Workplace wellness

Healthy behavior in the workplace

Workplace wellness, also known as corporate wellbeing outside the United States, is a broad term used to describe activities, programs, and/or organizational policies designed to support healthy behavior in the workplace. This often involves health education, medical screenings, weight management programs, and onsite fitness programs or facilities. It can also include flex time for exercise, providing onsite kitchen and eating areas, offering healthy food options in vending machines, holding "walk and talk" meetings, and offering financial and other incentives for participation. Companies most commonly subsidize workplace wellness programs in the hope they will reduce costs on employee health benefits like health insurance in the long run. Existing research has failed to establish a clinically significant difference in health outcomes, proof of a return on investment, or demonstration of causal effects of treatments. The largest benefits have been observed in groups that were already attempting to manage health concerns, which indicates a strong possibility of selection bias.

Wellness programs originated in the early 1900s, as labor unions fought for workers' rights and as employers saw the advantages of having a vital, alert, and rested workforce. A few key manufacturers invested in programs to keep their employees healthy and productive. In the 1950s, Dr. Halbert L. Dunn, chief of the National Office of Vital Statistics, introduced the concept of "high level wellness" to encourage individuals to maximize their potential progress towards better living.

Workplace wellness programs have been shown not to prevent the major shared health risk factors specifically for CVD and stroke. While the stated goal of workplace wellness programs is to improve employee health, many US employers have turned to them to help alleviate the impact of enormous increases in health insurance premiums experienced over the last decade. Some employers have also begun varying the amount paid by their employees for health insurance based on participation in these programs. Cost shifting strategies alone, through high copayments or coinsurance may create barriers to participation in preventive health screenings or lower medication adherence and hypertension. While it was once believed that for every dollar spent on worksite wellness programs, medical costs fell by $3.27, that hypothesis was disproven by a subordinate of the author of the original study. One of the reasons for the growth of healthcare costs to employers is the rise in obesity related illnesses brought about by lack of physical activity, another is the effect of an ageing workforce and the associated increase in chronic health conditions driving higher health care utilization. In 2000 the health costs of overweight and obesity in the US were estimated at $117 billion. Each year obesity contributes to an estimated 112,000 preventable deaths. An East Carolina University study of individuals aged 15 and older without physical limitations found that the average annual direct medical costs were $1,019 for those who are regularly physically active and $1,349 for those who reported being inactive. Being overweight increases yearly per person health care costs by $125, while obesity increases costs by $395. Obese employees spend 77 percent more on medications than non obese employees and 72 percent of those medical claims are for conditions that are preventable. According to Healthy Workforce 2010 and beyond, a joint effort of the US Partnership for Prevention and the US Chamber of Commerce, organizations need to view employee health in terms of productivity rather than as an exercise in health care cost management. The emerging discipline of Health and Productivity Management (HPM) has shown that health and productivity are "inextricably linked" and that a healthy workforce leads to a healthy bottom line. There is now strong evidence that health status can impair day to day work performance (e. g., presenteeism) and have a negative effect on job output and quality. Investing in worksite wellness programs not only aims to improve organizational productivity and presenteeism, but also offers a variety of benefits associated with cost savings and resource availability. A study performed by Johnson & Johnson (J&J) indicated that wellness programs saved organizations an estimated $250 million on health care costs between 2002 and 2008. Workplace wellness interventions performed on high risk cardiovascular disease employees indicated that at the end of a six month trial, 57% were reduced to a low risk status. These individuals received not only cardiac rehabilitation health education but exercise training as well. Further, studies performed by the U. S. Department of Health and Human Services and J&J have revealed that organizations that incorporated exercise components into their wellness programs not only decreased healthcare costs by 30% but improved lost work days by 80%. Also, a 2011 report by Health Fairs Direct which analyzed over 50 studies related to corporate and employee wellness, showed that the return on investment (ROI) on specific wellness related programs ranged between $1.17 to $6.04. In general, it is estimated that worksite health promotion programs result in a benefit to cost ratio of $3.48 in reduced health care costs and $5.82 in lower absenteeism costs per dollar invested, according to the Missouri Department of Health & Senior Services. Additionally, worksite health programs can improve productivity, increase employee satisfaction, demonstrate concern for employees, and improve morale in the workplace. Leadership involvement in wellness programs can additionally impact employee health outcomes just as well as the programs themselves. A study performed by David Chenoweth indicated the managers who were passionate and committed about their wellness programs increased employee engagement by 60%, even if their wellness goals were not achieved. Leaders are not only tasked with creating the organizational culture but also in coaching and motivating employees to be engaged in that culture. However, it turns out that employees generally detest these intrusive programs, and wellness's "Net Promoter Score" of 52 places it last on the list of all industries in user satisfaction.

