Wellness Program Introduction
The last ten years has brought major changes in employer attitudes toward 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 organizational structures of healthcare facilities, particularly 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 avoidance activities, for both government and private industry.
In corporations with existing 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 appraisal, use of tobacco cessation, blood pressure (BP) control, nutrition programs and stress management. Benefits cited range from improved health and productivity to lowering health care costs.
Demographics of the U.S. 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 percent of all staff work in businesses with between 2 and 500 employees; 45 percent work in businesses with fewer than 100 staff. 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 employees are employed in offices.
Prevalence of Worksite Wellness Activities
Based on a 1985 survey, almost 66% of workplaces with 50 or more staff had company health promotion activities in 1985. The frequency of workplace-based activities by selected categories in 1985 was –
Wellness Program Activities
Tobacco use Control 35.60%
Health Risk Appraisal (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 employees believe the advantages of their company wellness activities outweigh the costs, even though few formal evaluations exist.
The most frequently cited reason for beginning wellness programs and perceived benefit from programs is improved worker health.
At most worksites with activities (85.4%), all workforce are eligible to participate. 30 percent of worksites with activities offer them to corporation dependents, and an equal percent offer them to retirees.
When worksites seek outside wellness 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%).
Use of tobacco Cessation Programs
Tobacco use related health problems cost U.S. companies $26 billion annually in lost productivity and $7 to $8 billion in use of tobacco-related healthcare costs.
Workers who smoke are 50% more likely to be hospitalized than nonsmokers, have 2 times as many job-related accidents as nonsmokers and have absenteeism rates approximately 50% higher than nonsmokers.
People who smoked an average of one or more packs of cigarettes per day had 118% higher health care expenditures than nonsmokers.
76% of current smokers and 80% of former smokers and nonsmokers feel that organizations 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 tobacco use in the presence of nonsmokers.
In 1986, 17 states had laws regulating smoking in offices or worksites either in government-controlled offices or offices of private workforce.
Examples of use of tobacco cessation intervention program used by organizations include –
• offering nonsmokers a discount of health and life insurance;
• compensating full or partial fees for smoking cessation programs;
• providing cessation programs on organization or shared time;
• offering cash payments to quitters after 6 of 12 tobacco-free months;
• participating in national quit use of tobacco days; and
• Adopting a smoke free business policy and setting 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 shown 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 could 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 fitness plans 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 onsite fitness facilities.
The majority of workforce 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 worker participation in community “Ys,” fitness clubs or other community programs when no onsite facilities are available.
Workplace physical fitness programs could reduce costs to employers by lowering employee 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 USA population is obese to the extent of reducing their life expectancy.
Improvements in eating habits could reduce the risk of serious medical problems like 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 peers and management, availability of a daily consuming situation, and opportunities for follow-up and monitoring.
Worksite nutrition programs can 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 workforce.
Stress Management
Estimates suggest that 50% to 80% of doctor visits may be attributed to psychosomatic or stress-related origins.
Business compensates many of the costs related to staff member stress, both directly in the form of health care costs and in lower productivity.
Job factors which are associated with stress include –
• not authorizing personnel to take part in decisions about the work process;
• positions which require more or less skill than the staff member has;
• changes in work demands;
• lack of clarity about expectations and standards; and
• conflict with colleagues or supervisors.
Most workplace stress management programs are implemented then 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 –
• workshops conducted by trained professionals;
• 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 U.S. company.
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.
Employees 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 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 anyone riding in a corporation car or using a private car on corporation corporation, 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 commitment on the part of management;
• obviously defined and well enforced policy of required belt use on the job;
• positive incentives; and
• ongoing education and training programs.
Case Studies of Wellness Programs
Based on an extensive investigation of its extensive staff member 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 benefit of $316 per staff member. Their year 9 projected benefit is $677 per staff member.
Workers at four Johnson and Johnson companies 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 employees at companies that were offered only an annual medical test.
Participants in the United Methodist Publishing House’s wellness 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 typical 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 health promotion program even though the results are not conclusive.
In 1985, the Adolph Coors Corporation conducted a telephone interview of a random sample of its 10,000 staff to determine changes in health practices since the introduction of an staff member wellness program 4 years earlier.
The sample of 495 workforce was stratified to match the business profile for age, sex and job description.
The survey stated 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 company’s tobacco use cessation program and regular participants of the wellness center miss an typical of 1.96 workdays each year because of illness or injury compared to 3.08 days for non-participating workers.
The Coors Company also achieved a cost savings from a cardiac rehabilitation program that was implemented in 1981. In 1980 personnel 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.
