Health and
Productivity at Work — A Better Bottom Line
Today’s Dietitian
By Mary Kaye Sawyer-Morse, PhD, RD
Vol. 6, No. 9, p. 50
Poor employee health has lost billions for corporate
America. Smart industry leaders know that health promotion programs
prevent illness and save dollars.
It’s Monday morning and you drag yourself
into work, head pounding, eyes watering, and nose running. You’re
having a bad day during allergy season. Do you think how you feel
will affect your work performance?
Bet you said “Yes!”
Making the connection between employee health and
productivity seems logical, but until recently health promotion
experts did not focus on measuring the impact of worksite wellness
programs on work productivity. Rather, the focus has been on measuring
improvements in employee health—reduction of blood pressure,
control of diabetes, weight loss, and increases in activity. Over
the past 20 years, American businesses and corporations have become
increasingly aware of the potential that health promotion activities
offer not only for improving the health of employees and reducing
associated healthcare costs but also in contributing to a competitive
business advantage.
Defining Health Promotion
Health promotion and health education are two terms that
are often incorrectly used interchangeably. Health promotion is
defined as “the aggregate of all purposeful activities designed
to improve personal and public health through a combination of strategies,
including the competent implementation of behavioral change strategies,
health education, health protection measures, risk factor detection,
health enhancement and health maintenance” (Joint Committee
on Health Education Terminology, 1991). A definition that emphasizes
a broader social perspective comes from the Ottawa Charter for Health
Promotion, which states that health promotion is “the process
of enabling people to increase control over, and to improve their
own health” (World Health Organization, 1986).
Health education, on the other hand, is one aspect
of health promotion. Health education is the process of providing
learning experiences for individuals and groups to help them facilitate
voluntary selection of behaviors conducive to positive health and
wellness. Health education is learning-specific and involves education,
whereas the scope of health promotion includes many other types
of activities.
A Look at Evolution
In the early 1980s, the art and science of health promotion was
just emerging as an organized field of study and practice in the
United States. Less than 10% of employers offered health promotion
programs. Most of the program managers were trained in exercise
physiology with little training or expertise in program management
or working within a corporate setting. For the most part, the programs
were concentrated around a fitness center and focused on physical
fitness.
By the mid-1990s more than 80% of employers with
50 or more employees had health promotion programs in place. A wide
array of products and services became available through hospitals,
health promotion entrepreneurs, and insurance companies. Exercise
was still a dominant element, but most programs also addressed nutrition,
weight control, stress management, smoking cessation, and medical
self-care. The programs included strong educational components and
concentrated on changes in actual behavior instead of merely changing
knowledge and attitudes. Programs were managed by a variety of professionals:
nurses, health educators, dietitians, and exercise physiologists.
However, communication between health promotion researchers and
practitioners was limited, and outcome measures centered primarily
on changes of specific health variables (eg, pounds lost, improvements
in lipids, and blood pressure measurement).
The field of health promotion continues to evolve.
Though growth in the proportion of employers offering programs has
slowed—increasing from 81% in 1992 to 90% in 2000—it
has occurred in organizations that have not historically had programs
(eg, large industrial settings such as General Motors).1
In addition to the growth among employers, the science
supporting health promotion has changed substantially. At long last
there is sufficient evidence to make several strong statements about
the effectiveness of health promotion. First, there is no doubt
that lifestyle factors such as smoking, sedentary lifestyle, poor
nutrition, and excess stress are related to health outcomes. Second,
there is also little doubt that health risk factors are related
to medical care costs. Third, research has demonstrated that workplace
health promotion programs can improve health-related knowledge,
attitudes, behaviors, and specific health conditions such as blood
pressure, heart rate, blood lipid levels, and back pain. And finally,
programs are now demonstrating the ability to not only reduce medical
care costs and absenteeism rates but also affect overall employee
productivity.2
Why Health and Productivity Management?
While reducing healthcare-related costs has been an important cost-savings
tactic, it is not the only way that improved worker health advances
overall corporate performance.3 Indeed, the Institute for Health
and Productivity Management notes that “greater gains may
be experienced through the direct influence of positive worker health
on individual or group productivity, greater creativity and innovation,
enhanced resilience, and increased intellectual capacity.”4
How does this happen?
Chuck Reynolds, president of the Employer Health
Management Practice at The Benfield Group, offers a five-point explanation.5
First, he explains, human capital is an essential business asset.
What does this mean? As an employee, you bring to a job your skills,
talents, knowledge, and behaviors. By using these assets, you contribute
to the employer’s success. The employee force is then considered
an organization’s human capital. Though human capital is an
intangible asset that is difficult to measure, it is nonetheless
the essential core of any business.
The second point made by Reynolds is that health
is a primary factor in how efficient and effective the human capital—the
workforce—functions. Think back to that day when you were
suffering from allergies. Were you performing at your best? No.
In fact, it is estimated that untreated allergies may reduce employee
productivity by 10%.6
So compared with healthy employees, workers who
are impaired by diseases and/or injuries are absent from work more
(absenteeism) and have decreased productivity while at work—a
concept called presenteeism. Presenteeism means you are present
at work but not functioning at full capacity.
The third point Reynolds offers is his belief that
the overall health of the U.S. population is deteriorating. He points
to the fact that over the next 20 years the number of Americans
aged 55 to 64 will increase by 74% and the leading health problems
of this age group are chronic conditions that can undermine general
health and ultimately job performance. In addition, he notes the
increase in unhealthy behaviors of the general population as evidenced
by the increasing incidence of obesity along with chronic disease
such as diabetes.
