Introduction to Worksite Wellness Programs
The last ten years has brought big changes in corporation attitudes toward Worksite 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 corporation 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 workplace health care programs and facilities. Projections for the next decade indicate that workplace health programs will continue to become valuable factors in the provision of health care, including prevention activities, for both government and private industry. In employers 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, tobacco cessation, Blood Pressure (BP) control, diet programs and stress management. Benefits given range from improved health and productivity to lowering health care costs.
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 percent of the 1984 labor force was female; 10 percent 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% of all wage and salaried workers in 1985 were union members.
• 45 percent of all employees are employed in offices.
Prevalence of Employee Health Promotion Programs Activities
Based on a 1985 survey, almost 66 percent of worksites with 50 or more employees 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 percent
Health Risk Assessment 29.5%
Back Care 28.6%
Stress Management 26.6 percent
Exercise 22.1%
Off the Job Accidents 19.8 percent
Nutrition 16.8%
Blood Pressure (BP) Control 16.5 percent
Weight Control 14.7 percent
Job Site size is the strongest indicator of program prevalence.
Most employees believe the benefits of their Corporate Health Promotion Programs activities outweigh the expenditures, even though few formal evaluations exist.
The most usually given reason for starting programs and perceived advance 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 employer dependents, and an equal percent offer them to retirees.
When worksites seek outside program assistance, they turn to voluntary, not-for-profit businesses (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance businesses (43%).
Tobacco Cessation Programs
Smoking related health concerns cost U.S. employers $26 billion per year in lost productiveness and $7 to $8 billion in smoking-related health care costs.
Employees who smoke are 50% more likely to be hospitalized than people that do not smoke, have 2 times as numerous job-related accidents as people that do not smoke and have absenteeism rates approximately 50% higher than people that do not smoke.
People who smoked an average of one or more packs of cigarettes per day had 118 percent higher medical expenses than nonsmokers.
76% of current smokers and 80% of former smokers and people that do not use tobacco feel that organizations ought to restrict smoking to certain areas.
In 1985, 65 percent of smokers, 85 percent of nonsmokers and 78 percent of former smokers, felt that smokers must refrain from smoking in the presence of nonsmokers.
In 1986, 17 states had laws regulating tobacco use in offices or workplaces either in government-controlled offices or offices of private employees.
Examples of tobacco cessation intervention program used by employers include:
• making available nonsmokers a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• offering 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 employer policy and setting deadlines for implementing the policy.
Physical Fitness Programs
An active 55-year-old man is able to lead as vigorous a lifestyle as a sedentary 35-year-old.
Differences in work-related activity has been determined 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 are able to reduce the probability of back injuries among certain occupational groups.
93 million workdays in the United States are lost each year as the result of back concerns.
Research findings support the notion that workplace exercise programs better fitness and help lower other health risks, although results related to improved work rate are weak due to lack of methods for accurately quantifying work rate.
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 businesses subsidize employee participation in area “Ys,” health clubs or other area programs if no on-Site facilities are available.
Worksite exercise program may lower costs to employers by lowering employee healthcare 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% more on health claims than those who ascended at least 15 flights of stairs or walked 1 1/2 miles weekly.
Healthcare costs for obese people are roughly 11 percent 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 have the potential to reduce the risk of serious health problems such as elevated 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 effect of co-workers and management, availability of a daily eating situation, and opportunities for follow-up and monitoring.
Job Site diet programs are able to 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 take part in weight-loss programs than are female staff members.
Stress Management
Estimates suggest that 50 percent to 80 percent of physician visits have the potential to be attributed to psychosomatic or stress-related origins.
Corporation pays many of the expenditures related to employee stress, both directly in the form of healthcare expenditures and in decreased 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-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:
• 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 workplace 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.
Safety 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 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.
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 work rate, 88 percent of which is attributed to losses from workforce activities and future earnings.
In work settings where safety belt policies, requiring use of belts by those riding in a company vehicle or using a private vehicle for company business, have been enforced, 60 percent to 90 percent use has been stated.
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 senior staff;
• clearly defined and well enforced policy of required belt use on the job;
• beneficial incentives; and
• ongoing education and training programs.
Case Studies of Employee Health Promotion Programs
Based on an extensive assessment of its comprehensive employee Workplace Wellness Program, LIVE FOR LIFE, Johnson & Johnson published 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.
staff members at four Johnson & Johnson corporations who were exposed to the Worksite Wellness Program increased their daily energy expenditure in vigorous exercise by 104% compared to an increase of 33% among staff members at corporations that were provided only an annual health screen.
Members in the United Methodist Publishing House’s Worksite 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 reduced than projected use in medical expenditures for 1985 ($902,116 projected with actual expenditures $142,884) to the Workplace Health Promotion Program even though the results are not conclusive.
In 1985, the Adolph Coors Organization conducted a phone interview of a random sample of its 10,000 employees to determine changes in health practices since the introduction of an employee Worksite 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 percent of respondents started exercising in The previous 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 smoking cessation program and regular 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 employees.
The Coors Employer also achieved a cost savings from a cardiac rehabilitation program that was begun 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.
