The last ten years has brought major changes in employer 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 organizational 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 important factors in the provision of health care, including prevention activities, for both government and private industry. In businesses with existing worksite 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 control, nutrition programs and stress management. Benefits cited range from improved health and productivity to reducing health care costs.
Demographics of the U.S. Workforce
110 million Americans were in the civilian labor force in 1981; by the year 2000 the civilian labor force is expected to be nearly 140 million.
44% of the 1984 labor force was female; 10% 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 businesses with between 2 and 500 employees; 45% work in businesses with fewer than 100 employees. An additional 7.5 million Americans are self-employed and 3 million are farmers.
18% of all wage and salaried employees in 1985 were union members.
45% of all workers are employed in offices.
Prevalence of Worksite Health Promotion Activities
Based on a 1985 survey, almost 66% of worksites with 50 or more employees had worksite health promotion activities in 1985.
The frequency of worksite-based activities by selected categories in 1985 was:
|Health Risk Assessment||29.5%|
|Off the Job Accidents||19.8%|
|Blood Pressure Control||16.5%|
Worksite size is the strongest indicator of program prevalence.
Most employees believe the benefits of their worksite health promotion activities outweigh the costs, even though 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 employees are eligible to participate. 30% of worksites with activities offer them to employer dependents, and an equal percent offer them to retirees.
When worksites seek outside program assistance, they turn to voluntary, not-for-profit organizations (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance companies (43%).
Smoking Cessation Programs
Smoking related health problems cost U.S. businesses $26 billion per year in lost productivity and $7 to $8 billion in smoking-related medical costs.
Workers who smoke are 50% more likely to be hospitalized than nonsmokers, have 2 times as many job-related accidents as nonsmokers and have absenteeism rates approximately 50% higher than nonsmokers.
People who smoked an average of one or more packs of cigarettes per day had 118% higher medical expenses than nonsmokers.
76% of current smokers and 80% of former smokers and nonsmokers feel that companies should restrict smoking to certain areas.
In 1985, 65% of smokers, 85% of nonsmokers and 78% of former smokers, felt that smokers should 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 employees.
Examples of smoking cessation intervention program used by companies include:
- offering nonsmokers a discount of health and life insurance;
- paying full or partial fees for smoking cessation programs;
- providing cessation programs on company or shared time;
- offering cash payments to quitters after 6 of 12 smoke-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 can lead as vigorous a lifestyle as a sedentary 35-year-old.
Differences in work-related activity has been shown to yield 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 reduce the probability of back injuries among certain occupational groups.
93 million workdays in the United States are lost annually as the result of back problems.
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 proportion of worksites have on-site physical fitness facilities.
The majority of employees sponsored physical fitness programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.
Some businesses subsidize employee participation in community “Ys,” health clubs or other community programs if no on-site facilities are available.
Worksite physical fitness programs may reduce costs to employers by reducing employee health care claims and expenditures.
People whose weekly exercise was equivalent to climbing less than five flights of stairs or walking less than a half mile, spent 114% more on health claims than those who climbed 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 the U.S. population is obese to the extent of decreasing their life expectancy.
Improvements in eating habits can reduce the risk of serious health problems such as high blood pressure and cholesterol levels and is instrumental in the control of non-insulin-dependent diabetes.
The workplace offers several advantages for nutrition education; support and influence of co-workers and 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 nutrition education topics.
Men are less likely to participate in weight-loss programs than are female employees.
Estimates suggest that 50% to 80% of physician visits can be attributed to psychosomatic or stress-related origins.
Business pays many of the costs related to employee stress, both directly in the form of health care costs and in lower productivity.
Job factors which are associated with stress include:
- not allowing workers to participate 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-workers or supervisors.
Most worksite stress management programs are implemented as a result of requests from employees.
Stress management programs focus on three types of skills: relaxation skills, coping skills, and interpersonal skills.
Worksite stress management programs are often delivered in one of three formats:
- workshops 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 major techniques used in worksite stress management programs are:
- teaching people to reduce the negative 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 U.S. business.
Motor vehicle accidents account for 27% of all work-related deaths and 45 million days of lost work annually.
More than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.
Workers who routinely 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 activity as any other type of disability.
Motor vehicle crashes cost $15.2 billion in lost productivity, 88% of which is attributed to losses from workforce activities and future earnings.
In corporate settings where safety belt policies, requiring use of belts by anyone riding in a company vehicle or using a private vehicle on 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 worksite safety belt programs include:
- active commitment on the part of management;
- clearly defined and well enforced policy of required belt use on the job;
- positive incentives; and
- ongoing education and training programs.
Case Studies of Worksite Wellness Programs
Based on an extensive evaluation of its comprehensive employee 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 benefit of $316 per employee. Their year 9 projected benefit is $677 per employee.
Employees at four Johnson & Johnson companies who were exposed to the health promotion program increased their daily energy expenditure in vigorous activity by 104% compared to an increase of 33% among employees at companies that were offered only an annual health screen.
Participants in the United Methodist Publishing House’s 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 lower than projected use in health care costs for 1985 ($902,116 projected with actual costs $142,884) to the health promotion program even though the results are not conclusive.
In 1985, the Adolph Coors Company 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 health promotion program 4 years earlier. The sample of 495 employees was stratified to match the company profile in terms of age, sex and job description. The survey reported that 65% of respondents started exercising in the last 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped smoking as the result of the company’s smoking cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year because of illness or injury compared to 3.08 days for non-participating employees.
The Coors Company also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 employees 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.