Health Promotion in Small Organizations - Essay Example

Worksite Health Promotion Practices, Needs and Barriers REVIEW OF LITERATURE Worksite Health Promotion Practices Work and health are important aspects of individual lives. Health is one of the important factors that permit an individual to pursue goals, including successful performance in their work responsibilities. The worksite is usually a restricted environment, where individuals or groups can be exposed to health promotion practices or receives counseling. Over the past several decades, organizations have documented the advantages of health promotion programs that help to improve the health of their employees. Many programs began as worksite safety programs to safeguard employees against the risks and hazards of specific jobs and, over time, expanded to address a broader range of health needs such as immunizations and training in smoking cessation, stress management, exercise, nutrition and back care. Employers have special interest in maximizing health because of its connection with productivity at work, which affect both quantity and quality. This in turn reduces the incidence of diseases that lead to absences, disability, and performance that necessitates a high precedence and substantial investment. Currently there are several worker organizations established to improve the welfare of members and to have an inbuilt interest in supporting programs that can improve health status and quality of life. Worksite involvements have the potential to reach large numbers of people at low cost, who might not seek professional help on their own. Besides, worksites are natural locations where both social and physical atmospheres may be employed to influence behavior change. There are several strategies used to promote health in worksites, such as individual counseling, group education, and cafeteria-based programs. It appears that strategies that unite both intensive educational and environmental strategies are more effective. The physical environment at a worksite can be modified in order to support positive, healthy behavior changes. Policies that guide food choices, encourage physical activ­ity, and eliminate smoking and provide incentives for smoking cessation are some of the effective ways to help shape a healthy worksite (MDH, 2004). Employers have become ever more aware that Employees health has a major impact on productivity and in turn the financial health of their businesses. Since the 1970s, many employers have provided a variety of health promotion and disease prevention programs to their employees. In the recent years the efforts have focused on management of overweight and obesity, physical activity, and smoking, as well as other behaviors and conditions, such as depression and stress, linked to the health. The focus and extent of these efforts vary significantly across companies. Some worksite programs may focus on a single risk factor while others may focus on a multiple set of health risk factors and diseases. Employers offer a wide range of resources that differ significantly in intensity, comprehensiveness, and duration, and they bind together health promotion and disease prevention activities with employee health benefits, occupational health, employee assistance programs, disease management, workers compensation, disability benefits, and other benefit programs. A survey conducted on 1,000 employers in U.S consisting of more than 1000 employees under each employer found that 72% provided education on lifestyle behaviors to their employees, and 40% offered financial benefits for participation in health programs. The data from the Department of Labor show that in the year 2000, 18% of all employees were eligible for wellness programs, and 9 % were eligible for fitness center programs (U.S. Department of Health and Human Services, 2003). Many companies and studies have reported that these kinds of programs had positive effects on employee health and job performance, and have resulted in cost savings for the companies. For instance, as per 2002 Georgia Worksite Health Promotion Polices and Practices Survey of private sector worksites with at least 15 employees, 73% of all worksites reported contributing at least one health promotion program. Larger worksites in Georgia were more likely to provide health promotion programs than smaller worksites. To encourage physical activity 17% of worksites offered special breaks for physical activity, 23% worksites offered reduced rate health memberships. Only 2% worksites had a policy to encourage commute by foot or bike and 6% worksites subsidized the cost of public transportation. 90% of worksites had a formal tobacco policy to prohibit or restrict smoking on the job, 77% of worksites with a tobacco policy allowed smoking on the grounds but not inside, 14% of worksites with a tobacco policy allowed smoking in chosen areas inside. The 2002 Georgia Worksite Survey shows the worksite environment supporting healthy behavior such as 13% of worksites provided facilities for on-site exercise, indoor gyms and workout rooms. In 47% of worksites indoor stairways made available to increase physical activity during work hours. Environments to support healthy eating 26% worksites provided possible venues. 97% worksites allowed employees to bring healthier alternative foods. Screenings, disease and stress management were also offered to employees. 