Introduction to Worksite Health Promotion Programs
The previous ten years has brought primary changes in organization attitudes toward Workplace Health Promotion Programs. Interest in self-help and self-care programs has increased as growth in health care costs have encroached substantially into profits. Changes in the organization structures of health care facilities, in particular the growth of the for-profit health care sector, and the need to contain costs are changing the ways in which purchasers of health care plans are viewing their own efforts toward provision of worksite health care programs and facilities. Projections for the next decade indicate that worksite health programs will continue to become significant factors in the provision of health care, including prevention activities, for both government and private industry. In employers with existing Workplace Health Promotion Programs, administrative rationale for sponsoring these activities ranged from improving employee health (28%) to improving employee morale (9.7%). Programs include interventions associated with safety, health risk assessment, smoking cessation, Blood Pressure (BP) control, nutrition programs and stress management. Benefits given range from improved health and productivity to lowering health care costs.
Demographics of the American Workforce
• 110 million Americans composed the civilian labor force in 1981; by the year 2000 the civilian labor force is expected to be nearly 140 million.
• 44 percent of the 1984 labor force was female; ten percent was Black.
• The median age of the workforce is 32 years and is expected to increase to 32 years by 2030.
• 57.9% of all workers work in companies with between 2 and 500 workers; 45% work in companies with fewer than 100 workers. An additional 7.5 million American citizens are self-employed and 3 million are farmers.
• 18% of all wage and salaried staff members in 1985 were union participants.
• 45% of all workers are employed in offices.
Prevalence of Worksite Wellness Programs Activities
Based on a 1985 survey, almost 66 percent of worksites with 50 or more staff members had Corporate Wellness Programs activities in 1985. The frequency of workplace-based activities by selected categories in 1985 was:
Activity
Smoking Control 35.6 percent
Health Risk Assessment 29.5 percent
Back Care 28.6%
Stress Management 26.6 percent
Exercise 22.1%
Off the Job Accidents 19.8 percent
Nutrition 16.8%
Blood Pressure Control 16.5%
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most workers believe the advantages of their Worksite Health Promotion Programs activities outweigh the costs, although few formal evaluations exist.
The most frequently cited reason for starting programs and perceived benefit from programs is improved employee health.
At most worksites with activities (85.4%), all workers are eligible to take part. 30% of worksites with activities offer them to company dependents, and an equal percent offer them to retirees.
When worksites seek outside program assistance, they turn to voluntary, not-for-profit corporations (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance corporations (43%).
Tobacco Cessation Programs
Smoking related health issues cost U.S. companies $26 billion per year in lost productivity and $7 to $8 billion in smoking-related healthcare costs.
Staff Members who use tobacco are 50% more likely to be hospitalized than nonsmokers, have 2 times as a myriad of job-related accidents as nonsmokers and have absenteeism rates approximately 50% higher than nonsmokers.
People who used tobacco an average of one or more packs of cigarettes per day had 118% higher healthcare expenses than people that do not smoke.
76 percent of current smokers and 80 percent of former smokers and nonsmokers feel that corporations should restrict smoking to certain areas.
In 1985, 65% of smokers, 85% of nonsmokers and 78% of former smokers, felt that smokers must refrain from smoking in the presence of nonsmokers.
In 1986, 17 states had laws regulating smoking in offices or workplaces either in government-controlled offices or offices of private staff members.
Examples of tobacco cessation intervention program used by employers include:
• making available people that do not smoke a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• offering cessation programs on corporation or shared time;
• making available cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit smoking days; and
• adopting a smoke-free corporation policy and setting deadlines for implementing the policy.
Physical Fitness Programs
An active 55-year-old man has the potential to lead as vigorous a lifestyle as a sedentary 35-year-old.
Differences in work-related exercise has been determined to provide a two- to three-fold difference in cardiovascular deaths between active employees and their more sedentary counterparts.
In addition to improving strength, balance, and flexibility, physical activity programs have the potential to cut the probability of back injuries among certain occupational groups.
93 million workdays in the United States are lost annually due to back issues.
Research findings support the notion that worksite exercise programs improve fitness and help reduce other health risks, although results related to improved productivity are weak due to lack of methods for accurately measuring productivity.
A very small percentage of worksites have onsite physical fitness facilities.
The majority of workers sponsored physical activity programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal physical activity classes, and walking/jogging groups.
Some employers subsidize employee participation in area “Ys,” health clubs or other area programs if no on-Site facilities are available.
Job Site physical activity programs may reduce expenditures to employers by lowering employee health care claims and expenditures.
Participants whose weekly physical activity was equivalent to climbing less than five flights of stairs or walking less than a half mile, spent 114 percent more on health claims than those who ascended at least 15 flights of stairs or walked 1 1/2 miles weekly.
