Posts from — December 2008

Corporate Health Promotion Plans that support staff members and the setting that they work in have been shown to be a good return on investment (ROI). Corporate Health Promotion Plans can be extensive and sometimes costly. However, there are ways for small corporations to make positive changes at little or no cost.

Corporate Health Promotion Program: Nutrition Activities

Fruit and Vegetable Consumption

1. Make available healthy eating reminders and prompts to staff members via multiple means (i.e. e-mail, posters, payroll stuffers, etc.).
2. Make available appealing, low-cost fruits and vegetables in vending machines and in the cafeteria.
3. Make available cookbooks, food preparation, and cooking classes for staff members’ families.
4. Ensure worksite cafeterias follow healthy cooking practices and set nutritional standards for foods served that align with the U.S. Dietary Guidelines for Americans.
5. Make available healthy foods at meetings, conferences, and catered events.
6. Use point-of-decision prompts as a marketing technique to promote healthier choices.
7. Make available healthy cooking demonstrations that teach skills (i.e. fruit and vegetable selection and preparation).
8. Make available taste-testing opportunities at the worksite.
9. Make available staff member-led campaigns, demonstrations or programs.
10. Make available local fruits and vegetables at the worksite (i.e. worksite farmer’s market or community-supported agriculture drop-off point).
11. Use competitive pricing (price non-nutritious foods in vending machines and cafeterias at higher prices).
12. Make available protected time and dedicated space away from the work area for breaks and lunch.
13. Make kitchen equipment available to staff members.
14. Make available an opportunity for worksite gardening if possible.

Sweetened Beverage Consumption

1. Make water available throughout the day.
2. Make available appealing, low-cost healthful drink options in vending machines and the cafeteria.
3. Modify worksite vending contracts to increase the number of healthy options.
4. Price non-nutritious beverages at a higher cost.
5. Use point-of-decision prompts to promote healthier choices.

Portion Control

1. Label foods to show serving size and/or nutritional content.
2. Make available food models, food scales for weighing and pictures to help staff members assess portion size.
3. Make available appropriate portion sizes at meetings, worksite events and in the cafeteria.

Breastfeeding

1. Support nursing mothers by offering them rooms for expressing milk in a secure and relaxed setting, a refrigerator for storage of breast milk, policies that support breast feeding, and lactation education programs.
2. Make available flexible scheduling and/or worksite or near-site child care to allow for milk expression during the workday.
3. Adopt alternative work options (i.e. teleworking, part-time, extended maternity) for breastfeeding mothers returning to work.
4. Educate personnel on the importance of supporting breastfeeding co-workers.

Television & Food Advertising

1. Place televisionss in non-eating areas of the worksite.
2. Limit food advertising in the cafeteria (i.e. print and other media).

(Adapted from The Health Promotion First Act prepared by David Anderson, Ph.D., StayWell Health Management)

Worker Lifestyles Impact Worker Health
•    Approximately 40% of all deaths in the U.S. are premature (at least 900,000 deaths each year) and are due to unhealthy lifestyle choices such as tobacco use, poor diet, sedentary lifestyle, misuse of alcohol and drugs, and accidents. Other contributors to early death include genetic predisposition (30%), social circumstances (15%), poor access to quality medical care (10%), and environmental  exposures (5%).
•    Unhealthy lifestyle is the primary factor to the six leading causes of death in the U.S. – heart disease, cancer, stroke, respiratory diseases, accidents, and diabetes – which collectively account for over 70% of all deaths.
•    People with healthier lifestyles live an average of 6 to 9 years longer,  postpone disability by 9 years and compress disability into fewer years at the end of life.
•    The prevalence of obesity among U.S. adults rose to 30% in 1999-2000, a 33% increase from a decade earlier,  and the prevalence of diabetes also rose by 33% during approximately the same period (1990 to 1998).
•    About two-thirds of American adults are overweight or obese, 55% do not get enough physical activity,  26% are completely inactive,10 and only 25% eat recommended amounts of fruit and vegetables  If diet/physical activity patterns continue worsening at their current rate, these behaviors will soon surpass tobacco use as contributors to mortality.
•    Among young people, the prevalence of overweight has more than quadrupled in the past 20 years to 16%,  daily participation in high school physical education classes has dropped from 42% in 1991 to 28% in 2003,  more than 60% eat too much saturated fat, and almost 80% do not eat recommended amounts of fruit and vegetables.
•    Lifestyle diseases disproportionately affect women, racial and ethnic minorities, the poor and seniors:
•    The prevalence of diabetes among African Americans is about 70% higher than among white Americans, and the prevalence among Hispanics is nearly double that for white Americans.
•    Women comprise more than half of the people who die each year of cardiovascular disease.
•    Chronic conditions significantly limit daily activity for 35% of persons over 65 years of age.

