Health Tips A to Z

An initial health evaluation can include a survey of staff members’ interests as part of the assessment. Successful wellness programs are designed to meet the needs and interests of the staff members. The information you need to get from a survey depends on the scope of your program. A sample survey can be obtained in the HOPE Publications Web site. If you plan to adjust this sample survey or develop your own survey, keep the following hints in mind:

• Ask mostly closed-choice questions, especially if you will be sending the survey to a sizable number of staff members. Closed-choice questions support specific choices and are easy to tabulate. You may want to use a computer for data entry and analysis.
• Invite comments, suggestions and recommendations, or ask open-ended questions at the end of the survey. Open-ended items are more difficult to summarize.
• Include a brief explanatory cover letter with the survey with the signature of the organization president. Make sure to include a statement about confidentiality and anonymity.
• Ask a group of representative employees to review the survey before it is distributed. Find out if the questions will be understood by employees and will not be objected to.
• Include demographic information at the beginning or end of the survey. Consider various ways that you might analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When thinking of who must get the survey, a simple rule is if you have under 500 workers, everyone must receive one. The public relations benefit of everyone receiving a survey can be important. Over 500 workers, a sample of the work population will suffice. A sample saves on expenditures and time. You may want to consider hiring a statistician to determine the right sample size for your worksite.

Needs surveys are confidential and anonymous; they do not request information that may identify a person.

Getting reinforcement from management is crucial to the success of the program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the corporation. You can use the surveys here or make up your own. If you decide to do your own, keep the survey short. It shouldn’t take more than ten minutes to complete.

The interview process can also serve as a means of educating management. Provide concise fact sheets on the benefits of wellness programs for management. When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Provide these reports to management.

Once completed present a brief executive summary to management. Highlight a few interesting findings that can be used immediately to make decisions about the program.

Utilize charts and graphs to make your points. Prepare a detailed report for Company Wellness Program Committee participants itemizing each response. Provide a short article about the survey in the company newsletter.

The higher the response the more valid and reliable the results. A minimum response of 40% to 50% is acceptable.

Health Tip – Audio Version – “Older and sober”
Health Tip – Healthy Next Step – Find Treatment (Substance Abuse and Mental Health Services Administration)

For people who are at least middle aged and who have past alcohol dependence, also known as alcoholism, it looks like the safest amount of alcohol is none. Researchers at the National Institute on Alcohol Abuse and Alcoholism found that when they looked at people in recovery.

“For people 45 years of age and older, abstinence is by far the best approach. Even minimal drinking significantly increased the rate of relapse over a three-year period.”

For these folks, even a little alcohol raised the risk that they would return to alcoholism and the problems that come with it, such as driving while drinking.

Willenbring says the study supports the idea that abstinence is the best goal for such people.

The study was in Alcoholism: Clinical and Experimental Research.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: May, 09 2008

Health Tip – Audio Version – “Staying sharp”
Health Tip – Healthy Next Step – Treatment (National Institute on Aging)

From just forgetting something to the tragic decline of dementia, people commonly worry as they age about their ability to think. But a review of national data on people over age 70 indicates fewer of us need to worry.

Among seniors not in nursing homes, the rate of these cognitive impairments fell by 3.5 percentage points between 1993 and 2002, to 8.7 percent.

Researcher Kenneth Langa of the University of Michigan sees evidence that better education early in life, and better control of risk factors such as cholesterol and smoking, may help. He also says:

“Keeping your brain active in any way – and always – seems to be protective against these declines in brain health over time.”

The study in Alzheimer’s and Dementia was supported by the National Institutes of Health.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: May, 12 2008

Complete Employee Health Promotion Programs involve all workers, deal with all major health risks, offers choices, and target both the workers and the workplace environment; provide periodic assessment of its outcome.  Complete Employee Health Promotion Programs emphasize follow-up and offers backing for the employee as long as he/she is employed. Research studies have established this approach to be highly efficacious. Key components are planning, implementation, and assessment.

