Company Health and Wellness : Workplace Health Promotion Programs: The Facts

Introduction to Worksite Health Promotion Programs

The last ten years has brought major changes in business attitudes toward Company Wellness Programs. Interest in self-help and self-care programs has increased as growth in medical care costs have encroached substantially into profits. Changes in the business structures of medical care facilities, in particular the growth of the for-profit medical care sector, and the need to contain costs are changing the ways in which purchasers of medical care plans are viewing their own efforts toward provision of worksite medical care programs and facilities. Projections for the next decade indicate that worksite health programs will continue to become valuable factors in the provision of medical care, including prevention activities, for both government and private industry. In companies with existing Company Wellness 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, nutrition programs and stress management. Benefits cited range from improved health and work rate to decreasing medical care costs.

Demographics of the U.S. Workforce
• 110 million American citizens composed 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 percent of all workers work in businesses with between 2 and 500 workers; 45 percent work in businesses with fewer than 100 workers. An additional 7.5 million American citizens are self-employed and 3 million are farmers.
• 18% of all wage and salaried workers in 1985 were union members.
• 45% of all staff members are employed in offices.

Prevalence of Corporate Health Promotion Programs Activities

Based on a 1985 survey, almost 66 percent of worksites with 50 or more employees had Corporate 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 percent
Stress Management       26.6%
Exercise             22.1%
Off the Job Accidents    19.8 percent
Nutrition             16.8 percent
Blood Pressure (BP) Control    16.5%
Weight Control          14.7%

Job Site size is the strongest indicator of program prevalence.

Most staff members believe the advantages of their Workplace Wellness 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% of worksites with activities offer them to organization dependents, and an equal percent offer them to retirees.

When worksites seek outside program assistance, they turn to voluntary, not-for-profit employers (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance employers (43%).

Smoking Cessation Programs

Smoking related health issues cost American businesses $26 billion per year in lost work rate and $7 to $8 billion in tobacco-related medical expenditures.

Staff Members who smoke are 50% more likely to be hospitalized than non-smokers, have 2 times as a myriad of job-related accidents as non-smokers and have absenteeism rates approximately 50% higher than non-smokers.

People who used tobacco an average of one or more packs of cigarettes per day had 118% higher health care expenditures 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 must 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 employees.

Examples of smoking cessation intervention program used by corporations include:

• offering people that do not use tobacco a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• providing cessation programs on corporation or shared time;
• providing cash payments to quitters after 6 of 12 smoke-free months;
• participating in national quit smoking days; and
• adopting a smoke-free company policy and setting deadlines for implementing the policy.

Physical Fitness Programs

An active 55-year-old man has the potential to lead as vigorous a lifestyle as a sedentary 35-year-old.

Differences in work-related exercise has been shown 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 are able to lower 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 problems.

Research findings support the notion that worksite physical activity programs improve fitness and help reduce other health risks, although results related to improved productivity are weak due to lack of methods for accurately quantifying productivity.

A very small proportion of worksites have on-Site physical fitness facilities.

The majority of workers sponsored exercise program involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.

Some employers subsidize employee participation in community “Ys,” health clubs or other community programs if no onsite facilities are available.

Job Site fitness programs may lower expenditures to employers by decreasing employee health care claims and expenditures.

People whose weekly physical activity was equivalent to climbing less than five flights of stairs or walking less than a half mile, spent 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 expenditures for obese people are roughly 11% higher than those for thin people.

Nutrition and Weight Control

One-third of America population is obese to the extent of decreasing their life expectancy.

Improvements in eating habits have the potential to lower 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-workers and management, availability of a daily eating situation, and opportunities for follow-up and monitoring.

Job Site nutrition programs are able 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 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 can be attributed to psychosomatic or stress-related origins.

Company 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 staff members 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-workers or supervisors.

Most worksite 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.

Job Site stress management programs are often delivered in one of three formats:

• workshops 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 major techniques used in workplace stress management programs are:

• teaching people to decrease 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 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.

Workers 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 productiveness, 88 percent of which is attributed to losses from workforce activities and future earnings.

In corporate settings where safety belt policies, requiring use of belts by those riding in a corporation vehicle or using a private vehicle for corporation business, have been enforced, 60% to 90% use has been reported.

Incentive programs, accompanied by education and use requirement restrictions have resulted in 40% to 70% initial usage rates.

Factors influencing the sources of workplace safety belt programs include:

• active responsibility on the part of upper management;
• clearly defined and well enforced policy of needed belt use on the job;
• positive incentives/rewards; and
• ongoing education and training programs.

Case Studies of Workplace Wellness Programs

Based on an extensive assessment of its inclusive employee Workplace Wellness 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.

employees at four Johnson & Johnson employers who were exposed to the Worksite Wellness Program expanding their daily energy expenditure in vigorous exercise by 104 percent compared to an increase of 33 percent among employees at employers that were offered only an yearly health screen.

Members in the United Methodist Publishing House’s Company 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 lower than projected use in medical costs for 1985 ($902,116 projected with actual costs $142,884) to the Worksite Wellness Program although the results are not conclusive.

In 1985, the Adolph Coors Employer conducted a phone interview of a random sample of its 10,000 workers to determine changes in health practices since the introduction of an employee Employee Wellness Program 4 years earlier. The sample of 495 workers was stratified to match the corporation profile in terms of age, sex and job description. The survey reported 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 corporation’s smoking cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year because of illness or injury compared to 3.08 days for non-participating workers.

The Coors Employer 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.