worksite health promotion programs

Mountains of Evidence Show the Benefits of Workplace Health Promotion Programs

Think of the different benefits employers typically offer. These could include a retirement or pension plan, healthcare, paid time off, or maternity leave. These are designed to help your organization recruit and maintain qualified employees. Yet there is not a single published study that shows that offering these benefits has any measurable effect on a worksite’s ability to recruit or maintain workers. We do them because we believe they are important.

These things are actually very hard to study and we have a feeling or sense that they do make a difference in our ability to attract good workers. But, there is no science to back any of this up.

Now consider your workplace health promotion or wellness program. Unlike all the other benefits your worksite offers, workplace health promotion programs have been studied for decades. There are hundreds and hundreds of rigorous scientific evaluations of the impact of these programs. There is more research on the impact of health promotion programs than anything else your company does. Granted, the research is not perfect—no research ever is.

But after decades of scientists evaluating programs, we have an enormous amount of very solid data that show the benefits of having a worksite health promotion program. I personally have published 75 research papers on the impact of worksite health promotion programs. And I am just one of hundreds of scientists in the field.

This research is what I will use to back up the 7 most popular reasons to have a worksite health promotion program.

employee wellbeing at work

The Top 7 Reasons to Have Workplace Health Promotion Programs

1) Workplace Health Promotion Programs Improve Employee Health Behaviors

The core of every good health promotion program is behavior change. With the right education, skills, motivation, skills/tools, and social support, people change behaviors. Workplace health promotion programs are good at helping people adopt and maintain healthy behaviors.  This is perhaps the biggest benefit of having a heath promotion program.

Healthy behaviors lead to lower health risks, and lower health risks lead to less chronic disease.  With less chronic disease employees have fewer health care costs.  It looks like this:

Workplace Health Promotion Programs

Many studies have evaluated the ability of workplace health promotion programs to improve health behaviors. Not every heath promotion program is able to show positive results. The ones that are well-organized and follow effective behavior change models show the best results. Here are the results of an evaluation I published recently. The 1,800 employees at this worksite reported their health behaviors at baseline, one year, and two years after the program began.

Workplace Health Promotion Programs

Source: Population Health Management article

Just about anybody can have healthy behaviors for a few days or weeks. The key is to maintain healthy behaviors for years. As soon as you stop having healthy behaviors you stop getting the benefits.

I like studies that go out for two years because the results are pretty conclusive by that time. If you can get your employees to participate in a good heath promotion program, chances are they will adopt and maintain healthy behaviors for years to come.

Most studies show that employees have better health behaviors. They eat healthier foods, eat smaller portions, exercise more often, smoke less, don’t drink in excess, wear seat belts more often, and they’re pretty good at controlling their stress. Workplace health promotion programs can also help alleviate depression and the symptoms of depression as well as improve life satisfaction.

Even the American Heart Association has completed an extensive review of the ability of programs to improve health and reduce cardiovascular risk.

Others have evaluated all of the research and reported that workplace health promotion programs, do in fact, have the ability to improve employee health. In 2013 researchers completed one of the most rigorous and comprehensive reviews of heath promotion programs.  This study is called the Rand Report. Here is what the authors concluded:

We find that workplace wellness programs can help contain the current epidemic of lifestyle-related diseases, the main driver of premature morbidity and mortality as well as health care cost in the United States.

Soeren Mattke, Lead Author of the Rand Report

2) Workplace Health Promotion Programs Reduce Elevated Health Risks

The foundation of any good heath promotion program must be focused on helping employees adopt healthy behaviors.Eating and exercising are behaviors. Elevated blood glucose, high blood cholesterol, and high blood pressure are almost all caused by unhealthy diets and lack of physical activity.  A few years ago I published the results of a randomized clinical trial that helped people improve their nutrition and physical activity.

We were stunned to learn that in as little as six weeks health risks could improve dramatically. Those who maintain healthy behaviors experience lower health risks for six weeks, six months, 12 months, and even out to 18 months after this program began.

When you change your diet, get active, and avoid tobacco, really good things happen. Boise School District is a WellSteps client and not long ago we published the results of their changes in health risks. After one year, a lot of employees who had elevated health risks at baseline, had reached healthy risk levels.

Workplace Health Promotion Programs

Source: JOEM

Reductions in elevated health risks are important. The New England Journal of Medicine reported that for every 1% drop in total cholesterol, the risk of having a heart attack dropped by 2 to 3%. For every one point drop in elevated diastolic blood pressure, there is another 2 to 3% drop in heart disease risk.

Low health risks are the foundation of good health, and workplace health promotion programs are a great way to help employees and their spouses avoid elevated health risks. There are hundreds of research papers that evaluated the ability of workplace health promotion programs to reduce elevated health risks. One particular study looking at almost 200,000 heath promotion program  participants and showed that 5 0f 7 health risks improved after one year.

Another researcher looked at all of the published studies to get a consensus. This review showed that comprehensive workplace health promotion programs will have a significant impact on elevated health risks.

A Weakness of Workplace Health Promotion Programs

There is one weakness that almost all workplace health promotion programs have. After 30 years of evaluating dozens and dozens of programs it has become clear that it is difficult to impossible to get large groups of employees to reach and maintain a healthy body weight. The obesity epidemic is caused by a variety of cultural factors and helping employees lose weight has proven to be exceptionally difficult.

Workplace Health Promotion Programs

While the research suggests that helping people improve blood cholesterol, blood pressure, and blood glucose is possible, helping people lose weight and keep the weight off has proven to be hard to do. I’m the first one to admit that workplace health promotion programs are not very effective at helping people lose weight.

