Total Worker Health^®: Are You Looking at the Full Picture?

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Slide Presentation. Text, Wednesdays with Woodward (registered trademark) Webinar Series. Travelers Institute (registered trademark), Travelers.

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JOAN WOODWARD: Hi, there. Good afternoon, everyone, and thank you for joining us today. I'm Joan Woodward, President of the Travelers Institute, and I'm delighted to welcome you to our program this afternoon. One quick note before we get started. I'd like to share our disclaimer about today's program.

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Text, About Travelers Institute (registered trademark) Webinars. The Wednesdays with Woodward (registered trademark) educational webinar series is presented by the Travelers Institute, the public policy division of Travelers. This program is offered for informational and educational purposes only. You should consult with your financial, legal, insurance or other advisors about any practices suggested by this program. Please note that this session is being recorded and may be used as Travelers deems appropriate.

All right. So today, we're focusing in on a very important issue of worker health. This is a topic that has gotten increased attention over the last few years as employers and our communities at large navigated our way through the historic global pandemic. But where are we today? And what's the latest thinking about how we can support and promote health in the workplace? How has the thinking evolved?

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Text, Total Worker Health (registered trademark): Are You Looking at the Full Picture? Logos, I.A.C. Insurance Association of Connecticut, Travelers Institute (registered trademark), Travelers, UCONN School of Business M.S. in Financial Technology, MetroHartford Alliance.

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Right off the top, I'd like to thank our partners for their engagement in today's program-- the Master’s in FinTech Program at the University of Connecticut School of Business, the MetroHartford Alliance, the Insurance Association of Connecticut. Thank you, and welcome to all your members and networks. And welcome to our two fantastic speakers today.

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Photos of speakers. Text, Joan Woodward, Executive Vice President, Public Policy; President, Travelers Institute, Travelers. L. Casey Chosewood, MD, MPH, Director, Office for Total Worker Health (registered trademark), National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Allen McCalister, Director, Workers Compensation Cost Containment, Risk Control, Travelers.

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Joining us from Atlanta and from the Center for Disease Control-- the CDC-- is Dr. Casey Chosewood, who serves as the Associate Director of Strategic Initiatives and Director of the Office for Total Worker Health within the National Institute for Occupational Safety and Health, or NIOSH. In this role, he promotes the protection and improvement of safety, health and well-being of workers through research, intervention development and partnerships. Previously, Dr. Chosewood served as the Director of the CDC Office of Health and Safety, which serves the CDC's 15,000-person workforce. He's also a Medical Director of the CDC's three occupational health clinics among other leadership roles. Dr. Chosewood, thank you for joining us.

Then, we have Allen McCalister, who is Director of Workers Compensation Cost Containment and has served in various capacities within Travelers Risk Control during his 30-plus years with our company. Allen and his team conduct safety management seminars to provide consultative services to our clients throughout the country. Additionally, he's responsible for the development and delivery of services for our customers, brokers, agents and business unit partners.

So we're going to kick off with an opening presentation from Dr. Chosewood and Allen, then bring it back for some conversation and, of course, your questions. So please drop your questions in the Q&A feature at the bottom of your screen, and we'll get to as many as we can. So Dr. Chosewood, would you kick us off today? And again, we really appreciate your time and your expertise spent with our clients, customers, agents and brokers.

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Text, What’s Next for Worker Safety, Health, and Well-being? Travelers Institute – Wednesdays with Woodward, March 29, 2023. L. Casey Chosewood, MD, MPH, Director, CDC/NIOSH Office for Total Worker Health (registered trademark). The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy. Total Worker Health is a registered trademark of the U.S. Department of Health and Human Services (HHS).

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CASEY CHOSEWOOD: Thanks very much, Joan, and good day to all of you. It is really my pleasure to share with you a look into the future, if you will, of worker safety, health and well-being. And as Joan mentioned, this is a really critical topic. Work, as you know, is a very profound determinant of our overall health and well-being. And it really, in many ways, determines how happy we are going to be with our life.

Work makes important decisions for us, whether we like it or not. It dictates how we spend the majority of our time. It dictates our income, oftentimes. It influences whether we get married or not or when we get married and start a family. How much sleep we get. All of these things are directly impacted by our job. In fact, as you guys know, sometimes it can consume us.

So getting this sort of quotient between work and the rest of our life correct, trying to fine-tune that balance of work and the rest of our lives, is extremely critical to our overall health, our wealth, our happiness and our well-being. So I think it's very timely for us to examine some of these important issues that really-- these are watershed themes, if you will, that have been playing out in our lives, especially at an accelerated pace over the past two years. Let's take a closer look.

It won't come as a surprise to any of you that long before the COVID-19 pandemic began, how we work, what we do for work, the role it's playing in our lives was already changing fairly significantly. COVID accelerated these changes, though, quite dramatically. And like all disruptive phenomena, it's very, very unlikely that things are going to be back the way they were before. We should not hope for it, we should not wish for it because it's not going to happen.

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Photos of essential workers. Source: National Occupational Research Agenda. www.niosh.gov.

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Some jobs were lost and never, ever will return again. Some people will never return to the workforce again because of COVID. Others during the pandemic didn't lose a job, they worked harder than ever. In fact, we term this new term-- or we coined this new term "essential workers" during the pandemic. And I don't think any of us want to be thought of as unessential workers, but that was common language during the pandemic-- redefining who actually needed to do work and who perhaps could work alternatively. The bottom line is work was already changing pre-COVID, and now that accelerated pace of change is picking up steam, never, ever again returning to the baseline and the way things were before.

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Text, “Survival Mode.” Americans report elevated levels of stress, worry and uncertainty. Lingering pandemic. Reports of high stress levels. Inflation, supply chain and “life logistics.” Political divides and global unrest. Caregiving, child and family issues are a major source of worry for many. Quiet quitting, great resignation, return-to-work woes. “One of every three employees say their return to the workplace has had a negative impact on their mental health, and they’re feeling anxious and depressed.”

Source: March 2022 poll; McKinsey.

Unfortunately, today, many Americans are reporting to us that they are actually still in some level of survival mode. And while it's true that the acute phase of the pandemic is over, there are still several hundred people who are dying a day of COVID in this country. It's still a global pandemic with transmission across the globe. But our levels of immunity are increasing and rising, and that's decreasing some of the heat, if you will, of the pandemic. Nonetheless, Americans still report very high levels of stress because of their environment and because of the concerns and situations that they face around them.

