Health Promotion Research

Health Promotion Research

Ten Steps Toward Strategic Employee Health Promotion Programs

The Worksite Health Promotion Plan management world is evolving rapidly. Each month, there are new research findings that support the premise that Employee Health Promotion Programs and disease management have a long-term impact on health care costs. Many large companies that started Employee Health Promotion Programs three to five years ago are showing savings in health, disability, and workers compensation costs. Small to mid-size companies are watching all this and wondering where to start with wellness.

Getting upper management support and budget approval is one of the challenges at the beginning of a Employee Health Promotion Program. This is the case because Employee Health Promotion Programs can be expensive, averaging $150-300 per staff member per year in large companies. Most of the savings are not realized for a number of years. This long-term investing is hard for companies on the move.

The key to success for Employee Health Promotion Programs is to take a strategic approach. Here are ten steps to consider when starting a Employee Health Promotion Program.

1. Begin with upper management. Without upper management support, a health promotion strategy can fall flat. Begin with the health of your executive team and discover your wellness champions at the top of the business.
2. Analyze the problem. Look at your health care claims and assess the trends. Which conditions are driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your primary stakeholders both inside and outside the business. Ask your broker to facilitate the meeting and invite primary health vendors including health, disability, Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization data and identify primary areas of concern. Look at current offerings and see how they can be tailored to the needs of the population.
4. Look at both healthy and unhealthy employees. Since 85% of claims are usually attributed to 15% of claimants, it is essential to reach those with the most costly conditions while also reaching staff members who are at risk for developing preventable diseases in the future. Voluntary Employee Health Promotion Programs such as lunch and learns wellness seminars miss many of the staff members who need them most. Look at programs that are population-wide or target intact workgroups. Wellness incentives help but do not motivate everyone.
5. Set short-term goals for the Employee Health Promotion Programs. Set some realistic short-term goals based on your primary areas of concern. Are there any plan design changes that could have an immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Find out what employees are thinking. Hold some focus groups to determine where staff members are with wellness. What’s working? What isn’t? How much interest do staff members have in the Employee Health Promotion Programs? What obstacles and barriers are employees experiencing when they try to change behavior?
7. Make sure you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance Program (EAP) can provide a foundation for all of your future wellness programs. A good Employee Assistance Program (EAP) is a trusted link to the hearts and minds of employees. At no additional cost, the Employee Assistance Program (EAP) can provide needed follow-up coaching and individual attention for employees who are working on modifiable health behaviors or involved in disease management programs. Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value Employee Assistance Program (EAP).
8. Set three to five year goals for health care savings and measure them. Get help from your broker and insurance carrier help you on long-term goals for your health, disability, and workers compensation plans. Create program metrics that will help you to measure ROI. Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness, changes in behavior, and changes in risk factors. Create rigorous methods to measure health care savings over the long term.
9. Set goals for organizational health. Look at the more intangible benefits of a Employee Health Promotion Program and quantify them whenever possible. Include staff member turnover rates, cost of new hires, staff member morale, benefit satisfaction data, and employer of choice issues in setting goals. Create ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Worksite Health Promotion Plan strategy, a communication strategy, and a Worksite Health Promotion Plan incentive strategy that will fit with your company culture. Focus on integration of related components along a health continuum with communications that are focused, simple, and human. Create a budget that includes primary components such as consumer education, health promotion, Health Risk Assessments (HRAs), and regular biometric screens.

Employee Health Promotion Programs are crucial to improving the health of our nations. Most adults spend more of their waking hours at work than anywhere else, making it a excellent venue for promoting healthful habits. The worksite organizational culture and environment are powerful influences on behavior and this needs to be put to use as a way of assisting employees to adopt a healthier lifestyle. Benefits to Employee Health Promotion Programs include:
• Weight reduction
• Improved physical fitness
• Increased stamina
• Lower levels of stress
• Increased well-being, self-image and self-esteem

Companies can also benefit from Employee Health Promotion Programs. According to recently published research, employers’ benefits are:

• Improved recruitment and retention of healthy employees
• Lowered health care costs
• Decreased rates of illness and injuries
• Lowered staff member absenteeism
• Improved staff member relations and morale
• Increased productivity

A United States Department of Health and Human Services report revealed that at worksites with physical activity programs as components of their Employee Health Promotion Programs have:

• Lowered health care costs by 20 to 55 percent
• Lowered short-term sick leave by six to 32 percent
• Increased productivity by two to 52 percent

Thanks to modern medicine, life expectancy for Americans has continually improved. How much we enjoy these additional years, however, depends greatly on how we have lived our lives. If our quality of life is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be active and refrain from using tobacco products.

Who needs Employee Health Promotion Programs? If you work in an office or a worksite or are a member of an business who spends a considerable amount of time at work, you will benefit from a well-designed worker Employee Health Promotion Program. Employees spend a minimum of about 200 hours a month at work - a considerable amount of time.

