Wellness in the Workplace
Healthy Workplace Initiative
According to the Centers for Disease Control and Prevention (CDC), physical inactivity cost the United States nearly $76.6 billion in direct medical costs in 2000. Obesity, a companion problem with physical inactivity, is also on the increase in the US. CDC estimated that in 1998 medical expenses attributable to being overweight or obese accounted for 9.1 percent of total U.S. medical expenditures and may have reached as high as $78.5 billion. Working adults spend up to half of their waking hours at work, so effective initiatives to increase physical activity and healthy eating have the potential to significantly improve workers’ health and reduce related health costs. The following articles describe five new workplace wellness initiatives in the Northwest.
In 2005, the British Columbia (Canada) Ministry of Health implemented a Healthy Workplace Initiative with the goal of enhancing the health and well-being of employees of the Ministry by providing a work environment that makes the healthy choice the easy choice. Initiative activities address physical activity, healthy eating, tobacco cessation, and stress management.
Making it work
The Healthy Workplace Initiative has three key elements necessary for a successful wellness initiative: executive buy-in for the project, internal champions, and sufficient resources for coordination, implementation, and project management.
To have an effect on health outcomes at the worksite, wellness strategies need to enable healthy lifestyles for all, including those at risk for chronic disease, such as heart disease, cancer, and diabetes, as well as those with a lower risk for chronic disease or who are already convinced that they need to make healthy choices but haven’t yet taken the next step. Generally worksite health promotion efforts have focused on individual choice without consideration for the context in which individuals make their lifestyle choices. With this history in mind, the Healthy Workplace Initiative emphasized environmental and policy approaches to workplace wellness. Initiative activities included:
Information and Education: A wellness Web site for employees, HealthBytes (a
12 week electronic intervention available to all staff that provides information
and tips for lifestyle behavior change), newsletter inserts, lunchroom information,
lunch hour presentations, health and wellness fairs, events, and celebrations.
Behavior Change: Point-of-choice posters to encourage stair use, organizational
challenges such as the Mt. Everest and CN Tower Challenge, a 10,000 Steps pedometer
challenge, a fruit and vegetable challenge, a bike to work week campaign, a
library pedometer loaning program, healthy food choices at events, and a tobacco
cessation program called QuitNow.
Environmental Changes: Stairway beautification including paint, artwork, whiteboards,
and music in the stairwells; permanent stair signage; food policies, such as
making healthy items available in vending machines and cafeterias, ensuring
they were cheaper than the unhealthy items, and requiring at least some healthy
food options be available at meetings; a healthy workplace policy statement
that was endorsed by the Ministry Executive and posted throughout the building;
expansion of bike storage facilities; adequate facilities for showers, change
rooms, and lockers; and a smoke-free workplace.
Organizational Capacity: Development of a Healthy Workplace logo and brand, formation of a Ministry-wide wellness committee, and ongoing evaluation of Initiative efforts.
Seeing results
Research has shown that physical changes in stairwells combined with activities
that prompt employees to use the stairs are an effective component of an overall
health and wellness strategy for the workplace. After implementation of the
Initiative, the Ministry of Health’s environment was significantly different.
Stairwell use increased steadily over the year and increased significantly
over the baseline during the team challenges and stairwell events.
Vending machine choices were expanded to include more fruit juices, bottled water, and lower-fat food choices, such as baked chips and tuna snacks. Labeling on the machines identified the healthier options, which were priced cheaper to encourage their purchase. Healthy food such as fresh fruit and milk were provided at Ministry-sponsored events.
A positive work environment that encourages and promotes connections with others
is one determinant of health, and the initiative evaluation indicated that
participation in the initiative activities helped to create a feeling of connection
to others in the workplace. Healthy Workplace activities raised awareness of
lifestyle choices and helped to motivate some employees to initiate or maintain
healthy lifestyle changes. Approximately 20 percent of staff participated in
various events, such as the CN Tower Challenge, the fruit and vegetable challenge,
and the bike to work campaign in the pilot year of implementation. Pedometers
helped to motivate people to take up or maintain their activity levels.
The initiative staff has developed a tool kit of planning resources and tools
and templates for activities, events, and challenges; policy development; and
evaluation (available from their Web site).
