514 The Tower
School of Health Sciences
College of Health and Human Services
Ohio University
Athens, OH 45701
E-mail: randolfi@ohiou.edu
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Abstract
As the field of worksite health promotion continues to evolve, so will the need to define and articulate the dimensions of a comprehensive model of worksite health promotion. A representative model includes the following components; health education programs, employee health services and benefits, physical fitness and nutrition programs, health promotion policies and procedures, counseling and employee assistance programs, a safe and healthy work environment, and the integration of company and community resources. A comprehensive approach to health promotion programming will maximize the impact of all interventions by increasing communication between administrators, employees, and employee families, while encouraging the adoption of a healthy worksite culture and climate. Philosophically, this model supports the ideals of employee wellness and optimal health by encouraging worksites to go beyond programs designed to only reduce health care costs, prevent disease, or maintain health. A key factor in the utility of this model is the integration and overlap of responsibilities for health promotion by various departments and individuals inside and outside the company. As the structure of the workplace continues to change, in the future this dynamic model can be used to evaluate and plan for programs that are truly comprehensive in nature.
Introduction
According to the National Survey of Worksite Health Promotion Activities
(1992) eighty-one percent of companies in the United States with 50 or
more employees have some form of worksite health promotion activity. This
result puts us in proximity of the Healthy People 2000 (1990) objective
of 85% by the year 2000. Why are employers getting into the business of
health promotion? The three most common reasons cited for employer interest
in health promotion are the desire to control spiraling health care costs,
to encourage a healthy productive work force, and as a means of boosting
the morale of employees and the image of the company (O'Donnell, 1994).
As the motivations for health promotion differ, so do the extent of health
promotion efforts. A program may consist of distributing the occasional
health pamphlet on the warning signs of cancer to employees, or it may
comprise an elaborate and strategically planned worksite health enhancement
program targeted to the specific needs of a company and its employees.
Research indicates (O'Donnel & Harris, 1994) that some programs have
been more effective than others in improving health status, but what would
a truly comprehensive model of worksite health promotion consist of?
Close your eyes and imagine yourself working for the healthiest company
possible. What characteristics or health promotion strategies would make
that organization so healthy? Examine it from a holistic perspective. What
does that business do to enhance the physical, social, emotional, spiritual,
and intellectual aspects of employee health? How does that company develop
effective health policies and relevant programming that impact all employees?
Finally, how does that business demonstrate its belief that workers are
the company's most valued asset?
It is unlikely that any one component of a worksite health promotion program
will be responsible for the positive health outcomes of all employees.
Worksite health promotion has evolved from the occasional fitness facility
for the exclusive use of company executives, or the sporadic employee safety
program, to a wide range of health enhan cing services and programs. Worksite
health promotion professionals often speak of the importance of cultural
change and the need to institutionalize health promotion in today's workplace.
This goal can only occur through a comprehensive and integrated approach
that impacts on workers through numerous channels.
A Comprehensive Model
As the discipline of worksite health promotion continues to evolve,
the need to define succinctly the components of this comprehensive approach
increases. In 1987 Allensworth and Kolbe (1987) expanded the prevailing
definition of comprehensive school health to include the domains of Health
Instruction, Healthy Environment, Health Services, Physical Education,
Counseling and Psychological Services, School Food Service, Worksite Health
Promotion for Faculty and Staff, and the Integration of School and Community
Resources. To promote the health of school age children, prevention specialists
have realized that an integrated comprehensive approach is the most effective
strategy. Relying solely on health education or physical education programs
to foster children's health has demonstrated limited effectiveness. Consistent
health messages delivered by numerous agents increases the possibility
of attaining health goals and objectives. A similar model is essential
if worksite health promotion programs are to impact positively on the health
and performance of all employees.
A comprehensive model of worksite health promotion includes the following
components; Health Education Programs, Employee Health Services and Benefits,
Physical Fitness and Nutrition Programs, Health Promotion Policies and
Procedures, Counseling and Employee Assistance Programs, a Safe and Healthy
Work Environment, and the Integration of Company and Community Resources.
This model can be used to evaluate and plan for programs that are truly
comprehensive in nature, focusing on primary, secondary, and tertiary prevention
strategies for employees. One value of a truly comprehensive model is that
it is possible to promote a holistic philosophy of employee health. A healthy
productive employee, is one who is given the opportunity to develop physically,
emotionally, socially, intellectually and spiritually. In addition, this
model supports the ideals of wellness and optimal health by encouraging
worksites to go beyond programs designed to only reduce health care costs,
prevent disease, or maintain health.