32% of worksites offered at least one screening, 19% of worksites offered at least one disease management program which included heart disease, hypertension, diabetes and mental health and 25% of worksites offered stress management information or activities (Choi, et al 2004). Employee health needs of greatest concern to administrators/managers In recent years a number of comprehensive reviews reveal that large numbers of studies of worksite health promotion and disease prevention programs and these are the greatest concern among the administrators/managers. These studies also show that many health promotion and disease prevention programs do work and do result in major cost savings. Many studies have focused particularly on the return on investment (ROI) from worksite health promotion and disease prevention programs. One recent review identified well-conducted, thorough appraisal studies of ROI, then recognized the range of ROI estimates in these studies, and examined the factors that influenced program outcomes and ROI estimates. Findings on the return on investment for health promotion and disease management programs were reported for nine employers: Canada & North America Life; Chevron; City of Mesa, AZ; General Mills; General Motors; Johnson & Johnson; Pacific Bell; Procter & Gamble; and Tenneco. These programs provide health education to their employees to encourage behaviors that improve health or avert disease. And also include exercise programs, health-risk assessment, weight control, nutrition information, stress management, disease screening, and smoking cessation. The review found significant return on investment for the programs provided by these nine employers, with the range of benefit-to-cost ratios, ranging from $1.49 to $4.91 in benefits per dollar spent on the program. For instance, at the high end, General Motors realized at one of their sites an annual savings of $105.50 in total health care costs per enrollee for an annual program cost of $27 per enrollee-a ratio of 4.91 of benefits-to-cost. Another review also examined what they call "demand-management programs," or programs that encourage and help employees increase the use of self-care and decrease their use of medical care, often through self-care books, newsletters, telephone information lines, counseling, and other means. Looking at studies of ROI for demand-management programs concerning Blue Shield of California, five California counties, Group Health, Rhode Island Group Health Association, and United Health Care, they found greater variation in the return on investment in these kinds of programs, ranging from $2.19 to $13 in benefits per dollar spent. They also observed three studies of ROI for disease-management programs and found a range in benefit-to-cost ratios from $7.33 to $10.38. For every $1 invested on Motorolas wellness program company’s ROI was $ 3.93 and Caterpillars Healthy Balance program, which is projected to result in long term savings of $700 million by 2015. Similarly Johnson & Johnson’s Health and Wellness Program, which has produced average annual health care savings of $224.66 per employee. The goal of CIGNAs Working Well Program is to keep its 34,000 U.S. employees healthy and at work. The Working Well Programs annual budget is $2.5 million. The program is put into practice at all 250 domestic offices. Working well has a wide range of programs for all employees with special importance on issues of apprehension to women who make up 76% of CIGNAs employees. The Working Well Triumph Program provides skill training and support for disabled employees to improve their health, adopt healthy lifestyles, and reduce the likelihood of future disability leave. This program has resulted in healthcare costs savings of more than $900 per program participant. CIGNAs smoking termination program, which combines behavioral counseling and medical treatment, is offered to all CIGNA employees and eligible family members who want to quit smoking. The program helped 67 percent of its participants quit smoking after 12 months, a quit rate up to three times higher than other comparable smoking cessation programs. CIGNA estimates saving $949 in health care costs for each successful participant, a return on investment of 9.5 to 1. For these employers, disease management programs resulted in the highest returns on investment. The review suggests that the higher costs may stem from the larger capital investments that go into on-site fitness centers or classroom-based education programs. They also point out that the distinctive health promotion and disease prevention program provides health education to most employees but usually shows savings for only a small portion of the neediest employees, whereas disease management programs are targeted on a smaller selected group of employees. They conclude that, in designing effective programs that will improve employee health and productivity and produce good returns on investment, employers should consider a range of health and productivity programs and integrate them with health and disease-management activities. One recent study examined the long-term impact of the Johnson & Johnson Health & Wellness Program on medical care and expenditures. Johnson & Johnson has offered a health promotion program since 1979 and has spent several million dollars on evaluations of the program. According to this study, the Johnson & Johnson program put together, employee health, wellness, disability management, employee assistance, and occupational medicine programs, places significant importance on health promotion and disease prevention. The study looked at up to five years of data and found that, while there was a slight increase in emergency department expenditures per