Furthermore, stress, distractions and the pressures of the job can take its toll on the staff member, which makes it important that a Worksite Health Promotion Plan is started. Today, all across America, Canada, Europe and Asia, top Employee Health Promotion Programs are being used to help improve staff member conditions at work and reduce the cost of worker health care.

Some of the top Employee Health Promotion Programs currently in use today include:

Health Risk Assessments (HRAs)

Health Risk Assessments (HRAs) is a top Worksite Health Promotion Plan currently in use globally. Organizations that start it determine the safety and health concerns of workers by the assessment of appropriateness of the facilities and equipment against the needs of the employees.

It can, by way of example, guide the business into determining how much air quality within an office room affects the users and then help the assessment team to come up with the measures necessary to correct the problem. Health Risk Assessments (HRAs) can also evaluate the level of exposure workers have to certain hazardous or dangerous materials and practices.


This isn’t always practiced in every country since there are regions where government sponsored immunization shots are available. However, it has also become an important component of the top Employee Health Promotion Programs in many companies in North America.

Immunization, flu shots, such as those used to combat flu, by way of example, are offered to workers for free.

Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from offering educational resources to employees regarding health issues to sponsoring health services and medical care. In many companies, medical and insurance have also become a staple part of their benefits system.

Weight Management Programs

This is another Worksite Health Promotion Plan that companies use, particularly those that offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare, cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar substitutes.

Health-Wellness Newsletters - Health Education Programs

One of the top Employee Health Promotion Programs that companies can start is a self-powered tool using a newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically and focus on a specific topic, such as tobacco use hazards, cancer, stress, carpal tunnel syndrome, safety in the worksite, etc.

The newsletter in itself can be an effective way to deliver information to employees or members of an business but it is far from perfect. Some employees, by way of example, may not read the newsletter in its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through an active and highly visible campaign, it will be easier to maximize positive results.

Physical Fitness and Exercise Programs

Another top health promotion program for companies is one that involves physical activities. Companies frequently sponsor physical fitness-related events such as marathons and business sports programs to promote employees to remain fit or lose excess weight. In mid- to large-sized companies, companies may even pay for gym memberships or in-house physical fitness facilities.

Worksite Health Promotion Plan Incentives

Some of the top Employee Health Promotion Programs started by companies involve incentive rewards. This involves business-sponsored programs that reward employees for achieving specific wellness goals. Participation in health campaigns and signing up for Employee Health Promotion Programs are two of the most commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards) to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one of the top choices among companies who are willing to modify it in order to fit their unique needs.

Group Activities

In many companies, companies take advantage of peer pressure in order to encourage workers to participate in Employee Health Promotion Programs. This is currently one of the favorite worker Employee Health Promotion Programs currently in use today and growing in popularity. Peer pressure is frequently leveraged to help promote competitions and to persuade employees to be active in business-sponsored health fairs.

Employee Health Promotion Programs at the company level are beneficial, right? Wellness statistics clearly show that such Employee Health Promotion Programs are not only cost-effective for the business but can assist the staff member in developing a healthier lifestyle. With the increasing cost of health care, Employee Health Promotion Programs simply make sense. So where does the problem come in? Let’s examine the topic from both perspectives.

Employee Health Promotion Programs: The Good
• A sampling of ROI for Employee Health Promotion Programs: Bank of America: 600 percent; General Motors:370 percent; Pepsico: 300 percent; Citibank: 465 percent; and the Washoe County School District leading the pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts,, Albuquerque, New Mexico.)
• Companies with Employee Health Promotion Programs have realized a 28% reduction in sick leave, a 26% reduction in adjunctive health care costs and a 30% reduction in disability and workers compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 ROI for every dollar spent due to a 20% reduction in absenteeism. (Hardy,A. (2005). At the Top Of The Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Employee Health Promotion Programs provide the structure, encouragement, incentives and ongoing support that many individuals need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology business, gave employees who filled out a health risk assessment a significant discount on their health insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

Employee Health Promotion Programs: The Bad
The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to eat our veggies or lose 30 pounds? Some companies are doing just that and at least one lawsuit has resulted because of it.
• Three hundred companies have requested assistance from a national employment and labor law firm to institute more aggressive Employee Health Promotion Programs.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will begin reducing staff member paychecks by $10.00 for every staff member who has a Body Mass Index (BMI) of greater than 29.9 because not enough employees were utilizing their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he believed the business’s antitobacco use policy violated his civil rights. The business has a policy against hiring employees who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland, Kelley, The New York Times,July 22,2007.)
• staff member advocates are concerned that health discrimination may not be covered under the Americans with Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing employees by hitting them where it hurts the most,their pocketbook, does not appear to be a favorable approach to molding human behavior.
Such tactics may result in increased resentments and retaliation, primarily in the form of absenteeism and presenteeism (decreased productivity on the job.) Voluntary, incentive-based programs, such as the one in the Washoe County School District, can and do produce results. A positive attitude on the part of management along with an opportunity for employees to have a stake in the decision-making may yield the greatest dividends to both employer and staff member.The motivation and resolve needed to change unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and support.

