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1. Introduction And Historical Development
Organizational efforts to improve employees’ health began with an almost exclusive concentration on worksite safety and progressed rather slowly to broader areas of concern, which today include health promotion. In the 1920s, concerns over employees’ safety and health grew with industrialization. This was, to a large extent, due to organized labor’s concerted efforts to improve unhealthy and dangerous work conditions. These concerns led to the development of a broad range of occupational safety and health initiatives which, for the most part, dealt with physical, chemical, and biological hazards in the work environment (Wolfe et al. 1994).
Health promotion initiatives gained a new lease of life in the late 1970s and 1980s (for a typical review, see Parkinson et al. 1982). Shain et al. (1986), based on a sample of historical case studies, suggested that health promotion programs are really just a modern expression of an old idea, namely employer paternalism. It was criticized that these programs communicated the view that deteriorating health is a moral failing for which the individual worker is responsible. With the move to a more comprehensive approach to worker health, the adoption of the health promotion philosophy by a number of employers in the 1970s represented a move away from the previous industrial medicine (occupational safety and health) orientation in three ways. Firstly, the primary concern shifted from preventing injury and disease to the active promotion of health. Secondly, the newly-adopted health promotion model heavily emphasized employee or personal behavior instead of workplace conditions as the primary focus. Thirdly, health promotion programs which traditionally had been initiated by management and tended to be used primarily by white-collar staff were now extended to blue-collar workers as well (Wolfe et al. 1994).
2. Deﬁnition And Domain Of Workplace Health Promotion Programs
The terminology used to label employee health promotion initiatives varies. Terms such as ﬁtness programs, worksite health promotion programs, employee health management programs, health promotion programs, health enhancement programs, disease prevention programs, and wellness programs are only some of the most commonly used. Over the years, not only the name and content of workplace health promotion (WHP) programs have changed, they have also gradually broadened. For example, Elias and Murphy (1986) regard health promotion as ‘art of a broad spectrum encompassing all health services and activities. This spectrum consists of health promotion, health maintenance, and health restoration.’ Katzman and Smith (1989) deﬁned health promotion programs as ‘various combinations of inhouse activities initiated by a company with the intent of enhancing the overall physical and psychological health of its employee population.’ Kizer et al. (1992) refer to the deﬁnition of Parkinson et al. (1982) as they regard health promotion as ‘a combination of educational, organizational, and environmental activities designed to support behavior conducive to the good health and wellbeing of employees and their families.’ Wolfe et al. (1993) deﬁne WHP programs as ‘ongoing organizational activities designed to promote the adoption of personal behaviors and organizational practices conducive to maintaining and/or improving employee physiological, mental or social well-being.’
The common vision of WHP programs is that of an integrated approach of a total package of activities, targeting not only the individual and organizational levels, but also environmentally-focused strategies and community-based resources. Such an interactive approach would offer the possibility of remedying problems of a physical and mental nature, promoting and maintaining good physical and mental health among employees, and developing an environment and tapping into the community to facilitate successfully sustaining positive changes achieved by the WHP programs.
3. Why Promote Health At The Worksite?
There are a number of advantages and disadvantages associated with the use of the worksite for health promotion initiatives. From the employees’ perspective, they are convenient, affordable, and provide the opportunity for social support. These strengths may also be disadvantages where the timing of meetings may interfere with other valued activities, and or individuals may not wish to disclose certain behaviors in front of their peers. For employers, potential beneﬁts include better employee morale and public relations (Cataldo and Coates 1986, Everly and Feldman 1985); improvements in employees’ performance; positive inﬂuences on morale, absenteeism, turnover, recruitment and productivity (Robison et. al. 1992); as well as reduced healthcare costs, particularly in the USA (e.g., Harvey et al. 1993), and reduced absenteeism (Bertera 1990). However, as many programs focus on individuals rather than organizational structures, there is a danger of ‘victim blaming’ and the development of ineffective programs.
One of the attractive aspects of WHP programs is their potential to reduce the rapidly increasing healthcare and health-related costs incurred by ‘unhealthy’ organizations. With WHP programs, substantial savings can be achieved by the organization. For example, cost savings may be associated with reductions in the cost of heathcare insurance, disability payments, and workers’ compensation. In addition, a healthier workforce would absent themselves less frequently from work, thus reducing health-related costs. Of perhaps greater importance than a health promotion program’s ability to control potential healthcare costs is its potential to improve employees’ performance. Research has found that such programs can positively inﬂuence morale, absenteeism, turnover, recruitment, and productivity (Robison et al. 1992). Research has shown that generally, employees are satisﬁed with health promotion programs (Davis et al. 1984), and programs contribute to improvements in employee morale and job satisfaction (Pelletier 1991, Wolfe et al. 1993).
