Workplace Wellness

Workplace wellness is any workplace health promotion activity or organizational policy designed to support healthy behavior in the workplace and to improve health outcomes. Workplace wellness often comprises activities such as health education, medical screenings, weight management programs, and on-site fitness programs or facilities.

The lifestyles of people in the workforce are important both for the sake of their own health and for the sake of their employer’s productivity. Companies often subsidize these programs in the hope that they will save companies money in the long run by improving health, morale, and productivity, although there is some controversy about evidence for the levels of return on investment.

Other examples of workplace wellness organizational policies include allowing flex-time for exercise, providing on-site kitchen and eating areas, offering healthy food options in vending machines, holding “walk and talk” meetings, and offering financial and other incentives for participation. In recent years, workplace wellness has been expanded from single health promotion interventions to create a more overall healthy environment including, for example standards of building and interior design to promote physical activity.

In the US, many company wellness programs use financial incentives to encourage participation, meaning federal rules might apply. These include three laws that directly affect wellness initiatives:

Bowl of fruit

Rationale

Obesity and related conditions have risen to epidemic levels in the US and around the globe. The causes for this are numerous and included among the list are increases in automation and labor-saving devices that have resulted in a change in the way we live and work. Employees in many workplaces now spend much of their time sitting (sedentary) and often have easy access to energy-dense food and beverages. As a result, unhealthy workplaces are believed to be a contributory factor in the obesity epidemic.

Obesity has been linked to numerous chronic diseases including cardiovascular disease, dyslipidemia, osteoarthritis and some cancers.

Concern about the economic burden associated with obesity is also growing. Obesity is associated with increased absenteeism, disability, injury and healthcare claims, which alongside the affects on those affected, also drive up costs for employers. Furthermore, when compared to other industrialized countries, the US has the highest per capita costs for health care and also as a percentage of gross domestic product, yet ranks in the bottom quartile for life expectancy and infant mortality.

While the stated goal of workplace wellness programs is to improve employee health, many US employers have turned to them to help alleviate the impact of enormous increases in health insurance premiums experienced over the last decade. Some employers have also begun varying the amount paid by their employees for health insurance based on participation in these programs. Cost-shifting strategies alone, through high copayments or coinsurance may create barriers to participation in preventive health screenings or lower medication adherence.

One of the reasons for the growth of healthcare costs to employers is the rise in obesity-related illnesses brought about by lack of physical activity, another is the effect of an aging workforce and the associated increase in chronic health conditions driving higher health care utilization. In 2000 the health costs of overweight and obesity in the US were estimated at $117 billion. Each year obesity contributes to an estimated 112,000 preventable deaths. An East Carolina University study of individuals aged 15 and older without physical limitations found that the average annual direct medical costs were $1,019 for those who are regularly physically active and $1,349 for those who reported being inactive. Being overweight increases yearly per person health care costs by $125, while obesity increases costs by $395. A survey of North Carolina Department of Health and Human Services employees found that approximately 70 cents of every healthcare dollar was spent to treat employees who had one or more chronic conditions, two thirds of which can be attributed to three major lifestyle risk factors: physical inactivity, poor diet, and tobacco use. Obese employees spend 77 percent more on medications than non-obese employees and 72 percent of those medical claims are for conditions that are preventable.

Benefits

Wellness programs are being implemented across the country in large and small companies, and the results are positively impacting the bottom line. “Research is showing that it’s more cost-effective to invest in preventive health practices, such as screenings, immunizations, health risk appraisals, behavioral coaching, and health awareness/education, rather than spending resources exclusively on the small minority of employees/dependents who are responsible for high-cost health claims.” A U.S. Department of Health and Human Services report revealed that at worksites with exercise programs as components of their wellness programs, healthcare costs decreased from 20 to 55%, short-term sick leave was lowered from 38 to 32%, and productivity increased from 50 to 52%.

Researchers from the Centers for Disease Control and Prevention studied strategies to prevent cardiovascular disease and found that over a two- to five-year period, companies with comprehensive workplace wellness programs and appropriate health plans in place can yield $3USD to $6USD for each dollar invested and reduced the likelihood of employee heart attacks and strokes. Also, a 2011 report by Health Fairs Direct which analyzed over 50 studies related to corporate and employee wellness, showed that the ROI on specific wellness related programs ranged between $1.17 to $6.04. In general, it is estimated that worksite health promotion programs result in a benefit-to-cost ratio of $3.48 in reduced health care costs and $5.82 in lower absenteeism costs per dollar invested, according to the Missouri Department of Health & Senior Services. Additionally, worksite health programs can improve productivity, increase employee satisfaction, demonstrate concern for employees, and improve morale in the workplace.