Financial Impact of Lifestyle
•    It is estimated that lifestyle-related chronic diseases account for 70% of the nation’s medical care costs, which translates to over 11% of the entire U.S. gross domestic product.
•    Two broad-based scientific reviews identified 83 peer-reviewed studies reporting that people with unhealthy habits have higher medical costs.
•    Research conservatively estimates that high health risks (high blood cholesterol, high blood pressure, etc) account for at least 25% of total medical costs.
•    Recent research indicates a direct relationship between modifiable lifestyle risks and reduced worker productivity, and relevant data suggest that the costs to corporations in lost productivity due to poor employee health may be substantially more than the direct medical and disability costs.
•    Unhealthy lifestyles frequently lead to chronic disease, many of which cannot be cured and require years or decades of costly treatments. Below are estimated annual costs of selected unhealthy lifestyles and chronic diseases including obesity,  tobacco use,  hypertension,  diabetes,  stress,  and inactivity.

Corporate Health Promotion Plans Improve Health and Yield Major Savings
•    Comprehensive scientific reviews identified 378 peer-reviewed studies showing that Corporate Health Promotion Plans improve health knowledge, health behaviors, and underlying health conditions.
•    Research studies have demonstrated that lifestyle modification may frequently be more effective and cost-effective than medical intervention in lowering morbidity  and mortality.
•    Several scientific reviews indicate that Corporate Health Promotion Plans reduce medical costs and rates of absenteeism and produce a positive return on investment (ROI).  The most definitive review of financial impact reported that:
•    18 studies indicated that these Corporate Health Promotion Plans reduce medical costs, and 14 studies indicated that they lower rates of absenteeism costs.
•    13 studies that calculated benefit/cost ratios all showed the savings from these Corporate Health Promotion Plans are much greater than their cost, with medical cost savings averaging $3.48 and the rates of absenteeism savings averaging $5.82 per dollar invested in the Corporate Health Promotion Programs.
•    Medical costs are expected to exceed 16 percent of U.S. gross domestic product (GDP) in 2005 and to grow at 7.2 percent each year through 2015, when medical expenditures will account for 20 percent of GDP:
•    Per capita medical costs in the U.S. are the highest in the world and more than double the median for OECD nations,  yet the U.S. ranks 26th in terms of healthy life expectancy.
•    Medicaid is the second largest item in most state budgets, and its portion of the total budgets is increasing each year.
•    Increasing medical costs for U.S. corporations continue to outpace general inflation, averaging 12 percent per year for the past 10 years.   This trend is causing a tremendous financial hardship on U.S. corporations.

1. Senior management involvement in the Corporate Health Promotion Program- Evidence of enthusiastic commitment and involvement of senior management helps staff members understand their corporations’ serious commitment to health.  Workers need to perceive that their senior management, supervisors, and coworkers have positive attitudes toward health since these factors have all been associated with improved employee health status.   Management-related factors have been shown to contribute more to success than the content of the intervention.

2. Participatory planning - A Company Health Promotion Program should be undertaken in partnership with the workforce.  Workers from all levels of staff should be actively engaged in the health and management aspects of the project as well as all on-going processes of any Corporate Health Promotion Program.  Planning must also include processes for maintaining communication with all staff and building their commitment to the process.   Starting Company Health Promotion Program steering committees to lead interventions during the planning and delivery of worksite health promotion programming improves worker awareness, participation, and satisfaction. Worker committees can establish perceived staff member interests regarding educational programming, determine work site-specific characteristics that may affect the intervention or influence participation, and suggest the best methods for promotion and delivery of Corporate Health Promotion Plans and activities.  Ways to maximize staff member input and involvement might include interest surveys, focus groups, and peer counsellors.

