2.9.2. Healthy Work Design and Well-Being

In addition to forthcoming critical work by external TWH stakeholders and partners, NIOSH continues to make considerable headway. The TWH program has had a widespread impact on other NIOSH programs through the recognition of well-being as an imperative component of the NIOSH intramural research program structure. Indeed, the Office for TWH influenced the overall research trajectory of NIOSH, bringing to life the construct of worker well-being [25] into the decades-old NORA portfolio. This included enhancing future collaborations and deepening connections in the area of improved work design and well-being across NIOSH.

The programmatic synthesis of elements of three separate and independent programs: TWH, economics, and work organization and stress-related disorders is evident in a newly developed program entitled, Healthy Work Design and Well-Being (HWD). HWD is one of only seven NORA cross-sector programs in the third decade of NORA. The HWD program seeks to improve the design of work, work environments, and management practices in order to advance worker safety, health, and well-being. This program works with partners in labor, industry, trade associations, professional organizations, and academia to accomplish its goals.

Work design has implications for the safety, health, well-being, and functioning of individuals, families, groups, organizations, and communities. Like the TWH approach, the HWD program views workplaces as settings not only to impact work-related risks, such as unsafe working conditions, high job demands, and low control, but also to promote workplace programs and conditions that provide support for workers' health and well-being, such as smoking cessation or promotion of healthy physical activity [54]. The close alignment and potential for synergy with TWH efforts is apparent, rich, and compelling.

Healthy work design efforts include primary-level interventions that change the design of both the physical workspace and work processes to reduce sedentary behavior and increase physical activity during the work day. Furthermore, these efforts collectively serve another critical function, which is to support the overall well-being of workers. Worker well-being characterizes quality of life with respect to an individual's health and work-related environmental, organizational, and psychosocial factors [25]. Organizational practices that focus on prevention of safety and health hazards and promotion of well-being typically involve multi-level approaches that include commitment and involvement from management as well as worker input on identification of effective strategies.

Going forward, the HWD program, along with TWH professionals and other partners, will further our understanding of healthy work design and advance worker well-being through researching, implementing interventions, and translating findings into practice.

#### 2.9.3. New Workforce Challenges

As time goes on, the Office for TWH will strive to bring credible solutions to not only on-going but also new challenges facing workers and employers. One such pressing example the CDC is prioritizing—as is the Office for TWH—is the need for comprehensive remedies to the U.S. opioid epidemic, from which the workplace and workers are not immune.

The U.S. Bureau of Labor Statistics reported that overdose deaths at work from non-medical use of drugs or alcohol increased by at least 38% annually between 2013 and 2016. The 217 workplace overdose deaths reported in 2016 accounted for 4.2% of occupational injury deaths that year, compared with 1.8% in 2013 [55]. Opioids are often initially prescribed to manage pain arising from a work injury though workers can develop a subsequent non-work injury related dependence, making this a critical issue for all those involved in worker safety, health, and well-being. Though opioid use/misuse rates are higher in certain occupations/industries, there are some commonplace factors associated with use/misuse; these include heavy workloads; hazards causing slips, trips, and falls; job insecurity; job loss; and high-demand/low-control jobs [56]. Further, rates are higher in occupations with lower availability of paid sick leave, suggesting that the need to return to work soon after an injury may contribute to high rates of opioid-related overdose deaths [57,58].

Whether they involve examining antecedents of drug use or developing strategies for those returning to the workplace while recovering from addiction, TWH strategies can offer guidance for employers to follow. Briefly, using NIOSH- and the Office for TWH-developed resources [31,32,59], early efforts would focus on eliminating or minimizing working conditions that may predispose to worker injury or illness or that lead to increased levels of worker stress or excessive work demands. Next, educating occupational health providers, onsite and community-wide, of the organization's policies related to return-to-work after an injury and after the prescribing of opioids would be imperative. Additional steps would be taken to educate and train leaders, managers, and supervisors about likely red flags to observe, and how to effectively, efficiently, and compassionately address these. Careful examination of the impacts, risks, and considerations of safety-sensitive jobs and particular worker duties would occur, as well as of pre-employment/ongoing requirements. Finally, workers and their families would be provided with the necessary education on the proper and safe use of opioids, both at work and away from work. The Office for TWH and others across NIOSH are diligently working on actionable guidance and recommendations, materials, and resources to help address the opioid crisis affecting workers and employers [60].

No matter the complex, multi-faceted, or new challenge facing the future workforce, the Office for TWH will continue to work with its partners and stakeholders to effectively tackle issues amenable to integrated and comprehensive solutions that account for work and non-work factors.

#### **3. Conclusions**

The TWH framework, while rooted in the bedrock of worker health protection and prevention, must be a living, breathing entity, responding to the changing needs of workers, organizations, and the U.S. economy. Perennial challenges of the work environment, such as safety hazards, work stress, mental health, substance misuse, and chronic disease, are prime targets for integrated, holistic approaches rather than the more limited, siloed ones of the past. Where worker health issues cross the boundaries of work and home, affecting the lives of workers in and out of the workplace, there will be a place for TWH strategies that bridge this distance.

**Author Contributions:** Conceptualization, S.L.T., L.C.C., A.C., H.H., J.N. and C.-C.C.; Supervision, S.L.T.; Writing—original draft, S.L.T., L.C.C., A.C., H.H., J.N. and C.-C.C.; Writing—review & editing, S.L.T., L.C.C., A.C., H.H., J.N. and C.-C.C. All authors read and approved the final manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** The authors express their thanks to Harpriya Kaur, Sara Luckhaupt, Anita Schill, Reid Richards, and Seleen Collins for reviewing and editing the manuscript. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

**Conflicts of Interest:** The authors declare no conflict of interest.