Getting Started - Secure management support
• Justifications for having a Health and Wellness
• Health Risk Assessments (HRAs)
• Help for high-risk population: smokers, obese employees
• Early detection of diabetes, heart disease risk factors (high cholesterol, high blood pressure)

Health and Wellness Participation - Identify your audience
• Employees only, whole family, retirees?
• Community involvement? Theme?

Health and Wellness Time Line
• Set a date and time Allow 4-6 months of planning time

Health and Wellness Planning
• Identify health-related screenings, tests, other activities you’ll offer Identify educational literature and other learning opportunities Health and Wellness will provide Include any “fun” activities, or food/beverage needs for the fair

Health and Wellness Location & Logistics
• Look at location big enough to accommodate the largest volume of staff members at “peak time” periods
• Determine how booths/stations will be set up

Health and Wellness Vendors
• Target relevant health/safety-related community and corporate vendors to provide services, educational materials, incentives and giveaways

Health and Wellness Marketing
• Determine marketing tools to be used to inform employees/members (posters, mailings, e-mail)
• Determine any incentives or giveaways that will be included in the fair or used to promote participation in the fair

Health and Wellness Scheduling
• Coordinate timing and events with staff and/or volunteers

Health and Wellness Personnel
• Schedule appropriate experts Physician or similar health care personnel to provide patient consultation for review of blood draw lab results
• Nurse(s) to administer immunizations
• Administrative/all-purpose individual to facilitate paper work, finger sticks and to provide general assistance
• Pharmacist or pharmacist assistant if appropriate Dietitian for nutritional counseling suggested personnel designated for health fairs


1 The Robert Wood Johnson Foundation via Reuters Health E-Line.
2 Kaiser Daily Health Policy Report, (9/11/03)
4 “Is Stress Nibbling Away at Your Bottom Line?” By Stephen Alper, Nov. 15, 2002.
5 Health Promotion in the Workplace, Michael P. O’Donnell, page 415.

According to Gordian Health Solutions, the effectiveness of Employee Health Promotion Programs in improving health and reducing health care costs is directly linked to incentives: the more substantial the incentives, the higher the success rate. Incentives can range from tokens of achievement, such as t-shirts, water bottles and sports equipment, to more substantial financial awards, such as cash incentives or copay vouchers for the successful completion of a program.

Nationwide Insurance is seeing results from a small incentive program initiated by one of the business’s on-site nurses. To promote lunchtime walking, the staff member has informally launched a “shoelace program” modeled after the karate-belt color system. Employees progress through the color scale until they reach “black-lace” status. The reward system has resulted in more employees making commitments to walk during their lunch hour.

At the high end of the reward spectrum, some companies pay cash to employees who meet wellness goals. LuK, Inc. offers employees $250 for kicking the tobacco habit and remaining smoke free for 12 months. For logging fitness points that add up to 10 miles a month, employees are eligible for health assessments, which can result in reward amounts of up to $225.

The most effective motivator, according to Gordian research, comes through linking participation in Employee Health Promotion Programs directly to insurance premiums. Doing so clearly demonstrates to employees the positive effects of wellness on their own health care costs. frequently, the first step in linking wellness programming to insurance coverage is lowering deductibles for wellness care or eliminating deductibles altogether. By adding this benefit, companies can promote employees to undertake routine screenings and other procedures to respond to health problems before they become chronic. Early detection benefits both patient health and employer health costs.

Incentivizing Worksite Health Promotion Plan participation with health care credits

More frequently, companies are going beyond improved wellness care coverage and looking to demonstrate the importance of wellness by linking participation to employees’ bottom lines. Worthington Industries has recently rolled out a program that allows employees to eliminate their portion of the insurance premium by enrolling in a Healthy Choices Employee Health Promotion Program.

During the first year of the Healthy Choices program, employees and their spouses complete Individual Health Assessments and medical screenings to determine their levels of health risks. Nurses, dietitians and physical fitness specialists are available to help moderate- and high-risk members develop individual action plans for improved health through the use of educational materials, behavior modification, telephone help from third-party program health coordinators, and formal health management programs. By completing the assessments, employees earn their full premium credit. Because some plans at Worthington require no staff member contribution, a cash award takes the place of a credit in those cases. During year two of the program, the wellness bar is raised slightly. To continue to receive the wellness credit, members in the moderate- to high-risk category will be required to work at setting goals with third-party health coordinators.

