“Total Worker Health” vs. “Wellness” vs. “Well-Being”: Framing worker health issues

l to r: Larissa Barber, David Ballard, Lois Tetrick, Matt Grawitch

Organizational psychology experts discuss worker health at “Work, Stress and Health”: Larissa Barber (Northern Ill. U.), David Ballard (APA), Lois Tetrick (George Mason U.), and Matt Grawitch (St. Louis U.) (photo: DY)

What should be our primary framework for thinking about worker health?

Last month’s “Work, Stress and Health” conference in Los Angeles featured the theme of “Total Worker Health.” This important biennial event is co-sponsored by the American Psychological Association (APA), National Institute for Occupational Safety and Health (NIOSH), and Society for Occupational Health Psychology (SOHP). On its webpage, NIOSH defines Total Worker Health this way:

Total Worker Health™ is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.

As conceptualized by NIOSH and others, Total Worker Health engages both legal mandates and pro-active measures to promote worker health and safety.


Another term often invoked at this conference was “wellness,” usually in association with employer-sponsored programs that promote smart health habits, such as good nutrition, exercise, weight control, smoking cessation, and mindfulness practices.

Wellness programs are designed to contribute to healthier and more productive workforces and to save organizations money through lower health insurance premiums and less absenteeism and turnover.


A third term that recurred at Work, Stress and Health was “well-being.” The federal Centers for Disease Control and Prevention (CDC) examine well-being in the context of a concept they label “Health-Related Quality of Life.” They define well-being this way:

Well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life — i.e., their “well-being.” . . . Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy. 

More than word salad

Okay, so you might be thinking, “Total Worker Health” . . . “Wellness” . . . “Well-Being” . . . blah blah blah. Just a toss of word salad among terms that you basically can mix and match.

Maybe so, at least from a distance. But these terms do carry subtle distinctions and connotations within the world of employment relations, especially in the fields of occupational safety & health and organizational psychology.

In a Good Company blog post, Dr. Matt Grawitch (St. Louis U.), an organizational psychologist who plays a key role in the APA’s Psychologically Healthy Workplace Program, reflected upon how these terms were invoked at the conference and cast his vote for well-being as the best framing concept:

For organizations, this means you have to have a strategy, one emphasizing the development of a workplace that fosters (or at least does not detract from) overall worker well-being. It should not start with the implementation of a wellness program; it should start by taking a long hard look at the culture, structure and business practices of the organization to identify where those important contextual factors are enhancing or detracting from worker well-being. It should include an assessment of a range of well-being factors (including health). And it should result in a multi-faceted approach that leverages a host of psychologically healthy workplace practices to effectively improve worker well-being.

Exercise can be a good way to relieve stress that we experience from an abusive supervisor, work-life conflict or poor working conditions. But wouldn’t the organization and its employees reap greater rewards if abusive supervision, work-life conflict and poor working conditions were eliminated? Then, exercise could be used to enhance health rather than to simply maintain it (or keep it from deteriorating even more).

I’m happy to cast a concurring vote. I confess that I had not given this any attention before. But at the conference, my thought process was first triggered by a sidebar conversation with Dr. Tapas Ray of NIOSH, who shared with me how his research is centering on measures of well-being. By the end of the conference, further informed by other discussions and panels, I had became a convert. Indeed, I realized that well-being, within the context of workplace health and safety, is a very good fit with broader questions about human dignity and employment law that I’ve been raising for several years.

I’m sure that I’ll be exploring these conceptual links in future posts.

3 responses

  1. David, excellent post, and excellent tie in to the issues that are front and center on the Minding the Workplace blog. If nothing else, you post emphasizes that the issue of wellness in the workplace is not just an issue for psychologists, it is an issue for all professionals who seek to improve society as a whole. Whether it be lawyers, managers, consultants, psychologists, workplace well-being has got to occupy a central role in the conversation of how to improve organizations and even the broader community. There are so many positive examples out there of organizations that have created these positive workplace cultures, and hopefully the work we do can highlight some of those, so that they become the standard bearers of what is possible. These positive cultures cannot be forced into existence, they have to be developed with thoughtful, deliberate action and intervention. I guess that is why sometimes it seems they are the exception rather than the rule.

    • Matt, thanks for your comment and for your Good Company blog post that helped to shape this piece.

      To pick up on both, we need to find a way to bring considerations of the “light” and “dark” sides of work together. An example: Last year I presented at a monthly breakfast meeting for Boston-area HR and EAP folks at Boston College. The 1st half was devoted to wellness programs; the 2nd half to bullying. Both parts were well received and engaging, but there was no connection between them and the tenor of the room shifted dramatically from the wellness to the bullying segments.

  2. Pingback: Network of Wellbeing – World of Wellbeing News

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