Inflation, caregiving challenges, our politics are all sort of rubbing people the wrong way these days. In fact, some people call it, their life logistics have just been upended. And this is obviously, a critical concern when we're dealing with the health of the nation as a whole. There's record reporting in workplaces and in society in general of high levels of stress. Both mental health symptoms and actual formal diagnoses of things like post-traumatic stress disorder, anxiety and depression are elevated.

Substance use is up. Unfortunately, suicides in some demographics are up, as well. And mental health services are being demanded at a rate not seen before the pandemic. So all of this is playing out in your workforce, and it demands additional attention.

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Text, Unsettling, unprecedented trends. Life expectancy losses. Increases in overdose deaths and suicides in some groups. Educational losses. Chronic disease screenings, diagnoses, and management delays. New orphans and ACEs. Worldwide: 10.5 million children lost one or both parents, including 4.2 million in Southeast Asia, 2.5 million in Africa, 1.5 million in the Americas, 1.5 million in the Eastern Mediterranean region and 500,000 in Europe. United States: about 250,000 children lost one or both parents.

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There are also some sort of national and global trends that we're following at CDC that are unsettling to some degree. And you should know about these because they do have direct implications for your own homes, your own lives, your own workplaces. As you know, we lost about 1.1 to 1.2 million Americans from COVID-19, and this changed the overall life expectancy of our population as a whole. On average, women on the line today lost about a year of life expectancy, men on average up to two years of life expectancy loss because of the changes that we saw during COVID and the populations impacted. But some demographics in our country, like Alaska Native American Indians, saw up to six years of life expectancy reduced.

And while these numbers-- one year or two years-- may seem small on some level, I want you to understand that it took us an entire generation-- the past 40 years-- of all of the technology, the improvements that we made in our health care system and our public health system to make those gains. And to lose them very quickly in a couple of years is quite unsettling. So clearly, this is something that we need to pay attention to as we plan what the future is going to look like, both in public health and in our own lives.

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Text, Current Priorities of the U.S. Surgeon General. Our nation's current workplace landscape. Recent surveys suggest 76% of U.S. workers reported at least one symptom of a mental health condition.

Source: Mind Share Partners’ 2021 Mental Health at Work Report. 84% of respondents said their workplace conditions had contributed to at least one mental health challenge. Source: Mind Share Partners’ 2021 Mental Health at Work Report. 81% of workers reported that they will be looking for workplaces that support mental health in the future. Source: APA’s 2022 Work and Well-being Survey results.

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The surgeon general of the U.S. is Dr. Vivek Murthy, and he just brought additional attention to this idea of workplace well-being, workplace mental health and some of the stressors that workers are facing in the new reality of work. And I'll recommend this reading if you haven't had a chance to take a look at it because it's really a vital report. He says that three-quarters of U.S. workers reported at least one symptom of a mental health condition. This is a dramatic increase. In general, we were seeing numbers about a fourth or a third, but this is a dramatic increase post-pandemic.

Eight in 10 said their workplace conditions had contributed in the past to at least one mental health condition, so this is a substantial number. And again, about the same number said that they were specifically looking for workplaces that would support their mental health. So this is a determinant, a differentiator, of a company I want to work for and a company I do not want to work for.

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Text, Overdose deaths reached record high as the pandemic spread. More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said. Up 30% from prior year; more than the toll of car crashes and gun fatalities combined. Largely a result of lost access to treatment, rising mental health problems, and wider availability of dangerously potent street drugs. About 70% of deaths were among men between the ages of 25 and 54. “It has to be easier to get treatment than to buy a bag of dope.” Source: nytimes.com/2021/11/17/health/drug-overdoses-fentanyl-deaths.html.

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Unfortunately, there was a second epidemic going alongside COVID. This started pre-COVID, but certainly, again, accelerated during COVID. And that was the twindemic or secondary endemic, if you will, of substance use disorders and overdose deaths. And sadly, this is 2021 data here, but it looks like the number of deaths from overdose from drugs will be over 107,000 for 2022. This is a dramatic increase over the last 10 years.

It's both that substance use has increased to some extent during the pandemic, but the most important issue is that the lethality of the drugs on the street has dramatically increased. People who overdose are not trying to die. These, for the most part, are not suicidal in nature. These are poisonings where they are taking a drug far more potent or contaminated or really an unexpected contaminant or component that was not intended. And that really is driving the lethality of the drug overdose epidemic.

Now, it may not be apparent right off that there is a workplace connection with overdose deaths, but our research shows that is absolutely the case. And we're talking about a significant number of people here. This is deaths that are more than the addition of car crashes and gun fatalities when you put them together.

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Text, Exploring the Link: Opioid Use Disorders and Work. Lack of employment. Insecure employment, new employment arrangements. Hazardous work and increased risk of work-related injury. Wages, working conditions that can predispose to chronic health problems or pain. Lack of benefits/paid sick leave. Industry/occupational, cultural, and geographic differences. Source: cdc.gov/niosh/topics/opioids/default.html

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So what are some of those connections between opioid use disorders and work? Well, not having a job at all, unemployment, is certainly a risk factor for substance use disorder and overdose death. Having a bad job. One that's insecure where you don't know if it's going to be available three weeks, six weeks from now. The boom-and-bust jobs that we oftentimes see, like in construction or agriculture. Those increase risks for these workers.

Having a job that predisposes you to pain or injury, such that you might need to take medicine like a prescription opioid to treat an injury or pain. That can predispose to substance use disorder over time and to overdose death. Having a lack of certain benefits, like paid sick leave, can be a risk factor, as well. And certainly, we see some jobs really rich in benefits and other jobs with a very narrow range or no paid sick leave or no sick leave at all, whether it's paid or unpaid.

We also see a fair number of differences among industries, occupations and geographies. The geographical issue was more so early on. Now, we're seeing sort of a nationwide challenge around opioids, especially, but other drugs are at play as well. Unfortunately, if you're a construction worker in this country, your risk for overdose death is five to six times that of the average worker. And this is not because only people with a predisposition to substance use disorders go into construction. This is a direct indictment of the conditions of work, the lack of certain benefits, the insecurity of the work, the boom and bust of the work, and the other challenges associated with that industry. So it really does become a mandate for us to improve the work design and the work organization and the work arrangements that are present in high-risk industries where substance use disorders are critical issue.

