Health Promotion Program Introduction
The last ten years has brought major changes in employer attitudes toward wellness programs. Interest in self-help and self-care programs has increased as growth in healthcare costs have encroached substantially into profits.
Changes in the organizational structures of healthcare facilities, specifically the growth of the for-profit healthcare sector, and the need to contain costs 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 health promotion programs will continue to become important factors in the provision of healthcare, including prevention activities, for both government and private industry.
In corporations with existing health promotion programs, administrative rationale for sponsoring these activities ranged from bettering staff member health (28%) to bettering staff member morale (9.7%).
Programs include interventions associated with safety, health risk assessment, tobacco use cessation, blood pressure control, nutrition programs and stress management. Benefits cited range from improved health and productivity to reducing healthcare costs.
Demographics of the U.S. Workforce
o 110 million Americans were in the civilian labor force in 1981; by the year 2000 the civilian labor force is expected to be nearly 140 million.
o 44 percent of the 1984 labor force was female; 10 percent was Black.
o The median age of the workforce is 32 years and is expected to increase to 32 years by 2030.
o 57.9% of all personnel work in businesses with between 2 and 500 employees; 45% work in businesses with fewer than 100 personnel. An additional 7.5 million American Citizens are self-employed and 3 million are farmers.
o 18 percent of all wage and salaried workers in 1985 were union members.
o 45% of all workers are employed in offices.
Prevalence of Employee Health Promotion Activities
Based on a 1985 survey, nearly 66% of worksites with 50 or more staff had employee health promotion activities in 1985. The frequency of worksite-based activities by selected categories in 1985 was -
Wellness Program Activities
Tobacco use Control 35.60%
HRA 29.50%
Back Care 28.60%
Stress Management 26.60%
Exercise 22.10%
Off the Job Accidents 19.80%
Nutrition 16.80%
Blood Pressure (BP) Control 16.50%
Weight Control 14.70%
Workplace size is the strongest indicator of health promotion program prevalence.
Most workforce believe the benefits of their corporate health promotion activities outweigh the costs, even though few formal investigations exist.
The most frequently cited reason for beginning wellness programs and perceived benefit from programs is improved staff member health.
At most workplaces with activities (85.4%), all staff members are eligible to participate. 30 percent of workplaces with activities offer them to corporation dependents, and an equal percent offer them to retirees.
When workplaces seek outside health promotion 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 use Cessation Programs
Tobacco use related medical problems cost United States organizations $26 billion annually in lost productivity and $7 to $8 billion in tobacco-related health care costs.
Employees who smoke are 50 percent more likely to be hospitalized than nonsmokers, have 2 times as many job-related accidents as nonsmokers and have absenteeism rates approximately 50 percent higher than nonsmokers.
Individuals who smoked an typical of one or more packs of cigarettes per day had 118% higher healthcare expenditures than nonsmokers.
76% of current smokers and 80% of former smokers and nonsmokers feel that companies should restrict tobacco use to certain areas.
In 1985, 65 percent of smokers, 85 percent of nonsmokers and 78 percent of former smokers, felt that smokers should refrain from tobacco use in the presence of nonsmokers.
In 1986, 17 states had laws regulating tobacco use in offices or worksites either in government-controlled offices or offices of private employees.
Examples of use of tobacco cessation intervention program used by companies include -
o offering nonsmokers a discount of health and life insurance;
o compensating full or partial fees for use of tobacco cessation programs;
o providing cessation programs on corporation or shared time;
o offering cash payments to quitters after 6 of 12 tobacco-free months;
o participating in national quit tobacco use days; and
o Adopting a smoke free company policy and establishing deadlines for beginning 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 proven 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, exercise programs may reduce the probability of back injuries among certain occupational groups.
93 million workdays in the USA are lost yearly as the result of back problems.
Research findings support the notion that worksite exercise plans improve fitness and help reduce other health risks, although results related to improved productivity are weak as a result of lack of methods for accurately measuring productivity.
A very small proportion of worksites have onsite fitness facilities.
