*2.2. The National Total Worker Health® Agenda*

A prime feature of the 1st International Symposium to Advance *Total Worker Health*® was the launch of the National *Total Worker Health*® Agenda draft, another important and major step forward in the growth of the TWH approach [12].

Over 20 years ago, NIOSH partnered with wide-ranging stakeholders to pinpoint and establish national priorities for the most significant issues affecting workers across varied occupations and industries, by means of an OSH research framework known as the National Occupational Research Agenda (NORA), now in its third decade. The goal of the first NORA in TWH (National *Total Worker Health*® Agenda) was to encourage and motivate diverse stakeholders dedicated to concurrently protecting workers from hazards in the workplace and advancing their well-being. These stakeholders include OSH practitioners, labor organizations, health promotion and wellness professionals, researchers, workers, employers, educators, policymakers, health care providers, and many others. In line with NORA tradition, NIOSH sought extensive stakeholder input during the development of the National *Total Worker Health*® Agenda. This ensured that it emphasized stakeholder priority areas not only explicitly in TWH research but also in practice, policy, and capacity building.

To that end, in 2014, NIOSH announced in the Federal Register that a draft version of the TWH NORA, entitled "Proposed National *Total Worker Health*® Agenda," was available for stakeholder review. The Office for TWH subsequently reviewed, synthesized, and responded to all comments and critiques received [13]. On the basis of those comments, the Office for TWH added and further developed goals, and it refocused the TWH definition and approach. Refining the description ensured a better understanding of the program priorities and further differentiated the approach from traditional worksite health promotion programming that does not integrate worker safety and protection elements. Prioritizing a foundation of safety first, and then integrating workplace policies, programs, and practices that grow health, creates greater worker well-being and is the cornerstone of the TWH framework.

The National *Total Worker Health*® Agenda goals reflect not only stakeholder comments but also sources in the peer-reviewed literature [6,8,14–16] and two workshops. The latter were *Total Worker Health*™: Promising and Best Practices in the Integration of Occupational Safety and Health Protection with Health Promotion in the Workplace—A Workshop [17] and the Pathways to Prevention Workshop, *Total Worker Health*®: What's Work Got to Do With It? [18].

Four strategic goals, each supported by several intermediate and activity/output goals, comprise the following domains: research, practice, policy, and capacity building.

1. Research: Advance and conduct etiologic, surveillance, and intervention research that builds the evidence base for effectively integrating protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.

2. Practice: Increase the implementation of evidence-based 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.

3. Policy: Increase adoption of policies that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.

4. Capacity Building: Build capacity to strengthen the TWH workforce and TWH field to support the development, growth, and maintenance of 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.

The continued fulfillment of these goals by stakeholders over the next years (2016–2026) will better safeguard the safety, health, and well-being of workers, support overall workforce vitality, and foster economic prosperity.
