TheNationsHealth.org -September 7, 2007
Employers making room for health promotion in
workplace: Incentives, support yield health results
By Kim Krisberg
Employers making room for health promotion in workplace: Incentives,
support yield health results
Every Monday for about a year, Ghislaine Moore and her co-workers in King
County, Wash., used their lunch breaks to take a yoga class in their office
conference room. While employees were practicing their stretches and balance
poses, their manager would look after the office and eventually welcome
back a group of happier, more relaxed employees.
“We noticed that Monday afternoon became a completely different atmosphere,” said Moore, who works in the King County Business Relations and Economic Development Office. “Everyone is feeling good, their eyes are sparkling, there’s more smiles, and I would tell my manager, ‘Production is going to go up this afternoon.’”
For Moore and her King County colleagues, living healthy lifestyles has truly become part of the job description. In 2006, King County joined the growing ranks of private and public employers across the country taking an active health promotion role with their employees, organizing weight loss competitions, installing on-site gyms, offering discounted health insurance coverage and smoking cessation classes, and creating daily work environments supportive of employee wellness activities. Employers often cite the burden of escalating health care costs as the impetus for developing wellness programs, but have found a number of pleasant side effects along the way: higher employee productivity rates, less absenteeism and heightened camaraderie among workers.
As lifestyle choices such as poor nutrition and lack of physical activity compete with tobacco for the nation’s top causes of preventable death, workplace wellness programs have the potential to not only educate and motivate workers, but their families as well. A study in the July issue of Preventing Chronic Disease that examined outcomes of the American Cancer Society’s Active for Life worksite wellness program found that while the program increased physical activity, such changes were not sustained over time. In response, the study authors recommended extending a program’s length, providing better social support and offering larger financial incentives — all factors that helped a group of King County employees participating in a Weight Watchers at-work program collectively lose more than 5,700 pounds in 2006, according to Brooke Bascom, communication director for the county’s Health Reform Initiative.
“People have made amazing changes, there really is a culture shift here,” she told The Nation’s Health. “The challenge now is to maintain the momentum.”
Like many employers, the catalyst for King County’s Health Reform Initiative was health care costs, which officials were predicting to double in the next seven years, Bascom said. So, King County Executive Ron Sims convened a health advisory task force that eventually developed a non-punitive approach that rewards people for improving their health and gives them the tools and education to do so. The foundation of King County’s program, Bascom said, is a new health benefit design that ties employees’ out-of-pocket costs and co-payments to their willingness to participate in wellness activities.
To take part in the program, which began in 2006 and covers 13,000 workers and their families, employees as well as their spouses or domestic partners must undergo a wellness assessment gauging characteristics such as body mass index, cholesterol level and behavioral risk factors. According to assessment results, workers are placed in a low, moderate or high-risk category and assigned individual action plans. Those in the low-risk category are asked to track their nutrition and activity levels online, while workers at moderate or high-risk of health problems can be assigned a health coach with whom they’ll have three over-the-phone sessions over three months. Almost every employee who took an assessment also enrolled in an action plan, Bascom said.
During the program’s first year, 90 percent of 19,000 eligible people took part, Bascom reported. Workers who declined to participate are considered at the “bronze” level and their health benefits remain unchanged, with a $500 deductible for an individual and $1,500 for a family; those who only do the health assessment are at the “silver” level, which is $300 for an individual and $900 for a family; and those who participate in assessment and improvement activities are at the “gold” level, with only a $100 individual deductible and $300 for a family. Bascom noted that at the beginning, there was some “confusion and skepticism about the county’s motivations and thoughts that this was too ‘Big Brother,’” but guarantees that all assessment results would stay private as well as efforts to bring employee wellness suggestions to fruition helped quell concerns. For example, employees voiced a desire to engage Weight Watchers and local gyms, so health program organizers invited Weight Watchers to county worksites and arranged for employee discounts at 124 gyms throughout the Puget Sound region. Each county worksite also received $25 per employee to spend on creating a supportive environment. Some sites have decided to purchase gym equipment, some invited a yoga instructor to teach classes on-site, some purchased walking maps and pedometers and others arranged for weekly deliveries of organic produce.
While it’s too soon to report any health care cost differences, Bascom said she’s always hearing anecdotes of success, like a work shirt order for county jail employees that, unlike previous years, didn’t include any size XXL requests. Organizers have also collected data showing that 75 percent of high-risk employees who participated in coaching calls reported improving or eliminating at least one unhealthy risk factor such as smoking or hypertension.
“Cost is the catalyst for a lot of people, but there have been tremendous other benefits,” Bascom said.
Similar results are popping up in Baltimore, Md., where Myles Norin, chief executive officer of Agora Inc. publishing company, said a “day doesn’t go by when someone doesn’t stop and thank me for creating this program.” Agora’s wellness program started this year with a 12-week weight loss competition open to all 400 employees, 84 of whom competed and lost a collective 1,000 pounds. More than 80 employees decided to compete, but many more simply took advantage of Agora’s on-site gym and free classes with personal trainers, Norin said. Agora also partnered with local gyms so employees could work out on the weekends at no cost and offered a smoking cessation course, which helped 15 employees kick their habits, Norin reported. Norin said that although reeling in health care costs was a motivator, lending such support to employees was just the right thing to do.
“The support you get at work is just as important as the support you get at home,” Norin told The Nation’s Health. “Employees care that you appreciate them as a person and not just as a production unit.”
