Wellness Plans : Health Promotion Program Facts.

Health Promotion Program Introduction

The last ten years has brought major changes in company attitudes toward wellness 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, particularly 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 workplace health care programs and facilities.

Projections for the next decade indicate that wellness programs will continue to become important factors in the provision of healthcare, including avoidance activities, for both government and private industry.

In businesses with existing wellness programs, administrative rationale for sponsoring these activities ranged from bettering staff member health (28%) to bettering staff member morale (9.7%).

Programs include interventions associated with safety, health risk appraisal, smoking cessation, blood pressure (BP) control, nutrition programs and stress management. Benefits cited range from improved health and productivity to reducing health 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% of the 1984 labor force was female; 10% was Black.

• The median age of the workforce is 32 years and is expected to elevate to 32 years by 2030.

• 57.9 percent of all staff members work in organizations with between 2 and 500 employees; 45 percent work in organizations 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 staff members in 1985 were union members.            

• 45 percent of all staff are employed in offices.            

Prevalence of Employee Wellness Activities         

Based on a 1985 survey, nearly 66 percent of worksites with 50 or more staff members had corporate health promotion activities in 1985.  The frequency of worksite-based activities by selected categories in 1985 was –          

Health Promotion Program Activities         

Smoking Control          35.60%

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 personnel believe the benefits of their corporate wellness activities outweigh the costs, even though few formal investigations exist.         

The most frequently cited reason for beginning health promotion programs and perceived benefit from programs is improved employee health.

At most workplaces with activities (85.4%), all workforce are eligible to participate. 30% of workplaces with activities offer them to company dependents, and an equal% offer them to retirees.

When worksites seek outside wellness program assistance, they turn to voluntary, not-for-profit companies (57.1%), private for-profit providers-consultants (50%), local hospitals (44%), and insurance companies (43%).

Smoking Cessation Programs

Tobacco use related health problems cost U.S. companies $26 billion a year in lost productivity and $7 to $8 billion in smoking-related health care costs.

Workers 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.

Individuals  who smoked an typical of one or more packs of cigarettes per day had 118% higher healthcare expenses than nonsmokers.

76% of current smokers and 80% of former smokers and nonsmokers feel that businesses should restrict smoking to certain areas.

In 1985, 65 percent of smokers, 85 percent of nonsmokers and 78 percent 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 staff.

Examples of use of tobacco cessation intervention program used by companies include –

• offering nonsmokers a discount of health and life insurance;

• paying full or partial fees for tobacco use cessation programs;

• providing cessation programs on corporation or shared time;

• offering cash payments to quitters after 6 of 12 tobacco-free months;

• participating in national quit smoking days; and

• Adopting a smoke free company policy and establishing deadlines for implementing 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 workers and their more sedentary counterparts.

In addition to bettering strength, balance, and flexibility, fitness plans may reduce  the probability of back injuries among certain occupational groups.

93 million workdays in the USA are lost annually as the result of back problems.

Research findings support the notion that workplace fitness 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 workplaces have onsite physical fitness facilities.

The majority of employees sponsored fitness programs involve skills training like aerobic dance, low impact aerobics, strength 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 when no on-site facilities are available.

Worksite physical fitness programs may reduce costs to businesss by reducing staff member 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 people  are roughly 11% 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 eating habits may 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 several advantages for nutrition education; support and influence of colleagues and management, availability of a daily eating 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 take part in weight-loss programs than are female workers.

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 workforce 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 peers or supervisors.

Most worksite stress management programs are implemented thus 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 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 workplace 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 largest single cause of lost work time and on-the-job fatalities of United States company.

Motor car accidents account for 27% of all work-related deaths and 45 million days of lost work annually.

Greater than 36% 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 type of disability.

Motor car crashes cost $15.2 billion in lost productivity, 88% of which is attributed to losses from workforce activities and future earnings.

In corporate establishings where seatbelt policies, requiring use of belts by anyone riding in a business automobile or using a private automobile on business business, have been enforced, 60% to 90% 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 workplace safety belt programs include –

• Active commitment for 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 Wellness Programs

Based on an robust evaluation of its robust staff member health promotion program, LIVE FOR LIFE, Johnson and Johnson stated 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.

Staff Members 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 staff members at companies that were offered only an annual biometric test.

Participants in the United Methodist Publishing House’s wellness 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 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 are not conclusive.

In 1985, the Adolph Coors Business conducted a telephone interview of a random sample of its 10,000 workforce 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 corporation profile in terms of age, sex and job description.

The survey stated that 65 percent of respondents began 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 corporation’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 personnel.

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 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.