Worksite health promotion refers to the systematic approach endorsed by an organization designed to enhance the health of the company and its most important asset: its employees. In order to reach the greatest health improvement and cost containment potential, programs may include initiatives based in the worksite as well as in the employee's community, clinic, and home. These efforts may take the shape of awareness education, behavior and lifestyle change, and the creation of supportive environments. The ultimate goal of worksite health promotion is to create a culture that values and meets both individual and organizational needs for health improvement. (1)

The Centers for Disease Control and Prevention estimate that over half of all premature deaths in adults in the United States are from lifestyle-related causes. Less than one-fifth of premature deaths are from problems that are treatable through traditional medical care. (2)

It is predicted that health care costs will rise from 14% of the GNP in 1994 to 18% in the year 2000. Employers are instituting disease prevention/health promotion programs in order to hold down these costs. The most popular type of health promotion program is hypertension screening, followed by newsletters on nutrition; programs focusing on healthy lifestyles, smoking cessation, weight loss, and cancer screening; health club discounts/onsite health club; and prenatal screening. (2) A number of wellness programs are also beginning to add substance abuse prevention strategies.

In 1987, 65% of U.S. worksites with 50 or more employees had at least one health promotion activity. Today, most large corporations have complete wellness centers, and many small- to mid-size firms offer some type of wellness program. (3)

Employers are becoming more involved in promoting the health of their workers. In 1996, 89% of employers had some type of health initiative, up from 64% in 1992. The most common health promotion initiatives were: smoke-free Workplace (80%), education/training (78%), health risk assessment (76%), and special programs (71%). (4)

A study of 8,334 employees who participated in Procter & Gamble's health promotion program had significantly lower health care costs (29% lower total and 36% lower lifestyle-related costs) when compared with nonparticipants in the third year of the program. Similarly, in the third year of the program, participants had significantly lower inpatient costs, fewer hospital admissions, and fewer hospital days of care compared with nonparticipants. There were no differences noted in the first two years of the program. (5)

It has been shown that 60-90% of all visits to health professionals are for some sort of stress-related disorder. Employers invest in stress reduction programs in order to minimize these costs. Programs that have been shown to give the highest rate of return for the employer include: stress reduction, smoking cessation, and nutrition. (2)

Individual health promotion programs work only in already healthy organizations. Such programs place all responsibility for health enhancement and risk reduction with the individual, independent of the health norms within the organization. This strategy is not designed for maximum success. In contrast, organizational health promotion programs focus primarily on improving the corporate culture and on enhancing the environment in which people work.
Differences in the effectiveness of wellness programs can be attributed to the degree to which the corporate culture supports a comprehensive productivity/wellness plan. (6) (7)
 

MEDSTAT and the American Productivity and Quality Center identified the following effective strategies:

• Health promotion and productivity programs are aligned with business strategies
• A leader or champion is present for the program
• Team members are enthusiastic about developing and championing the health and productivity program
• Senior management buy into the program, with appropriate resources allocated
• Business operations managers are key members of the team
• Wellness and health promotion staff members are heavily involved, supporting a healthy company culture
• Research and outcomes projects are set up to demonstrate the link between productivity and health
• A corporate consensus exists that improving the quality of work life will improve productivity and cost savings will result. (8)

Utilization of wellness programs has been estimated at 20-40% of employees. (3) Successful incentives to influence participation in worksite wellness programs include: (a) throwing parties; (b) increasing insurance coverage; (c) cash bonuses; and (d) days off for meeting weight and/or exercise goals. (8)

Johnson and Johnson estimated savings of at least $1.9 million through decreased medical costs, reduced sick leave, and increased productivity. (8)

A retrospective study of 1,325 city employees insured by the City of Mesa, Arizona, revealed a significantly greater decrease in health care costs of employees who participated in a mobile worksite health promotion program, as opposed to employees not participating. Health care costs decreased 16%, resulting in a $3.6 savings for every dollar spent on health promotion services. (9)

The return on investment enjoyed by five large companies as a result of their health promotion activities ranged from $2.05 to $6.15. (10)

1. Association for Worksite Health Promotion (http://www.awhp.org), October 1998.

2. Finkel, M.L. (1996). Health care, a basic guide: Cost management, 3^rd ed. Brookfield, WI: International Foundation of Employee Benefit Plans.

3. Gemignani, J. (1998). Best practices that boost productivity. Business and Health March: 37-42.

4. Caldwell, B. (1998). Managed care firms slow to implement wellness initiative: Some try to measure cost effectiveness. Employee Benefit Plan Review May:44-46.

5. Goetzel R.Z.; Jacobson, B.H.; Aldana, S.G.; Vardell, K.; and Yee, L. (1998). Health care costs of worksite health promotion participants and non-participants. Journal of Occupational Environment Medicine 40(4):341-346.

6. Bellingham, R. (1990). Debunking the myth of individual health promotion. Occupational Medicine 5(4):665-675.

7. Conrad, K.M.; Riedel, J.E.; and Gibbs, J.O. (1990). Effect of worksite health promotion programs on employee absenteeism: A comparative analysis. American Association of Occupational Health Nurses Journal (AAOHNJ) 38:573-580.

8. DeMoranville, C.W.; Schoenbachler, D.D.; and Przytulski, J. (1998). Wellness at Work: Marketing Health Services, Summer.

9. Aldana, S.G.; Jacobson, B.H.; Harris, C.J.; Kelley, P.; and Stone, W.J. (1993). Influence of a mobile worksite health promotion program on health care costs. American Journal of Preventive Medicine 9(6):378-383.

10. Pelletier, K.R. (1996). A review and analysis of the health and cost-effective outcome studies of comprehensive health promotion and disease prevention programs at the worksite: 1993-1995 update. American Journal of Health Promotion 10(5):380-388.

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