The Affordable Care Act increases the cap on incentives which can be granted to employees for participating in health-contingent wellness programs from 20% of the total cost of employee-only healthcare to the 30% of the total cost, while smoking cessation must reach 50% of the total cost. Employers can incentivize employees with significant rewards for participation in biometrics screenings and health risk assessments and/or hitting their targets in a manner which theoretically saves both the employer and the employee money, especially when these programs are implemented at a large scale. Rewarding employees based on meeting goals is known as a “results-based wellness program.” Incentives, however, have increased from 2011 to 2012 by 13%. Generally, incentives take the form of “Pay or Play”.

Framework

Worksite wellness programs including nutrition and physical activity components may occur separately or as part of a comprehensive worksite health promotion program addressing a broader range of objectives such as smoking cessation, stress management, and weight loss. A conceptual model has been developed by the Task Force for Community Preventive Services and serves as an analytic framework for workplace wellness and depicts the components of such comprehensive programs. These components include worksite interventions including 1) environmental changes and policy, 2) informational messages, and 3) behavioral and social skills or approaches.

Worksite environmental change and policy strategies are designed to make healthy choices easier. They target the whole workforce rather than individuals by modifying physical or organizational structures. Examples of environmental changes may include enabling access to healthy foods (e.g., through modification of cafeteria offerings or vending machine content) or enhancing opportunities to engage in physical activity (e.g., by providing onsite facilities for exercise). Policy strategies may involve changing rules and procedures for employees, such as offering health insurance benefits, reimbursement for health club memberships, or allowing time for breaks or meals at the worksite.

Informational and educational strategies attempt to build the knowledge base necessary to inform optimal health practices. Information and learning experiences facilitate voluntary adaptations of behavior conducive to health. Examples include health-related information provided on the company intranet, posters or pamphlets, nutrition education software, and information about the benefits of healthy diet and exercise. Behavioral and social strategies attempt to influence behaviors indirectly by targeting individual cognition (awareness, self-efficacy, perceived support, intentions) believed to mediate behavior changes. These strategies can include structuring the social environment to provide support for people trying to initiate or maintain weight change. Such interventions may involve individual or group behavioral counseling, skill-building activities such as cue control, use of rewards or reinforcement, and inclusion of coworker or family members for support.

Blurry legs running on a treadmill, with other gym equipment visible in the background

Barriers

Most employers have yet to embrace the worksite wellness strategy according to the findings of the 2004 National Worksite Health Promotion Survey. Only 6.9 percent of surveyed organizations met the criteria for a comprehensive health promotion program. This is far short of the 75 percent target included in the Healthy People 2010 goal which shows that there are still significant barriers to the large-scale adoption of worksite health promotion practices by organizations, both large and small.

The encouraging news is that since the 2004 report was published, there appears to be more momentum toward implementation of comprehensive worksite health promotion. This is evident by pending federal legislation and the growth of employer-based health coalitions such as the National Business Group on Health, Institute for Health and Productivity Management, Center for Health Value Innovation, and the National Business Coalition on Health. Peer-based executive advocacy through the Leading by Example initiative of Partnership for Prevention is another example of this trend towards comprehensive workplace health promotion.

Low participation rates by employees significantly limit the potential benefits. Little is known or reported about the determinants of participation, but some clues are emerging. Ongoing management support and accountability are critical to successful worksite health promotion programs. Men and women participate in different types of activities, and white-collar employees engage in activities at a greater rate than blue-color employees. There are legal and ethical issues to consider as well including obtaining participant release forms, and maintaining employee confidentiality, especially concerning health risk appraisals and other information protected under federal law. One reason for low participation rates may have to do with the messaging associated with the policy or program. In order to motivate or persuade employees to participate and change behavior, messages should be individually targeted which results in more significant positive attitude change.

Workplace wellness programs should also be culturally sensitive and appropriate to economically challenged minority and other underserved populations. One of the strongest predictors of health status is socioeconomic status (SES), and the gap between SES groups is widening (Thompson). Research is being conducted to better understand the challenges and come up with solutions. One idea involves soliciting the assistance of member of the community and giving ownership of the program to the employees. This approach is based on Bracht’s 5-stage community organizational model for health promotion with adaptations for the worksite. Restrictive participation policies (e.g., off-the-clock scheduling) for onsite health promotion activities such as health screenings, health risk appraisals, and workshops may act as a barrier to participation and therefore have a negative impact on health outcomes and effectiveness.

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