Total Worker Health®

Since 2016, Pantaleon has partnered with the Center for Health, Work & Environment (CHWE) at the University of Colorado to evaluate the effectiveness of our existing programs and ways in which we could implement the concept of Total Worker Health (TWH). Our objective is to ensure the safety and wellbeing of our over 13,400+ employees. CHWE is one of only ten U.S. Centers for Disease Control and Prevention (CDC) Centers of Excellence for TWH. Through this partnership, we have developed programs and initiatives to identify and address the needs of our workers to ensure their integral health and wellbeing.

We have jointly published 20 papers in scientific journals, sharing recommendations, lessons learned, and best practices on a wide range of subjects related to occupational health. In 2020, we published an article on the applicability of the concept of TWH for Agribusiness Workers in Latin America at our operations in Guatemala, Mexico, and Nicaragua. This project is one of the first examples of international TWH in practice within the agricultural industry. Currently, we are working on two additional multi-year fieldwork studies at Pantaleon Sugar Mill in Guatemala focusing on evaluating environmental exposures and Chronic Kidney Disease of unknown cause (CKDu) on male and female sugarcane field workers with the support of the US National Institute for Environmental Health Sciences (NIEHS).

What is TWH?

This term was established by the National Institute of Occupational Safety and Health (NIOSH) of the United States and is an integrated approach of policies, programs, and practices dedicated to protecting employees from work-related health and safety risks as well as mitigating any form of injury and work-related illness.

This framework integrates traditional occupational health and safety programs to include other job-related factors, such as wages, benefits, workload and stress management to strengthen and optimize an organizational culture that puts security and health at the center of its business strategy and thus, simultaneously improves worker´s wellbeing and overall productivity. Through our research and the implementation of programs, we are continuously improving comprehensive prevention strategies to ensure worker´s safety and wellbeing, which in turn maximizes their performance and efficiency.

How it all began:

In 2004, Pantaleon implemented a hydration, shade, and rest program in Nicaragua, which expanded to Guatemala in 2009 to mitigate the occupational risks of heat stress. Different geographical areas around the world have reported the incidence of Chronic Kidney Disease (CKD) of unknown causes. This disease is mostly detected in communities of male agricultural workers who work under high temperatures. The disease is not correlated to traditional risk factors such as hypertension, diabetes, or obesity. The findings of some scientific research have linked the disease with dehydration and heat stress and acute kidney injury.

We designed a robust Epidemiological Surveillance Protocol for heat stress that includes kinesthetic exercises at the beginning of every workday, access to quality water and electrolyte solution (suero), providing breaks under shade as well as nutritional guidance. Medical personnel support workers in the field by monitoring their health, water intake and providing educational information on topics such as nutrition, sexual education, hydration, use and abuse of alcohol, drugs and medications, among other topics.

Understanding the importance of effective, evidence-based practices and the opportunity that improving workplace interventions can generate, in 2016, Pantaleon and CHWE signed a memorandum of understanding to evaluate the occupational and non-occupational risks and priorities for workers health, safety, and wellbeing across the company´s operations in Latin America, particularly for agricultural workers.

Together, we explore opportunities for collaboration in three main areas:

1. Identification of risk factors for non-communicable diseases including chronic kidney disease.
2. Evaluation of evidence-based practices to mitigate the risk of disease development among workers.
3. Evaluation and improvement of occupational and worker’s health prevention programs.

CHWE researchers helped us identify and address several priorities including Chronic Kidney Disease of unknown cause (CKDu), hearing conservation and noise mitigation in the sugar processing mills, worker nutrition, hydration, injury, illness and surveillance.

Based on the findings, we implemented a series of scientific recommendations, including:

• Guaranteeing quality water to all employees,
• Providing them with at least 5 liters of electrolyte solution (suero),
• Modifying working hours,
• Improving shade quality,
• Performing periodic medical evaluations.

In 2017, Pantaleon implemented an external validation project based on the best international scientific evidence for the occupational risks of noise, particulate matter, chemical substances, heat stress, and musculoskeletal disorders. Together, these programs and policies became TWH. Additionally, in 2018, we expanded these recommendations beyond our workers within the manual harvesting process to all Pantaleon employees and contractors within the organization. The overarching goal was to enhance our already existing workplace safety programs and policies and expand them to develop new health and safety initiatives that would successfully integrate employee wellness and wellbeing initiatives.

These efforts complemented our existing practices, which already included a robust safety program, senior commitment and support, and a dedicated medical team that executes programs available for workers and their families. These programs include primary health services at our onsite health and dental clinics, chronic disease screenings, health educational programs and health surveillance programs. A risk assessment in 2013, led by an external occupational physician, resulted in the construction of five programs to determine the proportion of workers exposed to occupational risks and preventive activities to mitigate it. These include musculoskeletal disorders, heat stress, hearing protection, respiratory protection, and exposure to agrochemicals. These Epidemiological Surveillance Programs are comprised of three components. First, an educational component to explain the science behind what we do and communication strategies to educate workers at all levels of the organization; second, preventive activities, including medical pre-employment and periodic check-ups; and third, epidemiological monitoring to analyze the impact and effectiveness of the program.

Implementing TWH with CHWE:

We recognize that an employee-focused workplace culture that supports employee health, safety and wellbeing contributes to our business success. Therefore, in partnership with CHWE, we carried out a study following the TWH Conceptual Model to assess our TWH needs and execute institutional transformational change across all levels of the organization, in the countries where we operate—Guatemala, Nicaragua, and Mexico—by adapting activities from existing research conducted in the United States. The study which included both CHWE and Pantaleon co-authors can be found here: https://www.mdpi.com/1660-4601/18/5/2252

The objective was to find ways to improve employees´ perception on how the organization is committed to their health and safety and elevate workers´ wellbeing. To do that, we first needed to carry out a comprehensive internal assessment to obtain a baseline of the current state of TWH within our organization, as well as understand the particularities within different countries and departments.