A key factor in the utility of this model is the integration and overlap
of responsibilities. Design and implementation are dependent upon the cooperation
and motivation of qualified - and ideally - credentialed professionals
throughout the administrative structure of a company. Such a model requires
consistent communication between health educators, medical staff, human
resource managers, physical therapists, industrial hygienists, exercise
physiologists, ergonomic engineers, dietitians, occupational therapists,
psychologists and independent consultants. Planning must also incorporate
active involvement of workers, administrators, family members, and company
retirees at all stages of the development, implementation and evaluation
stages. All must be committed to the development of a healthy organization
where employees are happy and proud to work.
Various professional groups are working to advance the science of worksite
health promotion. Health educators have the training and expertise to be
leaders in this field. On the basis of theoretical foundations of health
behavior and the results of empirical research, we must begin to articulate
a clear vision of what optimal programs should consist of. Descriptions
of components of this model are included below with selected principles
and examples.
A Comprehensive Model of Worksite Health Promotion
Health Education
Health education is easily integrated into all the areas of this model
and it is unlikely that any of the areas could survive without an educational
component. It is a key element of every primary, secondary, and tertiary
prevention program and a means of promoting wellness and optimal health.
A comprehensive health education program must be based on theoretically
and scientifically sound principles to ensure effectiveness. Successful
health education programs will incorporate adult learning theories and
encourage active participant involvement in all phases of program planning
and implementation. Health education efforts should emphasize skill development
and the adoption of health enhancing behaviors while being accessible to
all employees, their families and retirees. Methods of delivery may include;
one on one instruction, group presentations, seminars, workshops, educational
media lending library and health literature distribution. Program examples
may include:
Physical Fitness and Nutrition Programs
Physical fitness and nutrition programs have demonstrated effectiveness
in delaying the onset of employee morbidity while enhancing self esteem,
stress management and general feelings of well being. Although many physical
fitness and nutrition programs are instructional in nature, they should
go beyond educational programs by providing enabling supports for the adoption
of healthy behaviors. Quality health promotion programs encourage and facilitate
participation in daily physical activity for all employees, and when possible
family members and retired workers. This is accomplished through access
to fitness facilities, (preferably on site) and properly supervised exercise
classes. In addition a comprehensive program will provide opportunities
for individualized exercise and nutrition prescriptions from certified
professionals. Commitment to the model is demonstrated through occupational
food services and sales consistent with healthy nutrition. Specific programs
to include:
Employee Health Services and Employee Benefits
Small and large businesses carry a significant proportion of the provision
of health care for families in this country by providing health care insurance
for their employees. With the escalating increase in health care cost many
companies are attempting to slow the increase of health care insurance
premiums by providing creative cost control programs. Greater emphasis
is being put on primary prevention to keep employees healthy and secondary
prevention to identify and treat health conditions before they can become
serious. At some workplaces, employees are being encouraged to take greater
responsibility for their health related behaviors through risk rated incentive
packages. Linking wellness to employee benefits of gainsharing and co-payment
cost reductions, will provide new opportunities requiring efforts of collaboration
between the human resource managers and the health promotion specialists.
These two sets of professionals may also work together for the ongoing
evaluation of cost effective health promotion programming.
In conjunction with the above programs most large companies also have a
nurse or physician on staff to dispense on-site medical and preventive
care. Some programs have also found it cost effective to provide their
own physical therapy programming to assist injured and infirm workers in
regaining optimal functioning. A comprehensive selection of health related
employee services and benefits would include the following:
Counseling & Employee Assistance Programs
An employee's psychological health can never be neglected in a comprehensive
model of worksite health promotion. Originating out of a need for alcohol
abuse interventions in the workplace, today's employee assistance programs
(EAP) encompass assessment and counseling for substance abuse and dependency,
stress related disorders, family conflicts and other personal issues. Evidence
of the need for such programs is wide spread. In a national survey conducted
by the Northwestern Life Insurance Company (1992) 46 percent of employees
reported that their job was very stressful, 34 percent thought about quitting
their jobs because of workplace stress, and 14 percent did leave their
job because of stress. Alcohol and substance abuse problems as well as
issues of workplace violence and harassment are common areas of concern.
For many the only viable treatment solution is the worksite's health promotion
program Exemplary programming will include:
Safe and Healthy Work Environment
The environmental conditions of the worksite can be divided into both
physical and psychosocial domains, both of which influence the culture
and climate of a worksite. The cultural norms of a workplace have been
identified as powerful determinants of worker health and behavior (Baum,
1995). Ultimately, workers benefit most from a healthy, supportive, eustressful
workplace community were they feel valued and respected. Since adults spend
approximately one third of their waking hours at work, one would hope that
employees view work as less of a necessity and more of an enjoyable experience.
