Introduction to Company Health Promotion Programs
The previous ten years has brought major changes in employer attitudes toward Employee Health Promotion Programs. Interest in self-help and self-care programs has increased as growth in healthcare expenditures have encroached substantially into profits. Changes in the employer structures of healthcare facilities, in particular the growth of the for-profit healthcare sector, and the need to contain expenditures are changing the ways in which purchasers of healthcare plans are viewing their own efforts toward provision of workplace healthcare programs and facilities. Projections for the next decade indicate that workplace health programs will continue to become significant factors in the provision of healthcare, including prevention activities, for both government and private industry. In corporations with existing Employee 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 (BP) control, nutrition programs and stress management. Benefits cited range from improved health and productiveness to decreasing healthcare expenditures.
Demographics of the American 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 increase to 32 years by 2030.
• 57.9% of all staff members work in corporations with between 2 and 500 staff members; 45% work in corporations 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 staff members in 1985 were union members.
• 45 percent of all employees are employed in offices.
Prevalence of Workplace Health Promotion Programs Activities
Based on a 1985 survey, almost 66 percent of worksites with 50 or more staff members had Corporate Health Promotion Programs activities in 1985. The frequency of worksite-based activities by selected categories in 1985 was:
Activity
Smoking Control 35.6 percent
Health Risk Assessment 29.5 percent
Back Care 28.6 percent
Stress Management 26.6 percent
Exercise 22.1 percent
Off the Job Accidents 19.8 percent
Nutrition 16.8 percent
Blood Pressure Control 16.5 percent
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most employees believe the benefits of their Worksite Health Promotion Programs activities outweigh the costs, although few formal evaluations exist.
The most generally given reason for starting programs and perceived profit from programs is improved employee health.
At most worksites with activities (85.4%), all staff members are eligible to take part. 30% of worksites with activities offer them to company dependents, and an equal percent offer them to retirees.
When worksites seek outside program assistance, they turn to voluntary, not-for-profit corporations (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance corporations (43%).
Smoking Cessation Programs
Smoking related health issues cost U.S. businesses $26 billion per year in lost productiveness and $7 to $8 billion in smoking-related healthcare costs.
Workers who smoke are 50% more likely to be hospitalized than nonsmokers, have 2 times as a myriad of job-related accidents as nonsmokers and have absenteeism rates approximately 50% higher than nonsmokers.
People who used tobacco an average of one or more packs of cigarettes per day had 118 percent higher medical expenditures than nonsmokers.
76% of current tobacco users and 80% of former tobacco users and non-smokers feel that employers should restrict smoking to certain areas.
In 1985, 65 percent of smokers, 85 percent of people that do not smoke and 78 percent of former smokers, felt that tobacco users must refrain from smoking in the presence of people that do not smoke.
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 smoking cessation intervention program used by employers include:
• offering non-smokers a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• offering cessation programs on employer or shared time;
• making available cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit smoking days; and
• adopting a tobacco-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 established to yield a two- to three-fold difference in cardiovascular deaths between active staff members and their more sedentary counterparts.
In addition to improving strength, balance, and flexibility, physical activity 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 due to back issues.
Research findings support the notion that workplace exercise programs better fitness and help lower other health risks, although results related to improved productivity are weak due to lack of methods for accurately calculating productivity.
A very small proportion of worksites have onsite physical fitness facilities.
The majority of staff members 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 neighborhood “Ys,” health clubs or other neighborhood programs if no on-Site facilities are available.
Worksite physical activity programs may lower costs to employers by decreasing employee medical care claims and expenditures.
Participants whose weekly physical activity 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% 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 are able to reduce the risk of somber health problems such as elevated Blood Pressure (BP) and cholesterol levels and is instrumental in the control of non-insulin-dependent diabetes.
The workplace offers several advantages for nutrition education; support and impact of co-employees and senior staff, availability of a daily eating situation, and opportunities for follow-up and monitoring.
Job Site diet programs have the potential to be grouped in 6 broad categories:
• cafeteria programs;
• multi-component programs;
• weight management programs;
• blood lipid reduction programs;
• programs for pregnant and lactating women; and
• other diet education subject matters.
Men are less likely to take part in weight-loss programs than are female employees.
Stress Management
Estimates suggest that 50% to 80% of physician visits have the potential to be attributed to psychosomatic or stress-related origins.
Corporation pays many of the costs related to employee stress, both directly in the form of healthcare costs and in lower work rate.
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-employees or supervisors.
Most workplace stress management programs are implemented as a result of requests from staff members.
Stress management programs focus on three types of skills: relaxation skills, coping skills, and interpersonal skills.
Job Site stress management programs are frequently delivered in one of three formats:
• seminars conducted by trained professionals;
• self-learning tools; and
• personal teaching to help 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 harmful 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 annually.
More than 36 percent of the 11,300 accidental work deaths in 1983 involved motor vehicles.
Employees 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 activity as any other kind 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 organization vehicle or using a personal vehicle for organization business, have been enforced, 60 percent to 90 percent use has been reported.
Incentive programs, accompanied by education and use requirement restrictions have resulted in 40 percent to 70 percent 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 required belt use working;
• positive incentives; and
• ongoing education and training programs.
Case Studies of Workplace Wellness Programs
Based on an extensive evaluation of its all-inclusive employee 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.
staff members at four Johnson & Johnson businesses who were exposed to the Workplace Health Promotion Program expanding their daily energy expenditure in vigorous exercise by 104 percent compared to a rise of 33 percent among staff members at businesses that were provided only an annual health screen.
Members in the United Methodist Publishing House’s Employee 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 health care expenditures for 1985 ($902,116 projected with actual expenditures $142,884) to the Worksite Health Promotion Program although the results are not conclusive.
In 1985, the Adolph Coors Employer 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 Employee Wellness Program 4 years earlier. The sample of 495 employees was stratified to match the organization 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 organization’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 Organization also saw a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 staff members 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.
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