Addressing Total Worker Health

Today’s workforce is multigenerational and diverse in its demographics. A workforce’s health extends beyond conditions of employment and the workplace and can affect families, communities, and social and political systems. Factors, both inside (i.e., physical and chemical exposures, environmental tobacco smoke) and outside (i.e., lifestyle choices such as poor diet, smoking, limited exercise and alcohol use), cannot be separated merely as “at work” and “nonwork.” Working conditions affect the health and well-being of employees just as outside exposures and activities can substantially determine responses to exposures during work.

Employers realize that diminished health and injuries, whether brought about at work or elsewhere, leads to a reduced quality of life, decreased productivity, increase in absenteeism as well as rising health care costs¹ (also see Figure 1) ². In order to address these challenges and ensure the protection, preservation and improvement of the health and well-being of workers, employers should begin to focus on Total Worker Health ^TM, a strategy which integrates occupational safety and health and health promotion programs to improve the total health of workers and lead to a highly engaged and performing workforce³.

The health of American workers

Health risks associated with chronic health conditions are on the rise. Nearly 50 percent of Americans have one chronic health condition and half of this group has two or more chronic conditions. Chronic health conditions continue to rise in the United States and conditions such as heart disease, diabetes and cancer are expected to add to the financial burden of the already high costs of health care. Other health care conditions such as musculoskeletal/pain and depression also are adding to the costs. Employers are particularly impacted as they provide medical benefits and already absorb the costs of absenteeism and long- and short-term disability claims⁴.

Analysts project that by 2015 one of every five workers will be 55 years of age or older and between 2006 and 2016 workers ages 65 to 74 will increase by 36.5 percent and workers 65 and over will increase by 80 percent. These older workers often suffer from chronic health conditions, have multiple health risks, and require more care and disability as compared to their younger counterparts⁴.

The price of health in the workforce

In addition to the rising medical and pharmaceutical costs, researchers have found a greater connection between health and workplace productivity. According to recent findings, for every U.S. dollar an employer spends on worker medical/pharmacy costs, employers also absorb two to three U.S. dollars of health-related productivity. Most of these costs can be attributed to absence, disability and presenteeism which occurs when an employee is present but not fully productive⁵.

Safety issues and health-related -environ-mental hazards also complicate these issues for employers and add to the cost impacts related to poor health. Accidents, overexertion and injuries related to excessive lifting, carrying or pushing continue to significantly add costs for employers. In the U.S., the National Safety Council estimates that on-the-job injuries account for more than US$130 billion annually which includes US$68 billion for loss of productivity, US$24 billion for medical costs and administrative costs of US$22 million. A further US$10 billion is spent on employees investigating work-related injuries⁴.

The impact of health in the workplace

Research on the impact of health in the workplace has increasingly shown when health improves, worker productivity increases and costs are lowered. Studies have demonstrated when individuals reduce their health risks, their productivity increased while those who stayed the same experienced decreased productivity⁶. A well-designed workplace health program can achieve increased productivity in worksite populations⁷; for every U.S. dollar spent on comprehensive workplace wellness and prevention programs, medical costs could be reduced by US$3.27 and absenteeism costs by US$2.73⁸ and for every dollar spent on health promotion over a three-year period, an employer’s return-on-investment savings range from US$1.40 to US$4.70⁹.

Traditional safety and wellness programs: Too disconnected

Figure 1.

The evidence clearly demonstrates that workforce health is linked to productivity, costs and a nation’s economy. Although some employers have addressed both safety and health, and health promotion programs, most workplace health and safety programs and workplace health promotion programs are not connected.

This disconnect often has been attributed to the idea that health promotion activities may be a drain on the resources necessary for occupational health protection strategies⁴. According to the National Institute for Occupational Safety and Health, “The occupational health community has seen efforts at generic health promotion and disease prevention in the workplace at best as needed resources from occupational health protection strategies, and at worst involve victim blaming and distracting attention from the occupational health needs of workers. There has been concern that a narrow focus on health promotion will deflect employers from their legal responsibilities to provide workplaces free of recognizable hazards⁴.”

The non-integration of these two programs undermines resource utilization and hampers efforts to promote workers’ overall health and productivity. Furthermore, employers are more receptive to workplace strategies that promote health promotion in conjunction with safety and health in the workplace. Employers further recognize that workplaces with enhanced programs to promote the health and well-being of employees can lead to an energetic, engaged and high performance workforce¹⁰.