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Text, Cannabis and Work: Emerging Issues

Let's take a quick look at the issue of cannabis and work. Clearly, this is an increasing issue for all organizations as a whole. Cannabis use disorder is increasing, especially as more states legalize recreational or what we term at CDC "adult use." We don't consider it recreational. We just term it adult use of cannabis that's non-medical in origin. Of course, medical use and the loosening of restrictions

related to adult use and medical use is occurring in many, many jurisdictions across the country. We're seeing the greatest increases in cannabis use disorder in those age 18 to 34, but we've seen elevations in all demographic ages of adults. A VA study comparing 2005 to 2019 data showed a 10% increase in the diagnosis of cannabis use disorder over that 10-year period of time, roughly.

This slide summarizes our approach to cannabis research at NIOSH. Recall we're part of CDC so our job is to prevent harms related to any activity that Americans engage in, including drug use. We hope to increase awareness through better surveillance. Just find out how it's being used, what it's being used for, what are the predictors of moving from certain use to a use disorder. Not everybody, obviously, who uses cannabis develops a cannabis use disorder.

We're also, very importantly, interested in examining impairment issues. Unlike some substances that are fairly easy to screen for in real time, like alcohol, for example, cannabis does not fall into that category at all. So having a positive drug test for cannabis or a hair test for cannabis does not automatically indicate impairment. And how one responds to cannabis use is largely a reflection of when they used it last and how regular of a user they are. So it makes measurement and interpretation of measurements of cannabis levels in the bloodstream or in body fluids or body products very, very challenging. So we're looking to develop new ways to measure and gauge impairment, especially in safety-sensitive jobs.

We're also helping employers develop the right policies, programs and practices within their own workplaces to better manage the challenge of increased cannabis use across the nation. And lastly, there's an increasing population of workers in the cannabis industry in those states where it is legal. And they also need worker protections and interventions, and they need workers compensation provided to them. They are workers in a new, evolving, emergent industry, and we're obviously very interested in providing the safety protections they need.

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Text, Future-casting the way we will work. 

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Let's now sort of take a shift and look more about what we expect in the future of work. As I mentioned before, there are many, many jobs that are changing today. And it's probably too tame to say that some jobs that exist today won't exist for our grandparents. In truth, there are a lot of jobs that exist today that in a few years won't exist for us. So the pace of change, in general, is going to be increasing rapidly. I like to say that innovation will be relentless, and the challenge with that is we, as humans, do not evolve as quickly as technology does. We will always be lagging behind in our ability to keep up in our ability to feel competent in the new technologies that are being demanded of us. This is an additional overlay stress that every one of your workers is seeing each and every day.

We also expect to see some specific labor shortages. That's especially in the highly skilled or in jobs, frankly, that no one wants to take. So for example, some low-paying caregiver jobs are in very high demand because it's a job with low wage, low quality, poor flexibility, poor control. And unfortunately, those jobs are going to be increasingly difficult to fill unless we redesign how those jobs are done. It's an important mandate for some of the most difficult work in our country. Day care workers, other caregivers, nursing home workers, health care aides would be at the top of that list.

Higher paid health care workers are also in short supply in some areas of the country. That's lessening a little bit now that the pandemic is simmered down, but it was a critical issue. And intention to leave health care is still a major challenge in the country.

Work arrangements continue to shift, and the health impacts of working from home remotely, working at home part of the time or working at home none of the time are just emerging. I'll talk a little bit more about that a little bit later. We're also seeing certain industries that are completely being upended, oftentimes led by the new energy transition. And as I mentioned, this sort of mismatch of the speed of evolution of technology and our human ability to keep up is going to continue to perplex us.

We also think that psychosocial issues-- the connection between work conditions and our mental health-- those challenges and issues are going to continue to increase and remain front and center. And as I said, it may be a differentiator in how people decide where to work and what kind of job to take. We also expect the frequency, duration and severity of mental health diagnoses to increase over the next decade. Young folks have less stigma about seeking care, about engaging with medical treatment, and undergoing therapy and medications for certain mental health conditions. So we expect utilization of all these services and products to increase.

There's good news about destigmatizing mental health issues. So all in all, that may be a positive that comes about. Although, it will drive health care costs in many settings. Unlike a lot of chronic conditions, like diabetes or heart disease, that start in the fifth, sixth or seventh decade of life, mental health conditions generally are diagnosed in the second or third generation of life. So they are longer duration, more expensive over time, and can be more disabling than even a surgery incident or broken bone or a heart attack. So this is an important quotient for us to get right as we look at these issues in the context of work and compensation.

We also believe that employee assistance programs will take on new preventive roles as opposed to just being sort of a lagging indicator of there being a problem. And we're strongly encouraging that through some of our new program development. We mentioned that workplaces may be differentiated based on their services and benefits around mental health or psychosocial challenges.

And finally, we think that a focus on solutions and interventions need to benefit everybody-- workers certainly, but organizations and societies as a whole-- for this to be a win-win. From a compensation standpoint, we generally expect more coverage for psychosocial risks, either one-time events or ongoing exposures, and maybe more attention to how working conditions predispose people to certain mental health conditions and to the extent that may or may not be compensable. We're certainly seeing state variation already in that regard.

Certainly, workers compensation specialists will need more expertise in mental health conditions. And there's more and more talk about national standards, whether they be voluntary or not, on the national stage. We're developing currently a white paper that looks at the issue of the need for a workplace mental health standard. Most developed countries on par with the U.S. economy already have had those in place. Canada is five years or more. Australia has it. Most countries in the EU have national standards around mental health and work already. We're lagging behind that in many respects.

As I mentioned, mental health conditions occur earlier, they're lengthier when it comes to disability, they're costly, and they have special implications for return-to-work recovery and relapse. So it's an important area of expertise that your organization needs to have.

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Text, Total Worker Health (registered trademark) Approach. Funnel diagram with keep workers safe in one oval and Establish workplace policies, practices and programs that grow health in another oval leading to Worker Well-Being.

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Let's end today with some talk of solutions because I sort of portrayed a fairly grim circumstance for you, but we believe that there are some absolute winning ways to address some of these challenges. I lead a program at NIOSH that's called Total Worker Health, and it really is all about starting at your baseline to focus on workplace safety.