The majority of staff sponsored fitness programs involve skills training like aerobic dance, low impact aerobics, resistance training, preand post-natal exercise classes, and walking/jogging groups.
A lot of corporations subsidize worker participation in community “Ys,” health and fitness centers or other community programs when no onsite facilities are available.
Workplace fitness programs may reduce costs to businesss by lowering staff member health care claims and expenditures.
People whose weekly exercise 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 costs for obese individuals are roughly 11 percent higher than those for thin individuals .
Nutrition and Weight Control
One-third of the U.S. population is obese to the extent of lowering their life expectancy.
Improvements in consuming habits can reduce the risk of serious medical problems such as high 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 influence of coworkers and management, availability of a daily eating situation, and opportunities for follow-up and monitoring.
Worksite nutrition programs may be grouped in 6 broad categories -
o cafeteria programs;
o multi-component programs;
o weight control programs;
o cholesterol reduction programs;
o programs for pregnant and lactating women; and
o other nutrition education topics.
Men are less likely to take part in weight-loss programs than are female workers.
Stress Management
Estimates suggest that 50 percent to 80 percent of doctor visits may be attributed to psychosomatic or stress-related origins.
Company pays many of the costs related to worker stress, both directly in the form of healthcare costs and in lower productivity.
Job factors which are associated with stress include -
o not authorizing staff members to participate in decisions about the work process;
o positions which require more or less skill than the staff member has;
o changes in work demands;
o lack of clarity about expectations and standards; and
o conflict with colleagues or supervisors.
Most worksite stress management programs are implemented thus of requests from personnel.
Stress management programs focus on three types of skills - relaxation skills, coping skills, and interpersonal skills.
Worksite stress management programs are often delivered in one of three formats -
o workshops conducted by trained specialists;
o self-learning tools; and
o personal teaching to assist 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 -
o Teaching people to reduce the negative physical effects of stress; and
o Teaching people to recognize and control sources of stress at work and in personal life.
Seat Belt Usage
Motor car accidents are the largest single cause of lost work time and on-the-job fatalities of USA corporation.
Motor automobile accidents account for 27 percent of all work-related deaths and 45 million days of lost work yearly.
Greater than 36 percent of the 11,300 accidental work deaths in 1983 involved cars.
Workers who routinely 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 type of disability.
Motor car crashes cost $15.2 billion in lost productivity, 88% of which is attributed to losses from workforce activities and future earnings.
In corporate settings where seatbelt policies, requiring use of belts by anyone riding in a company automobile or using a private automobile on company company, 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 -
o Active commitment by management;
o obviously defined and well enforced policy of required belt use on the job;
o positive incentives; and
o ongoing education and training programs.
Case Studies of Health Promotion Programs
Based on an extensive examination of its extensive employee wellness program, LIVE FOR LIFE, Johnson and Johnson announced the break-even point for the program occurs in year 3 and by year 5 they have a net advantage of $316 per employee. Their year 9 projected benefit is $677 per employee.
Workers at four Johnson and Johnson organizations who were exposed to the wellness program increased their daily energy expenditure in vigorous activity by 104 percent compared to an increase of 33 percent among workforce at organizations that were offered only an annual biometric test.
Participants in the United Methodist Publishing House’s 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 lower than projected use in healthcare costs for 1985 ($902,116 projected with actual costs $142,884) to the wellness program even though the results are not conclusive.
In 1985, the Adolph Coors Company conducted a telephone interview of a random sample of its 10,000 employees to determine changes in health practices since the introduction of an staff member wellness program 4 years earlier.
The sample of 495 personnel was stratified to match the business profile respecting age, sex and job description.
The survey announced that 65% of respondents began exercising in the last 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped tobacco use as the result of the corporation’s tobacco use cessation program and regular participants of the wellness center miss an average of 1.96 workdays each year because of disease or injury compared to 3.08 days for non-participating staff.
The Coors Business also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 workforce were out of work 7.2 months after a heart attack or bypass operation.
In 1984, cardiac patients were out an typical 1.9 months saving $152,000 in lost work time and in 1985 cardiac patients missed an typical of 2.6 months, saving $125,000 that year.