Year three raises the bar again, requiring members to show progress in meeting goals and to continue to work with health coordinators to reach goals.

After year three, Worthington Industries employees will be on the wellness track. The business believes that will mean a healthier workforce and cost savings for employees and the business. The well being of Worthington employees is the foundation of this program, and both employees and the company are expected to benefit from the long-term advantages of the Healthy Choices Employee Health Promotion Program.

While Worthington has taken a broad approach to wellness, other companies have found success in offering incentives in specific areas. Longaberger, for example, offers a discount on health care policies for employees who do not use tobacco. An individual staff member who doesn’t use tobacco saves $7 per bi-weekly pay. For tobacco-free employees with family coverage whose families are also tobacco-free, the savings increases to $14 per pay.

The next step: Penalizing harmful behaviors

As it stands, health care is the only type of insurance that doesn’t focus on penalizing for behaviors that put the insured party at risk. With health care costs increasing so dramatically, that could soon change. Just as an accident likely raises auto insurance premiums, increasing premiums for those who engage in unhealthy behaviors is a possible next step in employers’ attempts to manage health care costs.

Reports that employees would support this type of action are stacking up. One Ohio employer conducted an informal survey that indicated employees would consider it a morale boost if health-conscious employees were relieved of some of the burden of subsidizing care for employees who engage in behaviors that adversely affect their health. Whether or not this type of program gains popularity, one thing is sure: the need to control the rise in health care costs is becoming ever more pressing.

The Last Step: Getting Started

Whatever the strategy, from offering employees health resources to offering incentives for healthy behaviors, companies have a real opportunity to improve morale and productivity, reduce absenteeism and control health care costs through wellness. The first step is committing to taking one, no matter what size effort is appropriate for your company.

Small steps lead to big strides.

Preventing injuries is a high priority for companies, especially in factory settings such as Honda. That’s why the business offers several programs—including line-site process evaluations —to identify potential hazards and help reduce the chance of injury. As part of an early intervention program, Honda employees who are feeling pain can receive a massage of the affected area during work time.

Stretching programs are another effective tool in injury prevention. According to the Best Practices in Manufacturing Web site, Dayton Parts, Inc. (DPI) in Harrisburg, Pa., conducted research that revealed approximately 80 percent of all manufacturing injuries occurred within the first two hours of each shift. After starting a program that mandated production employees to stretch for 10 to 15 minutes at the beginning of their shifts, they saw a dramatic reduction in injuries.

While the DPI Worksite Health Promotion Plan costs about $75,000 a year to operate, in conjunction with other business programs, it has helped bring the annual cost of workers’ compensation from $700,000 to $200,000 per year.6

To help prevent lengthy absences and reduce workers’ compensation claims, Honda instituted a work recovery program. Through the program, workers who have had an injury can work in a modified job—getting better. Employees in the program spend their work days receiving physical conditioning to increase overall fitness, physical therapy to restore functionality, health education and nutrition counseling. The program is based on data that shows fewer work days are lost when an staff member stays connected to the work environment.

The Ohio Bureau of Workers’ Compensation,, provides a “10-Step Business Plan” as a guide for companies in offering Employee Health Promotion Programs that aim to reduce injuries. The plan includes information on safety and health programs to prevent occurrences of on-the-job accidents, including:

Staff member involvement - To ensure the success of any Employee Health Promotion Program, employees must participate in the safety and health-management process. This can be done through safety and health audits, accident investigations, or by forming safety and health involvement teams, focus groups or committees.

Orientation and training plan - Conduct orientation and training sessions to educate employees on the business’s safety policies. These sessions should include procedures for the safe use of machinery and tools, chemical hazards and how to prevent contact or exposure, specific job/task safe practices, and hazard recognition and prevention.

Communication - Open communication keeps employees informed and provides suggestions and feedback on the effectiveness of the Employee Health Promotion Program. Through memos, bulletin boards and staff meetings, important safety and health information can be conveyed throughout the company, keeping all management staff and employees knowledgeable about the business’s safe practices.

The business plan also outlines incentives for post-injury procedures, including:

Medical treatment and return-to-work practices - arly return-to-work strategies help injured or ill workers return to work in a timely manner. Companies should establish a disability management policy to help injured or ill employees obtain quality medical treatment, making their transition back to work quick and effortless.

Timely notification of claims - Companies should document worksite injuries immediately after they occur and promptly send that documentation to a claims handler. Quickly offering claim information demonstrates care and concern for the injured staff member, prevents delays and confusion with the claim process, and reduces the potential for abuse or needless litigation.

Record keeping - Internal documents should be kept to record work-time injuries and to assess the success of the business’s safety efforts. Company audits, surveys and injury or illness reports can all be used to assess which safety practices and policies have proven successful, and what areas of health and wellness need improvement.

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