Integration modeling

To develop new integrative models for overall worker health and safety, the American College of Occupational and Environmental Medicine issued a guidance statement in 2011 recommending that integrative models should build a whole life approach to health thus integrating both on-the-job and off-the-job dimensions in a unified manner that leads to increased awareness in a culture of health; convey a message stressing the importance of the connection overall health and well-being; and recognize the evolution in the nature of workplace hazards and the associated awareness in the development of health strategies⁴.

Case study: BJC HealthCare¹²

The leadership at BJC HealthCare, a nonprofit health care organization known for excellent health care services for their patients that serves the greater St. Louis, southern Illinois and mid-Missouri regions, realized they wanted to bring the same level of commitment and care for their employees.

In 2003, the company launched their Help for Your Health program. Employees were encouraged to improve their health by reducing lifestyle risk factors and the occupational health and safety departments refocused their efforts to proactively prioritize the prevention and control of workplace injuries and illnesses.

The organization created a Health Literacy Advisory Committee and developed their program with input from representatives from all their affiliated hospitals and business units, as well as guidance from nearly 11,000 of their overall 27,000 employees via surveys and focus groups. Key components of the BJC HealthCare program included infection and ergonomic programs to promote health protection at the worksite; an annual Health Risk Assessment for all employees which helped direct wellness interventions such as weight management programs, smoking cessation courses, cafeteria initiatives, and annual campaigns for breast, colon and prostate health; and initiatives that extended into the community to include local health fairs and community awareness programs.

To fully ensure the effectiveness and sustainability of the program, BJC HealthCare developed an advisory board that was charged with integrating three critical activities: wellness and health promotion; safety and health protection; and the collection of data to evaluate the impact of their programs. BJC HealthCare aggressively evaluates their program and uses outside expertise to ensure their methods are rigorous and meaningful. As a result of their integrated and disciplined approach, it is estimated they have saved US$6 to US$12 million since program inception and are meeting their goal for their employees to become healthier than when they started as associates with BJC HealthCare ¹².

Impact beyond the workplace

The workplace can be considered a microcosm of society at large and provides an effective setting to help address the health of individuals and those in the community. For instance, worksite policies that have banned smoking have been the impetus for community efforts to ban smoking in public places and has decreased smoking prevalence in the U.S. Not only is focusing on total worker health a great value for employees and employers, it has the capacity to impact the health behaviors of families and others in the community and engage those who may not otherwise be exposed to health improvement efforts⁴.
FMJ

References:

1. Cherniacak M,et al. Statement on National Worklife Priorities. American Journal of Industrial Medicine 2011; 54:10-20.
2. Goetzel RZ. Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace: Final Report, January 2005. Thomson Reuters. (http://www.factsforhealthcare.com/management/Assets/NIOSH_Background_Paper_Goetzel.pdf) Date accessed: May 4, 2012.
3. Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH) Website, Total Worker HealthTM: What is Total Worker HealthTM ? (http://www.cdc.gov/niosh/twh/totalhealth.html). Date accessed: May 4, 2012.
4. Hymel PA et al. Workplace Health Protection and Promotion: A New Pathway for a Healthier and Safer Workforce. Journal of Occupational and Environmental Medicine 2011;53:695-702.
5. Loeppke et al. Health and Productivity as a Business Strategy: A Multi-Employer Study. Journal of Occupational and Environmental Medicine 2009;51:411-428.
6. Burton WN et al. The Association of Health Risks with On-The-Job Productivity. Journal of Occupational and Environmental Medicine 2005;47:769-777.
7. Goetzel RZ et al. Promising Practices in Employer Health and Productivity Management Efforts: Findings from a Benchmarking Study. Journal of Occupational and Environmental Medicine 2007;49:111-130.
8. Baicker K et al. Workplace Wellness Programs Can Generate Savings. Health Affairs 2010;29:1-8.
9. Goetel RZ et al. What’s the ROI? A Systematic Review of Return-On-Investment Studies of Corporate Health and Productivity Management Initiatives. AWHP’s Worksite Health 1999;6:12-21.
10. Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH) Website, WorkLife Transitions to Total Worker HealthTM. (http://www.cdc.gov/niosh/twh/transition.html). Date accessed: May 4, 2012.
11. Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH). Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing. DHHS (NIOSH) Publication No. 2010-140.
12. Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH) Website, Promising Practices for Total Worker HealthTM. (http://www.cdc.gov/niosh/twh/practices.html). Date accessed: May 4, 2012.