The major barrier to further implementation of these programs is the increasing realization that they fail to produce benefits and may harm employees. In 2018, the National Bureau of Economic Research (NBER) found no positive impact. Also in 2018, Medicare found no savings. Further, the NBER study concluded that the previous estimates of savings were largely invalid, due to a pervasive error in study design. Low participation rates by employees could significantly limit the potential benefits of participating in workplace wellness programs, as could systematically differences between participants and non participants. Research performed by Gallup indicated that out of the 60% of employees who were aware of their company offered a wellness program only 40% participated. Ongoing management support and accountability are critical to successful worksite health promotion programs. Primary prevention programs usually target an employee population which is already considered healthy and encourages workers to more frequently engage in health behaviors that will encourage ongoing good health (such as stress management, exercise and healthy eating). Secondary prevention programs are intended to reduce behavior which is considered a risk factor for poor health (such as smoking cessation programs and screenings for high blood pressure). Tertiary health programs are designed to address existing health problems (for example, by encouraging employees to better adhere to specific medication or self managed care guidelines). Worksite wellness programs including nutrition and physical activity components may occur separately or as part of a comprehensive worksite health promotion program addressing a broader range of objectives such as smoking cessation, stress management, and weight loss. A conceptual model has been developed by the Task Force for Community Preventive Services (The Community Guide) and serves as an analytic framework for workplace wellness and depicts the components of such comprehensive programs. These components include worksite interventions including 1) environmental changes and policy strategies, 2) informational messages, and 3) behavioral and social skills or approaches. Worksite environmental change and policy strategies are designed to make healthy choices easier. They target the whole workforce rather than individuals by modifying physical or organizational structures. Examples of environmental changes may include enabling access to healthy foods (e. g., through modification of cafeteria offerings or vending machine content) or enhancing opportunities to engage in physical activity (e. g., by providing onsite facilities for exercise). Policy strategies may involve changing rules and procedures for employees, such as offering health insurance benefits, reimbursement for health club memberships, healthy food and beverage policies or allowing time for breaks or meals at the worksite. Informational and educational strategies attempt to build the knowledge base necessary to inform optimal health practices. Information and learning experiences facilitate voluntary adaptations of behavior conducive to health. Examples include health related information provided on the company intranet, posters or pamphlets, nutrition education software, and information about the benefits of a healthy lifestyle, including diet and exercise. Behavioral and social strategies attempt to influence behaviors indirectly by targeting individual cognition (awareness, self efficacy, perceived support, intentions) believed to mediate behavior changes. These strategies can include structuring the leadership involvement and social environment to provide support for people trying to initiate or maintain lifestyle behavior changes, for example, weight change. Such interventions may involve individual or group behavioral counselling, skill building activities such as cue control, use of rewards or reinforcement, and inclusion of coworker, manager/leader or family members for support.

Wellness programs are typically employer sponsored and are created with the theory that they will encourage healthy behaviors and decrease overall health costs over time. Wellness programs function as Primary Care interventions as they are an example of primary prevention methods to reduce risks to many diseases or conditions. Workplace wellness programs have been around since the 1970s and have gained new popularity as the push for cost savings in the health delivery system becomes more evident as a result of high health care expenditures in the U. S. Employer wellness programs have shown to have a return on investment (ROI) of about $3 for every $1 invested over a multi year period, making them appealing to many as an effective way to achieve results and control costs. Most recently, the 2016 winner of the "best wellness program" award, Wellsteps, was shown to have harmed employees at the Boise School District and fabricated its savings figures. Workplace wellness programs have many components to help improve health outcomes and decrease health disparities. These components include smoking cessation programs, fitness center memberships, nutrition aids, and biometric screenings, often in exchange for health insurance premium reductions. The benefits of wellness programs are not limited to corporations and their employees; Otenyo and Smith argue that engaging in such programs produces positive spillover effects for society that are not reflected in markets, leading to them under consumption. Workplace wellness programs benefit employers as well; while the various components of the wellness programs helps to keep employees healthy, employers are able to increase recruitment and retention of workers. Some employers have also utilized penalties to improve employee participation within the company wellness program. While wellness programs promote healthier lifestyles and can bring significant cost savings, concerns about invasion of privacy and participation costs have arisen. The future of wellness programs as a valid method of preventative healthcare is still up for debate. Evidence of improved health outcomes for participants is mixed in terms of effectiveness. Writing in the New York Times, Frank and Carroll laid out several concerns with wellness programs, including limitations in empirical studies and the possibility that employers use these programs to shift costs to employees. That said, the 2019 Kaiser Family Foundation Employer Health Benefits Survey indicates that organizations continue to enact such programs due to their perceived benefits for employee health, morale, and productivity. Wellness programs have created a $6 billion industry due to its reputation of reducing health care costs. In their 2013 Workplace Wellness Programs Study, RAND Corporation researchers concluded that while lifestyle focused wellness programs can reduce risk factors and motivate healthy behavior, the reductions in healthcare costs are less than previously reported. However, most wellness studies that report the positive results of the wellness programs are not of high quality, indicate only short term results, and do not justify causation. Moreover, these studies are sponsored by their own wellness industry, creating bias. Other studies find that the programs don't improve health outcomes or reduce health care costs. In fact, a decrease of employers' health care costs has been simply passed on the employees. Based on the Affordable Care Act, employers are able to charge unhealthy employees up to 30 to 50 percent more of total premium costs. This has resulted in pushback from employees who have not met mandated health goals like quitting smoking or reducing body mass index (BMI). On the other hand, research on the 2003 PepsiCo Healthy Living program suggests that the wellness plan helps reduce health care costs after the third year of implementing the disease management components of the program. But, the wellness program does not show evidence of lower costs due to the lifestyle changes in the short run. This result is consistent with the one year study with the 3,300 employees of the University of Illinois at Urbana Champaign in 2016. The research also shows that without an incentive, about 46.9 percent participated in the wellness program. Then, the change in monetary incentive from $0 to $100 increases participation by 12 percent, from 46.9 percent to 58.5 percent. An additional incentive of $200 increases the participation from 58.5 to 62.5 percent. This study shows that when the company increases participants by only 4.5 percent or reduce 4.5 percent of non participants or high medical spending employees, it will compensate the total cost of the specific wellness program. This result is consistent with other studies that the wellness programs do not help lower health care costs, but only have passed on the costs to other employees. Regarding the employment and productivity, the participants believe that management places an importance on health, fitness, and safety. However, the study shows no significant difference on the happier feelings or more productive at work among the participants.