Based on feedback and the results of the first year of implementation, the
Healthy Workplace Initiative positively contributed to health at the Ministry.
Recommendations for the future include sustaining the organizational capacity
that supports implementation, sustaining and improving the successful activities,
building in employee incentives, extending the activities to additional employee
health issues, continuing to include strategies that target the physical and
policy environment, and finding ways to share the experiences with other worksites
in British Columbia.
Contact: Debbie Leach, Healthy Workplace Committee, BC Ministry of Health, Debbie.Leach@gov.bc.ca.
Take the Stairs, Save Your Heart
Physical activity can be difficult for people working inside all day or living
in climates such as Wyoming’s, with snow, wind, or ice much of the winter.
According to the Behavioral Risk Factor Surveillance System, nearly 56 percent
of Wyoming adults were overweight or obese and 20 percent of adults reported
no leisure time physical activity in 2002. This information led the Wyoming
Cardiovascular Disease Coalition to develop a simple, cost-effective program
to encourage office workers to be more active.
Since walking up stairs is a physical activity available in the winter, Coalition
members developed a simple, inexpensive project using point-of-decision prompts
(signs) to use stairs in place of elevators. The Coalition also decided to
evaluate the project in order to see how effectively it increased employees’ physical
activity.
The project was to be conducted during winter months (January–April), but due to Institutional Review Board (IRB) delays, it started in the summer. (Because the Coalition wanted to evaluate the project, which would involve collecting personal data on participants, it had to obtain IRB approval from CDC and Wyoming Department of Health before beginning.) Three office buildings (two in Casper and one in Cheyenne) agreed to participate. Site representatives were chosen for each building to assist with enrolling participants, collecting pre-project and post-project data, and ensuring the signs remained posted.
Step 1: Conducting a pre-project survey. The pre-project survey, conducted July 12–16, 2004, gathered data such as the participant’s gender, age, race/ethnicity, health status, daily physical activity level, and current use of elevators and stairs at the workplace.
Step 2: Posting signs. Site representatives posted signs one week after completing all pre-project surveys. At least one sign was placed on each floor at the elevators in the two Casper buildings. Signs were placed only at elevators in the basement and second and third floors in the Cheyenne building. Each 8.5 x 11 paper sign included a heart surrounding the Coalition’s mascot walking up a flight of stairs. The message “Save your Heart…Take the Stairs” was included on each sign along with text giving the Coalition credit for the sign.
Step 3: Conducting a post-project survey. Site representatives conducted the post-project survey five weeks later (August 16–20, 2004) among people who completed the pre-project survey. Post-project surveys included the same pre-project questions plus two new questions that asked if people had seen a sign encouraging the use of stairs and whether this sign caused them to take the stairs.
Overall, the project was a success and proved that a simple strategy can be
effective. The participants were informed that they would complete two surveys
as part of the project (taking the stairs was never mentioned). Also, we waited
one week to post the signs after conducting the pre-project survey. Pre-project
and post-project survey comparisons indicated that the signs led to increased
stair use and decreased elevator use. Almost 85 percent of the respondents
saw the signs, and nearly 47 percent reported the signs influenced them to
take the stairs rather than the elevator. These results suggest that a simple,
low-cost sign may change behavior and increase a person’s physical activity
level in office buildings.
It is important to remember some people have trouble taking the stairs due
to bone and joint problems, medical conditions, or other injuries or illnesses.
Other physical activity options, such as chair exercises, stretching, and light
dumbbell exercises at one’s desk, should be considered for these people
so they do not feel ignored and can still gain the benefits from physical activity.
Contact: Joseph R. Grandpre, jgrand@state.wy.us, or Star L. Morrison, smorri@state.wy.us, Wyoming Department of Health. This report was supported by the Preventive Health and Health Services Block Grant from CDC. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Seattle 5 a Day
“Eat your vegetables” is a classic mother’s command that
applies to adults as well as children. Fruits and vegetables are important
for good health, but working people rarely can take time for lunch, often turning
to fast food and snacking to make it through the day.
