FROM WORKPLACE HEALTH PROMOTION (WHP) TO TOTAL WORKER HEALTH (TWH): THE ROLE OF OCCUPATIONAL PHYSICIANS

WHP programs are a set of interventions that seek to improve the work organization and worker health, to achieve a better work ability. In the States these programs are spread out in the large majority of industries, because of reduced insurance premium. More recent and accurate meta-analyses have shown modest effects, restricted to improvements in work ability and absenteeism, with no effects on health behavioural risk factors. A critical issue is the low participation, as they are perceived by workers as poorly oriented to improve work safety. Since the early 2000s NIOSH has been promoting the integration of health promotion and occupational safety programs based on the notion that improvement in working condition has the potential to reduce occupational diseases and accidents as well as to prevent chronic-degenerative diseases with a high burden in populations. This effort resulted in launching a new prevention program in 2011, named Total Worker Health (TWH), with the objective of emphasising the integrating occupational safety programs with WHP. A recent review of 24 integrated programs, found low size-effect evidences of efficacy in cessation of smoking, improving dietary consumption of vegetable and fruits and reducing sedentary habits. This review also highlighted selection and attrition biases in many studies as well as heterogeneity in program design and implementation. Such evidence of low effectiveness is opposed to findings made by Italian studies that were characterised by the direct involvement of occupational physicians. The concept of TWH, being a holistic approach to worker health aimed at preventing work related diseases and chronic-degenerative diseases, cannot reduce the pivotal role of occupational physicians, who is the actor of the integration of work-related and personal risk profiles at individual level. This approach emphasises the key contribution of in the workplace by occupational physicians in a precision public health perspective, i.e. "to provide the right intervention to the right population at the right time", which means to deliver precise health prevention activities to populations that might benefit more, taking into account the work environment.