On the positive side, Reynolds’ fourth point
highlights the favorable effect health promotion and health interventions
have had on health-related costs, absenteeism, and disability. And
finally, he emphasizes how it is “clearly in a company’s
best interest to do what it can to protect or improve its employees’
health. By doing so, it gains a productivity advantage over its
competitors.”7
Therefore, the formula for increasing productivity
is: Maximize human capital by improving employee health through
worksite wellness programs and disease prevention = increased productivity
and improved competitive advantage.
Measurement Is Tricky Business
The connection between employee health and work productivity is
powerful and seems straightforward. The hard part comes when you
try to measure productivity. It is amazingly complex. Productivity
is affected by factors such as employee morale, corporate culture,
and team dynamics in addition to individual, physical, and functional
capacity. You can’t reduce productivity to simple widget counting
or volume of work output. Think about your own work situation. How
would you measure your productivity? Number of patients counseled?
Amount of trays produced? Number of doctors’ offices visited?
What measure would be the best reflection of your production? See
the problem?
While better productivity measurement tools are
evolving, most studies currently use rates of absenteeism and self-report
surveys asking detailed health information questions and the respondents’
perceptions of how they believe their health affects their work
productivity.8
What Works?
The next question that comes to mind is probably: What programs
and/or interventions have been shown to be effective in improving
worker health and thereby their productivity?
To answer that question, let’s divide interventions
into two broad categories: early-detection and behavior change programs.
While the primary motivation for offering early-detection
programs is the desire to control healthcare costs, these programs
have also been shown to enhance employee morale and reduce absenteeism
and short-term disability.9
The following screenings are considered effective
for adults (aged 18 to 64) with no known risk factors:
• blood pressure measurement;
• serum cholesterol;
• mammography for breast cancer screening;
• pap smear for cervical cancer screening;
• Fecal Occult Blood Test or sigmoidoscopy
for colorectal cancer screening; and
• depression screening.
The early detection programs listed above have demonstrated
cost effectiveness—always a concern for management—and
have a high potential impact on current and future productivity.
Through early-detection, you can immediately improve a person’s
health and therefore his or her performance, as is the case with
depression. Early-detection screening can also reduce the effect
of a disease and/or its treatment (eg, heart disease and cancer)
on future health concerns and related productivity.
In screening for depression, it may come as a surprise,
but it is estimated that 20% to 25% of working women aged 18 to
40 will experience depression during their career. In any given
year, 13% of employees in any setting can be expected to experience
depression severe enough to take time away from work.10
Behavioral change programs are ones where dietitians
and nutrition professionals have had more involvement as direct
providers of services and program managers. Examples include the
following:
• fitness programs;
• nutrition programs; and
• stress-reduction programs.
How successful are these behavior change programs?
Fitness Programs
Companies have many reasons for providing physical fitness programs
for employees: they have been shown to improve overall employee
health, reduce absenteeism, improve stamina, reduce fatigue and
stress levels, and improve attitude and mental concentration. Physical
fitness programs have a broad impact on various health-related and
productivity factors, which make them a win-win situation. Companies
with a high number of sedentary employees stand to benefit the most
(in terms of cost-benefit) from physical fitness programs.9,11
Nutrition Programs
The costs of poor nutrition and obesity may include absenteeism
(with higher rates of physician visits and other medical care issues)
and on-the-job productivity losses. It is also likely that poor
nutritional habits reduce a person’s cognitive abilities and
level of alertness. Current research emphasizes the greatest cost-benefit
when companies focus their intervention efforts on the highest-risk
employees (eg, those with elevated cholesterol, high blood pressure,
and obesity) and offer general education programs for the entire
workforce to promote and/or maintain a high level of low-risk employees
and maximize healthful eating behaviors.9,12
Stress Management Programs
Employers frequently underestimate the impact of workplace stress
on health and productivity. Recent research indicates that employees
who perceive substantial stress in the workplace have higher rates
of disease, take more time off, and report more work injuries than
those who perceived a lower level of stress. In addition, employees
under high levels of stress report more breaks in concentration,
errors, and omissions. A causal connection, however, between stress
and performance is difficult to establish, so the full financial
impact has not been well-documented. The literature suggests that
employers begin with a basic assessment of workplace stressors and
then develop programs that provide a combination of stress management
interventions addressing both individual coping skills and any organizational
issues that foster employee stress.13
What Does the Future Hold?
Businesses are changing how they view their human capital assets.
Historically, they have focused on providing workers with the latest
and greatest equipment and supplying necessary skills training while
largely ignoring the most important asset of all: their employees’
health and well-being. Health and productivity management is much
more than a paradigm shift in healthcare and health promotion; it
is a powerful business performance tool. Gains in performance from
better employee health require companies to actively develop, maintain,
and measure the outcomes of wellness and disease management programs.
Dietitians and nutrition professionals are poised to play an important
role in helping make this possible.
— Mary Kaye Sawyer-Morse, PhD, RD, professional
speaker, author, and health coach, is owner and education director
of The Center for Success, a Texas-based company that provides keynotes,
in-service training, and seminars to diverse industries.
References for this article are available upon
request by e-mailing TDeditor@gvpub.com.
Resources
America’s Health Insurance Plans
www.ahip.org
Institute for Health and ProductivityManagement
www.ihpm.org
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