Because people spend as much as 50 percent of their waking hours at work, workplace
interventions to increase consumption of vegetables—as well as fruit—offer
the significant potential for affecting employee health. The Seattle 5 a Day
research project, sponsored by the Fred Hutchinson Cancer Research Center and
funded by the National Cancer Institute, has been exploring activities in the
workplace that encourage increased vegetable and fruit consumption.
From 1993 to 1997, the first Seattle 5 a Day study (Study A) worked with 28
worksites with cafeterias, with an employee base varying from 250 to 4,999
people. The recruited worksites included high-tech manufacturers, health care
facilities, colleges, and financial institutions. From 1999 to 2004, the second
study (Study B) focused primarily on 44 blue-collar worksites including heavy
manufacturing, transportation, and service industries. Study B sites had a
much smaller employee base, 50 to 150 employees, and no on-site cafeteria.
The intervention
The intervention for both Seattle 5 A Day studies incorporated worksite-level
and individual-level behavioral change strategies to increase worksite-wide
fruit and vegetable consumption. Activities focused initially on awareness
building and were followed by skill building and maintenance.
As part of the skill building activities project scientists and staff developed
a self-help manual that encouraged adding more fruit and vegetables to the
diet. The manual included such tips as using vegetables as the main dish. The
manual was distributed to the individual mailbox of all employees at the participating
worksites. Project staff conducted food-tasting demonstrations, lunch samples
to incorporate fruits and vegetables, and recipe contests at each worksite.
They also sent out four newsletters, tailored for each employee, and conducted
poster campaigns challenging employees to evaluate how many servings of vegetables
they ate daily. Posters said, for example, “Are You Shortchanging Yourself?” and “Whenever
You Eat, Think of Fruits and Vegetables.”
A key piece of the project included developing an employee advisory board (EAB)
at each worksite. The EAB guided intervention activities at the worksite and
helped gain employee involvement and employee ownership of the project as a
means for maintaining the partnership between participating companies and the
research team. Each EAB member received a handbook that outlined the minimum
number of activities required by the project to take place at the worksite.
The EAB, with the support of worksite management, chose and promoted the intervention
activities that best fit that particular worksite. EAB members assisted in
the activities when possible. The EAB was also responsible for changing the
posters and distributing the flyers that provided constant, inescapable messages
throughout the worksite.
Each EAB was made up of individuals from all departments or areas of the worksite
in order to capture the diverse needs and interests of employees. The EABs
were encouraged to use personal contacts as well as company advertising channels
to foster employee participation.
Basic guidelines for EAB membership
• Good communication. Positive communication skills are an asset to
any group planning effort.
• Strong motivation. EAB members should have the ability to encourage
participation in activities and motivate the adoption of healthy behaviors.
• Ability to network. EAB members should be comfortable networking
with various departments in order to secure support for activities, assist
with the distribution of promotional and informational materials, and access
available resources.
The Seattle 5 a Day experience suggests that forming an employee advisory board
is an effective means of maintaining partnership with the companies in work-sponsored
wellness programs and increases employee participation in worksite-wide activities,
even when it comes to eating your vegetables.
Contact: Sonia Bishop, Seattle 5 a Day project coordinator, sbishop@fhcrc.org.
Washington Wellness Works
Washington State is in the beginning stages of an initiative called Washington
Wellness Works, which is focused on improving the health of all Washington
State employees, retirees, and their families. The initiative, in planning
for the past year, launched in August 2006 and is expected eventually to
reach 300,000 state employees and retirees.
The initiative is based on the Health and Productivity Management (HPM) model, which suggests that a healthier workforce will lead to reduced absenteeism, increased productivity, and reduced escalation of health care costs over time. The HPM model integrates population risk assessment and reduction, chronic illness management, care management, disability management, and productivity measures, such as employee absenteeism.
The most important concept underlying HPM is that it is less expensive to keep healthy people healthy than to reduce the health risk of high-risk individuals. An effective, integrated HPM program, however, combines a focus on maintaining low-risk with interventions to lower the risk of the high-risk population, such as disease, care, and disability management.
How do you know if a workplace health initiative is effective? Washington’s
initiative will use four categories of measurement: health, productivity, medical
cost, and return-on-investment.
