2.5.1. Partner and Stakeholder Efforts

Over the past few years, several initiatives have contributed to the National *Total Worker Health*® Agenda's intermediate goal of "implementing policy guidance developed from evidence-based research and consensus statements to promote worker safety, health, and well-being" and activity/output goals focused on promoting responsible organizational policies and sustainability of workers. These have been led by a number of stakeholders and partners, some with direct and some with indirect or no firm affiliation to the Office for TWH.

For instance, the theme of the 11th International Conference on Occupational Stress and Health in 2015, which NIOSH co-hosted along with the American Psychological Association and the Society for Occupational Health Psychology, was Sustainable Work, Sustainable Health, Sustainable Organizations [34]. During the conference, researchers and practitioners discussed how sustainable work and worker well-being can affect economic growth and organizational health. The relevance of OSH to sustainability was recognized by the U.S. Occupational Safety and Health Administration (OSHA) in its report based on interviews with stakeholders, *Sustainability in the Workplace: A New Approach for Advancing Worker Safety and Health* [35]. To facilitate implementation of policy guidance, OSHA identified opportunities in shareholder engagement, recognition of OSH as a business innovation, rankings of businesses, and materiality of factors that affect business performance.

Similarly, the Center for Safety and Health Sustainability (CSHS), which represents more than 70,000 OSH professionals in over 70 countries, has developed guidance supporting worker sustainability [36]. CSHS recommended integrated reporting of both financial and non-financial information, such as environmental, social, and governance (ESG) issues, including human, intellectual, social, and relationship capital. To facilitate sustainability policies that take into consideration worker well-being, CSHS highlighted the need to understand how organizations create value for their stakeholders through various types of capital. In 2016, CSHS outlined guidance for OSH in sustainability reports and key performance metrics to provide information on corporate performance. The Vitality Institute created a different approach, which recognized employee health as a crucial input to organizational success and proposed a comprehensive scorecard for sustainability reporting, to use for making decisions and tracking progress. By reporting on job satisfaction and turnover, health status, assessment of health risk, physical environment, corporate capacity, strategic communications, health policies/programs/practices, population health, corporate climate, leadership, and community relations, organizations can ensure that policies are supportive of worker well-being [37].

#### 2.5.2. Small- and Medium-Sized Businesses

A further area of progress in policy implementation is the targeting of small- and medium-sized companies and incorporation of TWH approaches within workers' compensation systems, which are additional activity/output goals in the National *Total Worker Health*® Agenda. To gather evidence to guide organizational policies, NIOSH and the U.S. National Academy of Medicine convened a public workshop noted earlier (*Total Worker Health*™: Promising and Best Practices in the Integration of Occupational Safety and Health Protection with Health Promotion in the Workplace) to identify prevalent and best practices in small, medium, and large workplaces. The summary report from this

workshop, which included recommendations from experts on the workshop's concluding reactors panel, was published in 2014 [17]. Common elements identified include the importance of leader recognition and prioritization of TWH in a business culture, a "comprehensive perspective" on safety, and attention to activities that can help workers be healthier and more satisfied, which in turn can positively impact businesses. Later in 2017, NIOSH and the Colorado School of Public Health's Center for Health, Work & Environment sponsored the International Understanding Small Enterprises conference [38]. The conference enabled small business owners, researchers specializing in small businesses, representatives from chambers of commerce, workers, and other stakeholders to share policy strategies for engaging workers and increasing happiness and productivity by creating safer and healthier workplaces.

A newly developed key small-business resource is a series of videos created by the Healthier Workforce Center of the Midwest. This center interviewed small businesses to identify gaps where it would be useful to provide guidance, and the resulting videos have shed light on useful policies for small businesses that seek to implement TWH approaches. Additionally, implementation of TWH approaches in workers' compensation programs has occurred by way of two NIOSH TWH Affiliates: the Ohio Bureau of Workers' Compensation (OBWC) and the State Accident Insurance Fund (SAIF), a workers' compensation company in Oregon. The OBWC created a program to support the health and well-being of workers for their client policyholders. SAIF shares the TWH approach with its policyholders and offers free consulting services to facilitate adoption of TWH policies. Furthermore, SAIF partnered with the Oregon OSHA and the Oregon Healthy Workforce Center to create a statewide alliance to encourage the updating of TWH policies in workplaces.