While 12 weeks of exercise was good, Norin said, it may not translate into a total lifestyle change, so Agora extended its wellness program another 12 weeks. The second time around there was no weight loss competition, but employees were asked to sign a contract committing them to exercise and Agora will pay for all of the classes. Employees are allowed four unexcused absences from the classes they’ve committed to, after which they have to reimburse Agora the cost of the personal trainer, Norin said. Agora spent $90,000 on the first 12-week program and has a budget of $45,000 for the second round. Norin said he realizes that many companies couldn’t afford such a budget, but that even tiny changes can make a difference, such as ordering water and fruit instead of soda and cookies for a work lunch or organizing group walks during working hours.
“You should provide as much support as you can, but it doesn’t have to be a lot,” Norin said. “Education is most of it.”
Workplace wellness fuels productivity
Expecting unhealthy employees to miss more work is hardly a new prediction, but more employers are realizing that the greater impact of healthy lifestyles lies in affecting “presenteeism” — the level at which an employee functions when she or he is at work — not absenteeism, according to Ron Davis, MD, president of the American Medical Association. Health care costs are certainly a factor when deciding to implement a workplace wellness program, Davis said, but employers can also realistically expect a healthy employee to help boost their bottom line.
“I think (the trend in workplace wellness programs) is being motivated by having employees who are healthier, have better morale and who are more productive,” Davis told The Nation’s Health. “We need to help improve employees’ healthy behavior to not only keep them at work, but to keep them functioning at a high level when they’re at work.”
Davis, who directs the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit, noted that his employer also offers financial incentives for workers who participate in health risk appraisals and risk reduction programs, in which about one-third of employees have taken part. In general, workplace wellness programs should strive to be fairly comprehensive, covering the major risk factors for disease and premature death, such as smoking, poor diet, lack of physical activity and alcohol abuse, Davis said. Even though the insurance system has been historically geared toward covering people only after they get sick, employers can play a role in encouraging more prevention coverage, Davis said.
“The most compassionate programs will combine services to help people change their behavior with positive incentives,” he said.
Some workplaces have drawn criticism for policies critics say dictate what employees do in their free time, such as employers who decide not to hire people who smoke or who give current employees an ultimatum: kick the cigarettes or lose your job. Critics have said such policies can be a slippery slope. In a December 2005 editorial in Tobacco Control against employers who won’t hire smokers, author Simon Chapman stated that “employers might consult insurance company premiums on all dangerous leisure activity…and interrogate employees as to whether they engaged in dangerous sports (or) rode motorcycles.” But Davis said such an argument is a “smoke screen — there’s no evidence that the slope is that slippery.”
“I’m neither endorsing nor condemning employers for having such policies, but what I will defend is their right to have such a policy if they find it appropriate,” he said. “I object to smokers’ rights laws because they elevate smoking as something to be protected on par with gender, race, religion or political ideology.”
Whether it is a smoking cessation class or a group walk, encouraging employees to help create their own workplace wellness programs can help lessen feelings that an employer is stepping over the “paternalistic” boundary. In Upton, N.Y., employees of the U.S. Department of Energy’s Brookhaven National Laboratory aren’t afraid to speak up about the wellness services they’re interested in, said Michael Thorn, health promotion program manager at Brookhaven. Ahead of its time, Brookhaven’s dedication to health is two decades old and many of its 2,600 employees are used to the perks of a robust wellness program. Employees can take advantage of an on-site gym that costs only $25 a year to join, free annual on-site physicals, a monthly nutrition group and heart-healthy choices in the cafeteria. They can also participate in the annual Healthfest, which takes place the entire month of October and offers two-mile walks, bike rides through the woods, swimming events, health fairs and a massage day, Thorn said.
“The health promotion program is seen as a source of positive morale,” Thorn told The Nation’s Health. “And it’s the right thing to do — we should take care of our people.”
Thorn said he is also studying data trends from Brookhaven’s insurer to help target health interventions even more. For example, insurance data show a downward trend of mammograms and colonoscopies among Brookhaven employees, so Thorn is working on a promotion to encourage more preventative screenings. He also studied the costs of generic and brand-name prescriptions and is hoping to educate workers on how to cut down their health care costs. In the end, small actions can make a really big difference, Thorn noted.
“The mistake is that people think they have to spend a lot of money (on a wellness program), but there’s lot of things to do that are inexpensive,” he said.
With just 15 employees, Redi-Tag of Cypress, Calif., proves that a small company with a limited budget can be as effective at promoting health as its larger counterparts. In 2004, the office product company kicked off its annual “12-Week Health Challenge,” which has included educational lectures on healthy eating and lifestyle changes, powerwalks twice a week with a trainer during work hours, 10-minute spurts of weight lifting at 10 a.m. and 2 p.m., and prizes for participation and most weight lost, according to Lori Stouffer, Redi-Tag’s human resources manager. Almost three-quarters of Redi-Tag’s work force took part in the challenge this year, Stouffer said, and the entire program only costs a few thousand dollars. Last year, Redi-Tag’s wellness program was honored by the California Task Force on Youth and Workplace Wellness with a Fit Business Award.
“It gives everybody a sense of teamwork,” Stouffer said. “And you’re less likely to hit the vending machine…because everyone’s watching.”
For more information on workplace wellness programs and how to start one, visit www.acsworkplacesolutions.com or www.americanheart.org/presenter.jhtml?identifier=3044646.