Beginning comprehensive Corporate Wellness Programs involve performing a needs and interest assessment, appointing a Corporate Wellness Program Committee, selecting wellness providers, setting goals for the corporate wellness program, marketing/promoting the program, and starting procedures to ensure confidentiality.

Implementation of inclusive Worksite Wellness Programs consist of five major tasks:

1.   Health assessment and referral
2.   Follow-up and counseling staff members
3.   Follow-up with physicians
4.   Health improvement programs
5.   Organizing worksite-wide activities.

Evaluation involves monitoring Corporate Wellness Programs to discover if it is working and to help you refine it. Measuring success shows what you have achieved, helps justify costs, and supplies information for management to support continued programming.

Health Tip – Audio Version – “Overpower underage drinking”
Health Tip – Healthy Next Step – Quick Stats: Underage Drinking (Centers for Disease Control and Prevention)

Teenagers who recognize persuasive alcohol advertising may be more likely to choose to refuse alcohol and resist peer pressure.

A study in the journal Addictive Behaviors found that in results from three years of data with 1,318 junior high students in New York City.

Seventh-graders who were able to identify the persuasive alcohol messages were more likely to resist peer pressure by the eighth grade. By the ninth grade, these students’ likelihood to drink was significantly reduced.

“Teens need to get with it, and realize they can resist the apparently clean and healthy images shown in alcohol ads.”

The study was supported by the National Institutes of Health.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: May, 14 2008

Health Tip – Audio Version  - “Making the grade“
Health Tip – Healthy Next Step – Reporting Foodborne Illness (Centers for Disease Control and Prevention)

Children aren’t the only ones evaluated with report cards. Germs are, too.

The Centers for Disease Control and Prevention’s Report Card on Food
Safety lists Salmonella as the most common foodborne illness last year.
Another germ, E. coli O157, also is a concern.

Salmonella can cause diarrhea, fever, abdominal cramps or vomiting.
Symptoms appear within three days and disappear in about seven in most
cases.

E. coli can cause severe illness, including kidney failure.

“Avoid the consumption of raw or undercooked foods including
oysters, eggs, ground beef and poultry, and also, always wash hands
thoroughly after contact with raw meat, animals, animal products or
animal environments.”

Health Tip courtesy of the U.S. Department of Health and Human Services.

E. coli can cause severe illness, including kidney failure.

Initially introduced by Halbert Dunn in the 1950’s, wellness became a popular buzzword during the late 1970’s and received considerable academic attention in the 1980’s.  Corporate Wellness Programs for workers became more widespread during the following decade, and credible evidence for their economic viability began to be published.  There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase expenditures.  Health Care Insurance expenditures escalate with both age and number of risks present.8,10   The number of risks is also strongly related to sick time absenteeism, Worker’s Compensation expenditures, short-term disability, and reduced work rate (”presenteeism”).

Early Corporate Health Promotion Programs were relatively basic and typically produced a return on investment of less than one dollar for every dollar spent operating the program (ROI = <1:1).8 Such programs might be characterized as "fun-oriented".  Participation is entirely voluntary, and there is no particular focus on the reduction of specifically identified high risks.  Interventions and activities are not customized, and there is no emphasis on the management of health costs.  These programs are typically site-based only, lack options to address all of the major behaviorally-related health risks, and lack multimodal presentation.  Minimal or no incentives/rewards are given to employees for participation, and services to spouses and family members are not available.  Most such programs lack meaningful assessment.  

More conventional programs are "activity-oriented" and have established an return on investment of between 1:2.5 and 1:3.5.8 These programs may have a greater emphasis on health and risk reduction, even though the efforts are relatively broad and not customized.  They may have some generalized emphasis on health cost management, even though not necessarily aimed at specific elevated risks.  Most are site-based and voluntary, with spouses included only rarely.  Modest incentives/rewards may be utilized to promote participation.  Formal assessment may be weak.

