The city of Eugene is one of Oregon’s largest, with a population of nearly 169,000. Home to the University of Oregon and a multitude of cultural and recreational activities, Eugene is the quintessential Oregon city, with a health-conscious and engaged citizenry. The city serves as an employment hub for the southern end of Oregon’s Willamette Valley and employs more than 1,200 people who range from firefighters and police to employees in parks, recreational venues, libraries, public works, administrative services, and planning and development.  In the last few years, Eugene has also proven to be an ideal environment for implementing Total Worker Health. As authors, each of us has been involved in implementing TWH through our work with SAIF Corporation (Liz Hill), the Oregon Institute of Occupational Health Sciences (Dede Montgomery), and the city of Eugene’s Risk Services Division (Randi Bowers-Payne). Initiated by NIOSH, TWH is a holistic approach to enhancing worker well-being that attempts to address workplace risks associated with health problems previously considered to be unrelated to work.  The NIOSH Total Worker Health Affiliate Program aims to foster an integrated approach to protecting and promoting worker well-being through collaborations with academic, labor, nonprofit, and government organizations. TWH affiliates and NIOSH may engage in joint research; develop programs, interventions, and other work products; collaborate on seminars, meetings, training events, and educational events; and create and disseminate publications and other communications. TWH affiliates include large organizations such as NASA and other government agencies, the Mount Sinai Health System, the University of Georgia, AIHA, the American Society of Safety Professionals, the National Safety Council, and many labor and professional groups. Corporations have also embraced TWH through development of metrics to track injury and illness prevention and holistic health promotion. 
The TWH approach considers many issues relevant to worker well-being. Smaller organizations and those with limited resources can feel overwhelmed and unsure where to start. The city of Eugene is one of the newest TWH affiliates and serves as an excellent example of how medium-sized or small organizations can engage with TWH. The city has taken an interest in employee wellness and invested time and resources into both evaluation and action.  #WELLBEINGWEDNESDAY Eugene was engaged in well-being-related initiatives even before the advent of TWH. The city manager, Jon Ruiz, has long promoted employee wellness and well-being; for example, he provides each new employee a copy of Well Being: The Five Essential Elements, a book based on a Gallup study of people in 150 countries. This action was an invaluable message that employee well-being is a priority.  When Bowers-Payne joined the organization as Eugene’s incoming Risk Services Division Manager in 2017, she began researching how TWH could work at and for the city. She had heard about TWH from SAIF, a nonprofit workers’ compensation insurance company that provides consultative services in safety management to its policyholders. Quickly, Risk Services staff recognized that TWH’s holistic connections between safety, health, performance, productivity, stress, customer service, and injury/illness rates were invaluable additions to the city’s already robust wellness offerings. Later, the city launched an initiative to support employees in their journey to “be well.”

Because the city’s executive leadership already understood the connectivity between health, wellness, innovation, and the organization’s mission, the first year’s effort focused on an informal information-sharing campaign to create energy around TWH and communicate the value it could provide. Bowers-Payne and the risk team introduced TWH-related topics to the organization through a variety of communication channels. The team sought ways to highlight TWH in conversations, formal presentations, and at committee meetings. The risk team implemented organization-wide “#wellbeingwednesday” communications, which highlighted benefits and resources that could help staff in their journey to be well. 
As the movement evolved beyond information sharing, members of the executive team began sponsoring monthly well-being activities, initiatives, and programs. One month, in partnership with the Risk Division, executives hosted activities that encouraged employees to invest in social, physical, and community well-being by completing a scavenger hunt related to Eugene history. Employees were encouraged to partner with colleagues, use their city bike-share benefit, and hit the town to learn about our community’s history. Communications during the month highlighted the connections between physical, social, and community well-being as contributors to workplace attendance as well as mental and physical health.  While the #wellbeingwednesday communications provide helpful resources related to a component of well-being, they also serve as a way to highlight engagement at all levels of the organization. Weekly communications have contained pictures of staff engaged in well-being at work and home. A consistent piece of feedback is the value of staff seeing their leaders and colleagues participate in the initiative.  Sponsorship of monthly activities has now transitioned from the executive team to division managers. This important transition further expands engagement in a measurable top-down, middle-out, bottom-up way.  CAPTAIN P-CARD By the end of the first year, employees had begun organizing around the opportunity to promote and invest in their journey to be well. Supervisors started asking for more information, then for formal presentations, and staff started asking how they could get involved, lead an initiative, or solve a problem. As staff began looking for action beyond information, a grassroots committee formed and the TWH movement became the BeWell initiative. TWH-related activities formerly owned by the risk team became owned, planned, and developed by the BeWell committee. Committee members develop, implement, and highlight organizational TWH initiatives, policies, strategies, and programs.  A recent BeWell month sponsored by the finance director featured financial well-being and focused on using both personal and city credit cards (known as “p-cards”) responsibly. A short video featuring “Captain P-card” in uniform (a play on the character Captain Picard from the Star Trek franchise) was a natural fit for this campaign. These examples demonstrate how the city has initiated and supported employee engagement, which is essential to developing and adopting effective TWH policies and practices. 
