HEALTH PROMOTION: A PROGRESS REPORT
It's better to have healthy employees than not to. That is the simple rationale that has supported the efforts of thousands of companies to offer health promotion programs to their employees. These programs typically encourage employees to exercise, quit smoking, eat better, and cope with stress.
During the past decade, say leaders in the field, lessons learned about promoting health at the worksite have translated into programs that do a better job of assessing what health risks the company's workforce faces, where health care dollars are being spent, and how health promotion and disease prevention programs can be more effectively delivered.
But along with improved program design and implementation has come a new philosophy about what constitutes an effective worksite health promotion program. In the 1990s, say experts such as Bob Rosen, Ph.D., president of Healthy Companies Inc., Arlington, Va., managers must broaden their concept of wellness and be willing to entertain changes in how their companies function, not just in employees' lifestyles.
"If your goal is to promote the health and well-being and productivity of a company, you have to do a lot more than just change individuals," Rosen asserts. "You have to change the whole fabric of the corporation - the policies, the programs, the practices, and the relationships."
"We're at the perestroika phase of workplace health promotion, where there is a new openness about what it can achieve and what we can do," says John P. Allegrante, Ph. D., an associate professor of education and clinical public health at Columbia University and director of the Center for Health Promotion.
Laying the Foundation
Preventive health programs in industry have their antecedents in the traditional executive physical. For many years, preventive health rarely extended to the wider workforce with the exception of some paternalistic firms.
"When we first started knocking on corporate doors over a decade ago, the only time we would get any interest would be if the CEO had had some kind of trauma," recalls Michael Samuelson, president of the National Center for Health Promotion. If the CEO's doctor told him to quit smoking after a heart attack, says Samuelson, the company could quickly find itself supporting a smoking cessation program.
Efforts to promote good health in the workforce broadened in the 1970s, particularly after the release of Healthy People, the Surgeon General's report which pointed to the impact that lifestyle factors such as smoking and exercise have on health.
Armed with this information, companies in growing numbers began to offer "wellness" programs aimed at improving employee health. While some companies initiated such programs simply as an employee perk, many saw them as a way to contain rising health care costs. By 1985, according to a Health and Human Services Department survey, two out of three firms with 50 or more employees offered some type of health promotion program.
But despite its attractiveness, health promotion was not without problems. Programs tended to be narrowly focused, frequently concentrating on physical fitness. Often, they were not integrated within the company's larger health care picture. Benefits and medical departments had little communication, and thus little opportunity to target high-cost health problems in the workforce.
"Initially, a big problem was that health promotion was oversold," says Allegrante. "Too many expectations were set up for it as a cost-containment mechanism in and by itself."
Moreover, because the field was so new, little data existed that indicated what, if any, benefits the programs would provide. Given the fact that there is no such thing as a generic health promotion program, say experts, it's little wonder that analysts have encountered difficulty in assessing and comparing the impact of programs. …