You don't want people to go home at the end of the day with less health than when they arrive that morning.

But a step beyond just keeping workers safe is to invest day in and day out in better working conditions and improving the practices, policies and programs that you offer to workers so that you actually grow the health of that workforce through high-quality work, through high-quality opportunity, through growth and development, through good wages and benefits, and good health promotion programming, good access to care that they need so that their health actually improves as an outcome of employment.

Now, obviously, that's good to workers. It may be helpful for them, their families, if they can work longer or being more self-sufficient and provide for their families. But those workers that went home with more health at the end of the day than the day before-- guess what? Those workers come back to your organization the next morning with a higher level of health and well-being. And that translates to your bottom line by decreasing health care spending, by decreasing injury risks, by increasing engagement, decreasing absenteeism, increasing customer service, increasing the way they interact with colleagues and supervision. So it really is a win-win approach in our estimation.

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Text, Total Worker Health Policies, Programs, Practices.

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And as you notice, we're really interested in this outcome of worker well-being. And we've developed a new way to measure it. Here's just a scattering of some of the Total Worker Health policies, practices and programs. And if you'll check your chat box, we just dropped a link to the Total Worker Health program in case you want to do a deeper dive.

Worker centricity-- essential to the Total Worker Health approach. More supportive, healthier supervision-

- an extremely important quotient. We ask our frontline managers to be responsible not only for people issues, but production issues and service issues and profit. They need additional training skills, development and resources. So we put a lot of our emphasis not on individual level programs, like most traditional health promotion does. We put our emphasis on organizational level fixes, usually at the level of the frontline manager. And we've said this person is perhaps one of the most critical determinants not only of your workforce health and safety, but your actual success as an organization. They are underutilized as a lever for better health and productivity.

We also think folks need good ways to advance. People can't be in dead-end jobs if you expect them to perform at a high level consistently. It's just not consistent with a human-- the way we're wired, as humans. Obviously, the provision of certain benefits, looking at work-life fit, confidential occupational health and prevention services is also very valuable.

I mentioned measuring worker well-being. We have a new tool to do that. It's free for you to use. It is six domains in a 15- or 16-minute survey. It's 68 easy-to-answer questions that will help you prioritize the challenges that your workforce is facing.

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Text, The NIOSH WellBQ: A new measure of worker well-being. Circle chart with Worker Well-Being in the center is surrounded by Workplace Physical Environment and Safety Climate, Workplace Policies and Culture, Health Status, and Work Evaluation and Experience. Source: cdc.gov/niosh/twh/wellbq/default.html.

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What are the issues they're dealing with the most? Are they at the workplace? Are they at the home? Is it personal health? Is it supervisory issues? Is it something in home, community or society? This is a really good tool to give you immediate feedback on the health of your workforce.

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Text, Engagement: the growing expectation of meaningful work. A chart lists job characteristics with corresponding definitions. Social purpose: Doing something that is useful to others or to society, that contributes to society. Moral correctness: Doing a job that is morally justifiable in terms of its processes and its results. Achievement-related pleasure: Enjoying one’s job, doing a job that stimulates the development of one’s potential and that enables achieving one’s goals. Autonomy: Being able to use one’s skills and judgment to solve problems and make decisions regarding one’s job. Recognition: Doinga job that corresponds to one’s skills, whose results are recognized and whose salary is adequate. Positive relationships: Doing a job that enables making interesting contacts and good relationships with others.

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I'll close by talking just a little bit about the topic of engagement. People want to feel like they belong in their workplace. That they have a purpose for being there. That they are accepted and warmly appreciated, not only by supervision, but also by their peers. People want to feel like their job is making a difference.

So our role as leaders is to help create-- to help create that opportunity for them to better experience work as a positive in their life. Not just as something they trade their health for wages or trade their time for wages, but that this actually means something to me beyond the widget we make or the service we provide. Here are a number of ways-- these six or so ways-- that you can work on increasing the engagement of workers. And they all have matching interventions that can be done to improve engagement, belonging and connectivity between people's lives and the rest of their work.

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Text, As Employers, Protecting and Improving the Mental Health of Workers More Vital than Ever. Focus first on primary prevention: improve the conditions of work. But also offer secondary and tertiary services. Establish organizational goals to measure, understand, and improve mental health. Encourage social connections at work; value peer-led interventions. Invest in/improve training of front-line leaders/managers. Provide a seamless connectivity to care when needed. Use operational measures and metrics to gauge and act upon challenges. Ensuring privacy and confidentiality remain vital.

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I will end by a mention of mental health and work as an increasing priority. If I look at all of the requests coming into our Institute from employers, labor unions, worker groups, mental health is at the very top of the list. So if you're not investing heavily in this area, both improving your employee assistance programs, your training, your skill-- upskilling of your frontline supervisors and managers, this is really a mandate.

This is going to increasingly become a time sink, a cost sink and turnover risk for your organization if it's not well-addressed. We're also strongly valuing now social connections and peer interactions. So to the extent you can encourage that activity in your workplace, we see great value.

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Family photo of Casey Chosewood and two granddaughters.

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I am an optimistic person. My two granddaughters-- Lily and Emory-- have instilled a hope for the future that I hope I've presented here today. There are things that can be done to improve the quality of our work experience. And we, as employers, managers, leaders, have a great deal of responsibility and control when it comes to moving these issues forward.

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Text, CDC/NIOSH Mental Health Strategies. Total Worker Health (registered trademark): Optimizing the work experience, increase worker well-being, work/life/family fit. Healthy work design & well-being cross- sector: Better work design, psychosocial health research and partnerships. Work organization & stress research program: Evaluate and improve work environments, work stress prevention. Mental health of health workers: National campaign to safeguard and improve mental health, healthcare partnerships.

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If you'd like to read more about our mental health strategy at CDC NIOSH, I've sort of highlighted four programs here. We have them all well covered on our website. I'm also going to give you an email address in case you have any questions or issues that you'd like to present to me offline. We'll be happy to assist your organization and move its strategy when it comes to workplace well-being rapidly forward.

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Text, Connect with us! Website cdc.gov/niosh/twh. Twitter @NIOSH_TWH. LinkedIn.com/groups/4473829/. TWH in Action e-newsletter cdc.gov/niosh/TWH/newsletter/.

