The Value of Worker Well-Being

On average, employed US adults spend more than half of their waking lives working or engaging in work-related activities.¹ The time spent at the workplace, the tasks performed there, and the work environment all affect overall health.^2,3 We know many colleagues for whom their job is a great source of joy and fulfillment. They are passionate about their work and derive from it a strong sense of purpose and connection to others. However, we have also seen people working long hours under stressful conditions, which makes it difficult for them to spend time with their families and friends, balance work and non-work commitments, and pursue hobbies and other interests. Many are fatigued and some are burned out, which, in the case of medical staff members, can lead to serious medical errors.⁴ In this article, we discuss how work can influence an individual’s well-being and describe strategies that employers can use to help improve employees’ happiness and wellness.

Traditionally, the discipline of worker health or occupational safety and health has focused on worker exposures to various workplace hazards. The field’s scope has broadened with time to include the concept of worker well-being, or the ability of people to address normal stresses, work productively, and achieve their highest potential.^5,6

Well-being is closely linked with health and productivity. Research shows that employees who are in good physical, mental, and emotional health are more likely to deliver optimal performance in the workplace than employees who are not.^7,8 Healthy and happy employees have a better quality of life, a lower risk of disease and injury, increased work productivity, and a greater likelihood of contributing to their communities than employees with poorer well-being.⁹ That is why the National Academy of Medicine^10,11 and the Occupational Safety and Health Administration¹² have identified worker well-being as a nationally important health issue.

Workplace conditions can affect employees at the physical, mental, or emotional level and enhance or harm their well-being. Studies have found differences among occupational groups in the prevalence of obesity, cardiovascular conditions (eg, elevated blood pressure and cholesterol), and other health indicators, including physical activity and diet quality.^13,14 Work environment can also influence employees’ mental health and stress levels.^3,15 Work-related factors that affect worker well-being include job demands and pressures, degree of autonomy and flexibility, quality of interactions with supervisors and coworkers, frequency of shift work, and length of the workday.^16-20

Jerome M. Adams, MD, MPH

Vice Admiral, US Public Health Service

US Surgeon General

The nature of work is changing, and some changes may have a considerable effect on worker well-being. On the one hand, new practices that are being adopted to promote employee well-being (eg, non-standard employment arrangements) can also foster team member engagement and improved performance,^20,21 and the evidence base for the effectiveness of workplace wellness and health-promotion programs is growing.^22,23 On the other hand, today’s emphasis on technology, artificial intelligence, and robotics may create new challenges for workers’ well-being and health.²¹ For example, the growing gig economy (ie, a labor market characterized by the prevalence of short-term contracts or freelance work rather than part-time or salaried employment) means that workers are less likely to have many of the benefits of employment and more likely to have job insecurity than they did in the past, which can lead to increased stress and negative health outcomes.^20,24

The good news is that there are proven actions an employer can take to foster employee well-being. In addition to being good for the worker, these policies and practices can further employers’ business interests and operations.²⁵ Such strategies include the provision of adequate paid leave²⁶; support for workers returning to work after injury; good management of disabilities; opportunities for higher wages²⁷; greater autonomy, flexibility, and control over job tasks^28-30; improvements to the organization of work and to the way jobs are structured; improvements to the physical work environment; and access to health care coverage. Although some of these strategies may be used more extensively by large employers than by small employers, they should be considered by all types of business ventures.^31,32

One example of a successful adoption of these approaches is the Health Improvement Through Employee Control (HITEC) program, which found that health improvement initiatives that were designed by employees had higher participation rates and better health outcomes than initiatives designed by the administration.³³ The HITEC program is a collaboration between the Center for the Promotion of Health in the New England Workplace and the Connecticut Department of Corrections to improve the well-being of correctional officers, a population that is exposed to high levels of mental health hazards and has a high risk of chronic disease. HITEC implemented a peer mentoring program designed by correctional officers and found that it resulted in greater improvements in participants’ fat-free muscle mass, diastolic hypertension, and workplace burnout than the conventional instruction of new officers.³⁴ HITEC also invested substantially in officer- and supervisor-led stress and mental health interventions. Future work will be needed to better define the effect of these investments on health and employment outcomes.

At the federal level, worker well-being efforts are spearheaded by the National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC). NIOSH supports a Total Worker Health (TWH) approach, which is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with prevention of injury and illness; its overarching goal is to advance worker well-being.³⁵ A key tenet of TWH is an integrated approach that involves identifying and engaging the many parts of an organization that have the shared goal of worker safety, health, and well-being, including human resources, benefits design, return-to-work programs, disability management, occupational health, risk management, health education, corporate social responsibility, equal employment opportunity, and business strategy. The TWH approach builds on prevention strategies such as job design and organization-level interventions and is consistent with recommendations of the American College of Occupational and Environmental Medicine and the American Industrial Hygiene Association.^36-38

To advance the science of worker well-being, NIOSH, the National Institutes of Health (NIH) Office for Disease Prevention, and NIH’s National Heart, Lung, and Blood Institute held a workshop in 2015 titled “Total Worker Health: What’s Work Got to Do With It?” which aimed to identify research needs in the field. A follow-up meeting of federal partners examined the priorities for developing knowledge and intervention strategies for future research on TWH.^39,40 NIOSH’s efforts also include funding 6 Centers of Excellence at various research universities that focus on TWH and coordinating an affiliate network of organizations across the country to share promising practices.

In the private sector, the National Business Group on Health, a nonprofit organization devoted to helping companies optimize business performance through health improvement, innovation, and health care management, offers various resources for implementing employee health and well-being programs, such as employer guides and case studies.⁴¹ The organization also gives awards to companies for innovative and comprehensive approaches to employee, family, and community health and well-being. One recent awardee was the global pharmaceutical company GlaxoSmithKline, which provides its employees and their families with a range of preventive services, such as tobacco cessation and cancer screening. Another awardee was The Hartford, a financial services company that offers employees a health and well-being program that is connected to their communities and helps participants improve their business performance and productivity through various programs, including on-site health centers, weight-management programs, and financial counseling.⁴²

Although these examples are encouraging, employers and companies need to ensure that workplace programs that address well-being are implemented more broadly, meet employee needs, and produce tangible health and business outcomes. To do so, public health leaders must continue to make a compelling business case to employers about the benefits of such programs to their financial and human capital needs. Making this case will require strengthening the evidence base for the effectiveness of worker well-being interventions in various types of settings and on a wide range of health and economic measures. With many of these efforts already underway, and working together with various employers and other stakeholders, we can achieve a future in which workers are safe, healthy, happy, and productive and enjoy every opportunity to attain their highest personal potential.