employee per year, there also were significant decreases in expenditures for outpatient and office visits, mental health visits, and inpatient hospital days. Across all of these categories, total savings were $224.66 per employee per year. And also the study found a considerable increase in savings in years 3 and 4 for outpatient and physician visits and inpatient days. The review suggest that a more in-depth and wide-ranging study would likely show that the total program savings were even greater. This reveals that a well-conceived health and wellness program that focuses on prevention, self-care, risk factor reduction, and disease management can produce extensive benefits for employers and their employees. Utilization and expenditures may be reduced by better coordination of existing health and productivity management programs, with many of these benefits occurring in later years. Another example for health and wellness program is the Union Pacific company in America. Their vision is to be the healthiest company in America. Over 27,000 employees have participated in Union Pacifics Health Risk appraisal and took part in follow-up programs. Union Pacifics long-term wellness program goals include: keep on decrease in lifestyle related diseases and health care claims, enhance employee productivity, improve employer relations and decrease injuries and absence. The Health Track Program includes a Health Risk evaluation, follow-up involvement programs which are stage based, a Smoking Cessation Program called Butt Out and Breathe, which includes a pharmacological assistance benefit, over 500 contracted Fitness Facilities across their system, an incentive program tied to the Companys incentive program and research study participation. Health Screenings, a work-related health nurse network in major repair facilities and support of local management and Executive Staff of the Company make possible the program (U.S. Department of Health and Human Services, 2003). Verification of the programs cost-effectiveness include: over a 10% decrease in Health Care Costs due to Lifestyle Related Factors comparing to a $53.6 million dollar difference in 2001; smoking prevalence at Union Pacific has plunged from 40% to 28% in the last 10 years; and Union Pacific has won a number of national awards in the last several years for its health programs. And henceforth Employees health plays a vital role in productivity and profit for the employers and this in turn creates greatest concern for administrators/managers. Barriers to worksite health promotion Even though many owners of firms are sympathetic of the concept of worksite health promotion, they are hesitating to implement a program in the face of the following perceived barriers. A common mistaken belief is that worksite health promotion is too costly for a business. However, some firms provide programs by making creative use of free or low-cost community resources.       Another misleading notion is that health promotion programs are too complex to fit into the structure particularly of the average small business. However, these firms can begin their efforts very modestly and steadily make them more comprehensive as additional needs are documented. Newsletters and health education materials can be distributed quarterly instead of monthly; a more limited number of health seminars can be held at appropriate seasons of the year.  It hasnt been proven that the programs work. Small businesses simply do not have the time or the funds to do formal cost-benefit analyses of their health promotion programs. They are forced to rely on unreliable experience which may often be misleading. Small firms don’t have the know-how to design a program. While this is true for most managers of small businesses, it need not present a barrier. Many of the governmental and voluntary health agencies provide free or low-cost kits with detailed instructions and sample materials, for presenting a health promotion program. In addition, many offer expert advice and consulting services. Finally, in larger communities and many universities, there are qualified consultants with whom one may discuss short-term contracts for relatively modest fees covering onsite help for a particular health promotion program to the needs and situation of a small business and guiding its accomplishment. Small firms dont have the space to accommodate the program. This may be true for most small organizations but it need not stop a good program. The employer can arrange for his employees, programs offered in the neighborhood by local hospitals, voluntary health agencies, medical groups and community organizations (Muchnick-Baku and Warshaw, N.D.). Minnesota Health Promotion Survey (2004) indicated that lack of expertise and staff, time, high cost were the most serious barriers to health promotion at their worksite. And also lack of facilities and that the sizes of their businesses were too small or employees were not interested. One out of four felt that management was uncooperative and few felt that the organization would not save money by engaging in health promotion activities (MDH, 2004). Another significant challenge to worksite health promotion is the individual unhealthy behavior and present life style. Expenditures for health care continue to rise and much of these costs can be credited to the diagnosis and treatment of chronic diseases and conditions such as diabetes, obesity, cardiovascular disease and asthma. A much smaller amount is spent on preventing these conditions. There is lot of evidence that much of the morbidity