3. Primary focus on staff members’ needs - A Company Health Promotion Program should meet the needs of all staff members, regardless of their current level of health and recognize the needs, preferences, and attitudes of different groups of participants. Program designers should consider the major health risks in the target population, the specific risks within the particular group of staff members, and the employer’s needs.   In other words, interventions should be tailor-made to the characteristics and needs of the recipients.   This means that different programs must be offered at different levels.   Participation and commitment can be increased if a group of employees has the opportunity to address a specific modifiable risk factor of their choice.

4. Optimal use of on-site resources - Planning and implementation of Corporate Health Promotion Plans should optimize use of on-site personnel, physical resources, and organizational capabilities.   For example, whenever possible, initiatives should use on-site health and safety, management, work organization, communication, HR, and other specialists.   Well-qualified external leadership may be introduced when in-house expertise is lacking.

5. Integration - An overall worksite health policy should be developed.  The policies governing the health of the employees must align with the business mission, vision, and values, supporting both short- and long-term goals. These consistent policies must affirm the value of staff member health and a commitment to engage staff members in health enhancement.  Company Health Promotion Program Strategies should be integrated into a company’s regular management practices and eventually should be formally incorporated into the company’s corporate plan  with adequate resources attached to them.

6. Recognition that a person’s health is determined by an interdependent set of factors - Any Company Health Promotion Program must address multiple components of an individual’s life:
•    the worksite physical and psychosocial setting;
•    their personal resources such as social support, sense of empowerment, etc.; and
•    their lifestyle practices influencing health.

7. Tailoring to the special features of each worksite setting  - Corporate Health Promotion Plans must be responsive to the unique needs of each worksite’s procedures, organization and culture.   Integrating health behaviors and program participation into the existing business culture will normalize program participation.

8. Company Health Promotion Program Evaluation - Project management should flow through needs analysis, setting priorities, planning, implementation, continuous monitoring, and evaluation.   Evaluation must include a clearly-defined range of process measures and outcomes  as well as mechanisms for monitoring the impact of non-intervention worksite changes such as plant closure, major worksite re-organization, and new technology on staff health.

9. Long-term commitment - To sustain the benefits of the Corporate Health Promotion Program, the worksite must continue the initiative over time, reinforcing risk-reduction behaviours and adapting the programs to ongoing personal, social, economic, and worksite changes.

Introduction to Corporate Health Promotion Plans

Risky health behaviors by staff members cost a company. Changing those behaviors can save the employer money and increase the staff member’s productivity.

Because work gives an staff member a stable environment and support system, Corporate Health Promotion Plans can have a great impact on lowering high-risk behaviors. This impact results in decrease health claims cost, less rates of absenteeism, and less short-term disability.

Corporate Health Promotion Plans can include:

Awareness Rasing Activities: Health and wellness newsletters, health topics covered in payroll stuffers, healthy emails.

Health Risk Assessment: Employee health screenings, wellness fairs / health fairs, health rist assessments.

Educational Programs: Lunch and Learn wellness seminars, guest speakers at staff meetings.

Skill Building: Healthy cooking demostrations, activity challenges, CPR instruction opportunites, stress management classes, weight management classes.

Interventions: Massage, smoking cessation, and skills to help you get the most out of your doctor visit.

Physical setting: Healthy items in the vending machines and cafeterias, clean air practices, ergonomics, bike racks, flex time, welllit stairways.

Evaluation: Worker needs assessment, baseline Company Health Promotion Program evaluation measures, ongoing Company Health Promotion Program evaluation of overall effectiveness.

Why Make available Corporate Health Promotion Plans

The typical employer spends about $8,000 a year on an employee’s healthcare. This includes medical insurance, disability and worker’s compensation. As these costs climb, medical insurance is expected to rise at least 10% per year.

