Introduction to Worksite Health Promotion Programs
The last ten years has brought big changes in company attitudes toward Worksite Wellness Programs. Interest in self-help and self-care programs has increased as growth in medical care expenditures have encroached substantially into profits. Changes in the company structures of medical care facilities, in particular the growth of the for-profit medical care sector, and the need to contain expenditures are changing the ways in which purchasers of medical care plans are viewing their own efforts toward provision of workplace medical care programs and facilities. Projections for the next decade indicate that workplace health programs will continue to become important factors in the provision of medical care, including prevention activities, for both government and private industry. In corporations with existing Worksite Wellness 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 control, nutrition programs and stress management. Benefits given range from improved health and work rate to lowering medical care expenditures.
Demographics of the U.S. Workforce
• 110 million American citizens were in the civilian labor force in 1981; by the year 2000 the civilian labor force is predicted to be nearly 140 million.
• 44% of the 1984 labor force was female; ten% was Black.
• The median age of the workforce is 32 years and is expected to rise to 32 years by 2030.
• 57.9% of all staff members work in employers with between 2 and 500 staff members; 45% work in employers with fewer than 100 staff members. An additional 7.5 million Americans are self-employed and 3 million are farmers.
• 18 percent of all wage and salaried staff members in 1985 were union participants.
• 45 percent of all employees are employed in offices.
Prevalence of Workplace Health Promotion Programs Activities
Based on a 1985 survey, almost 66% of worksites with 50 or more workers had Employee Health Promotion Programs activities in 1985. The frequency of workplace-based activities by selected categories in 1985 was:
Activity
Smoking Control 35.6%
Health Risk Assessment 29.5 percent
Back Care 28.6 percent
Stress Management 26.6%
Exercise 22.1%
Off the Job Accidents 19.8%
Nutrition 16.8%
Blood Pressure Control 16.5%
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most staff members believe the advantages of their Corporate Wellness Programs activities outweigh the expenditures, even though few formal evaluations exist.
The most frequently cited reason for starting programs and perceived profit from programs is improved employee health.
At most worksites with activities (85.4%), all workers are eligible to participate. 30 percent of worksites with activities offer them to organization dependents, and an equal percent offer them to retirees.
When worksites seek outside program assistance, they turn to voluntary, not-for-profit companies (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance companies (43%).
Smoking Cessation Programs
Smoking related health problems cost United States organizations $26 billion per year in lost productivity and $7 to $8 billion in tobacco-related health care costs.
Staff Members who use tobacco are 50 percent more likely to be hospitalized than people that do not use tobacco, have 2 times as many job-related accidents as people that do not use tobacco and have absenteeism rates approximately 50 percent higher than people that do not use tobacco.
People who used tobacco an average of one or more packs of cigarettes per day had 118 percent higher healthcare expenses than people that do not use tobacco.
76% of current smokers and 80% of former smokers and people that do not use tobacco feel that companies ought to restrict smoking to certain areas.
In 1985, 65 percent of smokers, 85 percent of people that do not use tobacco and 78 percent of former smokers, felt that tobacco users ought to refrain from smoking in the presence of people that do not use tobacco.
In 1986, 17 states had laws regulating smoking in offices or workplaces either in government-controlled offices or offices of private workers.
Examples of smoking cessation intervention program used by corporations include:
• offering people that do not use tobacco a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• providing cessation programs on corporation or shared time;
• providing cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit smoking days; and
• adopting a smoke-free company 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 activity has been established to give a two- to three-fold difference in cardiovascular deaths between active workers and their more sedentary counterparts.
In addition to improving strength, balance, and flexibility, exercise programs can cut the probability of back injuries among certain occupational groups.
93 million workdays in the United States are lost annually as the result of back concerns.
Research findings support the notion that worksite physical activity programs improve fitness and help decrease other health risks, although results related to improved productiveness are weak due to lack of methods for accurately quantifying productiveness.
A very small proportion of worksites have on-Site 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 community “Ys,” health clubs or other community programs if no on-Site facilities are available.
Job Site exercise program may decrease expenditures to employers by reducing employee health care claims and expenditures.
Those whose weekly exercise was equivalent to climbing less than five flights of stairs or walking less than a half mile, invested 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 percent higher than those for thin people.
Nutrition and Weight Control
One-third of this country population is obese to the extent of decreasing their life expectancy.
Improvements in eating habits can decrease the risk of serious 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 nutrition education; support and effect of co-employees and upper management, availability of a daily eating situation, and opportunities for follow-up and monitoring.
Worksite nutrition programs can be grouped in 6 broad categories:
• cafeteria programs;
• multi-component programs;
• weight control programs;
• cholesterol 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 staff members.
Stress Management
Estimates suggest that 50% to 80% of physician visits are able to be attributed to psychosomatic or stress-related origins.
Employer pays many of the expenditures related to employee stress, both directly in the form of medical expenditures and in lower work rate.
Job factors which are associated with stress include:
• not allowing employees 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-employees 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.
Job Site stress management programs are often delivered in one of three formats:
• courses conducted by trained professionals;
• self-learning tools; and
• personal teaching to assist with self-assessment, planning for changes, learning new skills and responding to life crises.
The two primary techniques used in worksite stress management programs are:
• teaching people to decrease the negative physical effects of stress; and
• teaching people to recognize and control sources of stress at work and in personal life.
Safety Belt Usage
Motor vehicle accidents are the largest single cause of lost work time and on-the-job fatalities of American business.
Motor vehicle accidents account for 27 percent of all work-related deaths and 45 million days of lost work annually.
Greater than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.
Staff Members who regularly fail to use seat belts may spend up to 54% more days in the hospital.
Traffic accidents caused about 3 times as many days of restricted exercise as any other type of disability.
Motor vehicle crashes cost $15.2 billion in lost productivity, 88 percent of which is attributed to losses from workforce activities and future earnings.
In work settings where safety belt policies, mandating use of belts by anyone riding in a company vehicle or using a private vehicle for company business, have been enforced, 60% to 90% use has been reported.
Incentive programs, accompanied by education and use requirement restrictions have resulted in 40% to 70% initial usage rates.
Factors influencing the sources of workplace safety belt programs include:
• active commitment on the part of upper management;
• clearly defined and well enforced policy of necessitated belt use working;
• beneficial incentives/rewards; and
• ongoing education and training programs.
Case Studies of Company Health Promotion Programs
Based on an extensive evaluation of its comprehensive employee Worksite Health Promotion 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 profit of $316 per employee. Their year 9 projected profit is $677 per employee.
employees at four Johnson & Johnson businesses who were exposed to the Corporate Health Promotion Program increased their daily energy expenditure in vigorous exercise by 104 percent compared to a growth of 33 percent among employees at businesses that were provided only an annual health screen.
Members in the United Methodist Publishing House’s Company Health Promotion 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 reduced than projected use in medical costs for 1985 ($902,116 projected with actual costs $142,884) to the Company Wellness Program although the results are not conclusive.
In 1985, the Adolph Coors Business conducted a telephone interview of a random sample of its 10,000 employees to determine changes in health practices since the introduction of an employee Company Health Promotion Program 4 years earlier. The sample of 495 employees was stratified to match the corporation profile in terms of age, sex and job description. The survey stated that 65% of respondents started working out in The previous 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped smoking as the result of the corporation’s smoking cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year due to illness or injury compared to 3.08 days for non-participating employees.
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.