Lawrence et al. (2015) indicates strengths and weakness of current worksite wellness models providing key considerations for the development of a strong program. Key strengths indicated were "leadership commitment, organizational culture and environmental structure" to build a culture of health, ultimately promoting the improvement among non communicable diseases. Furthermore, Lawrence et al. (2015) suggest that these characteristics are indicative of a "high quality program regardless of the model used: 1) leadership support, 2) clear importance of health and wellness by organization culture and environment, 3) program responsiveness to changing needs, 4) utilization of current technology, and 5) support from community health programs". Furthermore, this data indicates when senior leaders are involved and committed to wellness program initiatives 73% of employees feel their organization supports a healthy lifestyle and their overall well being; however, only 4 of 10 Americans said that their leadership team supports wellness initiatives. Stokes, Henley and Herget (2006) reported on findings from a wellness initiative pilot program using the North Carolina Department of Health and Human Services. This organization was selected as the pilot due to the leadership support model and its large size. This program focused on "reducing major chronic diseases (including cardiovascular diseases), demonstrating the effectiveness of a wellness program model that includes a full time department level director, establish wellness committees to sustain work environments that promote and support employee health and wellness, and change policies and environments to help employees be more active, make healthier food choices, avoid tobacco, and manage stress". Additionally, their research indicates appropriate models for these successes are through "a health and wellness culture driven by leadership support, specialized programs designed for the employee population, and strategic plans that partner with current organizational goals". The following is a simplified example for (a fabricated) Company ABC:

An employee (or Company ABC Human Resource Department) reviews the current aggregate data provided by the employer insurance company as it relates to weight, physical activity, and cardiovascular measures, including cholesterol, blood pressure, biometric screening, physical activity, smoking, or other indicators. Company ABC will review the available company culture survey results as it relates to wellness for both social and environmental supports. Conversations and focus groups will be established to assess and determine employee engagement, interests, concerns, and other wellness related brainstorming.

A meta analysis of the literature on costs and savings associated with wellness programs, medical costs fell by about $3.27 for every dollar spent on wellness programs and absenteeism costs fell by about $2.73 for every dollar spent. A 2019 study in the journal JAMA found that a workplace wellness program at BJ's Wholesale Club had a very limited impact. The study found no impact on health measures or health care costs, but participants in the study did report that they became more knowledgeable about health behaviors. The Centers for Disease Control and Prevention conducted a case study of a workplace wellness program at Capital Metro, the local transit authority in Austin, TX. The study found that there was a reduction in costs associated with employee health care and absenteeism after the workplace welfare program was implemented. Johnson & Johnson, one of the world's largest companies, has saved $250 million on health care costs within the last decade as a result of wellness programs; from 2002 to 2008, the return was $2.71 for every dollar spent. As these sophisticated technologies become increasingly integrated into organizational processes and workflows, valid apprehensions have arisen regarding the potential erosion of job security, autonomy, privacy, and ethical decision making. In light of the expanding influence of artificial intelligence (AI) across various industries, a recent survey by Ernst & Young LLP reveals that 71% of US employees harbor apprehensions about its implications. The study discloses that 48% of respondents express heightened concerns about AI compared to a year ago, with 41% attributing their unease to the perceived rapid evolution of AI technology. Moreover, 75% of employees fear that AI may render certain jobs obsolete, and 65% are uneasy about the prospect of AI replacing their roles. Concurrently, proponents highlight the myriad opportunities AI affords to enhance workplace wellness through task automation, human machine collaboration, personalized well being support, and fostering inclusivity. This piece aims to critically examine both the challenges and potential benefits of AI integration concerning employee welfare, and propose recommendations for a responsible and ethically grounded approach to harnessing this transformative technology.