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NIOSH Publishes Groundbreaking “Total Worker Health” Agenda

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NIOSH is the National Institute for Occupational Safety and Health. It is part of the Centers for Disease Control and Prevention. Their charter is the opposite of the wellness industry’s, and can best be described as a focus on the health of workers, rather than on the health of workplace wellness vendors. That puts me and them (meaning NIOSH) in total alignment.

They recently published their workplace safety and health agenda for the next 10 years. Readers can either read these highlights, a longer summary, or the actual report, entitled: A National Agenda to Advance Total Worker Health® Research, Practice, Policy, and Capacity.

By way of background, since the federal government became actively involved in workplace safety 43 years ago, deaths in the workplace have fallen by about two-thirds, while the size of the workforce has doubled–meaning the death rate is down about more than 80%. To put this in perspective, the entire age-adjusted death rate overall during this period has fallen by less than half. Plus, the reductions in the latter rate are concentrated among the very young and very old, not so much working-age people.

Lately, of course, death rates in one of NIOSH’s target populations have been rising–making the workplace mortality improvement even more striking.

The improvement is multi-factorial. Yes, NIOSH and OSHA regulations, oversight, inspections and penalties are partly responsible. But reputation, safety features, technology, offshoring of “dirty” work, and fewer inherently dangerous jobs (like coal mining) also contribute. Note that the improvement in the overall age-adjusted death rate has also benefited from similar major favorable trends. Yet the workplace death rate reduction has far outpaced the general decline.

On the other hand, there remain 3-million workplace-related injuries and illnesses/year, meaning the task is still at hand.  And unlike heart attacks and diabetes, many of these injuries and illnesses can actually be prevented by the employer.


The centerpiece of the NIOSH Total Worker Health agenda is that the workplace should be a safe and healthy place. Employees should be safe from accidents, hazards, chemicals, bullying and other “risk factors in the workplace that contribute to common health problems previously considered unrelated to work.”

The report calls for “risk assessment and risk management” in the workplace. That is, of course, exactly the opposite of what’s done by the wellness industry, which could never be confused with MENSA. They (meaning the wellness industry) continue to flog the same discredited, worthless “biggest loser” and “pry, poke and prod” programs despite the overwhelming evidence that these programs contribute to, rather than ameliorate, risks and hazards and stress in the workplace–and of course lose money.

As a wellness professional, you should read the section: “Issues Relevant to Advancing Worker Well-Being through Total Worker Health.” That, my friends, (plus Quizzify, which does address worker health) should be your agenda for the next 10 years, just like it’s theirs.

The report goes on to specify how NIOSH and their collaborators are going to address this agenda, but the gist is in that one section.


Along with what the NIOSH report does advocate in its 10-year agenda, it’s important to note what it doesn’t advocate: conventional “pry, poke and prod” wellness.

One can only imagine the political pressure NIOSH had to withstand in order to avoid turning this outstanding document into a paean to wellness, or at least including a section on wellness–or at least a few passing mentions of the word, which doesn’t appear once. Likewise “screenings,” “health risk assessments,” and any form of crash-dieting weight-loss initiatives are also omitted.

Why do I infer “political pressure”? Because NIOSH’s overlords are the CDC. Having allowed Ron Goetzel to paint them into the wellness corner, they are doing exactly the opposite of NIOSH: in order to try to prop up their wellness friends, they are doubling down on demonizing chronic disease.  Using a round-up-twice-the-number-of-usual-suspects approach to biostatistics, they recently and inexplicably bumped their previous mantra of 75% of healthcare spending being on people with chronic disease up to 86%.

How?  Simple: among other things, that figure includes someone with allergies having a baby or breaking a leg. Naturally vendors take advantage of their trademark innumeracy to further misinterpret the CDC’s already-fictional figure as “86% of spending is due to chronic disease.”  Neither 86% nor even 75% makes any sense whatsoever as a practical matter, and long ago we debunked the 75% as healthcare’s biggest urban legend.

This isn’t the first time the CDC’s numbers haven’t added up. These are also the people who are horrified both that “7 out of 10 deaths are due to chronic disease” (that’s called “civilization,” folks) and that a shocking 20% of children are at or above the 95th percentile for weight.*

And yet, these are the same people who wiped out malaria in the US, smallpox worldwide, (eventually) helped contain the spread of AIDS, and possibly prevented a domestic Ebola mini-epidemic.

So here’s a modest four-part proposal. The CDC should:

  1. Let NIOSH take the lead on total worker health;
  2. Let me take the lead on fifth-grade arithmetic;
  3. Let Mr. Goetzel take the lead on delaying the wellness industry’s asymptotic decline into irrelevance; and instead
  4. Do the one thing they know how to do very well, which is keeping people alive.

*Yes, we know what they meant. The growth charts were developed in 1979 (as it happens my very own uncle, Dr. Michael Lane, led the project, after he led the smallpox eradication project). They meant to say that 20% of today’s kids would be at or above 1979’s 95th percentile. But that’s not what they did say.

Ironically given the Chicken Little-esque histrionics in the CDC’s other bogus claims, this particular observation would have actually been both dramatic and compelling — if they had only managed to get it right.


In the immortal words of the great philosopher Pat Benatar, hit me with your best shot.

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