Employee Health Promotion

Introduction to Employee Health Promotion Programs

The last ten years has brought major changes in business attitudes toward Employee Health Promotion Programs. Interest in self-help and self-care programs has increased as growth in healthcare costs 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 costs are changing the ways in which purchasers of healthcare plans are viewing their own efforts toward provision of worksite healthcare programs and facilities. Projections for the next decade indicate that worksite health programs will continue to become valuable factors in the provision of healthcare, including prevention activities, for both government and private industry. In organizations with existing Employee 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, tobacco cessation, Blood Pressure control, diet programs and stress management. Benefits cited range from improved health and productivity to reducing healthcare costs.

Demographics of the U.S. Workforce

• 110 million Americans 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; 10% was Black.
• The median age of the workforce is 32 years and is expected to increase to 32 years by 2030.
• 57.9% of all employees work in organizations with between 2 and 500 employees; 45% work in organizations with fewer than 100 employees. 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 employees are employed in offices.

Prevalence of Employee Health Promotion Programs Activities

Based on a 1985 survey, almost 66% of worksites with 50 or more employees had Employee 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%
• Exercise 22.1%
• Off the Job Accidents 19.8%
• Nutrition 16.8%
• Blood Pressure Control 16.5%
• Weight Control 14.7%

Worksite size is the strongest indicator of program prevalence.

Most employees believe the benefits of their Employee Health Promotion Programs activities outweigh the costs, although few formal evaluations exist. The most generally cited reason for starting programs and perceived benefit from programs is improved employee health. At most worksites with activities (85.4%), all employees are eligible to participate. 30% of worksites with activities offer them to business dependents, and an equal percent offer them to retirees. When worksites seek outside program assistance, they turn to voluntary, not-for-profit organizations (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance organizations (43%).

Smoking Cessation Programs

Smoking related health problems cost U.S. organizations $26 billion per year in lost productivity and $7 to $8 billion in smoking-related healthcare costs. Workers who use tobacco are 50% more likely to be hospitalized than people that do not use tobacco, have 2 times as a myriad of 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 smoked an average of one or more packs of cigarettes per day had 118% higher healthcare expenditures than people that do not use tobacco. 76% of current smokers and 80% of former smokers and people that do not use tobacco 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 organizations include:

• making available 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 business or shared time
• making available cash payments to quitters after 6 of 12 smoke-free months
• participating in national quit smoking days
• adopting a smoke-free business 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 shown to provide 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 have the potential to decrease the probability of back injuries among certain occupational groups. 93 million workdays in the United States are lost annually due to back problems. Research findings support the notion that worksite physical activity programs better 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 employees sponsored exercise program involve skills training such as aerobic dance, low impact aerobics, weight training, preand post-natal physical activity classes, and walking/jogging groups. Some organizations subsidize employee participation in area “Ys,” health clubs or other area programs if no on-Site facilities are available. Worksite exercise program may decrease costs to employers by reducing employee healthcare claims and expenditures. Those 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 climbed at least 15 flights of stairs or walked 1 1/2 miles weekly. Healthcare costs for obese people are roughly 11% higher than those for thin people.

Nutrition and Weight Control

One-third of this country population is obese to the extent of decreasing their life expectancy. Improvements in eating habits have the potential to decrease the risk of genuine health problems such as elevated Blood Pressure and cholesterol levels and is instrumental in the control of non-insulin-dependent diabetes. The workplace offers several advantages for diet education; support and influence of co-employees and upper management, availability of a daily eating situation, and opportunities for follow-up and monitoring. Worksite diet programs have the potential to be grouped in 6 broad categories:

• cafeteria programs
• multi-component programs
• weight management programs
• cholesterol reduction programs
• programs for pregnant and lactating women
• other diet education issues.

Men are less likely to participate in weight-loss programs than are female employees.

Stress Management

Estimates suggest that 50% to 80% of physician visits have the potential to be attributed to psychosomatic or stress-related origins. Corporation pays many of the costs related to employee stress, both directly in the form of healthcare costs and in reduced productivity. Job factors which are associated with stress include:

• not allowing employees 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
• conflict with co-employees or supervisors.

Most worksite 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 often delivered in one of three formats:

• sessions conducted by trained professionals
• self-learning tools
• personal teaching to assist with self-assessment, planning for changes, learning new skills and responding to life crises.

The two primary techniques used in worksite stress management programs are:

• teaching people to reduce the negative physical effects of stress
• 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% of all work-related deaths and 45 million days of lost work annually. More 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% 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 productivity, 88% 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 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% to 70% initial usage rates. Factors influencing the sources of worksite safety belt programs include:

• active responsibility on the part of upper management
• clearly defined and well enforced policy of necessitated belt use working
• positive incentives
• ongoing education and training programs.

Case Studies of Employee Health Promotion Programs

Based on an extensive evaluation of its inclusive employee Employee Health Promotion , 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 organizations who were exposed to the Employee Health Promotion increased their daily energy expenditure in vigorous exercise by 104% compared to a rise of 33% among employees at organizations that were provided only an yearly health screen. Participants in the United Methodist Publishing House’s Employee Health Promotion 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 Employee Health Promotion although the results are not conclusive. In 1985, the Adolph Coors Corporation 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 Employee Health Promotion 4 years earlier. The sample of 495 employees was stratified to match the business profile in terms of age, sex and job description. The survey reported that 65% of respondents started exercising in The last 4 years, 37% had improved their diets, 20% were regular users of the wellness center, 9% had stopped smoking as the result of the business’s tobacco cessation program and active participants of the wellness center miss an average of 1.96 workdays annually 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 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.