The newest and most economically viable programs are "results-oriented" and exemplify the health and productivity management model.  These programs consistently produce return rates of 1:4 or greater within a 12-24 month period.8   Such programs are strongly focused on the reduction of specifically identified high risks and the management of health costs.  They are generally voluntary, but use strong monetary and other incentives to encourage participation.  They are multi-component in nature (address all major risks), and have both workplace and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses as well as workers.

For businesses, the expense of providing healthcare insurance for their staff members is of great significance.  Those expenditures have been rising at yearly rates between 6% and 14%. Chapman's 2007 systematic review stated an average reduction in medical expenditures of 26.5% as a result of Workplace Health Promotion Programs.  His review covered 60 of the most scientifically valid research studies, with an average of 3.77 years of study.

Absenteeism due to illness is another cost driver.  Chapman's review reports an average decline in sick time of 25.3%.   Cost for Worker's Compensation was reduced by 40.7%, and disability expenditures by 24.2%. There is also an emerging literature on the expenditures of presenteeism (reduced productivity).11,13  In one study, every risk reduced through a wellness program provideed a 9% decline in presenteeism (and a 2% decline in absenteeism).

Some companies have achieved a zero percent increase in health care costs across at least brief periods of time.10  Doing so requires 90-95 percent participation of the employee population in focused wellness initiatives, with 75%-85 percent of the staff members falling into the low risk category.10  Although robust efforts to cut the risk status of those in moderate or high risk categories must be made, the needs of currently healthy staff members must be addressed as well to avert increases in risk-status.

Given the size of the federal workforce, valuable cost savings in the government's contribution to medical insurance premiums for workers might be achieved if a majority of that population were participating in active wellness programs.  Similarly, improvements in absenteeism, worker's compensation, disability, presenteeism, and turnover as a result of robust Worksite Wellness Programs would yield substantial fiscal advantages for the government.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Corporate Wellness Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Assessment of Workplace Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Worksite Health Promotion Programs and Worksite Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Employee Wellness Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Job Site: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.

Health Tip – Audio Version – “Exercise for the brain”
Health Tip – Healthy Next Step – Exercise for Seniors (National Library of Medicine)

There may be another way to protect the aging brain besides exercising it with intense sudoku puzzles.

A Mayo Clinic study finds regular physical exercise can help protect against mild cognitive impairment, which can include difficulty in remembering things such as events, appointments or even parts of conversations.

Researchers examined data from over 800 people ages 70 through 89.

“Persons who engage in this type of moderate, physical exercise between ages 50 and 65 at the frequency of two to five or six times a week appear to be protected against mild cognitive impairment.”

The study supported by the National Institutes of Health was presented at the American Academy of Neurology’s 2008 annual meeting.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: May, 16 2008

Health Tip – Audio Version – “Muscling up protein”
Health Tip – Healthy Next Step – Protein (Centers for Disease Control and Prevention)

Research on older women indicates they may be more at need of protein as a way to help them maintain muscle.

The study looked at men and women ages 65 to 80 who didn’t eat overnight, so researchers could compare muscle tissue samples taken before and after a protein drink.

The scientists found women absorbed less protein from the drink than men did.

“Definitely, I’d recommend a good protein intake because that’s one of the known factors. And there seems to be a little bit of a response – just not as good in the women as it is in the men.”

But they might subtract other foods so they don’t raise total calories.

The study in the journal Public Library of Science One was supported by the National Institutes of Health.

Health Tip courtesy of the U.S. Department of Health and Human Services.

Last revised: May, 15 2008

Business America is increasingly investing in employee wellness because it is good business.  In order to meet productiveness demands, organizations must rely on a healthy, constructive workforce to succeed in the highly competitive global marketplace.  Over a hundred research studies in both corporate and governmental settings have documented the economic benefits of Worksite Wellness Programs, including reduced absenteeism, reduced injuries and workman’s compensation expenditures, reduced medical care expenditures, reduced employee turnover, as well as enhanced productiveness, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment (ROI).  In general, the more focused and intensive the program, the greater benefit realized.  To enhance their success federal government Worksite Health Promotion Programs may be able to incorporate some of the features described.  Employee wellness programs determined to have beneficial returns on investment frequently include the following features:

1.   Health and productivity management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical exercise, excess weight, unhealthy diet, elevated cholesterol, high Blood Pressure, stress, depression, and so on.  High-risk workers are specifically targeted for intervention, although the most thriving programs also direct efforts towards healthy workers in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in thriving programs.  Staff Members take the questionnaire annually in numerous cases.  The HRA serves to expand awareness, offer direction, and excite individuals to better specific behaviors.  In some cases, the customized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It often serves as the entry point into wellness programs.