Here are other ways you can follow our progress. We fund 10 academic centers of research across the country in a robust research portfolio looking at all of these issues. And everything we recommend will have a strong evidence base that you can depend on. Our email is below. And with that, I'd say thank you very much for letting me spend some time with you. I look forward to rejoining on the panel, but now we'll turn it over to our next speaker.

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Allen McCallister. Slide, Post-Injury Management, Process review. Logo, Travelers. (SPEECH)

ALLEN MCCALISTER: Thank you very much, Dr. Chosewood, for that information-- very valuable. And we're fortunate in Risk Control that our consultants on a daily basis deal with the employers that you talked about that are facing many of these challenges. Our customers, agents and brokers, we're all dealing with the continuously changing work environment and business landscape.

For many of us, the pace of change, just a fierce acceleration of new issues and emerging trends, affect us all.

Attracting, hiring and retaining quality employees is at the forefront of many of these headwinds. Because our risk control professionals are on the front line, we have a unique perspective of how these pressures and others affect frontline employees, supervisors, managers and business owners. Nothing demonstrates this more than responding to and managing workers compensation or on-the-job accidents and injuries. At the Travelers, we've been consistently able to help our customers deal and address some of these issues by focusing on two critical, essential organizational assets-- one, that frontline employee and two-- as you spoke of, Dr. Chosewood-- that frontline management.

For most people, being injured on the job is a first-time experience. And depending on the nature of that injury, it can be very frightening, not only for the injured employee, but for that supervisor team, for that management, as well as for family members. In our experience, organizations that basically do a good job at responding to and taking care of the needs of their injured employees do a good job in managing their costs for workers compensation. It's with these concepts that we've developed what we refer to as our Corridor of Care. And in that, we help organizations build a systematic and structured process to respond to and deal with on-the-job accidents and injuries.

The goal is that everyone should know exactly what needs to happen and have the ability to execute those things from the moment someone's injured until they're back to their normal and customary job responsibilities. By doing this, employers are able to do what we call keep their employees in their Corridor of Care. Now, we've had more than 6,000 respondents to our online survey around injury management, and to the statement, "My company has provided me information on my workers compensation benefits," only 24% of employees and only 18% of managers strongly agree with that statement. And we know without a well-defined and a well-executed process for dealing with on-the-job injuries, employees may seek information and advice elsewhere.

We've interviewed, also, thousands of people who've been injured on the job, and they tell us in the absence of direction from their employers, they turned to family members, friends, co-workers and sometimes, attorneys. It can be difficult for people who don't understand workers compensation to explain it successfully to injured employees. That's why we say it is so important that management provides the basic information and knowledge around workers compensation for that frontline employee as well as that frontline management. And it's critical to keeping them in their Corridor of Care. I'm now going to share with you an overview of our Corridor, and I'm going to talk about those essential strategies that we see are necessary to be consistently successful in managing people who get injured on the job.

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Corridor of Care (registered trademark) graphic. 

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I talked about if someone ends up outside of an organization's Corridor of Care, these people that they may turn to. What we want to do is create a process that everybody knows what to expect and what to do when someone's injured on the job. And instead of these people-- family members, friends and co- workers-- having to provide information about workers compensation, they should be there to provide emotional support and care for the injured employee in an effort to get them back into the work environment. That employee should have enough knowledge to be able to explain to family members, friends and co-workers about what the organization has in place and ultimately reduce the need for attorney engagement.

So how do we do this? We have to build trust for that frontline employee. That the employer has their well-being and interest in mind. That's critical, and our five essential strategy starts with this-- initial response.

What happens in the immediacy of the injury truly sets the stage for the ultimate outcome of that experience for the injured employees. So one of the things we do is teach frontline management how to respond to injured employees in a caring and non-judgmental manner and have their health and well- being at the forefront of how they engage with that employee. Who does what also in this sequencing and the order that that's carried out and the timeliness can impact the entire process from that initial engagement through the rest of the Corridor.

The second in our Corridor we refer to as medical provider relationships. We look at medical providers as vendors. And what's important is that these vendors understand what the organization's desires are as to how their injured workers will be treated in their care. Important also that the provider has understanding and knowledge about what the employees do for a living and, more importantly, the value that the organization has for them in the work environment. Now, this varies by state because some states are what we call employer-choice states where the employer can select the provider. Some are employee- choice states where the employee gets a chance to select the provider. Regardless, we think it's important that those providers understand that organization's desire to care for and also help manage people back into the work environment. So how organizations do that become critical.

One of the single greatest tools we think for managing workers compensation is what we call return to work. Now, we're very intentional on referring to this as transitional duty. It's our belief that unless there's permanency, that individual should be in active transition back to his or her normal and customary job responsibilities. And the elements that we look to be in place in that is that whatever we find that person to do, it should be useful, productive, beneficial and valuable, not only for the organization, but for the employee as well. And that everybody should know their role in getting that person back in that transitional duty capacity and that we're rapidly moving them through the Corridor.

The fourth piece is what we call workers compensation coordination. This could be an individual or several individuals that play this role. And what they're going to do is shepherd this employee through the Corridor to make certain that any obstacles, any barriers or any challenges that employee's having that they have an advocate on their side as well as that frontline management in helping to work and get those people back. In that same survey that I mentioned earlier, of the people we interviewed in response to the question, "I feel our return-to-work program is working well," only 16% of employees and only 18% of frontline management strongly agree with that statement. So again, understanding the value and the importance of how we return people to work and how we manage through this process.

The last piece in our Corridor is what we refer to as performance measurement. Someone has to establish metrics that we ensure the outcomes that we desire. And when done well, the dynamics that we see is we can reduce days away from work, bring people back to something useful and productive, and then compress the time that we do that to speed that recovery to their normal and customary job responsibilities.

And in doing this, instead of waiting until there have been time, we look at every injury that occurs and we simply ask the question, did we get the right response from the management team to that employee's needs? Did the medical provider provide their services and care that we need and that we desire? And was that employee pleased with that process? Did we optimize the organization's ability to get someone back to something useful, productive, beneficial and valuable? And are we making certain that they have that advocacy and someone who has a unique knowledge about workers compensation to help guide them through the Corridor?

