Integrating power into research, outreach, and practice to make the most of the next decade of the Total Worker Health® Program (June 2025)-Integrating power into research, outreach, and practice to make the most of the next decade of the Total Worker Health® Program

Integrating power into research, outreach, and practice to make the most of the next decade of the Total Worker Health® Program

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The article "Integrating Power Into Research, Outreach, and Practice to Make the Most of the Next Decade of the Total Worker Health Program" published in the Journal of Occupational and Environmental Medicine discusses the National Institute for Occupational Safety and Health’s (NIOSH) Total Worker Health (TWH) program. It emphasizes the importance of addressing power imbalances in occupational safety and health to promote worker well-being effectively. The authors advocate for bringing issues like wage gaps, inequalities, monitoring, and employment insecurity, which are often marginal in occupational health discussions, to the forefront.<br /><br />The article suggests that power imbalances at work contribute to unsafe and unhealthy conditions by limiting workers' control over their work environment and disregards broader social determinants of health. It introduces the concept of social health causation, contrasting it with the traditional biomedical model, which often overlooks social factors influencing health outcomes. The authors argue for a greater focus on power dynamics and the social determinants of health, which include the underlying social, economic, and political factors that influence health and safety at work.<br /><br />Key assumptions hindering progress include focusing on workers instead of underlying work structures, assuming employer economic interests align with worker well-being, and treating any job as better than no job. Power dynamics, the article argues, should be examined to understand and address these systemic issues.<br /><br />The authors discuss how occupational safety and health professionals can influence these dynamics by advocating for policies that address social determinants and are involved in broader societal discussions on worker health. This involves a shift from focusing solely on changing individual behavior or workplace conditions to considering broader societal influences. The article uses the example of silicosis in engineered stone workers, primarily affecting vulnerable foreign-born Latino workers, to illustrate how power dynamics and societal structures influence health risks and outcomes in specific industries. By addressing these broader power relations, the TWH program can work toward its vision of achieving safe and health-promoting work conditions for all.

Keywords

Total Worker Health

power imbalances

occupational safety

worker well-being

social determinants

health outcomes

employment insecurity

wage gaps

silicosis

NIOSH