Introduction to Corporate Health Promotion
The last ten years has brought big changes in company attitudes toward Corporate
Health Promotion . Interest in self-help and self-care programs has increased
as growth in medical care costs have encroached substantially into profits.
Changes in the company structures of medical care facilities, in particular
the growth of the for-profit medical care sector, and the need to contain costs
are changing the ways in which purchasers of medical care plans are viewing
their own efforts toward provision of worksite medical care programs and facilities.
Projections for the next decade indicate that worksite health programs will
continue to become valuable factors in the provision of medical care, including
prevention activities, for both government and private industry. In employers
with existing Corporate Health Promotion , 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 control, diet programs and
stress management. Benefits cited range from improved health and productivity
to decreasing medical care costs.
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 percent of the 1984 labor force was female; ten percent was Black.
- The median age of the workforce is 32 years and is expected to grow to 32
years by 2030. - 57.9 percent of all workers work in employers with between 2 and 500 workers;
45 percent work in employers with fewer than 100 workers. An additional 7.5
million American citizens are self-employed and 3 million are farmers. - 18 percent of all wage and salaried workers in 1985 were union participants.
- 45 percent of all workers are employed in offices.
Prevalence of Corporate Health Promotion Activities
Based on a 1985 survey, almost 66 percent of worksites with 50 or more workers
had Corporate Health Promotion 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 percent
Back Care 28.6 percent
Stress Management 26.6 percent
Exercise 22.1 percent
Off the Job Accidents 19.8 percent
Nutrition 16.8 percent
Blood Pressure Control 16.5 percent
Weight Control 14.7 percent
Worksite size is the strongest indicator of program prevalence.
Most workers believe the benefits of their Corporate Health Promotion activities
outweigh the costs, although few formal evaluations exist.
The most usually cited reason for starting programs and perceived profit from
programs is improved employee health.
At most worksites with activities (85.4%), all workers 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
employers (57.1%), private for-profit providers-consultants (50%), local hospitals
(44%), and insurance employers (43%).
Tobacco Cessation Programs
Smoking related health problems cost United States employers $26 billion per
year in lost productivity and $7 to $8 billion in tobacco-related healthcare
costs.
Staff Members who use tobacco are 50 percent more likely to be hospitalized
than non-smokers, have 2 times as numerous job-related accidents as non-smokers
and have absenteeism rates approximately 50 percent higher than non-smokers.
People who used tobacco an average of one or more packs of cigarettes per day
had 118 percent higher healthcare costs than non-smokers.
76 percent of current smokers and 80 percent of former smokers and non-smokers
feel that employers should restrict smoking to certain areas.
In 1985, 65 percent of smokers, 85 percent of non-smokers and 78 percent of
former smokers, felt that smokers should refrain from smoking in the presence
of non-smokers.
In 1986, 17 states had laws regulating tobacco use in offices or workplaces
either in government-controlled offices or offices of private workers.
Examples of smoking cessation intervention program used by employers include:
- offering non-smokers a discount of health and life insurance;
- paying full or partial fees for smoking cessation programs;
- offering cessation programs on company or shared time;
- offering cash payments to quitters after 6 of 12 smoke-free months;
- participating in national quit smoking days; and
- adopting a smoke-free company 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 demonstrated to give a two- to
three-fold difference in cardiovascular deaths between active workers and their
more sedentary counterparts.
In addition to improving strength, balance, and flexibility, physical activity
programs have the potential to lower the probability of back injuries among
certain occupational groups.
93 million workdays in the United States are lost each year due to back problems.
Research findings support the notion that worksite physical activity programs
better fitness and help lower other health risks, although results related to
improved productivity are weak due to lack of methods for accurately calculating
productivity.
A very small proportion of worksites have onsite 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 physical activity classes, and walking/jogging groups.
Some employers subsidize employee participation in neighborhood “Ys,”
health clubs or other neighborhood programs if no onsite facilities are available.
Worksite physical activity programs may lower costs to employers by decreasing
employee medical care claims and expenditures.
Participants whose weekly physical activity was equivalent to climbing less
than five flights of stairs or walking less than a half mile, invested 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 this country population is obese to the extent of decreasing their
life expectancy.
Improvements in eating habits have the potential to lower the risk of serious
health problems such as high Blood Pressure and blood lipid levels and is instrumental
in the control of non-insulin-dependent diabetes.
The workplace offers several advantages for diet education; support and effect
of co-workers and 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 control programs;
- blood lipid reduction programs;
- programs for pregnant and lactating women; and
- other diet education topics.
Men are less likely to participate in weight-loss programs than are female
workers.
Stress Management
Estimates suggest that 50 percent to 80 percent of physician visits have the
potential to be attributed to psychosomatic or stress-related origins.
Employer pays many of the costs related to employee stress, both directly in
the form of medical care costs and in reduced productivity.
Job factors which are associated with stress include:
- not allowing workers 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-workers or supervisors.
Most worksite stress management programs are implemented as a result of requests
from workers.
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 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 detrimental 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 United States business.
Motor vehicle accidents account for 27 percent of all work-related deaths and
45 million days of lost work each year.
More than 36 percent of the 11,300 accidental work deaths in 1983 involved
motor vehicles.
Staff Members who routinely 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 exercise
as any other type of disability.
Motor vehicle crashes cost $15.2 billion in lost productivity, 88 percent of
which is attributed to losses from workforce activities and future earnings.
In work settings where safety belt policies, mandating use of belts by anyone
riding in a company vehicle or using a personal vehicle for company 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 percent to 70 percent initial usage rates.
Factors influencing the sources of worksite safety belt programs include:
- active responsibility on the part of management;
- clearly defined and well enforced policy of necessitated belt use on the
job; - beneficial rewards and incentives; and
- ongoing education and training programs.
Case Studies of Corporate Health Promotion
Based on an extensive assessment of its accross the board employee Corporate
Health Promotion Program, 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 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 Corporate
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 provided only an annual health screen.
Members in the United Methodist Publishing House’s Corporate 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 decreased than
projected use in medical care costs for 1985 ($902,116 projected with actual
costs $142,884) to the Corporate Health Promotion Program although the results
are not conclusive.
In 1985, the Adolph Coors Employer conducted a phone interview of a random
sample of its 10,000 workers to determine changes in health practices since
the introduction of an employee Corporate Health Promotion 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 reported that 65 percent of respondents
started working out in The last 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 smoking cessation program and regular
participants of the wellness center miss an average of 1.96 workdays each year
because of illness or injury compared to 3.08 days for non-participating workers.
The Coors Employer also saw a cost savings from a cardiac rehabilitation program
that was implemented in 1981. In 1980 workers 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.
