Worksite Health Promotion and Wellness Programs Research Paper

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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:

Worksite Health Promotion and Wellness Programs Research Paper

4.1    Globalization

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).

4.2    Unemployment

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.

Worksite Health Promotion and Wellness Programs Research Paper

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:

  1. 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).
  2. 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.
  3. 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.
  4. 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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