CPH-NEW Responds to: Wellness — Why Ergonomists Need to Get Involved

[Editor's Note: This article was submitted as a response to Wellness: Why Ergonomists Need to Get Involved (Reprint), by Jill Kelby, PT, CEA.]

We were pleased to see that ergonomists are beginning to pay attention to the NIOSH “Total Worker Health” (TWH) program, but we were also very surprised to read the assertion that ergonomics is being “co-opted” by “others” (i.e., non-ergonomists) within this program.

On the contrary:  Ms. Kelby and readers of Ergonomics Today should be pleased to know that knowledge about ergonomics is being contributed to TWH by investigators who are trained in and also teach in the field.  The Center for the Promotion of Health in the New England Workforce (CPH-NEW) (http://www.uml.edu/Research/centers/CPH-NEW/) has been one of the TWH Centers for Excellence since 2006.   It is a collaborative research-to-practice initiative of the University of Massachusetts Lowell (UML) and the University of Connecticut (UConn). Participants include faculty, research staff, and students in the UML Department of Work Environment, the UConn programs in Occupational & Environmental Medicine and Occupational Health Psychology, and the UConn Ergonomic Technology Center.  Ergonomics credentials among our personnel include several BCPE certifications and many years of research on musculoskeletal disorder risk factors, methods for assessing ergonomic exposures in the field and the laboratory, computer-mediated work, work organization and participatory ergonomics. Our emphasis on the potential contributions of occupational ergonomics and macroergonomics to the TWH program is well-grounded in theory and the recent scientific literature.

Those of us within CPH-NEW who are ergonomists believe that the field concerns much more than job-level physical stressors and human factors. Ergonomics, commonly defined as “fitting the work to the worker,” necessarily addresses multilevel determinants of worker/job fit including the psychosocial environment, work organization, and organizational climate.  This means that ergonomists address work stress not only by improving human factors (as noted by Ms. Kelby to reduce stress-related accidents), but also through primary prevention: reducing psychosocial and work organization factors that are root causes of job stress. 

NIOSH’s goal for TWH is to evaluate whether workplace health promotion (WHP) programs could be more effective if they incorporate attention to workplace health protection, or occupational health and safety (OHS), and vice versa.  Our goal is precisely to bring a systems approach to this work, broadening the understanding of WHP far beyond attempts to improve individuals’ health behaviors (exercise, diet, smoking, etc.), stress management and/or coping skills.

In particular, a great deal of scientific evidence now shows that the physical and psychosocial work environment also has a large impact on health behaviors.  For example, work scheduling (e.g., night shifts, overtime) is an important risk factor in eating and exercise patterns and obesity.  Low decision-making latitude on the job is strongly associated with obesity, alcohol consumption, smoking, and lack of aerobic exercise during leisure time.  Clearly, ergonomists have a great deal to offer in seeking to remediate these and similar work organization stressors.

Thus we have made it our responsibility to educate others within TWH about the field of ergonomics.  Our arguments about why ergonomics is relevant to WHP have included these key points:

1. Ergonomists are trained to address the broad range of relevant work organization issues, including job design to increase decision latitude, optimize work scheduling, and improve quality of supervision – all necessary to reduce logistical and behavioral obstacles to better personal health.
2. WHP expectations should accommodate the physical and psychosocial demands of workers’ jobs.  For example, someone who stands all day long may experience fatigue or pain at the end of the day that greatly decreases motivation to exercise.
3. Most importantly, participatory ergonomics offers a valuable model for program design, starting with engaging workers themselves in identifying their health priorities and the environmental factors that affect them.  Since lack of decision-making opportunities at work is itself an important risk factor for health as well as for health behaviors, it is critical that WHP not be implemented in a top-down fashion but rather in a way that increases workers’ role in decision-making.

Thus, the references to ergonomics that Ms. Kelby took exception to are actually evidence of our success in influencing and expanding the range of topics under discussion within the TWH program at NIOSH.  We agree with her that a good part of what ergonomists do, if they take a broad view of the field, could be thought of as worksite health promotion by another name. She and other readers should be pleased that part of the CPH-NEW effort is precisely to educate others to that fact and to ensure more explicit credit to our field and incorporation of its knowledge basis.  Our strategy of submitting articles for publication in a wide variety of journals (see selected list below) also illustrates our attempts to educate professionals in other fields about the content and the value of ergonomics to this work. When presenting regularly at major scientific conferences, such as Work Stress and Health (http://www.apa.org/wsh/), we repeatedly emphasize the important role that ergonomics plays in our research-to-practice interventions.

