DEPARTMENTS
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PRESIDENT'S MESSAGE
Total Worker Health for All?
BY DEBORAH IMEL NELSON, AIHA® PRESIDENT
Total Worker Health is a holistic approach to worker well-being that integrates protection from work-related safety and health hazards with promotion of injury and illness prevention efforts. AIHA is now a NIOSH Total Worker Health Affiliate, strengthening our current relationship with the agency and opening the door even wider to collaborate with NIOSH on programs, meetings, trainings, publications, and cross-promotion of individual and joint activities. Learn more about TWH on NIOSH's website.

In contrast, as presented by Col. Kirk Phillips at the AIHA Fall Conference in October 2017, Total Exposure Health (TEH) is a holistic approach to integrating science, technology, informatics, and medicine into interconnected preventive health systems, with an emphasis on exposure sciences applied to environmental, workplace, and lifestyle exposures. TWH and TEH overlap but are not synonymous. Col. Phillips will be keynoting the Closing Session at AIHce EXP 2018 in Philadelphia. Both TWH and TEH offer potential benefits to employers and their employees, and to the professionals responsible for promoting and protecting employee health. Organizations that have integrated their health protection and health promotion programs can potentially expect improved employee well-being, reduced healthcare costs, increased productivity, and improved organizational performance. 
Organizations that have integrated their health protection and health promotion programs can potentially expect improved employee well- being and organizational performance.
DEBORAH IMEL NELSON, PhD, CIH, is president of AIHA. She can be reached at (720) 587-7500 or via email.

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TWH AS A PROFESSIONAL SPECIALTY Successful design and implementation of a TWH program in an organization requires knowledge and skills traditionally “owned” by a range of OEHS, medical, human resource, and business professionals. An emerging professional specialty in TWH that integrates competencies from these disciplines is supported by an expanding list of peer-reviewed literature, as research adds to the body of knowledge of TWH. NIOSH currently collaborates with six Centers of Excellence in TWH, and professional programs are now available. PROTECTING CONTINGENT WORKERS
So, what’s wrong with a concept that can provide health and safety benefits, improved efficiency in OEHS management, and cost savings for adopting organizations and their employees? Unfortunately, these benefits are unlikely to accrue to workers outside of standard employer/employee relationships, including millions in developing economies and increasing numbers in developed economies. The International Labor Organization has estimated that one-half to three-quarters of workers not including those in agriculture in developing countries are engaged in the informal economy. In the United States, 20 percent or more workers are “contract workers.” Workers in the informal sector; cottage industries; precarious and at-risk employment; gig, flexible, or migrant work; subcontracted employment; day labor; and so on have rarely benefitted from traditional OEHS programs, and are not likely to benefit from programs such as TWH and TEH that require sophisticated knowledge, investment of resources, and stability of workplace. How, then, can these be provided to workers outside of standard employment relationships? Thought leaders agree that the solution lies in returning industrial hygiene/occupational health to its roots in public health, including a wider educational base in fundamentals of public health and the social determinants of health. But what would such a development mean in terms of practice? Even the World Health Organization has stated that “occupational health and safety grew up in the environment of the large factory and enterprise, and we are only now learning how to carry it out in small enterprises and the informal sector.”  The answer to this challenge will likely require policy and legal changes, as well as the collaborative efforts of many partners: legislative bodies, governmental agencies including health departments, professional associations, trade and labor organizations, employer associations, academic institutions, and educational initiatives such as Safety Matters in the U.S. and ENETOSH in the European Union.  AIHA is forming an ACTIONS Subcommittee on protection for contingent workers. If you’d like to be part of the solution, join Mark Ames, our director of Government Relations, and me for an organizing meeting at AIHce EXP 2018. For more information, email Mark or me.