The current medical system is often described as a bottom-of-the-cliff system due to a strong focus on the treatment of disease as opposed to prevention of disease. Lifestyle or non-communicable diseases (NCDs) currently account for over 63% of the annual death toll in most countries. Globally, the leading NCDs include cardiovascular diseases, cancers, diabetes mellitus, mental disorders, and chronic kidney diseases, while the major pathophysiologic risk factors for many of these diseases include overweight/obesity, hypertension, and hyperglycemia, all of which are treatable to a large extent by individualized clinical exercise interventions.
The economic impact of NCD’ is considerable. Between 2010 and 2030, the direct and indirect costs of NCDs worldwide are estimated to exceed US$30 trillion and push millions of people below the poverty line, accompanied by unprecedented levels of economic and social strain on healthcare systems and national economies.
Few genuine solutions to the global NCD burden have been proposed. However, it has been acknowledged that major suffering could be averted and billions to trillions of dollars could be saved if a large proportion of the public were to adopt health-supporting behaviors. There are very little funds available within the healthcare systems for disease prevention programmes. Health-promotion at or through the workplace, therefore, makes considerable sense. It is a practical and economically viable solution for the out of control escalating health care costs of modern society.
The workplace is considered the ideal place for health promotion for the reasons highlighted below:
a. The population is captive
New Zealand had 528,170 enterprises in 2017. The number of paid employees in these enterprises was 2.2 million in 2017 which is 95% of the working population (2.3 million between the ages of 25 to 64 years). This large group is essentially captive due to the nature of the workday.
Webster defines captive as ‘obliged or forced to listen, whether wanting or not.’ Health promotion information delivered at the workplace are generally hard to avoid and therefore have considerable potential to influence a large percentage of the population directly (48.8% of the 4.5 million New Zealanders).
It is virtually impossible for a person who works seven to eight hours per day at the same location not to take notice of strategically well-delivered health information. It will be hard not to be influenced if you are constantly motivated and supported at the workplace to make healthier lifestyle choices.
Blair et al. (1986) report a 104% increase in leisure time and work-related physical activity energy expenditure two years after the implementation of a worksite lifestyle intervention programme. In New Zealand, 48 percent of adults are inactive, with women, at 50 percent, more inclined to take it easy than men, at 45 percent. Sedentary employees incur $250 more in annual health care costs than moderately active (1-2 times/wk) and very active (3 + times/wk) employees (Wang et al., 2004).
A 1% reduction in excess weight, elevated blood pressure, glucose, and cholesterol, has been shown to save $83 to $103 annually in medical costs per person (Henke et al., 2010).
Shipley and Orleans (1988) report a 22.6% smoking cessation at Johnson and Johnson. During 2000–2004, cigarette smoking was estimated to be responsible for $193 billion ($96 billion in direct medical cost and $96.8 billion in lost productivity) in annual health-related economic losses in the United States (Centers of disease control, 2008).
Vickery and Kalmer (1983) documented a 35% decrease in medical visits for non-serious health issues after implementation of a self-care education programme.
b. There is potential for effective incentives
A large portion of the population at the worksite are stable enough to utilize a wide variety of incentives. Programme participation and adherence to healthy behaviors can be the objectives of incentives. The use of monetary incentives (e.g., paid gym membership), material goods, time-off (e.g., to attend structured supervised exercise sessions), lottery prizes, or recognition are all feasible and appropriate for use at the worksite. Incentives can add a significantly larger impact to a health promotion programme’s impact on the lifestyle of employees and their families.
c. The potential to influence behavior is high
The repeated exposure abilities associated with the worksite along with the large number of people exposed to communication, incentives and social reinforcement, make the potential to influence behavior the greatest of any social setting. Interdepartmental competitions (e.g., group with greatest amount of weight lost or highest attendance of workshops) as well as company sports club constructions and competitions (e.g., company squash or tennis league, and cycle and running clubs) could provide social support unique to the workplace.