The assessment took place between November 2018 and July 2019, and it analyzed corporate headquarters and all departments within each national branch. The study included five main components:

1. Key informant interviews and focus groups to understand the organization´s current efforts to promote and maintain the health, safety and well-being of all employees, as well as the leader´s individual efforts and actions in their respective areas of work.
2. Organizational assessment to understand the organization´s level of engagement around health and safety policies: 1. Organizational support, 2. Workplace assessments, 3. Health policies and programs, 4. Safety policies and programs, 5. Engagement, and 6. Overall evaluation.
3. Leadership self-assessment to measure leader’s commitment to and promotion of health, safety, and well-being in their respective departments.
4. Employee health and safety culture assessment focused on overall health and well-being, physical activity, stress behaviors including tobacco and alcohol use, fatigue, absenteeism, and presentism.
5. Employee health and risk assessment of clinical consult data by analyzing aggregate data on employee clinic visits.

For the development, coordination of survey administration, and follow-up, CHWE worked closely with the communications and medical teams. Acknowledging the cultural and organizational differences between countries, input from local collaborations in the design and development of each phase was key. Results were used to:

• Inform recommendations for new health and safety programs as well as implementing changes to existing policies and practices. Pantaleon’s health and safety personnel took the recommendations and developed tailored protocols for piloting program implementation and evaluation across the company’s operations giving place to 3 new programs: stress and work fatigue, systematic alcohol and drug monitoring and encouragement of healthy lifestyles.
• Assess leaders’ understanding of TWH and use them as catalyzers.As a result, researchers at CHWE developed a TWH Leadership Training, along with evidence-based program and policy recommendations to address the key priority areas identified.

The content of the training incorporated the results of the assessments through a TWH methodology, with the underlying goal of improving TWH climate, providing leaders with personalized tools to aid in their decision making and prioritize actions. Additionally, based on the most common health risks identified, CHWE focused on three main health promotion priority-training areas:

1. Chronic disease prevention,
2. Sleep hygiene,
3. Preventive stress management and mental health.

Priorities were identified by weighting the potential risk and severity of each health outcome with a) the potential for the company to be able to help prevent said outcome, b) the potential benefit to worker health and safety and c) the potential benefit to the company´s productivity by reducing said risk. Allowing us to quantify the importance of taking these preventive measures, for both workers wellbeing and the company´s productivity.

The training was divided into four modules:

1. TWH fundamentals and how it applies to the role of organizational leaders
2. TWH leadership best practices, including personal well-being and mental health, as well as the impacts of fatigue, sleep and chronic conditions
3. Employees´ perspective of health and safety
4. TWH and organizational sustainability within the organization´s policies and programs

Through these trainings and analyses, priority areas to address were identified. As a result, Pantaleon developed an organizational program and policy recommendations to employee health and well-being that included:

1. Maintaining the established safety culture in the organization
2. Improving employee health and well-being through the development of a sustainable health and wellness culture that mirrors the thoroughness and commitment of the established safety culture
3. Chronic disease prevention
4. Preventive stress management and mental health
5. Sleep hygiene and fatigue

TWH Today

Strengthened by our partnership with CHWE, the TWH approach at Pantaleon is now more robust than ever and we continuously look for innovative ways to further improve the integral wellbeing of our workers.

All mills have health clinics that offer primary care and dentistry services, and we have a robust medical team comprised by over 150 people. This includes 1 epidemiologist, 3 occupational physicians, 2 public health specialists, 13 general practitioners, 2 nutritionists, 59 nurses, 3 paramedic and 45 health brigades. These services are part of the benefits received by our employees and their families.

In 2021, we supported the access to Covid-19 vaccines to all employees who wanted it, reaching a 94% complete scheme vaccination coverage. As a group, in 2022 we also successfully achieved:

• 17,005 pre-employment medical consultations
• 5,562 dental consultations
• 6,637 health training hours
• 9,576 training events
• 6,902 follow-up medical exams
• 34 health outreach programs
• 101 health campaigns

Proof of our success is that in 2022 Pantaleon and CHWE were selected to present at the 3^rd International Symposium to Advance Total Worker Health®, hosted by the National Institute for Occupational Safety and Health (NIOSH) of the United States and CHWE, in Bethesda, Maryland. Health and safety leaders from Pantaleon in Guatemala and Nicaragua provided insight of their current TWH practices and protocols, tackling integral health priorities that have also been exacerbated by the Covid-19 Pandemic.

That same year the team was also invited to present best practices at the First Congress on Safe and Healthy Work Environments of the National Mexican Social Security Institute at the University of Monterrey.

To learn more visit CWH page here.

Our Partner: Center for Health, Work & Environment:

The Center for Health, Work & Environment (CHWE) is an academic center within the Colorado School of Public Health. The center is one of 10 Centers of Excellence for Total Worker Health® and houses the Mountain & Plains Education and Research Center (MAP ERC), one of 18 centers of its kind supported by the National Institute for Occupational Safety and Health (NIOSH). The center team works with faculty, students, and community partners to advance worker health, safety, and well-being.

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Disclosures: University of Colorado and Pantaleon are separate, independent organizations. University of Colorado employed appropriate research methods in keeping with academic freedom, based conclusions on critical analysis of the evidence and reported findings fully and objectively. The terms of this arrangement have been reviewed and approved by the University of Colorado in accordance with its conflict of interest policies.

Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by Pantaleon does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health.