From a theoretical perspective, the worksite offers an excellent opportunity to maximize behavioral change through long-term individual programs, and the potential for environmental policies and manipulations to foster and maintain such change. However, not all programs have utilized the full potential of the worksite. For example, worksites which provide health screening clinics with no provision for followup or support through other environmental changes gained no advantage over similar interventions conducted in other settings (e.g., Erfurt et al. 1990). Accordingly, while the worksite provides an excellent setting for health promotion, its beneﬁts can only be maximized through programs that utilize its environmental and social resources to the full.
4. The Environment—Challenges For The Working World In The Twenty-ﬁrst Century
Clearly, a range of new challenges are confronting the world of work today. The world of work is undergoing major changes—a process which will continue for some time to come. A few random examples include genetics, the widespread of use of new technologies, and demographic change. More general socioeconomic developments are also generating tremendous pressure on innovation, which also impacts on the ﬁeld of work and health. Some of the key issues to be confronted are:
As more ﬁrms become global in their operations, organizations will have to take into account the diversity in the workforce when deciding on wellness issues and programs. Some issues involved are differences in customs, language, and communication styles; differences in attitudes toward time; and the effects of labor laws, ethical standards, and the political climate.
The global workforce is anything but homogeneous. Employees’ attitudes and value systems vary greatly in a wide variety of important ways. Table 1 summarizes some of the major differences in the workforces around the world. For example, about 7 percent of the Western population suffers from hypertension in such a measure that it needs to be treated in order to prevent cardiovascular problems. Another 7 percent has moderately heightened blood pressure which also needs to be attended to. Only a small number of people are being treated for this condition. Several studies which offered non-medication therapy (e.g., reduced smoking, losing weight, better nutrition, relaxation exercises, and stress management) reported success in the hypertension programs (Baier et al. 1992, Fielding 1982, Glasgow and Terborg 1988).
Millions of workers at all occupational levels have lost their jobs in recent years as a result of reorganizations and the inability of some industries to remain competitive in the world market. Retrenchment is traumatic, not only for the incumbent but also for those who remain in the job. Organizations involved in layoffs have found reduced morale, job commitment, and job involvement among their remaining workers (Seppa 1996).
4.3 Increasing Use Of Technology
Of the 20 fastest growing occupations, one-half are related to the health and computer ﬁelds. Bezold et al. (1986) have cited data indicating that computers and robots will probably affect 7 million factor jobs and 38 million office jobs. The projected effects of this will include job displacement, deskilling, and lower paying jobs.
4.4 Changes In Employment Practice
With the advances in personal computers, telecommunications, and fax machines, ﬂexibility has come to characterize the workplace. In recent years, ﬂexibility in work scheduling (e.g., short-term and part-time employment) has become more widespread. Telecommuting—the decentralizing of work—is already in effect at more than 600 US companies. Increases in productivity of up to 30 percent have been reported (Becker and Steele 1995).
4.5 Change In Organizational Size And Structure
Due to the huge changes in company structures, new production and management concepts are introduced. The ‘classic’ company with its stable and predictable structures is heading towards a new ﬂexibility involving ever smaller core workforces, new forms of work, and greater mobility between jobs. Overall, there is an increase in the number of small and medium-sized enterprises. These companies are subject to special conditions, particularly with regard to occupational safety and health and workplace health promotion.
4.6 Changing Demographics
The demographic development must be observed as regards its effects on workplace health promotion.
4.6.1 Gender Composition. According to Fullerton (1985), of every 10 new jobs between 1985 and 1995, six would be ﬁlled by women, and the proportion of women would continue to increase to 46 percent of the workforce. Because of role demands and constrained occupational opportunities, this trend may have an adverse impact on physical and mental health.
4.6.2 Ethnic Composition. Another emerging demographic trend is that of an increased participation of minority-group members in the workforce. Data from the USA identiﬁes a strong association between ethnicity and health status. Blacks have higher ageadjusted mortality rates for heart disease, cancer, liver disease, diabetes, and pneumonia than whites. They are also more likely to die from violence (Markides 1983). In the UK, rates of ill health and mortality amongst ethnic minorities differ from those of the native (white) population, but there are also marked differences between them (see Balarajan and Raleigh 1993). As differences in health behaviors are associated with both race and gender, health promotion programs will do well to take these factors into consideration. According to Narang and Murphy (1994) and Doyle (1991), ethnic minorities experience more problems in gaining access to health services such as cancer screening and antenatal care, and have lower survival rates following diagnosis of cancer or AIDS, than their white counterparts (Primm 1987). They are also more likely to experience environmental stressors such as poverty, poor housing, and poor working conditions.