3.   Health Testing
Many programs combine the outcome of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure (BP), blood lipids, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computerized health risk appraisals often incorporate biometric data in their risk analysis.

4.   Incentives
workers are generally given monetary or other significant rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or exercising, and for maintaining healthy status and/or behaviors.  In numerous cases the monetary incentives are associated with reductions in health care insurance premiums.  Some programs use disincentives as well as incentives, such as charging workers who smoke higher rates for their health care insurance contribution.

5.   High participation rates
Successful programs use rewards and incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and bolster participation.

6.   Wellness coaching
staff members with identified risks or desire to improve their health habits may be periodically coached via telephone by trained health and wellness coaches.  Health & Wellness Coaching helps staff members set and achieve realistic lifestyle-related objectives and goals including those addressing stress, work life balance, smoking, weight, physical exercise, and various behavior modifications.  Three or more sessions are generally available.  In some intensive programs, the coaching extends to actual disease management intervention for staff members with identified high-risk diseases.

7.   Multiple formats
Programs may offer wellness content in online, paper, and seminar formats to provide stimulating variety and alternatives in order to accommodate the needs of all staff members.  In addition to onsite physical activity and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and organization courses are common dissemination strategies.

8.   Senior Management reinforcement
Enthusiastic and frequent endorsement by upper management is essential to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective programs have successive contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of health and wellness opportunities and reinforce the corporate emphasis on wellness through successive and multiple “touches”.

10.   Open enrollment
To advocate high participation rates staff members must have simple access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some businesses automatically enroll all staff members and then allow those who do not wish to take part to “opt-out”.  This practice has been demonstrated to boost enrollment rates in some settings.

11.   Family involvement
Many programs bolster spouses and other family members to participate in the employer wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is critical to offer employees effective and convenient assistance with quitting.  Access to tobacco cessation pharmaceuticals is frequently part of such programs.  In-house programs support the most convenient access to these services, although on-line or phone-based programs may be available as well.  

13.   Exercise
Regular physical exercise is a core component of every wellness program.  Workers must be strongly encouraged to engage in regular physical exercise.  Most programs provide either periodic or continuous onsite opportunities, and some locations have onsite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to community exercise facilities is a common alternative to onsite facilities.

14.   Weight management
Because obesity is a major threat to health it is imperative that programs offer effective assistance with weight control.  Robust encouragement from senior staff to shed excess weight is important.  Web-based programs, workplace programs, or discounted access to weight control programs in the community may all be available.  Long-term follow-up is vital for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common criticism among workers and a major contributor to absenteeism, presenteeism (reduced productivity), and low morale.  Almost all successful wellness programs offer assistance with personal and worksite stress.  Some programs refer workers to outside resources for more serious conditions like depression and anxiety disorders, but most offer online or common worksite general stress reduction programs.  Some businesses endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Health screenings/immunizations
employees are actively encouraged to complete recommended medical care screenings for Blood Pressure (BP), blood lipids, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites support these services at the worksite.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   On-Site medical care
Actual provision of on-Site primary care medical services is a growing trend.  The rapidly escalating expenditures of medical care insurance for employees has stimulated this trend.  Some corporations have saw that it is less expensive to offer primary care services themselves than to fund those services through health care insurance.  On-Site care also reduces the amount of time employees would otherwise spend away from the worksite getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Worksite Health Promotion Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Evaluation of Corporate Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Health Promotion Programs and Corporate Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Company Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Worksite Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.