Health Care costs for obese people are roughly 11% higher than those for thin people.
Nutrition and Weight Control
One-third of America population is obese to the extent of decreasing their life expectancy.
Improvements in eating habits are able to reduce the risk of weighty health issues such as high Blood Pressure (BP) and blood lipid levels and is instrumental in the control of non-insulin-dependent diabetes.
The workplace offers several advantages for diet education; support and influence of co-staff members and senior staff, availability of a daily eating situation, and opportunities for follow-up and monitoring.
Worksite nutrition programs have the potential to be grouped in 6 broad categories:
• cafeteria programs;
• multi-component programs;
• weight control programs;
• blood lipid reduction programs;
• programs for pregnant and lactating women; and
• other diet education topics.
Men are less likely to participate in weight-loss programs than are female workers.
Stress Management
Estimates suggest that 50 percent to 80 percent of physician visits are able to be attributed to psychosomatic or stress-related origins.
Corporation pays many of the costs related to employee stress, both directly in the form of medical costs and in decreased productiveness.
Job factors which are associated with stress include:
• not allowing staff members to take part in decisions about the work process;
• positions which require more or less skill than the employee has;
• changes in work demands;
• lack of clarity about expectations and standards; and
• conflict with co-staff members or supervisors.
Most workplace stress management programs are implemented as a result of requests from workers.
Stress management programs focus on three types of skills: relaxation skills, coping skills, and interpersonal skills.
Worksite stress management programs are frequently delivered in one of three formats:
• sessions conducted by trained professionals;
• self-learning tools; and
• personal teaching to support with self-assessment, planning for changes, learning new skills and responding to life crises.
The two major techniques used in workplace stress management programs are:
• teaching people to lower the detrimental physical effects of stress; and
• teaching people to recognize and control sources of stress at work and in personal life.
Seat Belt Usage
Motor vehicle accidents are the largest single cause of lost work time and on-the-job fatalities of United States business.
Motor vehicle accidents account for 27 percent of all work-related deaths and 45 million days of lost work each year.
More than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.
Employees who regularly fail to use seat belts may spend up to 54 percent more days in the hospital.
Traffic accidents caused about 3 times as many days of restricted exercise as any other kind of disability.
Motor vehicle crashes cost $15.2 billion in lost work rate, 88% of which is attributed to losses from workforce activities and future earnings.
In work settings where safety belt policies, requiring use of belts by anyone riding in a business vehicle or using a personal vehicle for business business, have been enforced, 60% to 90% use has been stated.
Incentive programs, accompanied by education and use requirement restrictions have resulted in 40 percent to 70 percent initial usage rates.
Factors influencing the sources of worksite safety belt programs include:
• active commitment on the part of upper management;
• clearly defined and well enforced policy of necessitated belt use on the job;
• positive rewards and incentives; and
• ongoing education and training programs.
Case Studies of Workplace Wellness Programs
Based on an extensive assessment of its accross the board employee Employee Wellness Program, LIVE FOR LIFE, Johnson & Johnson reported the break-even point for the program occurs in year 3 and by year 5 they have a net advance of $316 per employee. Their year 9 projected advance is $677 per employee.
employees at four Johnson & Johnson organizations who were exposed to the Corporate Health Promotion Program expanding their daily energy expenditure in vigorous activity by 104% compared to an increase of 33% among employees at organizations that were provided only an annual health screen.
Members in the United Methodist Publishing House’s Corporate Wellness Program submitted more claims (1.14 per participating employee and .82 for the control in 1984, 1.44 and 1.3 respectively in 1985), but the average cost per claim was less for participants ($316 for participants and $567 for control, in 1984, $262 and $602 respectively in 1985, $270 and $566 respectively in the first four months of 1986).
The United Methodist Publishing House attributes some of the lower than projected use in healthcare costs for 1985 ($902,116 projected with actual costs $142,884) to the Workplace Health Promotion Program even though the results are not conclusive.
In 1985, the Adolph Coors Company conducted a phone interview of a random sample of its 10,000 staff members to determine changes in health practices since the introduction of an employee Worksite Health Promotion Program 4 years earlier. The sample of 495 staff members was stratified to match the company profile in terms of age, sex and job description. The survey published that 65 percent of respondents started exercising in The last 4 years, 37 percent had improved their diets, 20 percent were regular users of the wellness center, 9 percent had stopped smoking as the result of the company’s tobacco cessation program and active participants of the wellness center miss an average of 1.96 workdays annually because of illness or injury compared to 3.08 days for non-participating staff members.
The Coors Organization also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 workers were out of work 7.2 months after a heart attack or bypass operation. In 1984, cardiac patients were out an average 1.9 months saving $152,000 in lost work time and in 1985 cardiac patients missed an average of 2.6 months, saving $125,000 that year.
Wellness Proposals