The climate of a workplace is also more conducive to enhancing health and
human performance when the environment is safe, clean, aesthetically pleasing
and ergonomically engineered. While some occupations maybe inherently dangerous
(e.g., fire fighter, military personnel) all comprehensive worksite health
promotion programs should control exposure to unhealthy conditions including:
hazardous chemicals, noise, temperature, radiation and other risky conditions.
Program examples include:
Health Related Company Policies and Procedures
At times worksite health promotion programs have been instituted as
public relations vehicles intended to enhance the corporate image with
little concern for improvements in employee health. Companies who are truly
committed to enhancing employee health and wellness, are companies who
have worked to include employee health promotion into the company's mission
statement. With this commitment, policies and procedures can be written
to address short and long term goals of increased employee health, productivity,
and morale. These policies and procedures are critical to the establishment
of supportive organizational cultures conducive to employee health and
wellness.
Integration of Company and Community Resources
Worksites do not exist in a vacuum. They are part and parcel of the
community in which they are located. Successful corporate administrators
are cognizant of the need for positive community relations and should do
what is necessary to promote good will. What better way to bridge relationships
than by utilizing existing community health promotion services and programs
whenever possible (e.g., voluntary, private and public health agencies)
and providing health related services back to the community. Since the
community is also the home of the employee, an effective mode of health
promotion is through programming directed at the larger community. Sponsorship
of community related health fairs is one example more are listed below.
Future Developments, Directions and Challenges
Technological and demographic transformations are changing the nature
of work in our society. As these changes occur the comprehensive model
of worksite health promotion described above will evolve and continue to
develop. If current trends continue, the workers of tomorrow will be older,
more racially and ethically diverse, increasingly female, and will often
be located off-site. In the later case, technological advances are making
it possible for more and more professionals to conduct their work from
their homes. Thus the very character of the worksite will change and so
must our efforts to deliver health promotion programs. As an example, in
the future it is likely that a great deal of health education programming
will be delivered through personalized interactive multimedia formats,
conveniently supplied to any number of employees through telecommunication
systems.
As technological innovations increase in the workplace, health promotion
professionals will face new health related challenges. In the past, some
have assumed that technology would make workers more efficient, thereby
allowing employees to work less, while being more productive. In reality,
increases in technological innovation have simply allowed more of us to
take our work with us where ever we go and feel guilty for not being increasingly
productive. This trend may absorb increasingly greater amounts of leisure
time that is normally devoted to relaxation and recreation. Subsequent
increases in stress and fatigue will ensure the continued need for effective
health promotion programming.
When considering the scope of worksite health promotion described in this
article, many will think of substantial investments made by large corporations.
The reality is that 60% of individuals working in the United States work
for a company of less than 100 employees (U. S. Bureau of Census, 1988).
Due to economy of scale, it has been difficult and expensive for small
business owners to supply adequate health care insurance as well as prevention
programming for workers. Health promotion professionals must understand
this challenge and develop the means to overcome these obstacles. The evidence
is clear that much more could be done to advance the health of our society
through the workplace. As change agents, health educators must work to
empower employers and employees through education of the benefits of worksite
health promotion.
References
Allensworth, D.D. & Kolbe, L (1987). The comprehensive school health
program: Exploring an expanded concept. Journal of School Health. pp, 409-412.
Baum, W. B. & Williams, K. (1995). Cultural change in worksite health
promotion. In DeJoy D. M. & Wilson M. G. (1995). Critical issues in
worksite health promotion. (pp. 30-49),
Boston:Allyn and Bacon.
O'Donnell, M. P. (1994). Employers' financial perspective on health promotion.
In O'Donnell, M. P. & Harris, J. S. (Eds.), Health promotion in the
workplace. (2nd ed.), (pp. 390-424). Albany, New York: Delmar.
Northwestern National Life Insurance Company (1992). Employee burnout:
Causes and cures. A research report. Part 1: Employee stress levels. Part
2: Addressing stress in your organization. Minneapolis, MN: NWNL Employee
Benefits Division.
U.S. Department of Health and Human Services. (1990). Healthy people 2000:
National health promotion and disease prevention objectives. (DHHS Publication
No. (PHS) 91-50213). Washington, DC: U. S. Government Printing Office.
U.S. Department of Health and Human Services. (1992). National survey of
worksite health promotion activities. Washington, DC: U.S. Government Printing
Office.
U.S. Beurau of Census. (1988). County business patterns, 1988: Technical
documentation (CBF-7-88) Washington, DC: U.S. Department of Commerce-Bureau
of the Census.
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