A 1999 study showed that organizations using Corporate Health Promotion Plans had a return on investment (ROI) from $1.49 – $13 in benefits per dollar spent. The amount depended on the nature of the Corporate Health Promotion Plans used. (S. Aldana, American Journal of Wellness, 2001; 15:296-320)

One study showed that a “stop smoking” component to Corporate Health Promotion Plans can save between $404 -$40,829 per employee, depending on the age and sex of the staff member.

The Corporate Health Promotion Plans at Traveler’s Company included a self-care book, a newsletter, single-topic brochures, and videotapes. The Corporate Health Promotion Plans saved the company $7.8 million in employee benefi t costs, decreased doctor visits, and it reduced rates of absenteeism by 1.2 days per staff member per year. The estimated Corporate Health Promotion Plans ROI was $3.40 per dollar spent.

In 1998, the Health Enhancement Research Organization (HERO) reported a study of 46,026 staff members from six large corporations for three years. Workers with an inactive lifestyle had 10% higher costs; staff members with depression had 70% higher costs.

Benefits of Corporate Health Promotion Plans

Improved Productivity - The Canada Life Assurance Company realized a 4% rise in productivity after beginning an employee fitness program.

Improved Job Satisfaction - According to employee opinion surveys conducted by the Silverstone Group about thier Corporate Health Promotion Programs, staff members’ morale increased, which helped support a more creative work environment.

Enhanced Recruitment & Retention - In the midst of a tight labor market, Corporate Health Promotion Plans could be a vital tool to draw new recruits.

Decreased Absenteeism - Canada Life Assurance Company’s rates of absenteeism dropped 42% among staff members in the Corporate Health Promotion Programs.

Decreased Workers Comp & Disability - In one year, Boeing Company’s number of back injuries decreased by 34%. Six million dollars was saved by tracking injuries as they occurred.

Managed Healthcare Costs - Golden, Colorado Adolf Coors Company’s Corporate Health Promotion Plans returned $6.19 for each dollar spent.

Why have Company Health Promotion Program goals?

Company Health Promotion Program goals take your employer’s priorities for employee health improvement and make them specific and measurable. Well-defined Company Health Promotion Program goals provide direction for determining Strategies and a basis for which to measure progress.

Writing Company Health Promotion Program goals

Writing Company Health Promotion Program goals is not complicated or difficult. It does require some thought, about your employer’s Company Health Promotion Program vision for a culture of wellness and they should be:

Specific Company Health Promotion Program Goals
Measurable Company Health Promotion Program Goals
Attainable Company Health Promotion Program Goals
Realistic Company Health Promotion Program Goals
Timely Company Health Promotion Program Goals

Specific Company Health Promotion Program Goals: What is the specific outcome your employer is looking for? “Reduce tobacco use among staff members” is more specific than “Improve the health of staff members.” You may wish to write some goals about specific outcomes (reducing smoking among staff members) and other goals about specific progress (implementing a tobacco-free campus policy or lowering the price of fresh fruit in the cafeteria to 25 cents a piece).

Measurable Company Health Promotion Program Goals: Making your goals measurable provides a means of evaluating your progress and success. There is a saying: “what gets measured, gets done.” Measurable goals can be powerful motivators for your employer. “Provide more time for staff members to be physically active” is much less measurable than “implement a daily 15-minute walking break into the schedule of all staff members.” “Increase the number of staff members who want to quit smoking” is less measurable than “increase enrollments in the stop-smoking program to 120 staff members per year.”

Attainable Company Health Promotion Program Goals: Set goals that challenge your employer to change and that will demonstrate a real commitment to the health of the employees. At the same time, set goals that are achievable. Goals that are set too far out of reach can be overwhelming and may become a barrier rather than a motivator.

Realistic Company Health Promotion Program Goals: Write goals that are do-able, given the skills, time, finances and overall strategy of the employer. A realistic project may push the skills and knowledge of the people working on it but it shouldn’t break them.

