To me, the benefit for our institute in that regard is that we are separated from some of the more challenging areas of enforcement, and we get to focus on problem-solving with organizations.
- They're more likely to work with us and to collaborate with us if they're not worried we're going to use information we get from that collaboration to find them or punish them in some way. So, we take a very broad approach to partnerships. We will work with any organization that has a challenge. We have this very nice consultation model called the Health Hazard Evaluation Program, where any worker, labor union, owner, operator of a company can come to NIOSH and say, "Hey, we're really having a major challenge with this issue. Can you help us solve this issue?"
And we will send in a team to do a health hazard evaluation and help find the best approach for decreasing the risk that those workers face. It's an excellent example of how collaboration is quite easy and low-risk for employers. They might not perceive the risk as being quite so low with a regulatory body like OSHA, but nonetheless, we respect the work of OSHA.
In fact, much of the research in our laboratories across all of the NIOSH campuses inform much of the scientific underpinning that sets the standards that OSHA enforces, the chemical exposures, the noise exposure levels, the PPE requirements, the construction safety guidance, and other documents that our research has developed. Those inform the standards that OSHA uses in their specific and general duty clauses to actually improve the safety of workplaces.
- I've spoken with people who work with OSHA and they say it's unfortunate that they're seen as the safety cop of the safety cops, because they do actually love it when people reach out and collaborate with them. And they'd much rather see that than having to enforce. But it's true that without that enforcement, I don't want to say cloud, the enforcement aura about NIOSH maybe it's a little bit easier to reach out to them.
- We strongly value what we would call the tripartite approach to partnership. So, it's really the government with private industry and labor. That tri-part approach we feel like is usually the most efficient, strongest way to settle any challenge, getting input from all three, finding common ground, trying to find the win-win-win across all of those is really a very important part of our effort.
- So, in your years with NIOSH and with Total Worker Health and just over your experience, is there anything that surprised you in terms of work? So hopefully, good surprises and success stories, but anything that's made a big impression or maybe changed your personal approach to the issues that you work with every day?
- I'll start with a pleasant surprise and then maybe move to one that was surprising to me and continues to be a big challenge. So, the pleasant one was really how the majority of workplaces are very much interested in improving the experience of their workforce.
It is not a hard sell for us to convince employers that these things really matter. And at first, I wasn't sure that would be the case. I wasn't sure we'd be met with a lot of criticism, that people would say, oh, my goodness, you know, that's not possible. It's too expensive. Our research shows that there's really good value for these types of investments, good return on investment, if you will, in these areas.
And companies seem to get that because we have more than ever companies interested in approaching the challenges they're facing using this comprehensive integrated health and well-being approach. So, that's a pleasant surprise. It wasn't an uphill push. It's not a heavy sales lift to get people to buy in. That's great. We are oftentimes limited by capacity to serve the people who want our help to get started.
So, it's a great issue to have. The perhaps challenging learning I have come across over the past five, six years, so later in the development of total worker health is the real challenge of substance use disorders and work. I knew in the back of my head as a physician that there were always a challenge underneath of substance use.
And, of course, I understood the connection between harmful substance use and the risk for safety and job performance and attendance, and obviously, the health effects that come from substance use disorder. But what I did not realize was how some jobs themselves strongly predispose to substance use disorder. And that was a huge wake-up call for me.
And because of that evolving sort of truth related to these strong connections, we've dedicated quite a bit of our research and our efforts over the past several years to this connection between work, job, industry and occupation, work quality, work injury, and substance use disorders, trying to better understand that connection and find ways to interrupt that influence because it is killing a generation of certain workers.
The leading cause of death in the state of Massachusetts in the workplace was drug overdose in 2015 and 2016. It wasn't a motor vehicle accident. It wasn't fall from a construction site. It wasn't struck by or any other type of injury, the leading cause of workplace death in that state, one of our most populous states, was drug overdose in the workplace.
That is a wake-up call. We see high burdens of substance use disorder deaths and overdoses in construction, in mining, in agriculture settings, in fishing. And it's not to indict these workers, it isn't folks prone to substance use disorder go into these occupations, unfortunately, this is a type of work setting, a type of work arrangement, an insecure job, a boom-and-bust job, a job that predisposes to injury, a job that doesn't have paid sick leave benefits, which encourages people to take pain meds to get a paycheck.
All of those things lead to increased risk factors for substance use disorder and death. And that was a dramatic uncovering of some of these challenges that have really strongly influenced me as a practicing physician and as a public health official.
- So, I was going to ask about the conditions, but I think you've just named them really, like, the conditions of industries or jobs that might predispose someone to this sort of thing. So, insecurity, maybe lack of access to healthcare, boom and bust, which is economic insecurity, - Right.
Yeah. I would say not having a job at all, so unemployment, certainly a risk factor. So, that is an important one, but having a bad job, right? One that predisposes to injury, one that doesn't have good benefits, one that is not secure. So, if I don't know I'm going to have a paycheck two weeks from now, my outlook on life is significantly different. And the type of work arrangement that we see in some industries is extremely insecure.
And that predisposes to this hopelessness, you know, these feelings of loss of really just sort of, you know, sort of a grim outlook on the future, if you will. And then those jobs that predispose to injury, which, unfortunately, many of these do and lead to painful work each and every day.
Maybe you're not injured, but the work is so demanding that you have pain as a constant underlying theme to your employment that also predisposes to pain medication use. And we know that the bridge to illicit drug use is often a prescription drug. It isn't that like cannabis or marijuana is the bridge to opioids, it's a prescription opioid is a bridge to illicit opioids.
And that connection is very well seen in many occupational settings.
- And I imagine one thing that makes it more challenging is that there is still a stigma about, you know, well, you're choosing to do this, and yeah, there's still absolutely a stigma around substance use.
- Yeah. And, unfortunately, that plays out in a number of ways, stigma people, especially macho climates, you know, really strong male-dominated like construction, fishing, farming, those sort of things, people don't access services even if they might be available. And there's the social construct around substance use as well, right?
Go out with the guys and have, you know, lots of rounds of beers together. There's a social climate that also may predispose in some occupational settings as well. But stigma I think is a huge issue. We're seeing less stigma in younger workers, which is a good thing. But many of the traditional types of employment, and among older workers and male-dominated careers, we still see high levels of stigma, not only for seeking treatment for substance use, but any mental health concern.
And that, unfortunately, leads to higher rates of suicide death and depression untreated in some of these work groups as well.
- I'd like to zoom out again now into what do you see for the future of the occupational health industry. On an industry level, what are some of the biggest challenges facing safety practitioners today?
- Yeah, it's interesting that you raised that question because we, as I mentioned, we're starting our third decade and we plan our research portfolio in decade-long spans, but then we readjust, obviously, as new challenges arise. And we've been thinking a lot about where we're going to emphasize our effort over the next decade where we're going to ask our centers to propose research, what are the areas that we think are the most pressing.
This area of substance use and impairment. And work is going to be one of those areas, both because I feel like it's an underappreciated connection. All of us realize that substance use is an issue in the general population, but when you see such a concentration in certain occupations, it's a wake-up call that the disparity is really the story here and that we need to focus on specific solutions for those specific jobs.
- I don't want to belabor the point, but if you're a construction worker in the U.S., your chances of dying of drug overdose are six to seven times that of the average worker. That's how dramatic the disparity is. So, we're going to invest in substance use disorder and work as a very important research horizon to really come up with better solutions for those.
There are two others where we're going to focus heavily. One is what is technology in all its many forms doing to the work experience? Many workers tell us they struggle to keep up with the technological demands, even updates on their iPhone or their software and, you know, programs that they use every day are constantly being updated and upgraded such that they feel stress using programs and apps that they've used for decades, right?
The truth of the matter is that our brains do not evolve nearly as fast as the pace of technological evolution is requiring. And we are the most critical link, the most fragile link in any operation is the human, not the technology. We talk about, oh, the technology went down, or the platform went down, or the app failed. In truth, they're not the fragile element of the operation, we are the most fragile element of the operation.
We need the most investment, we need the most insulation and the most contingency, not our systems. So, we're going to focus on the stressors, the workplace stressors that are rising from technology, from AI, from job replacement, from job loss, from the need to constantly upskill and reskill how that is playing out in the workforce, both for good.
Certainly, there are very many technological innovations that have lowered risk for workers, but, unfortunately, we're seeing just the opposite in many others. Invasive monitoring of workers, the remote worker keystroke counting, and eavesdropping, and constant, you know, sort of surveillance, if you will, of people working remotely is a very commonplace.
So, what are the health impacts of this? What are the solutions that organizations can use? And how can we empower and encourage workers to have more agency and autonomy over technology? And then the third area that I think we'll focus on heavily, and that's because workers and workplaces are demanding this and burnout is driving this issue as well, is we need better solutions around workplace mental health and psychological safety.
If we have one top issue that employers are bringing to us now, it is related to mental health. How can we help our workers who are struggling, not just necessarily with work issues, but life issues as well? And we know those two connect. So, our focus on workplace mental health will be really a primary focus on decreasing the exposures of unhealthy work, whether it be unhealthy supervision, too much work and too little time, the pace of work, the technology of work.
How can we lower those demands so that people have a better match between their innate skills and what's being demanded of them on the job? You can redesign work. You can improve supervision. You can improve flexibility so people have options. Those are really where we will focus on actionable solutions for workers that at the end of the day, we believe will lower risk for depression, lower risk for anxiety, lower absences related to mental health concerns, decrease spending.
A huge area of concern for employers is the cost and the loss of continuity that comes with absences related to mental health. Burnout is threatening so many occupations as well. Like, we expect maybe up to a quarter or a third of hospital nurses to leave the profession because of the very high levels of burnout we're seeing in healthcare.
This is a vexing problem that we see, it's ubiquitous in almost every workplace. So, I think it's an important area for increased investment and research.
- And those three are also so finely interrelated, I think, that they'll complement each other. The research in each of those areas will complement solutions in the other material.
- Yeah, completely agree. We are trying to explore some of those links. You know, mental health is broad, substance use disorder some people say is a mental health disorder, others say, no, it's something different. At the end of the day, we're really just trying to find solutions that help workers and organizations manage these realities that they're living with each and every day.
- Is there anything, in particular, that excites you or brings you hope for what's happening in the industry?
- Yeah, and I alluded to it earlier, but it's the fact that younger workers are more comfortable demanding more of their work experience, right? I have two sons both in their early 30s who make it very clear that if we're not really pleased with this work, if it's not doing it, if you will, for us, we're going to go find another job, right? One of them has opened his own shop so that he's sort of able to call the shots.
So, I think there'll be more entrepreneurial approaches in the younger generation. More I can do this on my own and craft my own work-life interface the way I want it to be. For those who take a job from an employer, they're also feeling more empowered to speak up and ask for certain benefits. We're seeing new benefits design strategies approaching because younger workers are wanting more.
I think about a third of workers say that they would like more mental health benefits than actual vacation days or higher pay. So, it's a very powerful movement out there to really from the worker side, demand more high-quality experiences when it comes to the work environment.
So that makes me excited and happy to see that agency autonomy, that empowerment, that younger workers are making in our modern workplaces. And I think with that younger worker also comes more willingness to seek help, to engage in, you know, both recognition and treatment of challenges around mental health and substance use disorder that we didn't see in older workers.
And I also think they're more likely to engage in peer connectivity to support each other. And some of our emerging research shows that perhaps more than anything, the social bonds you build at work are one of the critical keys to engagement and enjoyment and a substantial source of well-being when it comes to the work experience. So, peer supports, decreasing stigma when you do need help, accessing services more readily, and then lastly you know, just demanding more of the job experience.
It's not just a paycheck. Really it needs to be more than that. And I think younger workers get that far more than my generation of workers.
- Yeah, I know. I'm caught in the middle between boomers and millennials, I'm Gen X, but I know there's sometimes a joke about how millennials are so demanding, but it has occurred to me that their demands are actually making things better for all workers. So, maybe we shouldn't complain.
So, I have a few questions that I ask every guest at the end of the interview. If you were to develop training for tomorrow's safety professionals and putting aside all technical training and just focusing on soft skills or interpersonal skills, what do you think would be the most important skill to help them develop?
- Yeah, I actually love the whole concept of improving soft skills of leaders and managers. Because to me, it is where the rubber meets the road. They are the ones who hold all the keys to your success as a worker. That frontline first-generation leader, supervisor, manager, team lead, they're making the call on everything.
When you start work, what your deadlines are, the pace, all of those elements under that person's control, we don't invest enough in their skillset. We don't give them the tools they need to be able to do that very important role well each and every day. So we say, when you're ready to invest in Total Worker Health programs, invest in skills development of that frontline supervisor and manager.
I oftentimes say they are more important to your health and well-being than your personal physician will ever be because the exposure, sort of the span of exposures they control is so massive. So, they need better listening skills. They need to understand the tenants of supportive supervision. They need to be able to solve problems.
Recognize early when someone's struggling, give them the assistance and guidance they need. They need to have a network of people they can quickly refer to if someone has a need that exceeds their skill set. They need to have no stigma related to some of the challenges that are existing. They need to be able to relate on a personal level to their worker. I often get asked the question, how personal should I be with my own life back to my staff?
- Yeah. Where are the boundaries there?
- Yeah. My answer is, let the staff person decide that. So, if they share a lot of details about their personal life, then you should mirror and match that. If they're fairly standoffish, they don't want to go into much detail, no need for you to because it may be seen as uncomfortable or invasive. Match their level of openness and candor when it comes to personal issues. But at the very same time, be willing to share your own experiences.
The more human you are as a leader, the more vulnerable you become. All of the research shows that the trust and the engagement, the interaction at that level improves dramatically. We also need really to give folks the power on that frontline to solve problems. We call it the participatory approach, but basically, it says, the people are most affected by problem need to have a strong seat at the table in solving that problem.
So, training in the participatory approach to problem-solving of any type is critical for these frontline managers. Softer skills, listening skills, vulnerability, and oftentimes people get into these roles because of their technical ability, not their people's skills, right? People skills are more critical than technical ability in almost every job, especially in the frontline management.
So, that would be my sort of wishlist for improving the work experience for everybody. The other strong thing you've mentioned earlier is policy, right? That helps people who don't even know they have an issue that needs help, right? Improved policies is the sort of...it floats all boats higher because even people would never access any care or any issue or never admit to a problem, they're benefiting from improved overarching workplace policies.
- If you could go back in time to the beginning of your career, maybe your career with NIOSH, you can choose whichever point in time you like. What's one piece of advice that you might give to yourself?
- Yeah. You know, I wish that when I was in the private sector or working full-time as a clinical occupational medicine provider, that I had known what I know now because it would have dramatically changed my medical directorship when I led a tech firm's, you know, occupational medicine program. It would've changed the programs that I put in place to develop our health promotion efforts.
It would've informed a much better employee assistance program that I was in charge of. So, I really regret that the skillset I have now was not available to me when I was practicing medicine in a clinical setting or in an occupational medicine setting day in and day out. So, that drives me to really try to target those young professionals in those positions now.
This is critical information you need that will help you succeed in your job and make a world of difference to all of the employees within your care. So, I wish that I had that opportunity, but I would also, you know, say that I will give myself a little bit of grace and really say that I'm able now to hopefully influence much greater populations than I was able to as a practicing physician.
And to try to create new science and new approaches and new discipline, if you will, that can improve the work of every industrial hygienist, every safety engineer, safety professional, every employee assistance provider, every workplace manager, leader. So hopefully, our effort will continue to find good uptake and will be able to influence generations of future folks.
And I'm really hopeful that total worker health professionals of the future really are found in every workplace, in every setting because that integrated, broad, comprehensive approach of understanding work and home, work and life is really here with us to stay. And I think it's more critical than ever that we optimize that awareness.
- So, you did actually mention a bunch of these things, but I'm wondering if you can summarize quickly how can our listeners learn more or sort of tap into some of the resources and topics that we discussed today?
- Yeah, absolutely. The simplest way to find all our resources is just to Google, Total Worker Health. You're going to immediately go to our website, to our homepage, and there you're going to see very easy-to-follow groupings of our promising practices or our links to the centers of excellence, all those 10 funded centers that each have their own very rich websites with lots of free tools and content and webinars.
We have a very large archive of webinars with all sorts of training topics covered there. We have a textbook, too. You know, I mentioned that we have six-degree programs or certificate programs. There's a Total Worker Health textbook that we published a couple of years back with the American Psychological Association. So, for people who want an academic approach, we have a textbook that you can access as well. And we have really good tools and resources both on our own page with links to the really vast occupational safety and health network within NIOSH and CDC, our parent organization.
And then lastly, I'd invite your listeners to reach out to us in person, twh@cdc.gov is a surefire way to get a response really quickly from our team, and we'll be happy to direct you in any way that we can.
- And if people want to reach out to you on the web, where's the best place to find you?
- Yeah, probably by email, twh@cdc.gov is really one of the easiest and quickest ways to find us. You know, by Googling Total Worker Health, you will also have access to that email address. So, if you just want to remember Google, Total Worker Health, you're going to have a very easy way to find our resources.
- Four words to remember, folks, Google Total Worker Health. There you go. That's it.
- You got it. I'm on LinkedIn as well. L. Casey Chosewood. So, I would love folks to follow me on LinkedIn. It's where really I showcase some of our latest and greatest.
- Well, that's it for our show today. I'd like to thank our listeners all over the world. The Safety Labs team appreciates your input, your suggestions, your discussion on LinkedIn, and of course, we love it when you share the podcast with your colleagues. Thank you, Casey, for taking the time to share your work with us today.
- My pleasure. Thank you.
- And to the "Safety Labs by Slice" team, as Ted Lasso would say, "I appreciate you." Bye for now. Safety Labs is created by Slice, the only safety knife on the market with a finger friendly blade. Find us at sliceproducts.com. Until next time, stay safe.