For organizations who share these concepts and embrace these best practices and essential strategies, we've seen significant loss reductions in their cost of workers compensation-- 20, 30, 40, 50% reduction and higher. And one of the main drivers of those loss reductions are the reduction in days away from work. We've been able to achieve reductions of 70, 80% in days away from work, which has a definitely direct impact on their ability to take care of and manage the needs of their injured employees.

So this is an overview of our Corridor, and it encompasses many of those dynamics that Dr. Chosewood spoke about. And what's absolutely critical is that increased engagement between that line management and that employee because it is not likely that any professionals are going to be involved in what we call that initial 24 hours, but it's going to be that employee and that supervisor. And they need to be armed with the knowledge, the information that they need, to execute the process successfully. So I'm going to stop here and turn it back over to Joan. And Joan?

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Joan Woodward and speakers shown on splitscreen.

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JOAN WOODWARD: All right, terrific. Well, that was just so helpful, Dr. Chosewood and Allen. We really appreciate your thoughts and comments on getting workers back and just the new way we're working with the pandemic's influence on all of us. So I have a quick polling question for our audience.

So audience members, you know we like to do this. Travelers did conduct this 6,000-person survey, as Allen just mentioned. What percentage strongly agreed that their company managed on-the-job accidents and injuries well? So what percentage do you think agreed that their companies are managing these on- the-job accidents well? Let's see-- 77%, 44, 27, or 14? So let's take a look and we'll get you the right answer. Allen will reveal what the correct answer was. Allen.

ALLEN MCCALISTER: Yes, thank you. JOAN WOODWARD: What one did you find?

ALLEN MCCALISTER: Yeah, the actual results were 27% felt that their organizations did a good job in managing on-the-job accidents and injuries. And Joan, just to add a bit to that-- one of the things we find is that employees and line management respond more to perceptions, even if they're based in reality or not. And that's a pretty strong perception for a smaller percentage to have that belief system.

JOAN WOODWARD: OK. So Dr. Chosewood, you have said previously that a frontline manager has more influence over a person's health than their own physician. I mean, let's let that sink in. Explain your thinking here.

CASEY CHOSEWOOD: Yeah, a pretty dramatic statement. And every time I say it, I usually get some press for it. So thanks for sharing that again today.

Before entering, really, full-time public health and occupational medicine, I was a family physician for 10 years. So I really compared my experience as a family medicine physician, maybe, spending five to 10 minutes with my patient in a typical office visit, maybe 20 to 25 minutes in a full comprehensive physical exam that maybe occurred a few times a year for the simple visit and maybe once every other year or never for a full physical exam. So my time limited or my limited time with that patient-- pretty narrow.

Yeah, I could make some important recommendations and maybe prescribe some drugs, but the day in and day out influence that I, as a physician, had over the lives of my patients had no comparison at all to the day in day out influence of the conditions of work that these workers faced. And those conditions are largely influenced by the frontline manager. How you do your work, the stress level, the culture, the climate of that workplace, very much, all those shots are called by your leadership and supervision.

So to the extent that they have such power and control over something very influential that such a huge exposure-- eight hours every day, hundreds of hours over the course of a year-- compared to my five minutes of influence as a physician.

All of our research shows that work is such a powerful influence around things like am I going to get heart disease or not? What about cancer risk? Strongly linked to certain-- obviously, certain occupations. Shift work, for example, has a cancer link. So many health influences controlled by work. That really is sort of the basis for that claim. But thank you for mentioning that today.

JOAN WOODWARD: So with that in mind though, what is a top piece of advice for managers today? So folks who are on the line with us today, if you're a manager tuning in, what piece of advice would you give them? And Allen, same question to you, but Dr. Chosewood first.

CASEY CHOSEWOOD: Yeah. Thanks, Joan. I mentioned it in the presentation, but I'll just reiterate it here. Investing in those frontline managers to give them an increase in people skills-- the ability to listen, the ability to, again, create that climate and culture that's supportive of workers regardless of where they are at on their spectrum of development, their level of health, their level of engagement. Helping them develop that richer set of supportive supervision skills-- the ability to intervene early when they see a problem, knowing how to get additional help and refer people who are struggling, the ability to help people grow their career and make that connection between this job and what it does greater for me, my family and my society. That engagement piece that we were talking about.

The other thing I would recommend folks do is take a look at their employee assistance programs. Almost all organizations over 100 employees have access to EAP. It's time to retool the traditional way we're doing employee assistance programs. Move them from just reactive to proactive. Involve them in training your frontline managers and supervisors. If you're not getting regular reports about the mental health status of your workplace from your EAP providers-- not names and private information, but an overall-- a summary of what's going on in your workplace based on EAP utilization and trends-- that's a missed opportunity. So that's another takeaway that I think is really actionable right away.

ALLEN MCCALISTER: Joan, I would echo Dr. Chosewood's description of that. I think engagement is probably critical. And what I would say is they really need to focus on two-way communication.

Oftentimes, a line organization, they're accustomed to directing, but they need to learn listening skills as well. So I would say, engagement around all those things that Dr. Chosewood spoke of, but make certain that dialogue is two-way in nature.

JOAN WOODWARD: OK. So Allen, talk to us about the role of the insurance industry here. So where do you see the industry adding the most value?

ALLEN MCCALISTER: Yeah. We've been fortunate to collect a lot of data, Joan, around what drives outcomes in work environments. In addition to having that knowledge, we have to do a better job of sharing and then also engaging and collaborating with our customer base around how do you use that knowledge.

JOAN WOODWARD: Can you give us maybe some examples of what Risk Control has been working on?

ALLEN MCCALISTER: Yeah, I'll give you one example. We talked a little bit-- I did-- about the attraction and hiring of quality employees. We've worked with an organization that was struggling with getting people to work and I went out to work with the frontline employees. And it was not the employees doing the work, it was not their direct manager, but it was their district manager doing the job. So we have to be there and support them, getting and using those employees that are there.

JOAN WOODWARD: OK. So what are the challenges then that you're helping customers implement this Corridor of Care?

ALLEN MCCALISTER: Yeah. Some of the biggest challenges we have is just communication. Helping the organization understand how and who to communicate what to. And then, more importantly, giving people a platform by which they can implement those changes. One of the biggest ones in that Corridor that I talked about, Joan, is what I call role clarity and what that looks like. Supervisors not knowing what supervisors should do. Doctors not playing the doctor's role, so role clarity and communication.