A critical component of a holistic journey to well-being is the recognition that safety is the foundation of the TWH approach. 
The BeWell movement continues to evolve to meet organizational needs such as raising awareness of the connections between physical, financial, community, career, and social well-being to work performance and to personal and occupational health and safety. To highlight these connections, the BeWell committee recently began integrating the organization’s “competencies” into monthly programs. Competencies are aspects of work culture such as fostering a respectful work environment and encouraging employees’ self-awareness and emotional intelligence. These competencies complement the tenets of well-being identified by the Gallup study and are the framework for the city’s TWH movement. The monthly programs provide a common language for employees to share their personal and occupational journeys to BeWell.  MINDFULNESS Employees will not achieve well-being exclusively through #wellbeingwednesdays, program highlights, benefit plans, or information sharing. A critical component of a holistic journey to well-being is the recognition that safety is the foundation of the TWH approach.  The effects of workplace psychosocial stress on health and safety have been well documented, particularly for municipal first responders. Less well documented are the stressors related to modern library and planning work. Staff in the library and planning departments are required to interact extensively with the public and are continuously exposed to a stressed citizenry. In the case of library staff, interactions frequently include communities struggling with chronic trauma including the unhoused, the substance addicted, and those with untreated or undertreated mental health conditions. 
The BeWell program brought these seemingly different departments together for a single trauma-informed resiliency workshop. Trauma-informed practices are leadership models that encourage awareness of how an individual’s history or current circumstances may affect their ability to interact, connect, learn, or engage. Trauma-informed practices also encourage resiliency in staff and promote understanding of how to maintain proper boundaries in their interactions with the public. Workshop attendees learned fundamentals of trauma-informed self-care practices and how to “bounce back” after difficult encounters.  Shortly after the workshop, library staff set aside a “mindfulness room” for employees to take quiet time when needed. The room hosts resources to promote resiliency and rejuvenation, and allows space for staff to practice meditation. The city also provided access to a trauma-informed book club and workshop for staff and the community to assist them with interacting effectively and compassionately with clients who have experienced trauma. At the end of July, a six-month onsite Employee Assistance Program pilot was launched that will allow any staff working in the downtown area to schedule an appointment at their local library branch and visit with a counselor without having to leave a four-block area.  The Planning Division also engaged a mindfulness consultant for yearlong coaching. Mindfulness is a common practice similar to meditation that asks participants to be aware of their feelings, experiences, and thoughts. Mindfulness practices are linked to reduced stress and anxiety as well as improved productivity and feelings of contentedness. The consultant will help management and staff approach work through a TWH lens and may also support staff in organizing, prioritizing, and managing tasks in a way that helps them “be well.”  The mindfulness consultant, EAP pilot, and mindfulness room will be evaluated through an employee survey to gauge efficacy and progress. These actions all reflect the city’s intent to incorporate mental well-being as a key component of a safe work environment. COMMITMENT TO HEALTH The city also understands that TWH practice must be met with budget support. To strengthen its safety foundation, the Risk Division manages an account for unforeseeable but needed workplace safety enhancements. The fund has supported the expansion of TWH initiatives—for example, ergonomic assessments for all workgroups including those who aren’t based in office buildings, such as first responders and public works and library staff. To support data-driven safety decisions, the city developed a detailed workers’ compensation claims analysis for police and fire in 2015. The results continue to inform improved training protocols and physical fitness expectations geared toward injury prevention. With this commitment to enhance worker well-being so firmly incorporated into the organization’s culture, the city of Eugene continues to imagine new initiatives. The organization makes an effort to connect people and find ways to support all employees with ideas that sustain and promote TWH. Ideas such as the onsite EAP pilot, year-long mindfulness practice, and a new interview club are developed and operated entirely by department staff.  