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Essential Elements of Effective Workplace Programs

Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing

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The Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing is a resource document developed by the National Institute for Occupational Safety and Health (NIOSH) with substantial input from experts and interested individuals.

This document, a key part of Total Worker Health®, is intended as a guide for employers and employer-employee partnerships wishing to establish effective workplace programs that sustain and improve worker health. The Essential Elements document identifies twenty components of a comprehensive work-based safety and health program and includes both guiding principles and practical direction for organizations seeking to develop effective workplace programs.

Total Worker Health® is intended to identify and support comprehensive practices and policies that take into account the work environment–both physical and organizational– while also addressing the personal health risks of individuals, are more effective in preventing disease and promoting health and safety than each approach taken separately” with “risk factors in the workplace can contribute to health problems previously considered unrelated to work. In recognition of this emerging relationship, the TWH approach integrates workplace interventions that protect safety and health with activities that advance the overall well-being of workers. In 2016, the Office for Total Worker Health plans to release an update to the original Essential Elements on this page to better support the needs of our stakeholders.

The twenty components of the Essential Elements, presented below, are divided into four areas: Organizational Culture and Leadership; Program Design; Program Implementation and Resources; and Program Evaluation. The document is a framework that will be enhanced by links to resource materials intended to assist in the design and implementation of workplace programs and offer specific examples of best and promising practices.


The following citations provide an updated source of reference material to support many of the Essential Elements. A forthcoming revision of Essential Elements will align with the latest research and expert guidance.

  1. Mark A. Rothstein, JD and Heather L. Harrell, MD, JD. Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part I—Efficacy. JOEM, 51, no. 8 (2009):943-950.
  2. Mark A. Rothstein, JD and Heather L. Harrell, MD, JD. Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part II—Law and Ethics. JOEM, 51, no. 8 (2009):951-957.
  3. Michael O’Donnell. Editors Notes. AJHP, 28, no. 1 (2013):iv-vi.
  4. Jill R. Horwitz, Brenna D. Kelly and John E. DiNardo. Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers. Health Affairs, 32, no.3 (2013):468-476
  5. Nancy Lessin. Total Worker Health®: Promising and Best Practices in the Integration of Occupational Safety and Health Protection with Health Promotion in the Workplace—A Workshop. Power Point Presentation at the National Academy of Sciences, Washington, D.C. (2014, May 22). Retrieved from .


We appreciate the contributions of the following individuals who participated in the 2007 workshop leading to the development of this document:

Benjamin Amick, PhD, Scientific Director, Institute for Work & Health (Canada)

David Anderson, PhD, Vice President, Program Strategy and Development, StayWell

Ron Goetzel, PhD, Vice President, Consulting and Applied Research, Thomson Healthcare

Nico Pronk, PhD, Vice President, Health and Disease Management and Executive Director, Health Behavior Group, HealthPartners

Bonnie Rogers, DrPh, Director, North Carolina, Occupational Safety and Health Education Center and Director, Occupational Health Nursing Program, University of North Carolina at Chapel Hill

Martin Sepulveda, MD, Vice President, Global Occupational Health Services Health Benefits, IBM

Seth Serxner, PhD, Principal, Mercer Health and Benefits

Michael Silverstein, MD, MPH, Clinical Professor, Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington

Glorian Sorensen, PhD, MPH, Director, Center for Community-based Research, Dana-Farber Cancer Institute and Professor, Department of Society, Human Development, and Health, Harvard School of Public Health

Laura Welch, MD, Medical Director, Center for Construction Research and Training

View PDF Version of Essential Elements