and mortality associated with these chronic diseases are preventable. For many, individual behavior and lifestyle influence the development and route of these chronic conditions. Unhealthy behaviors, such as a poor diet, lack of physical activity, lack of rest and tobacco use are some of factors for many chronic conditions and diseases. A high calorie diet and inactive lifestyle normally result in excessive weight gain. Overweight and obesity are risk factors for a large number of chronic diseases, most significantly, type 2 diabetes, congestive heart failure, stroke, and hypertension. Encouraging individuals to adopt healthy habits and practices may reduce the burden of chronic disease at worksites. Presently, public and private efforts and programs are increasingly designed to promote healthy behaviors. Employers are becoming more aware that overweight and obesity, lack of physical activity, inadequate rest and tobacco use are negatively affecting the health and productivity of their employees and eventually, the businesses profit. As a result, innovative employers are providing their employees with a variety of work-site-based health promotion and disease prevention programs. These programs have been shown to improve employee health, increase productivity and yield a significant return on investment for the employer. For example, a recent review of health promotion and disease management programs found a significant return on investment for these programs, with benefit-to-cost ratios, ranging from $1.49 to $4.91 The goal of Northeast Utilities WellAware program is to improve the health and well-being of employees and families through partaking in targeted programs and services that address lifestyle-related health risks; and to reduce health care costs. Northeast Utilities found that almost 17% of its health care claims were attributable to lifestyle behaviors. Key features of the program include: financial incentives for participation, employees and spouses eligible, strong senior management support, and ongoing assessment and re-design. The components of the program include: a health risk assessment, a telephonic high risk intervention, a secondary coronary artery disease management program, telephonic smoking cessation counseling and rebate for purchasing smoking cessation aids, integration with internal departments and external partners (health plans, local hospitals, etc.), accessible via on-site programs, communication of community programs, guidebooks, videos, and telephonic intervention programs, Internet site allows access at work and home, and a toll free hotline for materials and questions. In its first 24 months, Northeast Utilities documented a 1.6 return on investment from the WellAware program, including a $1,400,000 reduction in lifestyle and behavioral claims and flat per capita costs for health care. Participants in the program established a reduction in health risk factors including a 31% decrease in smoking, a 29% decrease in lack of exercise, a 16% decrease in mental health risk, an 11% decrease in cholesterol risk, and 10% improvement in eating habits, and a 5% decrease in stress (U.S. Department of Health and Human Services, 2003). Present trend towards Worksite health promotion programs are expanding beyond the established topics of controlling alcohol and drug abuse, nutrition, weight control, smoking cessation, exercise and stress management. Today, activities generally cover a wider variety of health topics, ranging from healthy pregnancy or the menopause to living with chronic health conditions such as arthritis, depression or diabetes. Increased importance is being placed on aspects of good mental health. For example, under the employer-sponsored programs may appear courses or other activities such as improving interpersonal communications, building self-esteem, improving personal efficiency at work and home, or overcoming depression. Another trend is to provide a wider range of health information and counseling opportunities. Individual and group counseling may be added with peer counseling, computer-based learning, and use of interactive videodiscs. Appreciation of multiple learning styles has led to a broader array of delivery modes to increase efficiency with a better match between individual learning styles and preferences and instructional approaches. Offering this diversity of approaches allows individuals to choose the setting, intensity and educational form that best fits their learning habits. Today, health education and counseling are being increasingly offered to employees of larger organizations, including those who may work at distant locations with few co-workers and those that work at home. References Choi, H.S., Bricker, S.K., Troy, K., Kanny, D. and Powell, K.E. (2004) Worksite Health Promotion Policies and Practices in Georgia: 2002 Georgia Worksite Survey. Georgia Department of Human Resources, Division of Public Health. Publication Number DPH03/156HW. MDH, (2004) Minnesota Health Promotion Survey- Results and Recommendations. Minnesota Department of Health Heart Disease and Stroke Prevention Program, Retrieved June 18, 2006, from http://www.health.state.mn.us/divs/hpcd/chp/cvh/pdfs/worksitereport.pdf Muchnick-Baku, S and Warshaw, L.J. (N.D). Health Promotion in Small Organizations: The US Experience, Retrieved June 18, 2006, from http://www.ilo.org/encyclopedia/?print&nd=857400223 U.S. Department of Health and Human Services, (2003) Prevention Makes Common “Cents” Retrieved June 18, 2006, from http://aspe.hhs.gov/health/prevention/prevention.pdf Read More