Data collection around the TWH movement is still evolving, since the early phase focused on coaxing engagement, fostering trust, and empowering new leaders. Employee surveys will play an important role in gauging success and identifying areas for improvement. The next priority is to track the employer self-funded health plan experience, which is expected to provide meaningful feedback.  The city isn’t limiting its efforts to employees alone. As a municipality, the city of Eugene recognizes itself as an important community resource, with the potential to positively affect the health, safety, and well-being of all community members. Staff continue to seek creative ways to engage the workforce around community by sponsoring volunteer events, launching a “couch to 5K” program open to employees and community members through the Recreation Division, and actively exploring a “Blue Zones” initiative with community partners. (Blue Zones is a comprehensive community approach to individual wellness and well-being.)  Eugene is demonstrating its commitment to the health and livability of its entire community, including those who live and work in Eugene. The city understands the connectivity between a vibrant workforce, the community, and the local economy. The investment in its workforce through BeWell is a clear illustration of the positive change that can come about through leadership commitment and employee engagement in Total Worker Health.    LIZ HILL, MPH, CIH, CSP, is Total Worker Health advisor at SAIF Corporation.  DEDE MONTGOMERY, MS, CIH, is senior research associate for outreach and education at the Oregon Institute of Occupational Health Sciences, Oregon Healthy Workforce Center, Oregon Health and Science University. RANDI BOWERS-PAYNE, JD, is Risk Services Director for the City of Eugene.  Send feedback to The Synergist.

lzf/Getty Images, Sean Pavone/Getty Images
American Psychological Association: “What Are the Benefits of Mindfulness?” (July 2012). NIOSH: NIOSH Total Worker Health Affiliates. Psychiatric Clinics of North America: “Mindfulness-Based Interventions for Anxiety and Depression” (December 2017). The New York Times: “How to Be More Mindful at Work.” UCLA Mindfulness Awareness Research Center.
Implementing Total Worker Health in Eugene, Oregon
The Journey to "Be Well"
Although the print version of The Synergist indicated The IAQ Investigator's Guide, 3rd edition, was already published, it isn't quite ready yet. We will be sure to let readers know when the Guide is available for purchase in the AIHA Marketplace.
My apologies for the error.
- Ed Rutkowski, Synergist editor
Disadvantages of being unacclimatized:
  • Readily show signs of heat stress when exposed to hot environments.
  • Difficulty replacing all of the water lost in sweat.
  • Failure to replace the water lost will slow or prevent acclimatization.
Benefits of acclimatization:
  • Increased sweating efficiency (earlier onset of sweating, greater sweat production, and reduced electrolyte loss in sweat).
  • Stabilization of the circulation.
  • Work is performed with lower core temperature and heart rate.
  • Increased skin blood flow at a given core temperature.
Acclimatization plan:
  • Gradually increase exposure time in hot environmental conditions over a period of 7 to 14 days.
  • For new workers, the schedule should be no more than 20% of the usual duration of work in the hot environment on day 1 and a no more than 20% increase on each additional day.
  • For workers who have had previous experience with the job, the acclimatization regimen should be no more than 50% of the usual duration of work in the hot environment on day 1, 60% on day 2, 80% on day 3, and 100% on day 4.
  • The time required for non–physically fit individuals to develop acclimatization is about 50% greater than for the physically fit.
Level of acclimatization:
  • Relative to the initial level of physical fitness and the total heat stress experienced by the individual.
Maintaining acclimatization:
  • Can be maintained for a few days of non-heat exposure.
  • Absence from work in the heat for a week or more results in a significant loss in the beneficial adaptations leading to an increase likelihood of acute dehydration, illness, or fatigue.
  • Can be regained in 2 to 3 days upon return to a hot job.
  • Appears to be better maintained by those who are physically fit.
  • Seasonal shifts in temperatures may result in difficulties.
  • Working in hot, humid environments provides adaptive benefits that also apply in hot, desert environments, and vice versa.
  • Air conditioning will not affect acclimatization.
Acclimatization in Workers