Timely Company Health Promotion Program Goals: When do you hope to achieve the goal? Next week? Next year? Without a timeframe, the goal is still not clear and is much less likely to galvanize resources and energy within your employer.

“Reduce the percent of staff members who use tobacco from 20% to 10%” is much less of a challenge than “By the end of 2010, reduce the percent of staff members who use tobacco from 20% to 15%”.

If your employer is interested in measuring the impact of your Company Health Promotion Program efforts in future years, you’ll want to gather relevant baseline data on the health and health behaviors of your staff member population.

Company Health Promotion Program Data on your staff member population

Health Risk Assessments (HRAs)

Some health plans offer corporations free internet-based Health Risk Assessments (HRAs), complete with summary aggregate reports. If your healthcare plan does not offer a free HRA, you could pay for an HRA either through your healthcare plan or through a third party vendor.

To encourage participating in an HRA, assure staff members of confidentiality and consider offering rewards for completing the assessment. The higher the participation rate, the more likely that the aggregate data will accurately represent the behaviors and risks of your staff member population.

Company Health Promotion Program Health Surveys

You can get a general sense of staff members’ health-related attitudes and behaviors using a “lowtech” paper survey. As with a health risk assessment, staff members will be more likely to respond to a survey if there is an incentive and if they are confident that their responses are confidential. Remember that without widespread participation you’ll only get a “feel” for staff member behaviors rather than a statistically accurate picture.

Company Health Promotion Program Focus Groups and Informational Interviews

The information you can collect from focus groups or informational interviews with staff members is an important supplement to the anonymous survey or HRA data. Listening to staff members discuss their attitudes, values, receptivity and obstacles related to health provides a wealth of information on which to base decisions on how to increase your employer’s Corporate Health Promotion Program. Company Health Promotion Program focus groups are especially useful for capturing information from hard-to-reach staff member populations, such as those for whom English is a learned language.

Keep Company Health Promotion Program focus groups small (8-19 staff members, ideally all of a similar job class). If possible, offer rewards such as movie tickets or lunch, to recruit participants. Develop a list of open-ended questions in advance and allow 60-90 minutes for the discussion.

Informational interviews are an alternative to Company Health Promotion Program focus groups. The Company Health Promotion Program coordinator of your health improvement Strategies or selected members of the Health and Wellness Committee can conduct one-on-one interviews with staff members in a variety of positions to better understand their attitudes, interests and obstacles related to a) health behaviors and b) the worksite policies, settings and practices.

Population data

If data on the employee population are not available, you can use state or national data to estimate the prevalence of risk behaviors among staff members.

In addition to looking at the health behaviors of staff members, take a good look at your employer. The following questions can help you establish opportunities for your employer to support and encourage healthy behaviors among staff members.

A strong foundation for employee health improvement

1. To what extent does the senior management in your employer actively and visibly support the Corporate Health Promotion Program?

__ No support for the Company Health Promotion Program
__ Support, but not at senior level
__ Support at senior level, but not visible to staff members
__ Strong and visible Company Health Promotion Program support
Comments:

2. Is the Company Health Promotion Program tied to your employer’s mission statement?

__ No
__ Yes, the Company Health Promotion Program is tied to business plan OR mission statement
__ Yes, the Company Health Promotion Program is tied to both business plan and mission statement
Comments:

3. Is there an staff member within your employer whose job responsibilities include Company Health Promotion Program coordination?

__ No
__ Yes, but has little time available to dedicate to Company Health Promotion Program
__ Yes, and has at least part of the job dedicated to Company Health Promotion Program
__ Yes, and has at least one full-time position dedicated to Company Health Promotion Program
__ Yes, and has at least part of the job dedicated to wellness AND has a background that includes Company Health Promotion Program qualifications
__ Yes, our employer has at least one full-time position dedicated to health improvement AND the staff member’s background includes Company Health Promotion Program qualifications
Comments:

4. Does your employer have an active wellness committee with diverse representation?

__ No (does not have a Health and Wellness Committee, or has a committee that doesn’t meet)
__ Yes, we have a Health and Wellness Committee, but with limited representation
__ Yes, we have a Health and Wellness Committee with widespread representation
__ Yes, we have a Health and Wellness Committee with widespread representation AND committee involvement is part of each representative’s job responsibilities
Comments:

5. Does your employer have an annual budget for Company Health Promotion Program expenses? (Corporate Health and Wellness Program expenses may be associated with offering a health assessment, paying for behavior change programs/coaching programs, covering rewards that encourage healthy behaviors, subsidizing healthy food options, communications and programs around specific health topics, fitness centers/walking paths, etc).

