Health Promotion Program Introduction
The last ten years has brought major changes in corporation attitudes toward health promotion programs. Interest in self-help and self-care programs has increased as growth in health care costs have encroached substantially into profits.
Changes in the organizational structures of health care facilities, especially the growth of the for-profit health care sector, and the need to contain costs 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 important factors in the provision of health care, including avoidance activities, for both government and private industry.
In companies with existing health promotion programs, administrative rationale for sponsoring these activities ranged from improving staff member health (28%) to improving staff member morale (9.7%).
Programs include interventions associated with safety, health risk (assessment|appraisal}, tobacco use cessation, blood pressure control, nutrition programs and stress management. Benefits cited range from improved health and productivity to lowering healthcare costs.
Demographics of the United States Workforce
• 110 million Americans were in the civilian labor force in 1981; by the year 2000 the civilian labor force is expected to be almost 140 million.
• 44 percent of the 1984 labor force was female; 10 percent was Black.
• The median age of the workforce is 32 years and is expected to raise to 32 years by 2030.
• 57.9% of all staff members work in businesses with between 2 and 500 employees; 45% work in businesses with fewer than 100 staff members. An additional 7.5 million Americans are self-employed and 3 million are farmers.
• 18% of all wage and salaried workers in 1985 were union members.
• 45% of all employees are employed in offices.
Prevalence of Company Health Promotion Activities
Based on a 1985 survey, nearly 66% of worksites with 50 or more workers had company health promotion activities in 1985. The frequency of worksite-based activities by selected categories in 1985 was –
Health Promotion Program Activities
Tobacco use Control 35.60%
Health Risk (Assessment|Appraisal} 29.50%
Back Care 28.60%
Stress Management 26.60%
Exercise 22.10%
Off the Job Accidents 19.80%
Nutrition 16.80%
Blood Pressure Control 16.50%
Weight Control 14.70%
Worksite size is the strongest indicator of program prevalence.
Most workers believe the advantages of their employee health promotion activities outweigh the costs, even though few formal investigations exist.
The most frequently 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 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 organizations (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance businesses (43%).
Use of tobacco Cessation Programs
Smoking related health problems cost U.S. businesses $26 billion per year in lost productivity and $7 to $8 billion in use of tobacco-related medical costs.
Staff Members 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.
People who smoked an average of one or more packs of cigarettes per day had 118 percent higher health expenses than nonsmokers.
76 percent of current smokers and 80 percent of former smokers and nonsmokers feel that corporations should restrict tobacco use 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 use of tobacco in offices or workplaces either in government-controlled offices or offices of private employees.
Examples of tobacco use cessation intervention program used by companies include –
• offering nonsmokers a discount of health and life insurance;
• compensating full or partial fees for use of tobacco cessation programs;
• providing cessation programs on business or shared time;
• offering cash payments to quitters after 6 of 12 smoke-free months;
• participating in national quit tobacco use days; and
• adopting a smoke free company policy and establishing deadlines for beginning the policy.
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 employees 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 United States are lost annually as the result of back problems.
Research findings support the notion that worksite exercise programs improve fitness and help reduce other health risks, although results related to improved productivity are weak due to lack of methods for accurately measuring productivity.
A very small proportion of worksites have on-site physical fitness facilities.
The majority of employees sponsored fitness programs involve skills training like aerobic dance, low impact aerobics, weight training, preand post-natal exercise classes, and walking/jogging groups.
Some corporations subsidize staff member participation in community “Ys,” fitness clubs or other community programs if no onsite facilities are available.
Worksite physical fitness programs may reduce costs to employers by reducing staff member health care claims and expenditures.
Individuals 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 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 reducing their life expectancy.
Improvements in consuming habits could reduce the risk of serious health problems like high blood pressure and cholesterol levels and is instrumental in the control of non-insulin-dependent diabetes.
The workplace offers a few advantages for nutrition education; support and influence of coworkers and management, availability of a daily consuming situation, and opportunities for follow-up and monitoring.
Worksite nutrition programs may be grouped in 6 wide categories –
• cafeteria programs;
• multi-component programs;
• weight control programs;
• cholesterol reduction programs;
• programs for pregnant and lactating women; and
• other nutrition education topics.
Men are less likely to participate in weight-loss programs than are female staff members.
Stress Management
Estimates suggest that 50 percent to 80 percent of doctor visits may be attributed to psychosomatic or stress-related origins.
Company compensates 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 –
• not permitting 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; and
• conflict with coworkers or supervisors.
Most worksite stress management programs are implemented thus of requests from employees.
Stress management programs focus on three kinds of skills – relaxation skills, coping skills, and interpersonal skills.
Worksite stress management programs are often delivered in one of three formats –
• seminars conducted by trained specialists;
• self-learning tools; and
• personal teaching to assist with self-assessment, planning for changes, learning new skills and responding to life crises.
The two major techniques used in worksite stress management programs are –
• teaching individuals to reduce the negative physical effects of stress; and
• teaching individuals to recognize and control sources of stress at work and in personal life.
Seat Belt Usage
Motor car accidents are the biggest single cause of lost work time and on-the-job fatalities of USA company.
Motor automobile accidents account for 27% of all work-related deaths and 45 million days of lost work yearly.
More than 36 percent of the 11,300 accidental work deaths in 1983 involved cars.
Staff Members 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 kind of disability.
Motor automobile 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 anybody riding in a business automobile or using a private automobile on business business, have been enforced, 60 percent to 90 percent 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 commitment on the part of 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 Health Promotion Programs
Based on an robust examination of its robust staff member health promotion 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 staff member. Their year 9 projected benefit is $677 per staff member.
Employees at four Johnson and Johnson corporations who were exposed to the health promotion program increased their daily energy expenditure in vigorous activity by 104% compared to an increase of 33% among staff members at corporations that were offered only an annual medical screen.
Participants in the United Methodist Publishing House’s health promotion program submitted more claims (1.14 per participating staff member 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 health care costs for 1985 ($902,116 projected with actual costs $142,884) to the health promotion program even though the results aren’t conclusive.
In 1985, the Adolph Coors Corporation conducted a telephone interview of a random sample of its 10,000 staff members to determine changes in health practices since the introduction of an staff member health promotion program 4 years earlier.
The sample of 495 employees was stratified to match the corporation profile in terms of age, sex and job description.
The survey stated that 65 percent of respondents started exercising in the last 4 years, 37 percent had improved their diets, 20 percent were regular users of the wellness center, 9 percent had stopped tobacco use as the result of the company’s tobacco use cessation program and regular participants of the wellness center miss an average of 1.96 workdays yearly because of disease or injury compared to 3.08 days for non-participating employees.
The Coors Business also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 staff members 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.
Corporate Wellness Companies