Health will be measured in two ways: A validated health risk assessment will develop a risk profile of the defined population (employees, retirees, and their family members/dependents), and claims and clinical data will demonstrate over or under-utilization as well as changes in health status. Productivity will be more difficult to measure. The most common measure is absenteeism, but an emerging measure is workplace productivity, or effectiveness. For employers, medical costs and return on investment will be the measures that ultimately determine the success of workplace wellness interventions.
Washington Wellness Works tools
Health screenings: The challenge with preventive care screenings is to convince
the workforce to participate. Boosting the completion rate for targeted screenings
can be accomplished by helping to make access easy—for example, by providing
flu vaccination or clinics at the worksite.
Telephonic personal health coaches: Coaching by telephone is a cost-effective
tool. Members identified with specific conditions are coached toward behavioral
changes. Evidence-based readiness to change techniques are employed, along
with giving employees access to behavior change tools and skills.
Wellness programs: Worksite wellness programs can include changes in policies
and in the physical workplace environment. One example is increasing access
to healthy food choices in cafeterias, vending machines, and meetings.
For more information on the initiative see www.wellness.wa.gov.
ACS Workplace Solutions
A large body of high-quality research has identified health promotion practices
that have positive effects on employee health and productivity. A gap exists,
however, between the findings of this research and the health promotion efforts
of employers. For instance, a comprehensive tobacco cessation health insurance
benefit helps smoking employees quit and produces a positive return-on-investment,
yet only 1 in 25 employers offer this benefit to employees.
Practice-oriented research aims to bridge this gap between knowledge and
action, pointing the way to better health through the use of evidence-based
interventions and real-world experience. The Health Promotion Research Center
(HPRC) at the University of Washington (UW) specializes in academic- community
partnerships that conduct research in practice settings. HPRC is one of 33
Prevention Research Centers funded by the Centers for Disease Control and
Prevention (CDC) to focus on practice-oriented research.
In 2002, HPRC teamed up with the American Cancer Society (ACS) to develop ACS Workplace Solutions, a practical program designed to illustrate the business case for employer-sponsored cancer prevention, and to show employers how to implement best practices in prevention of cancer and other chronic diseases. Cancer is the leading cause of death for working-age Americans, and the workplace is a logical site for health promotion. Most working-age Americans receive their health insurance through their employers, and increasingly they receive other health promotion benefits, such as behavior-change programs, at work as well.
The aim of ACS Workplace Solutions is to increase employers’ implementation
of fifteen evidence-based practices proven to influence key behavioral risk
factors such as tobacco use, physical activity, nutrition, and use of clinical
preventive services (breast, cervical, and colorectal cancer screening and
flu vaccination). The practices come from systematic, expert reviews by the
Task Force on Community Preventive Services, the United States Preventive Services
Task Force, and the Partnership for Prevention. The intervention includes three
steps: 1. an initial survey to assess which of the recommended practices the
employer already has in place, 2. face-to-face delivery of recommendations
for new health promotion practices, and 3. face-to-face delivery of detailed
how-to materials aimed at helping employers implement the recommendations.
Earlier this year, ACS and HPRC completed a twelve-month follow-up with seven
Northwest-based large employers (five Fortune 500 companies and local and state
governments) who participated in the intervention’s pilot. The results
of the pilot are very promising. At baseline, the employers averaged 38 percent
of recommended practices in place, compared to 60 percent at follow-up. Employers
were most likely to implement new practices that influenced tobacco use. The
participating employers doubled their coverage of effective smoking-cessation
aids, including counseling, prescription and over-the-counter medications,
and telephone quitlines.
ACS and HPRC are busy building on the promising results of the pilot. ACS is training staff nationwide to offer Workplace Solutions to large employers. This summer, HPRC and ACS received funding from CDC as a project of the new UW Center for Health Marketing and Communication to carry out a randomized, controlled trial of Workplace Solutions among mid-sized employers (100–5,000 employees). Mid-sized employers employ even more Washingtonians than do large employers. The trial will double the potential reach of this promising intervention.
Contact: Jeff Harris, associate director, Health Promotion Research Center, jh7@u.washington.edu.
