Introduction to Corporate Health Promotion Programs
The previous ten years has brought primary changes in business attitudes toward Workplace 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 business 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 valuable factors in the provision of healthcare, including prevention activities, for both government and private industry. In companies with existing Workplace 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 work rate to decreasing healthcare expenditures.
Demographics of the American Workforce
• 110 million American citizens composed 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 percent of all employees work in corporations with between 2 and 500 employees; 45 percent work in corporations with fewer than 100 employees. An additional 7.5 million American citizens are self-employed and 3 million are farmers.
• 18% of all wage and salaried employees in 1985 were union members.
• 45% of all employees are employed in offices.
Prevalence of Employee Wellness Programs Activities
Based on a 1985 survey, almost 66% of worksites with 50 or more employees had Workplace Health Promotion Programs activities in 1985. The frequency of worksite-based activities by selected categories in 1985 was:
Activity
Smoking Control 35.6%
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 percent
Blood Pressure Control 16.5 percent
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most workers believe the benefits of their Worksite Wellness Programs activities outweigh the costs, although 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 take part. 30 percent 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%).
Tobacco Cessation Programs
Smoking related health problems cost United States organizations $26 billion per year in lost productivity and $7 to $8 billion in smoking-related medical costs.
Workers who use tobacco are 50% more likely to be hospitalized than people that do not use tobacco, have 2 times as many job-related accidents as people that do not use tobacco and have absenteeism rates approximately 50% higher than people that do not use tobacco.
People who used tobacco an average of one or more packs of cigarettes per day had 118 percent higher health care expenses than people that do not use tobacco.
76 percent of current tobacco users and 80 percent of former tobacco users and non-smokers feel that companies ought to 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 staff members.
Examples of tobacco cessation intervention program used by employers include:
• making available people that do not smoke a discount of health and life insurance;
• paying full or partial fees for smoking cessation programs;
• offering cessation programs on organization or shared time;
• making available cash payments to quitters after 6 of 12 smoke-free months;
• participating in national quit smoking days; and
• adopting a tobacco-free employer 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 exercise has been demonstrated to give 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, exercise programs have the potential to decrease 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 physical activity programs improve 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 proportion of worksites have onsite physical fitness facilities.
The majority of workers sponsored fitness programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.
Some corporations subsidize employee participation in community “Ys,” health clubs or other community programs if no on-Site facilities are available.
Worksite fitness programs may lower expenditures to employers by lowering employee health care 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 climbed at least 15 flights of stairs or walked 1 1/2 miles weekly.
Healthcare expenditures 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 can decrease the risk of somber health concerns such as elevated Blood Pressure and blood lipid 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.
Job Site diet programs are able to be grouped in 6 broad categories:
• cafeteria programs;
• multi-component programs;
• weight control programs;
• blood lipid reduction programs;
• programs for pregnant and lactating women; and
• other diet education issues.
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.
Business pays many of the expenditures related to employee stress, both directly in the form of medical expenditures and in decreased productiveness.
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-workers 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:
• seminars conducted by trained professionals;
• self-learning tools; and
• personal teaching to support 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 detrimental 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 American business.
Motor vehicle accidents account for 27% of all work-related deaths and 45 million days of lost work annually.
Greater than 36% of the 11,300 accidental work deaths in 1983 involved motor vehicles.
Workers who regularly fail to use seat belts may spend up to 54 percent more days in the hospital.
Traffic accidents caused about 3 times as many days of restricted exercise as any other kind of disability.
Motor vehicle crashes cost $15.2 billion in lost productiveness, 88% 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 employer vehicle or using a private vehicle for employer business, have been enforced, 60% to 90% use has been published.
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 upper management;
• clearly defined and well enforced policy of required belt use on the job;
• positive incentives/rewards; and
• ongoing education and training programs.
Case Studies of Worksite Wellness Programs
Based on an extensive evaluation of its comprehensive employee Company Health Promotion 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.
employees at four Johnson & Johnson organizations who were exposed to the Corporate Wellness Program increased their daily energy expenditure in vigorous activity by 104% compared to an increase of 33% among employees at organizations that were provided only an annual health screen.
Members in the United Methodist Publishing House’s Employee 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 healthcare costs for 1985 ($902,116 projected with actual costs $142,884) to the Company Health Promotion Program even though 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 Corporate Wellness Program 4 years earlier. The sample of 495 employees was stratified to match the employer profile in terms of age, sex and job description. The survey stated that 65 percent of respondents started exercising in The last 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 employer’s tobacco cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year due to illness or injury compared to 3.08 days for non-participating employees.
The Coors Corporation also saw a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 workers 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.