JOAN WOODWARD: OK, that's very, very helpful. Casey, back to you. So we've had COVID for the last couple of years. We had monkeypox. We had surging flu, the RSV cases. Where are we now and where do you see this all heading with all of these major, major health issues we've just experienced?

CASEY CHOSEWOOD: Yeah, thanks, Joan. CDC has always been a very busy place when it's sort of scanning and responding to the public health, not only of our country, but really, globally. In fact, there are about 40 people currently-- CDC employees-- who are deployed around the world in various public health responses. As I mentioned, COVID is slowing down, but it's not gone. And we're still very closely monitoring where that trend is going to go over time. The projections are that we'll continue to stay in control of this pandemic. What is not yet known is will there need to be some annual vaccinations or some periodic revaccination schedule? That's already being recommended in some high-risk populations. So more to come on that for healthy adults, in general.

Thankfully, monkeypox is less of an issue, in the U.S. especially, even though there is still transmission on a low level in the United States, but more so globally. And this largely reflects a very robust immunization campaign in the highest risk populations that did a really good job of slowing down transmission. Another example of good communication to the right people at the right time who respond as a population and control an epidemic really, really quickly.

Flu season continues, but it is also looking better. We're seeing low levels of flu across most parts of the country. We did have that surge in November and December that was quite worrisome, but happily now flu seems to be moving away for this year without much of a worry moving forward.

There was a confluence early on of COVID, flu and RSV or respiratory syncytial virus, especially in young patients, that increased the number of hospitalizations in pediatric hospitals. That was quite worrisome.

We're also seeing those levels return to normal. We think that surge of RSV cases was because we had a lot of infants who were sort of shielded from RSV during the COVID lockdown, but when things sort of came back to normal, we had two populations-- new babies and those that had been locked down during COVID-- all at risk for RSV. And that combination sort of gave us a double dose of RSV in a short period of time. Which RSV can be quite dangerous and can require hospitalization, but luckily, those trends are better.

We still are tracking Ebola outbreaks in Uganda. Currently, there's a cholera outbreak in parts of Africa and the Dominican Republic and Haiti. There are some polio hot spots in Africa that we're responding to. The train derailments in Ohio and the environmental health concerns related to those have quite a few people deployed to that response currently. And obviously, our ongoing work around chronic disease prevention, workplace safety and health issues where mental health is taking a really central role right now, those continue to keep us all quite busy.

JOAN WOODWARD: Wow, that's a lot. I do have one more question for you and then we'll go to back to Allen. What about long COVID? I know a lot of people feel they're suffering from long COVID. And what are the symptoms? How can you catch it? I mean, how can you, as an employer, how can you help your employees who feel they have long COVID? And how are employers able to stay up to date on the latest findings and research?

CASEY CHOSEWOOD: Yeah, I certainly want folks to take a look at the long COVID webpages on CDC.gov because those are very helpful but here's sort of where we're at. Unfortunately, the story of long COVID is not yet fully written. While we know some things about it, there's a lot that we don't know. And it's looking like it is sort of a very complex compilation of challenges.

Anything that goes on more than four weeks after acute infection is really what we would consider the onset of long COVID. But yet, some people have had symptoms far longer than a few weeks, a few months or even years. And we don't know how long they will persist. We do think it's multi-systemic, meaning there are some systems that can be engaged in some people and not in others. Some people may have their respiratory or their neurologic systems engaged, and other people might have other components of their body engaged.

It can relapse. It can remit. It can come and go. It's not one condition either that's well-described. It's overlapping entities with probably multiple biologic causes. The way that we're managing and treating it now is just symptomatic. How can we optimize the symptoms someone's having? There doesn't appear to be any value in revaccination or in retreating folks for long COVID, but rather just managing the symptoms, the sequelae, the sort of downstream effects of the acute infection.

There is, however, a lot of ongoing research at NIH dedicated to the treatment-- the best ways to treat and manage long COVID or the sequelae of COVID-19. Recall CDC is in the prevention space. NIH is in the treatment space. So we're sister agencies within the Department of HHS that are attacking this from two levels. Not getting COVID in the first place or limiting the number of times you get COVID is an important way to prevent long COVID.

JOAN WOODWARD: OK, thank you for that. I'm going to shift a little bit back to workers comp now and Allen. So talk to us about educating employees about their benefits under workers comp programs and how employers should go about that. Or is that something that you don't recommend? Or do you feel it should be front and center when someone joins the company?

ALLEN MCCALISTER: Yeah, I think it should be part of the orientation. Just like they get information on their benefits for health care, they should know about those basic workers compensation benefits. One of the biggest reasons, Joan, is that if they don't find out from the employer, they could go online on a website, or they can have an attorney tell them. And those people are way more vulnerable that don't understand workers compensation and how it works and easily are influenced by external resources. So we advise that it be part of orientation.

JOAN WOODWARD: OK. So let's talk about HIPAA because the privacy laws, as you know, are pretty direct and clear. How much are you able to communicate with medical providers about employee job accidents and injuries? Tell us what the law says.

ALLEN MCCALISTER: That's a great question, Joan. And there's a lot of miscommunication and misinformation about that. The HIPAA laws do not relate to workers compensation. That is, they don't apply to that specific injury. And the employer, along with the medical provider, has great discretion as to what they can talk about and share relative to that specific work-related injury, unlike non-oc injuries where there's quite a bit of privacy around the injuries.

JOAN WOODWARD: OK. I'm going to get to some audience questions because we have a bunch coming in. And thank you all for your engagement. This one comes from Jennifer Gunson. "How does medical marijuana affect workplace safety? What about medical marijuana's role in treatment?" And also, maybe, Dr. Chosewood, if you'd take this one, talk about recreational use of cannabis. What you're seeing.

CASEY CHOSEWOOD: Yeah, thanks very much. This is, obviously, front and center on the minds of many employers, as I mentioned, the increase in use across the country, the more permissive laws in many, many states. Now, more than half the states have adult use. Many more than that have medical marijuana usage. We're also interested in the interplay between workers compensation and marijuana use. And our own national workers compensation studies component at NIOSH has done a number of analyses of data to look at these issues. So happy to connect any of those who want to learn more about this issue with our workers compensation team that's specifically looking at this issue.