4.6.3 Age Composition. The change in health structure has, on the one hand, resulted in a higher proportion of older employees in the working population: on the other hand, this change also requires longer working lives to safeguard the ‘agreement between the generations’. This demographic development means that the group of older employees is growing in relative terms. While at risk from poorer health and from sometimes outdated qualiﬁcations, these older employees offer a large but frequently untapped potential of experience and qualiﬁcations.
5. The WHP For The Twenty-ﬁrst Century—A Multitier Strategy
It is generally agreed by health promotion researchers that in the twenty-ﬁrst century, mental health problems in the workplace are prevalent. These problems have high human and economic costs (both direct and indirect) and are related to overutilization of general medical care and increasing healthcare costs. Unfortunately, mental health problems are not yet sufficiently addressed at the worksite. Today, the objective of WHP is therefore more than just protection against accidents and occupational diseases. It includes all the activities that serve to maintain and promote the physical and mental performance and motivation of the employees. A ‘biobehavioral,’ multidimensional perspective to WHP programs is recommended—that of examining occupational-related stress and/or health factors in combination with life-style factors (e.g., sedentary behavior, smoking, poor diet). Such life-style factors affect the health of the individual worker and collectively affect the wellbeing and productivity of the entire workforce. These concerns should be addressed collectively through comprehensive disease prevention and/or health promotion efforts.
In modern companies, strong involvement of the employees in this process is essential, taking into consideration the changes in the communication and information conditions in society and within companies. Successful WHP is not feasible without intensive communication and constructive cooperation at all levels. The future success of organizations is dependent on having well-qualiﬁed, motivated, and healthy employees. Worksite health promotion has a signiﬁcant role to play in preparing and equipping people and organizations to face these challenges. In view of the multiple issues faced by organizations in the twenty-ﬁrst century, a multitier approach is suggested. Workplace health promotion programs need to be implemented strategically and with some permanence. To ensure that this happens, there is a need to disregard the notion of creating ‘programs,’ which are temporary by deﬁnition. Change must begin with policy; thus, a need to involve both the micro (individual and environmental) and macro (organizational and community) levels are essential. These will include:
- Individually-focused strategies of health risk appraisal, clinical preventive services for employees and their dependants, and employee life-style change (including physical exercise, good nutrition, avoidance of tobacco products and excessive alcohol consumption, safe driving practices, safe sexual behavior, safe work practices, and the application of sunscreens when exposed to direct sunlight).
- Environmentally-focused strategies of ergonomic workplace design, industrial hygiene and occupational safety (e.g., removal of chemical and environmental hazards, maintenance of good indoor air quality), and effective facilities design and management practices.
- Organizational efforts to promote employee wellbeing and healthful workplaces, for example, policies that establish smoke-free worksites; efforts to facilitate ﬂexible work schedules; provision of employee health beneﬁts and insurance plans that incorporate disease prevention and health promotion services; managerial efforts to cultivate socially supportive and responsive organizational climates and to offer worksite violence prevention programs; and corporate compliance with occupational safety and health regulations.
- Beyond the workplace, community programs and resources that enhance the health of employees and their dependants, including the development of ‘healthy city’ programs and effective healthcare delivery services at local and regional levels. The community also includes employee groups, the private sector, healthcare providers, health insurance companies, unions, educational institutions, and the federal and state governments.
6. The Future Of Work And Health Programs
Based on the above, one of the goals of future WHP programs should be understanding the rapidly changing nature of work and its impact on the health of employees. In addition, sophisticated program evaluation activities need to be incorporated in the planning phase of such programs. Employees must have a primary role in the conceptualization of the research questions and methodologies in order to anticipate limitations and ensure that the ﬁndings can be assimilated into corporate policies. A change towards a culture in which it is seen as normal and positive to be concerned with improving health and maintaining good health at the workplace causes a change of attitude and social norms with regard to healthy behavior. An important part of the health program is that information reaches employees through different channels, thus raising the level of knowledge of health promotion and, importantly, inﬂuencing the existing culture with regard to health-promoting activities at the workplace. Evaluation should be an integral part of the program. In order to attain good evaluation, the aims of the program should be described in terms of clear, quantiﬁable, and feasible goals. These goals should be formulated in such a way that they are recognizable and in accordance with the needs of the participants.
Many organizations are currently investing considerable resources in WHP, with the expectation that it will produce substantial organizational dividends. This presents a window of opportunity for health and organizational scientists to develop WHP programs based on sound scientiﬁc principles that will meet both public health goals and organizational objectives. This will extend the beneﬁts of WHP programs to reach not only the working population, but also the population at large.
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