While the potential for behavior change is high, it still requires a focused effort for the promotion programme to fully realize its potential.
d. There is a real potential to influence family members
Employees will undoubtedly share lifestyle information with family members meaning that worksite health promotion will gain access to large parts of the society through spouses/partners that work. Exercise incentives, in particular, can easily be constructed to involve family members directly.
e. For many, job relationship stretches over a long time period
For a distinct percentage of the workforce, there is a stable work relationship that allows long-term exposure to wellness programming. Approximately 35-45% of the workforce seems to remain with a given employer for 10 to 15 years. Most people have at least three distinct careers each lasting more than seven years. As more companies and public agencies implement wellness programmes, there is also much greater continuity in wellness programming for individuals who change jobs.
f. Employers can give credibility to the health promotion initiative
Because most employees view their employer with some sense of credibility, the employer's promotion of concepts can give added credence to it.
g. Employees perceive wellness programmes as a benefit
Wellness programmes are often seen as a tangible benefit. Survey data reveal that the provision of wellness programmes to impact positively on employees view of the company.
h. Economics of scale is possible in programming
Due to large numbers of individuals employed at many worksites, it is possible to gain benefits from economies of scale in programming activities. Lower prices can be negotiated for groups at gyms and with psychologists and dieticians.
i. Potentially all parties can benefit
If a wellness programme is successful, all parties can potentially benefit.
Benefits for employees
Benefits for employers
· Increased lifestyle knowledge
· Increased opportunity to take control of health
· Improved health and quality of life
· Lower cost gym membership
· More support to make and maintain lifestyle changes
· Reduced medical cost on the long-term
· Reduced pain and suffering from poor health and lifestyle choices
· Affordable professional health to make dietary and exercise-related lifestyle changes
· Increased worker morale
· Higher productivity
· Informed and health conscious workforce
· Positive public relations
· Recruitment tool
· Reduced sick leave absenteeism
· Reduced disability claims
· Decreased health care utilization
· Reduced premature retirement
· Decreased overall health benefit costs
· Fewer on-the-job accidents
· Lower casualty insurance costs
Most experts agree that exercise should be the cornerstone of health promotion initiatives. A wealth of empirical evidence accumulated over the past several decades has shown that exercise can be used to prevent, manage, and treat many leading NCDs and risk factors. Physical exercise impact on NCD’s in a direct (through inducing physiological changes, e.g., lowering glucose and insulin levels) and indirect (triggering the adaptation of other healthy behaviors, e.g., healthier diet, smoking cessation and reduced alcohol consumption) way. There is indeed irrefutable evidence of the effectiveness of exercise in the primary and secondary prevention of many leading NCDs and a reduction in related mortality.
Reference list
Blair, S.N., Piserchia, P.V., Wilbur, C.S & Crowder, J.H. 1986. A public health intervention model for worksite health promotion. Impact on exercise and physical fitness in a health promotion plan after 24 months. Journal of the American Medical Association, 255(7): 921-926.
Centers for Disease Control and Prevention. 2008. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses— United States, 2000–2004. Morbidity and Mortality Weekly Report 2008; 57(45):1226–8 [accessed 2011 Mar 11].
Henke, R.M., Carls, G.S., Short, M.E., Pei, X., Wang, S., Moley, S., et al. 2010. The Relationship between Health Risks and Health and Productivity Costs Among Employees at Pepsi Bottling Group. J Occup Environ Med, 52(5): 519–527.
Shipley, R & Orleans, T. 1988. Effect of the Johnson and Johnson LIVE FOR LIFE program on employee smoking. Preventive Medicine, 17: 25-34.
Vickery, D & Kalmer, H. 1983. Effect of a self-care education program on medical visits. Journal of the American Medical Association, 250(21): 2952-2956.
Wang, F., McDonald, T., Champagne, L., Edington, D.W. 2004. Relationship of Body Mass Index and Physical Activity to Health Care Costs Among Employees. J. Occup Environ Med, 46(5): 428-436.