ACOEM GUIDANCE Integrating Health and Safety in the Workplace How Closely Aligning Health and Safety Strategies Can Yield Measurable Benefits Ronald R. Loeppke, MD, MPH, FACOEM, Todd Hohn, CSP, Catherine Baase, MD, FACOEM, FAAFP, William B. Bunn, MD, JD, MPH, FACOEM, Wayne N. Burton, MD, FACOEM, Barry S. Eisenberg, CAE, Trish Ennis, CSP, ARM, CRIS, Raymond Fabius, MD, CPE, DFACPE, R. Jack Hawkins, CSP, T. Warner Hudson, MD, FACOEM, FAAFP, Pamela A. Hymel, MD, MPH, FACOEM, Doris Konicki, MHS, Paul Larson, MS, Robert K. McLellan, MD, MPH, FACOEM, FAAFP, Mark A. Roberts, MD, PhD, MPH, FACOEM, Cary Usrey, Joseph A. Wallace, CSP, RRE, Charles M. Yarborough, MD, MPH, FACOEM, and Justina Siuba, MPH Objective: To better understand how integrating health and safety strategies in the workplace has evolved and establish a replicable, scalable frame- From Chief Health Officer (Dr Baase), The Dow Chemical Company, Midland, MI; Northwestern University and University of Illinois at Chicago, School of Public Health (Dr Bunn), Hilton Head, SC; Chief Medical Officer (Dr Burton), American Express, Chicago; Executive Director (Mr Eisen- berg), American College of Occupational and En- vironmental Medicine, Elk Grove Village, IL; VP Denver Risk Control Manager, Risk Control and Claim Advocacy Practice (Ms Ennis), Willis Group, Wheat Ridge, CO; Co-founder & Presi- dent (Dr Fabius), HealthNEXT, Newtown Square, PA; Director, Environmental Health & Safety (Mr Hawkins), Time Warner Cable, Inc., Char- lotte, NC; Global Director - Workplace Health and Safety (Mr Hohn), Underwriters Laborato- ries, Inc.; Medical Director, Occupational and Employee Health (Dr Hudson), UCLA Health System and Campus, Los Angeles; Chief Med- ical Officer (Dr Hymel), Walt Disney Parks and Resorts, Anaheim, CA; Director Corporate Re- lations (Ms Konicki), ACOEM, Chicago; Paul Larson Communications (Mr Larson), Evanston, IL; Vice-Chairman (Dr Loeppke), US Preventive Medicine, Inc., Brentwood, TN; Associate Pro- fessor (Dr McLellan), Medicine, Community and Family Medicine, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Principal Scientist/Director Center for Occupa- tional & Environmental Health (Dr Roberts), Ex- ponent, Chicago, IL; Process Improvement Leader (Mr Usrey), Predictive Solutions, Oakdale, PA; Risk Control Director - Nashville & New Or- leans (Mr Wallace), CNA Insurance, Old Hickory, TN; Director of Medical Strategies (Dr Yarbor- ough), Lockheed Martin Corporation, Bethesda, MD; and Health Educator (Ms Siuba), Department of Health and Environmental Control, Columbia, SC. Recommendations from the Summit on Integration of Health and Safety in the Workplace, hosted by the American College of Occupational and Environ- mental Medicine and Underwriters Laboratories, August 2014. The authors declare no conflicts of interest. Address correspondence to: Ronald R. Loeppke, MD, FACOEM, Vice-Chairman, US Preventive Medicine, Inc., 5166 Remington Dr., Brentwood, TN 37027-3001 (RLoeppke.MD@USPM.com). Copyright C  2015 by American College of Occupa- tional and Environmental Medicine DOI: 10.1097/JOM.0000000000000467 work for advancing the concept with a system of health and safety metrics, modeled after the Dow Jones Sustainability Index. Methods: Seven lead- ing national and international programs aimed at creating a culture of health and safety in the work- place were compared and contrasted. Results: A list of forty variables was selected, making it clear there is a wide variety of approaches to integration of health and safety in the workplace. Conclusion: Depending on how well developed the culture of health and safety is within a company, there are unique routes to operationalize and institutionalize the integration of health and safety strategies to achieve measurable benefits to enhance the overall health and well-being of workers, their families, and the community. In recent decades, US employers have made significant progress in addressing issues of health and safety in the workplace. Since 1970, workplace fatalities have been reduced by more than 65% and injury and illness rates have declined by 67%, according to the Oc- cupational Safety and Health Administration (OSHA). 1 Worker deaths have been reduced from approximately 38 per day in 1970 to 12 per day in 2012. During this time, major safety im- provements have been made through the use of risk assessment, medical surveillance examinations, safety training, improved pro- tective equipment, better mechanical safety engineering and other physical changes in the workplace, and a host of other factors. These include efforts by labor and management to address safety issues more comprehensively, the rise of new governmental agencies focused on safety, and an increase in re- search and education devoted to safety. The establishment of OSHA and the National Institute for Occupational Safety and Health (NIOSH) in 1970 was also an important factor. Over time, employers adopted safety as a company value and built what came to be known as a “culture of safety” among their employees. Coinciding with these advances in safety was the rise of a workplace wellness movement in the United States, driven in part by rising health care costs. 2 As costs in- creased, employers began to introduce “work- site health promotion” programs on a large scale in an effort to keep their employees healthier and thus reduce total health-related costs (medical/pharmacy costs and absen- teeism/presenteeism costs). Early workplace wellness programs consisted of health screenings, smoking ces- sation, weight-loss education, and on-site ex- ercise offerings, including corporate fitness centers. Over time, these programs evolved into much more sophisticated efforts, which today include the use of health risk appraisals (HRAs) and biometric monitoring; programs for the management of chronic health con- ditions, such as diabetes, behavior modi- fication, and large-scale population health strategies based on clinical data. Many large employers have even established medical clinics and pharmacies on site. Increasingly, employers use these programs and other strategies to integrate health broadly into cor- porate practices in an effort to establish what is often referred to as a “culture of health” alongside a culture of safety. Over the course of many decades, these two workplace activities—safety and wellness—have evolved in tandem, but they have operated mostly independently, with separate work teams and organizational re- porting structures. 3 Today, they are broadly known as “health protection” (safety) and “health promotion” (wellness). Health protection usually encom- passes the activities that protect workers from occupational injury and illness—ranging from basic safety training and the use of protective gear to equipment safety enhance- ments and improvements to the work environ- ment. Health promotion encompasses the ac- tivities that maintain or improve the personal health of a workforce—ranging from the use of health risk assessments and immunizations Copyright © 2015 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited. JOEM  Volume 57, Number 5, May 2015 585