A recent editorial in the American Journal of Health Promotion by Michael O'Donnell titled "Does Workplace Health Promotion Work or Not? Are You Sure, You Really Want to Know the Truth?" addresses the recent criticism of the effectiveness of workplace health promotion (or corporate wellness).
Michael delivers a well-balanced assessment of the scientific literature with regard to the impact of workplace health promotion, and makes a case for the effectiveness of comprehensive programs, which provide education, engagement strategies, skill building as well as social and environmental support.
While these elements no doubt play a role in the success of programs; a distinctive blueprint does not yet exist, and most programs in place are not able to produce the desired outcomes. Therefore, more focus should be given to the "how" of workplace health promotion.
A number of reputable organizations are dedicated to this goal, such as the Centers for Disease Control and Prevention (CDC), the Health Research Enhancement Organization (HERO) and the International Association for Worksite Health Promotion (IAWHP).
What Does the Rest of the World Think?
While the discussion is no doubt making waves in the U.S., many of us have an interest (and need to in our jobs) of global issues. Does workplace health promotion work beyond the U.S.? First, the term "wellness" does not have as broad a reach as "health promotion" does, and in some cases has a different meaning.
Therefore I prefer the term "workplace health promotion". Back to the original question: the answer results in good news and bad news. First the bad news, there probably is less evidence for program impact outside of the United States, especially with regard to financial impact and cost-benefit.
The field has a longer tradition and record of accomplishment in the U.S., and the U.S. healthcare system allows for the linking of program outcomes with cost indicators. This, however, is not the case in most other countries.
The good news is that the pressure for proving the cost-benefit of health promotion programs is not as imminent abroad as employers invest in employee health for other reasons.
Why do Companies Outside of the U.S. Invest in Workplace Health Promotion?
First, employers are faced with similar challenges when it comes to their employees' health. The rise of non-communicable diseases (NCDs) is a global phenomenon, for example, 63 percent of all deaths worldwide currently stem from non-communicable diseases (NCDs), approximately 500 million people are obese and more than one in seven are overweight.
Coupled with the global aging trend, the need for enhanced prevention and health promotion has become a priority. The workplace has been established as one of the priority settings for health promotion in the 21st century, including by the World Health Organization (WHO).
The majority of adults spend most of their waking hours at the workplace, often as a captive audience, and thus the workplace provides a huge opportunity to inform and help workers to improve their health. The increased awareness of the workplace as a viable setting has led to an increase in programs.
The Global Survey on Health Promotion and Workplace Wellness Strategies has documented a steady increase with regard to employers recognizing their role in employee health and well-being since 2007.
The key drivers or reasons for employers offering programs are:
- Improving worker productivity
- Reducing absenteeism
- Improving workforce morale
The issue of workforce morale and work engagement coupled with rising work-related mental illness has become a major challenge for enterprises worldwide and many programs are addressing this gap. Employees feel constantly overstressed, pressured, worried about their job security and often display a lack of motivation thus affecting productivity and customer service.
Other big drivers for employers are corporate image as well as recruitment and retention. The main health issues driving health promotion and wellness strategies are strikingly similar across the globe: stress (a key contributing factor to mental illness), physical activity, nutrition, work-life issues and chronic disease.
In spite of the difficulty of showing a direct link to healthcare costs, employers outside of the U.S. still demand high program standards and positive outcomes. In many countries, a preferred outcome indicator is the sickness absence rate, although we know of the limitations of absenteeism as an indicator.
Measuring presenteeism is not fully accepted as a valid method and measurement instruments are often scrutinized, including in the U.S. A greater emphasis is placed on satisfaction scores outside of the U.S., especially in Europe with the program or the workplace in general. A number of valid tools with a track record are being used in various countries, like the Work Ability Index or the Q12 Engagement Survey.
Global Guidance for Successful Programming
Back to the significance of the "how" of workplace health promotion: the body of evidence of what works, and what does not, is much thinner outside of the U.S. due to the young age of the field in most countries. One can attest the lack of documentation of successful or good practices across the globe.
While a number of domestic as well as regional initiatives exist to close this gap, like the European Network for Workplace Health Promotion (ENWHP), global initiatives are rare. A notable global initiative is the Global Healthy Workplace Awards program (http://globalhealthyworkplace.org), which has set the ambitious goal to gather and disseminate better practices globally for the creation of healthy workplaces based on the World Health Organization (WHO) Healthy Workplace framework.
The WHO model provides guidance for a comprehensive and systematic approach on a global scale. Four main areas of influence are identified (see exhibit B):
1.Physical work environment
2.Psychosocial work environment
3.Personal health resources
4.Enterprise-community involvement
The Healthy Workplace model also follows a continual improvement process, such as highlighting the need for evaluation, and places leadership engagement and worker involvement as central priorities.
Perhaps most importantly, the very center of the model exemplifies that promoting health at the workplace is both the right thing (ethical) and the smart thing (adds value) to do. For more information on the Healthy Workplace model and initiative visit: http://www.who.int/occupational_health/healthy_workplaces/en.
While not a blueprint for successful programming, the Healthy Workplace model does provide a much-needed framework and starting point relevant anywhere in the world. Based on the existing evidence in the U.S., and elsewhere, it is much more likely for a corporate wellness program to work if it follows the eight-step process outlined in the WHO model.
While a number of studies and reports in various countries point that workplace health promotion does work outside of the U.S., we need more research, reports, compilations of good practices and instruments, cost-effectiveness data to solidify the gains the field has made globally and further defuse the type of criticism, which we as professionals have to face now and then.
About the Author:
Wolf Kirsten is the Founder and President of International Health Consulting based in Tucson, Arizona and Hamburg, Germany (www.wolfkirsten.com) and the current President of the International Association for Worksite Health Promotion (IAWHP).
Wolf is a globally recognized expert on health promotion and well-being with on-the-ground experience in many different countries. Connect with him at wk@wolfkirsten.com