The bottom line is-- really, we're most interested in are people impaired or not when they're coming to work? We're less interested in their private lives and their issues. Even though there are certainly health effects for those who have cannabis use disorder. There is no substance that can be used in all settings perfectly in a safe manner. It's just not possible. So any use can be detrimental to workers because it can cause impairment. And certainly, more chronic use increases risk. No doubt about that.

But to the extent that it increases injury at work is largely a reflection of the acuity of the use. Was it recent, the amount of use and is the person impaired or not? Obviously, impairment of any kind increases the risk to workers, to co-workers, to property and increases liability across the board. So one of our research projects is really trying to find the best ways to measure real-time impairment. And there are a number of new technologies that are arising that will help people in safety-sensitive roles take real-time testing to measure their level of impairment.

While it's not cannabis-specific, it's still valuable. If I've been awake all night with a crying two-year-old, I may be impaired more so than someone who just used marijuana before coming to work. So impairment can arise for many reasons. Having a reliable way to measure impairment is an important solution here for workers and for workplaces. We don't have a set of recommendations about those. We are looking at some of those measures and trying to come up with better ways to look at it. It's part of our research portfolio. We're teaming with the National Safety Council on this issue because they've developed some products and activities and good advice for workers and employers that we would recommend you take a look at. Happy, though, to respond individually to folks who have more questions on this. And we'll get you connected, too, to our workers comp research in space.

JOAN WOODWARD: OK, very good. Thank you so much for that. I just quickly want to take this other question, and let's just try to do it quickly. I want to talk about quiet quitting because I'm curious of your take on this. And some other people have called it "Minimum Mondays." That people are only doing the minimum amount of work to kind of get by and just the whole cultural shift from remote, work from home, hybrid. What are you seeing? There's 11 million job openings in this country today. And talk to us just for a minute. And Allen, I want to get your take on this, too, but Casey, go ahead first.

CASEY CHOSEWOOD: Yeah, I have two adult sons and they say, oh, they have friends who've been quietly quitting for decades now.

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All smile.

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So I don't think this is necessarily a new phenomenon. It did take on a new flavor, though, as people were working remotely. And I really think it comes back to this level of engagement, this connection people feel to their job. Does it give me purpose? Is it something I'm just doing for a paycheck, or does it mean something more to me? And as leaders, the more we push people to the job means something more than just an income is going to be critical to minimize the effects of "Minimum Mondays" or "quiet quitting." Giving people new opportunities and new pathways for growth is also an important thing.

And then the other emerging information I'll share is what we know about the mental health of people who work at home full-time, not at all or a mix. So it may surprise you to know the worse mental health outcomes are those who work at home full-time. They report the highest levels of mental health symptoms and conditions that are diagnosed. In the middle are those who work on-site, that have no option for remote work and maybe a little bit less flexibility. They have sort of mid-level reports of mental health concerns. The healthiest are those that have a very flexible mix of working at home or working in the office. So valuable decision-making information there.

JOAN WOODWARD: Allen, do you have a thought?

ALLEN MCCALISTER: Yeah. For employees that I talk to, it's just a recognition and appreciation for what they do. And they want to hear that, I think, more from their frontline management because that's the person that's giving them direction, giving them information as to whether or not they're on target, what their performance is. And I think just having that appreciation for that person they engage in the most with is important, Joan.

JOAN WOODWARD: OK. This is a little complicated, but I think it's worth bringing up. Allen, this is to you. "When you say HIPAA does not apply to workers comp, are you referring to discussion regarding the industrial industry only? What if there are non-industrial comorbidities-- underlying conditions like diabetes, kidney disease, heart conditions-- that may impact the industrial industry? Can information on those non-industrial conditions be discussed?"

ALLEN MCCALISTER: Yeah, they could be discussed contributory, but detailed information about someone's history is not what's discussed. So again, as long as it's industrial-related, we have that preview of that discussion. And in non-oc, we can't have that discussion.

JOAN WOODWARD: Dr. Chosewood, this is to you. "For at-risk populations, immunocompromised, do you recommend getting a booster for COVID after another six months? What is the latest recommendation?"

CASEY CHOSEWOOD: Yeah. The very latest, and this changes on a weekly basis, really is located at CDC.gov. So definitely keep up to date with that information. But currently, even if you received the new Omicron-specific vaccine in the fall, it is now recommended by some professional societies and some doctor organizations to get a reboost if you're immunocompromised or very old. So you have chronic conditions that predispose you to a poor outcome should you be infected, a booster is being recommended by some groups. CDC has not made formal recommendations about that yet, but it is common practice in some patient settings.

JOAN WOODWARD: OK. Listen, the hour has just flown by, and we will have a replay of this on our website in a week or so. I want to thank you both very much. You're just incredible resources for us. And I invite you back to a webinar soonish to continue this conversation. So thank you so much to both of you.

ALLEN MCCALISTER: Thank you, all. (DESCRIPTION)

Text, Upcoming Programs. Webinars: April 5, Navigating the Rapidly Changing World of Professional and Financial Lines Insurance. April 26, Surety Protects: The Economic Value of Surety Bonds. In-Person: April 17, Cybersecurity Symposium (Portland, Oregon). Register: travelersinstitute.org

JOAN WOODWARD: OK, wonderful. Folks, we have a couple of other upcoming webinars I just want to get on your radar screen. So April 5, we have a deep dive into the current trends in Bond, especially the financial lines-- professional and financial lines of insurance. So that will definitely be in the weeds of our financial lines’ products. And then, on April 26, we're going to drill down into the report of the economic value of construction surety bonds. So again, these folks are very, very specific. We're going to go deep dive in the next few weeks on these two topics.

And lastly, and if you're in the Portland, Oregon, area, we're going to be coming to you live on Monday, April 17 for a Cybersecurity Symposium featuring the U.S. Small Business Administration and other

government officials. So if you're in Portland, please look us up and join us for lunch. Fill out our survey, folks. It's the only way I know what you want to hear next from us. And we really do read every comment, so we appreciate your engagement. Have a wonderful afternoon. Thanks for joining.

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Text, Watch Replays: TravelersInstitute.org. Connect, Linked In, Joan Kois Woodward. Take our Survey, Link in chat. #WednesdaysWithWoodward. Travelers Institute (registered trademark), Travelers.

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