We would also encourage other ergonomists to join this effort. Worksite health promotion programs are widespread, and in many workplaces there might be opportunities to influence those programs in the ways that we have suggested above.  In fact, we respectfully suggest that Ms. Kelby might instead have titled her article, "Wellness: Why MORE Ergonomists Need to Get Involved.”   We would also very much welcome hearing from other ergonomists who have experience with participating in WHP programs.

Last, Ms. Kelby also mentioned the National Prevention Strategy, which is obviously a much larger initiative but will likely be informed in part by findings from the CDC’s National Healthy Worksite Program.  We are participating in that effort, as well, with similar orientation and objectives as described above.  Again, we believe that we are serving our fellow ergonomists well by calling attention to the important contributions of our field to these important new policy directions.

Selected Bibliography

A selected list of relevant publications from CPH-NEW includes the following articles and chapters, produced with NIOSH TWH support, which explicitly incorporate ergonomics methods and content knowledge in seeking to bridge the gap between worksite health promotion and occupational health and safety:

1. Punnett L, Cherniack M, Henning R, Morse T, Faghri P, CPH-NEW Research Team.  A conceptual framework for the integration of workplace health promotion and occupational ergonomics programs.  Public Health Reports 2009; 124 (Suppl 1): 16-25.
2. Henning RA, Warren N, Robertson M, Faghri P, Cherniack M.  Workplace health promotion through participatory ergonomics: An integrated approach.  Public Health Reports 2009; 124 (Suppl 1): 26-35.
3. Cherniack M, Warren N, et al.  Workplace interventions and changing patterns of cardiovascular disease.  European J Oncology 2009; special issue (e-pub only). Available at: http://collegiumramazzini.org/gest/up/Cherniack.pdf
4. Henning RA, Nobrega S, Flum M, Punnett L, CPH-NEW Research Team. Engaging workers in health promotion and health protection efforts: A participatory approach for innovation and sustainability at two worksites. In: P.A. Lapointe and J. Pelletier (Eds), Different perspectives on work changes, Proceedings of Second international workshop on work and intervention practices, Les Presses de l’Université Laval, Quebec, 2009: 199-208.
5. Nobrega S, Champagne N, Azaroff LS, Shetty K, Punnett L. Barriers to workplace stress interventions in employee assistance practice: EAP perspectives.  J Workplace Behavioral Health 2010; 25 (4): 282-295.
6. Cherniack M, Punnett L. Implementing Programs and Policies for a Healthy Workforce. Chapter 38 in:  Levy BS, Wegman DH, Baron SL, Sokas RK, eds., Occupational Health: Recognizing and Preventing Work Related Disease and Injury, 6th ed.  New York: Oxford University Press, Inc., 2011.
7. Miranda H, Punnett L, Gore R, Boyer J.  Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers. Occupational Environmental Medicine 2011; 68(1):52-57.
8. Zhang Y, Flum M, Nobrega S, Blais L, Qamili S, Punnett L.  Work organization and health issues in long-term care centers: Comparison of perceptions between caregivers and management.  J Gerontological Nursing 2011; 37(5): 32-40.
9. Kurowski A, Boyer J, Fulmer S, Gore R, Punnett L.  Changes in ergonomic exposures of nursing assistants after the introduction of a safe resident handling program in nursing homes.  International J Industrial Ergonomics  2012; 42: 525-532.
10. Kurowski A, Gore R, Buchholz B, Punnett L.  Differences among nursing homes in outcomes of a safe resident handling program. J Healthcare Risk Management 2012; 32(1):35-51.
11. Zhang Y, Punnett L, Gore R.  Relationships among employees' working conditions, mental health and intention to leave the job in long-term care centers.  J Nursing Administration 2012 (in press).

This article was authored and submitted by:

Laura Punnett, Sc.D.,¹ Robert Henning, Ph.D., CPE,² and Nicholas Warren, Sc.D.²

Center for the Promotion of Health in the New England Workforce (CPH-NEW)

¹University of Massachusetts Lowell and ²University of Connecticut