Introduction to Corporate Health Promotion Programs
The previous ten years has brought big changes in employer attitudes toward Worksite Wellness Programs. Interest in self-help and self-care programs has increased as growth in health care expenditures have encroached substantially into profits. Changes in the employer structures of health care facilities, in particular the growth of the for-profit health care sector, and the need to contain expenditures are changing the ways in which purchasers of health care plans are viewing their own efforts toward provision of worksite health care programs and facilities. Projections for the next decade indicate that worksite health programs will continue to become valuable factors in the provision of health care, including prevention activities, for both government and private industry. In employers with existing Worksite 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, smoking cessation, Blood Pressure (BP) control, diet programs and stress management. Benefits given range from improved health and productivity to decreasing health care expenditures.
Demographics of the U.S. Workforce
• 110 million American citizens were in 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 rise to 32 years by 2030.
• 57.9% of all workers work in organizations with between 2 and 500 workers; 45% work in organizations with fewer than 100 workers. An additional 7.5 million Americans are self-employed and 3 million are farmers.
• 18% of all wage and salaried employees in 1985 were union members.
• 45% of all workers are employed in offices.
Prevalence of Company Wellness Programs Activities
Based on a 1985 survey, almost 66% of worksites with 50 or more employees had Workplace Wellness 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%
Back Care 28.6 percent
Stress Management 26.6 percent
Exercise 22.1%
Off the Job Accidents 19.8%
Nutrition 16.8 percent
Blood Pressure Control 16.5%
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most employees believe the advantages of their Company Health Promotion Programs activities outweigh the expenditures, although few formal evaluations exist.
The most commonly given reason for starting programs and perceived advance from programs is improved employee health.
At most worksites with activities (85.4%), all staff members 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%).
Smoking Cessation Programs
Smoking related health problems cost U.S. businesses $26 billion per year in lost productiveness and $7 to $8 billion in tobacco-related medical costs.
Employees who use tobacco 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% higher health care costs than non-smokers.
76% of current tobacco users and 80% of former tobacco users and people that do not smoke feel that organizations ought to restrict smoking to certain areas.
In 1985, 65% of smokers, 85% of people that do not use tobacco and 78% of former smokers, felt that smokers ought to refrain from smoking in the presence of people that do not use tobacco.
In 1986, 17 states had laws regulating smoking in offices or workplaces either in government-controlled offices or offices of private employees.
Examples of tobacco cessation intervention program used by companies include:
• offering non-smokers a discount of health and life insurance;
• paying full or partial fees for tobacco cessation programs;
• providing cessation programs on company or shared time;
• offering cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit smoking days; and
• adopting a smoke-free employer policy and setting deadlines for implementing the policy.
Physical Fitness Programs
An active 55-year-old man is able to lead as vigorous a lifestyle as a sedentary 35-year-old.
Differences in work-related activity has been demonstrated to give a two- to three-fold difference in cardiovascular deaths between active employees and their more sedentary counterparts.
In addition to improving strength, balance, and flexibility, physical activity programs can cut the probability of back injuries among certain occupational groups.
93 million workdays in the United States are lost each year due to back concerns.
Research findings support the notion that worksite physical activity programs improve fitness and help decrease other health risks, although results related to improved productivity are weak due to lack of methods for accurately measuring productivity.
A very small percentage of worksites have on-Site physical fitness facilities.
The majority of workers sponsored physical activity programs involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.
Some companies subsidize employee participation in community “Ys,” health clubs or other community programs if no on-Site facilities are available.
Job Site exercise program may reduce costs to employers by reducing employee healthcare 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, invested 114% more on health claims than those who ascended 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 have the potential to lower the risk of somber health issues 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 diet education; support and impact of co-employees and upper 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 participate in weight-loss programs than are female employees.
Stress Management
Estimates suggest that 50 percent to 80 percent of physician visits are able to be attributed to psychosomatic or stress-related origins.
Organization pays many of the expenditures related to employee stress, both directly in the form of health care expenditures and in decreased productivity.
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-employees or supervisors.
Most workplace stress management programs are implemented as a result of requests from employees.
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:
• classes 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 decrease the negative 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 each year.
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 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 work settings where safety belt policies, requiring use of belts by anyone riding in a business vehicle or using a personal vehicle for business business, have been enforced, 60% to 90% 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 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; and
• ongoing education and training programs.
Case Studies of Employee Health Promotion Programs
Based on an extensive evaluation of its inclusive employee Company Wellness 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 profit of $316 per employee. Their year 9 projected profit is $677 per employee.
workers at four Johnson & Johnson employers who were exposed to the Employee Health Promotion Program expanding their daily energy expenditure in vigorous exercise by 104 percent compared to a growth of 33 percent among workers at employers that were offered only an yearly 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 lower than projected use in healthcare expenditures for 1985 ($902,116 projected with actual expenditures $142,884) to the Corporate Health Promotion Program even though the results are not conclusive.
In 1985, the Adolph Coors Business conducted a telephone 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 company profile in terms of age, sex and job description. The survey stated that 65 percent of respondents started exercising in The previous 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 company’s tobacco cessation program and regular participants of the wellness center miss an average of 1.96 workdays every year because of illness or injury compared to 3.08 days for non-participating workers.
The Coors Employer also achieved a cost savings from a cardiac rehabilitation program that was begun in 1981. In 1980 employees 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.