__ No
__ Yes, but funds are earmarked for Corporate Health Promotion Plans (e.g. only for Weight Watchers or fitness discounts) and do not meet all existing Company Health Promotion Program needs
__ Yes, funds are available to meet current Company Health Promotion Program needs
Comments:

6. Does your employer have a plan for engaging staff members in the Corporate Health Promotion Program?

__ No
__ Yes, we have a communications plan for our Company Health Promotion Program
__ Yes, we have a communication plan AND we offer meaningful incentives or rewards (such as premium discounts or debit cards) for the Company Health Promotion Program to engage in healthy behaviors.
Comments:

A data-based approach to the Company Health Promotion Program

7. Does your employer have clearly stated Company Health Promotion Program goals and priorities for employee health improvement?

__ No
__ Yes
__ Yes, data (e.g. HRA, claims, productivity) are the basis for defining Company Health Promotion Program goals or priorities
__ Yes, data AND evidence-based best practices are a basis for defining Company Health Promotion Program goals or priorities
__ Yes, data and best practices are basis for defining Company Health Promotion Program goals or priorities as well as measuring Company Health Promotion Program progress (evaluation)
Comments:

8. Has your employer completed a Health Risk Assessment?

__ No
__ Yes, but more than 2 years ago
__ Yes, within the last two years, and achieved a participation rate of less than 50%
__ Yes, within the last two years, and achieved a 50% - 79% participation rate
__ Yes, within the last two years, and achieved an 80% or greater participation rate
Comments:

A worksite setting that supports healthy behaviors

9. Does your employer’s tobacco reduction strategy reflect best practices?

(Check all that apply)
__ A no-tobacco use policy that includes both buildings AND grounds
__ 100% coverage for the cost of over-the-counter nicotine replacement therapy
__ Worker access to – and strong promotion of — a tailored stop-smoking program
Comments:

10. Does your employer provide opportunities (time and places) for physical activity during the work day?

__ No
__ Yes, indoor places for physical activity (on-site fitness center) OR outdoor places for physical activity (walking paths)
__ Yes, both indoor AND outdoor places for physical activity
__ Yes, indoor and outdoor opportunities AND workers can use work time for physical activity
Comments:

11. Does your employer promote healthy eating by offering access to fruits and vegetables?

__ No
__ Yes, fruits and vegetables are available at the worksite (in vending machines, break areas, or cafeterias)
__ Yes, fruits and vegetables are available and discounted at the worksite
Comments:

Benefits that support employee health improvement

12. Does your employer provide staff members with self-care resources?

(Check all that apply)
__ Distribution of self-care books
__ internet-based access to health information
__ Nurse advice line
Comments:

13. Which of the following preventive services are covered at 100% by your employer’s health benefits?

(Check all that apply)
__ Vision screening
__ Hearing
__ Immunizations (per CDC/ACIP recommendations)
__ Radiology
__ Laboratory services
__ STD screening
__ Preventive medical examination for adults
__ Cancer screen (includes: colon, cervical, breast, prostate and ovarian cancers)
__ Contraceptive management
Comments:

14. Which of the following are included in your employer’s pharmacy benefit?

(Check all that apply)
__ Mail order or other 90-day supply option for medications
__ Specialty pharmacy network
__ Incentive-based tiered formulary design
Comments:

15. Do your employer’s health benefits provide coverage for behavioral health (such as depression, mental illness, counseling, stress management, and chemical dependency)?

__ Yes, at the same level as medical benefits
__ Yes, but at a reduced level (less coverage) than medical benefits
__ No coverage for mental or behavioral health
Comments: