Workplace health promotion

A video on creating an organizational culture of health in the workplace

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work.^[1] The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise.

The World Health Organization has prioritized the workplace as a setting for health promotion because of the large potential audience and influence on all spheres of a person's life.^[2] The Luxembourg Declaration provides that health and well-being of employees at work can be achieved through a combination of:

• Improving the organization and the working environment
• Promoting active participation
• Encouraging personal development.^[1]

Workplace health promotion combines alleviation of health risk factors with enhancement of health strengthening factors and seeks to further develop protection factors and health potentials.^[1][3] Workplace health promotion is complementary to the discipline of occupational safety and health, which consists of protecting workers from hazards.

Successful workplace health promotion strategies include the principles of participation, project management, integration, and comprehensiveness:

• Participation: all staff must be included in all program stages
• Project management: programs must be oriented toward the problem-solving cycle
• Integration: programs must be incorporated into company management practices and workplace health-promotion strategies should influence corporate planning
• Comprehensiveness: programs must incorporate interdisciplinary individual-directed and environment-directed health strategies.^[4]

A report by the European Agency for Safety and Health at Work notes growing evidence that significant cost savings can be made by implementing workplace health promotion strategies, and over 90% of United States workplaces with greater than 50 employees have health promotion programs in place.^[5][6]

Strategies to promote health in the workplace

Strategies for workplace health promotion need to be inclusive to account for diversity in the workforce, and behavioral economics is a key tool for implementing workplace health programs.^[7] The United States Department of Health and Human Services includes five strategic guidelines for workplace health promotion in its Healthy People 2010 initiative. These include:

• Health education, focused on skill development and lifestyle behavior change along with information dissemination and awareness building.
• Supportive social and physical environments, reflecting the organization’s expectations regarding health behaviors and implementing policies promoting healthy behaviors.
• Integration of the worksite program into the organization’s benefits, human resources infrastructure, and environmental health and safety initiatives.
• Links between health promotion and related programs like employee assistance.
• Screenings followed by counseling and education on how to best use medical services for necessary follow-up.^[8]

More generally, workplace health promotion efforts are implemented at three functional levels, including:

• Level I: awareness programs such as newsletters, health fairs, and educational classes that may or may not directly improve individual health or influence behavioral change.
• Level II: lifestyle modification programs of 8 to 12 weeks duration that are available to employees on an ongoing basis and directly influence health outcomes.
• Level III: the creation of a work environment that assists employees in sustaining healthy lifestyles and behaviors, such as workplace cafeterias offering healthy food choices or the provision of workplace exercise facilities.^[9]

In most instances physical activity interventions conform to Level II of this framework and may also include elements from Level III. Incentive-based Fitness Rewards Programs (FRPs) aim to influence employee behaviors and thereby conform to Level I.

Physical activity interventions

Approximately half of all current workplace health promotion programs are based on physical activity interventions given the relative ease by which employers can advocate such efforts to employees.^[10] Employer-sponsored activity interventions in the form of team sports originated as early as the 17th century in the United Kingdom, however, most 21st century interventions rely on employer sponsorship of employee access to health and fitness facilities.^[11] Employee convenience to sponsored fitness facilities strongly influences program participation, and facilities located near employee locations of residence hold lower time costs, receive increased use, and yield better program and health outcomes.^[12] Women frequently demonstrate lower participation in workplace exercise programs than men, and young, single individuals are often more predisposed to pursue employer-sponsored physical activity initiatives.^[13] In many cases, exercise-based workplace health promotion programs struggle to attract those who would benefit the most from such fitness efforts, including aging, sedentary, blue-collar, female, or less-educated employees.^[14]

The sedentary nature of many modern workplaces increases negative metabolic risk factors such as high body mass index (BMI), waist circumference, and blood pressure and elevated fasting glucose and triglyceride levels. Breaking up long periods of sedentary time is shown to improve these risks.^[15][16] Specifically, utilization of portable pedal exercise machines in office environments has been shown to improve employee health, and use was demonstrated feasible during working hours.^[15] Interventions using pedometers to influence employee behavior, decrease the duration of sedentary periods, and increase total movement during the work day have also proven successful.^[17] Smartphone applications and workplace signs promoting stair use are known to improve employee health, and many employers are now investing in wearable technologies to encourage employees to monitor physical activity.^[18][19][20] Workplace Tai Chi programs have also proven effective as a health intervention and means of reducing absenteeism, particularly in older workers.^[21] Despite these efforts, many health promotion programs struggle with poor participation, and the introduction of incentives is shown to improve employee involvement.^[22]

Incentive based programs

To encourage physical activity among the workforce, many employers offer financial incentives to employees through Fitness Rewards Programs (FRPs).^[12] Seeing that exercise and dieting produce immediate discomfort, the benefits of weight loss are often not noticeable in the short-term, and many people seek long-term health but succumb to near-term temptations of unhealthy eating and inactivity (hyperbolic discounting), maintaining employee involvement in wellness programs is difficult. To solve these problems of immediacy, salience, and hyperbolic discounting FRPs offer financial incentives to employees for healthy behaviors.^[23] Though lack of participation remains a problem even among well crafted FRPs, attrition is not random and greater weight loss success is associated with a reduction in later program dropout probability.^[23]

Effects of workplace health promotion

The positive impact of workplace health promotion programs on productivity is widely discussed. The impact of workplace health promotion on absenteeism is substantial since productivity is impossible if an employee is absent.^[24] However, the effects of presenteeism are also significant, and working while sick is estimated to cost the United States economy more than $150 billion per year.^[25] Absenteeism is estimated to cost the average employer $660 annually per employee.^[26] Based on productivity costs, employees experiencing negative health conditions or at risk of developing impaired health cost employers up to $1601 more than healthy employees per year.^[27] Improvements in productivity and absenteeism following implementation of workplace health promotion programs can annually save employers $15.6 for every one dollar spent on health initiatives.^[6] More generally, employee health care costs and absentee day costs decrease by $3.27 and $2.73, respectively, for every dollar spent on workplace health promotion.^[22] In some cases, employer-based health programs have been shown to yield no reduction in health care spending or employer insurance outlay.^[28][29]

Relevant to health outcomes, workplace health promotion programs have demonstrated numerous short and long term benefits. Significantly, workplace physical activity interventions are shown to improve employee fitness, activity behavior, unhealthy lipid levels, work attendance, and job stress, and workplace exercise programs are known to reduce supervisor stress and abusive supervision of subordinates, increasing productivity.^[30][31] Additional improvements have been noted following workplace health programs in injury incidence, blood pressure, cholesterol levels, body mass index, cardiovascular disease risk, dynamic muscle performance, and maximal oxygen consumption.^{[12][13][32][33]} Some improvements vary by gender, with men often experiencing more consequential improvements in body mass index than women.^[16] Workplace health promotion is also known to improve the “perceived health status” of employees, enhancing productivity and improving health program participation.^[14]

Summarily, the expected outcomes of an ideal workplace health promotion program include:

• “Make workers aware of their health and how being in good health improves quality of life.”
• “Workers should take ‘ownership’ of their behaviors and be accountable for health and cost outcomes.”
• “High participation and active involvement in these programs. People should take advantage of the many programs offered.”
• “Employees should lose weight, stop smoking, exercise more often, eat a healthy diet, better manage their stress levels, and generally adopt healthy habits.”
• “Medical claims costs should go down. The company should experience a lower incidence of certain diseases linked to behaviors like diabetes, heart disease, cancer, chronic obstructive pulmonary disease (COPD), musculoskeletal disorders, and stroke.”
• “Workers will be absent less often, disability costs will be controlled, accidents will be avoided, and injury rates should drop sharply.”
• “These programs will attract the best talent—and turnover rates will be reduced because we are the employer of choice in the community.”
• “Workers will perform at higher levels—they will be happier, have more energy, and produce better results for our company.”
• “Establish a culture of health and well-being, where every worker feels valued and important to the enterprise—this will inspire greater loyalty and a high level of engagement.”
• “The program will produce a positive return-on-investment (ROI) for the company—for every dollar spent, two or three will be saved.”^[8]

See also

• Absenteeism
• Body mass index
• Physical exercise
• Presenteeism
• Public health
• Sedentary lifestyle
• Workplace stress
• Workplace wellness

References

1. Luxembourg Declaration on Workplace health promotion in the European Union. 1997
2. http://www.who.int/occupational_health/topics/workplace/en/
3. Burton, Joan. "WHO health workplace framework and model" (PDF). http://www.who.int/.
4. Chu, Cordia; Bruecker, Gregor; Harris, Neil; Stitzel, Andrea; Gan, Xingfa; Gu, Xueqi; Dwyer, Sophie (2000). “Health-promoting workplaces--international settings development.” Health Promotion International, 15.2, 155-167.
5. Hassard, J (2012). “Motivation for employers to carry out workplace health promotion.” European Agency for Safety and Health at Work. Retrieved 9 February 2016.
6. Aldana, Steven G. (2001). Financial impact of health promotion programs: a comprehensive review of the literature.” American Journal of Health Promotion, 15.5, 296-320.
7. Watson, Towers (2011). "Employee Engagement and Health Plan Management.” Towers Watson. Retrieved 9 February 2016.
8. Goetzel, Ron Z.; Henke, Rachel M.; Tabrizi, Maryam; Pelletier, Kenneth; Loeppke, Ron; Ballard, David W.; Grossmeier, Jessica; Anderson, David R.; Yach, Derek; Kelly, Rebecca K.; McCalister, Tre; Serxner, Seth; Selecky, Christobal; Shallenberger, Leba G.; Fries, James F.; Baase, Catherine; Isaac, Firky; Crighton, Andrew K.; Wald, Peter; Exum, Ellen; Shurney, Dexter; Metz, Douglas R. (2014). “Do Workplace Health Promotion (Wellness) Programs Work?” Journal of Occupational and Environmental Medicine, 56.9, 927-934.
9. Gebhardt, Deborah L.; Crump, Carolyn E. (1990). “Employee Fitness and Wellness Programs in the Workplace.” American Psychologist, 45.2, 262-272.
10. Batt, Mark (2009). “Physical activity interventions in the workplace: the rationale and future direction for workplace wellness.” British Journal of Sports Medicine, 43, 47-48.
11. Mcgillivray, David (2005). “Fitter, Happier, More Productive: Governing Working Bodies Through Wellness.” Culture and Organization, 11.2, 125-138.
12. Abraham, Jean; Feldman, Roger; Nyman, John; Barleen, Nathan (2011). “What Factors Influence Participation in an Exercise-Focused, Employer-Based Wellness Program.” Inquiry, 48, 221-241.
13. Erickson, Jill; Gillespie, Catherine (2000). Reasons Women Discontinued Participation in an Exercise and Wellness Program.” Physical Educator, 57.1, 2-6.
14. Pohjonen, Tiina; Ranta, Riika (2001). “Effects of Worksite Physical Exercise Intervention on Physical Fitness, Perceived Health Status, and Work Ability among Home Care Workers: Five-Year Follow-up.” Preventive Medicine, 32.6, 465-475.
15. Carr, Lucas J.; Walaska, Kristen A.; Marcus, Bess H. (2012). “Feasibility of a portable pedal exercise machine for reducing sedentary time in the workplace.” British Journal of Sports Medicine, 46, 430-35.
16. Lara, Agustin; Yancey, Antronette K.; Tapia-Conyer, Roberto; Flores, Yvonne; Kuri-Morales, Pablo; Mistry, Ritesh; Subirats, Elena; McCarthy, William J. (2008). “Pausa para tu Salud: Reduction of Weight and Waistlines by Integrating Exercise Breaks into Workplace Organizational Routine.” Preventing Chronic Disease: Public Health Research, Practice, and Policy, 5.1, 1-9.
17. Chan, Catherine; Ryan, Daniel A.J.; Tudor-Locke, Catrine (2004). “Health benefits of a pedometer-based physical activity intervention in sedentary workers.” Preventive Medicine, 39, 1215-1222.
18. Eves, Frank F.; Webb, Oliver J.; Mutrie, Nanette (2006-12-01). "A workplace intervention to promote stair climbing: greater effects in the overweight.” Obesity (Silver Spring, Md.). 14 (12): 2210–2216. doi:10.1038/oby.2006.259. ISSN 1930-7381. PMID 17189548.
19. "Evidence and guidance - StepJockey". www.stepjockey.com. Retrieved 2016-02-09.
20. Gibbs, Samuel (2015-06-19). "Is 'corporate wellness' the big new thing that will keep Fitbit ahead of the pack?" The Guardian. ISSN 0261-3077. Retrieved 2016-02-09.
21. Palumbo, Mary V.; Wu, Ge; Shaner-McRae, Hollie; Rambur, Betty; McIntosh, Barbara (2012). “Tai Chi for Older Nurses: A Workplace Wellness Pilot Study.” Applied Nursing Research, 25.1, 54-59.
22. Baicker, Katherine; Cutler, David; Song, Zirui (2010). “Workplace Wellness Programs Can Generate Savings.” Health Affairs, 29.2, 304-311.
23. Cawley, John; Price, Joshua (2013). “A case study of a workplace wellness program that offers financial incentives for weight loss.” Journal of Health Economics, 32, 794-803.
24. Wolf, Kirsten (2008). “Health and productivity management in Europe.” International Journal of Workplace Health Management, 1.2, 136-144.
25. Hemp, Paul (2004). “Presenteeism: At Work--But Out of It.” Harvard Business Review, October.
26. Navarro, Chris; Bass, Cara (2006). “The Cost of Employee Absenteeism.” Compensation Benefits Review, 38.6, 26-30.
27. Mitchell, Rebecca; Bates, Paul (2011). “Measuring Health-Related Productivity Loss.” Population Health Management, 14.2, 93-98.
28. Gowrisankaran, Gautaum; Norberg, Karen; Kymes, Steven; Chernew, Michael E.; Stwalley, Dustin; Kemper, Leah; Peck, William (2013). “A Hospital System’s Wellness Program Linked to Health Plan Enrollment Cut Hospitalizations But Not Overall Costs.” Health Affairs, 32.3, 477-485.
29. Lerner, Debra; Rodday, Angie M.; Cohen, Joshua T.; Rogers, William H. (2013). “A Systematic Review of the Evidence Concerning the Economic Impact of Employee-Focused Health Promotion and Wellness Programs.” Journal of Occupational and Environmental Medicine, 55.2, 209-222.
30. Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Brown, Lori M.; Lusk, Sally L. (2009). “Meta-Analysis of Workplace Physical Activity Interventions.” American Journal of Preventive Medicine, 37.4, 330-339.
31. Burnton, James; Hoobler, Jenny M.; Scheuer, Melinda L. (2012). “Supervisor Workplace Stress and Abusive Supervision: The Buffering Effect of Exercise.” Journal of Business and Psychology, 27.3, 271-279.
32. Van Rooy, Kim; Sutherland, Stephanie; Squillace, Mike (2014). “Mayo Clinic’s Mindful Movements in the Workplace.” Health Benefits, 13.
33. White, Karen; Jacques, Paul H. (2007). “Combined diet and Exercise Intervention in the Workplace: Effect on Cardiovascular Disease Risk Factors.” Workplace Health and Safety, 55.3, 109-114.