Just take a look at the body mass index (BMI)data in the table above. Those who are obese do lose some weight after a few years but not very much.

There is some hope. Recently, the RAND study showed some promising results:

Workplace Health Promotion Programs

Source: Rand Report

If the focus of your heath promotion program is to help individuals reach and maintain a healthy body weight you should prepare yourself to be disappointed. The unhealthy culture that surrounds most of us makes it extremely difficult to lose weight, in fact, most people in the United States and in the industrialized world gain weight every year.

So there are couple ways to look at this. Workplace health promotion programs are very effective at reducing elevated health risks like blood pressure, glucose, and cholesterol. But they are not very effective at helping people lose weight.

Without the impact of all the workplace health promotion programs in the world, obesity would be even worse than it currently is.

Workplace health promotion programs may not help your employees reach a healthy body weight, but they are helping your employees to stop gaining weight.

3) Workplace Health Promotion Programs Reduce Health Care Costs

There are almost 100 different studies that have looked at the financial impact of workplace health promotion programs. I have published six of these myself, and I have years of experience conducting some extremely complicated ROI studies. These studies are not easy to do and they take years to complete.

In 2001 I published the most comprehensive review ever completed on the financial impact of workplace health promotion programs.

That study alone are reviewed 100 different research papers. The ability of a heath promotion program to reduce healthcare costs depends upon how effective the program really is. Having an occasional lunch and learn about nutrition or just doing a biometric screening will not be enough to move the healthcare cost needle.

Comprehensive workplace health promotion programs that improve employee behaviors will see a bending of the healthcare cost trend. Most often they will discover that the savings from program participation will be greater than the actual cost of the program. Almost every one of these return on investment (ROI) studies show a positive return on investment. Researchers from Harvard recently published another summary of the worksite heath promotion ROI research.

Here is what they found:

Study Focus Number  of Studies Average Study Length Average ROI
Health Care Costs 22 3 years 3.27

Source: Health Affairs 

Among the 22 different studies that looked at workplace health promotion programs and healthcare costs, the average return on investment was 3.27. This means that for every dollar that was spent on the program the company saved $3.27 because of reduced healthcare costs.

Last year researchers evaluated the impact of the WellSteps wellness program at a large school district. Here is the actual healthcare cost trend for this worksite. After four years of heath promotion this worksite is actually spending less on healthcare costs than it did before the program began. For every dollar they spent on heath promotion they saved $3.3.

Workplace Health Promotion Programs

Source: Merrill et al. 2015

Anyone who still thinks workplace health promotion programs don’t improve health is choosing to completely ignore hundreds of peer-reviewed scientific research papers that say otherwise.

4) Workplace Health Promotion Programs Improve Productivity

Poor employee productivity can be defined as physically being at work but not working. This type of poor productivity is called presenteeism. It is estimated that the cost associated with presenteeism due to poor employee health is at least 2 to 3 times greater than direct health care expenses. While the estimated cost of presenteeism dwarfs the cost of health care, it does not receive the same level of scrutiny among employers preoccupied with controlling the direct costs of poor employee health.

Workplace Health Promotion Programs

There are a lot of reasons why employees have low productivity. They may not know how to use the equipment, they may be distracted by other employees, they may not know what they are doing, they may be tired, or they might be on Facebook. One of the main causes of presenteeism is poor health.

New understanding of presenteeism has been revealed in recent research published by the journal Population Health Management.

 Workplace Health Promotion Programs

Smokers were 28% more likely to have high presenteeism than non-smokers. Employees with an unhealthy diet were 66% more likely to have high presenteeism than those who regularly ate whole grains, fruits, and vegetables. Employees who didn’t exercise very much were 50% more likely to have high presenteeism than employees who were regular exercisers. These findings demonstrate that poor health behaviors are strongly associated with high levels of presenteeism.

In short, unhealthy individual lifestyle choices may result in substantially higher levels of lost productive work time.

This figure displays increased rates of high presenteeism among employees who smoke, don’t eat healthy, or don’t exercise regularly. Poor health behaviors eventually lead to elevated health risks and chronic diseases. The figure below shows how health risks such as excess body weight, elevated blood pressure, and high cholesterol increased the odds of having high presenteeism.

The other health conditions in this figure further paint the presenteeism picture—the presence of risk factors, pain, and chronic disease, especially chronic depression, dramatically increase the odds of having high presenteeism.

Looking at this graph, you can see that employees who suffer from neck/back pain are 79% more likely to have high presenteeism than employees who do not have neck/back pain.

Workplace Health Promotion Programs

These results confirm several ideas about the benefits of worksite heath promotion. Presenteeism is associated with poor health behaviors as well as elevated health risks and the presence of chronic disease.

Workplace health promotion programs that focus on helping employees have good health behaviors will eventually have an impact on productivity. I have written extensively about the connections between worksite heath promotion and productivity in a previous blog.

5) Workplace Health Promotion Programs Can Decrease Absenteeism

There are over 50 papers that have looked at the connections between workplace health promotion programs and reduced absenteeism. Worksites with comprehensive programs can experience reduced absenteeism for a variety of reasons:

  1. Employees with good health behaviors have lower absenteeism
  2. Employees who can control their stress have lower absenteeism
  3. Employees with healthy blood pressure, cholesterol, and glucose have lower absenteeism.
  4. Employees who are not overweight or obese have lower absenteeism

I summarized all of these studies in one monster paper that was published a few years ago. You can read the nitty-gritty details of all 46 papers if you ‘re really curious.

Any heath promotion program that can reduce absenteeism will experience cost savings. Harvard researchers looked at the ROI of workplace health promotion programs as they relate absenteeism and demonstrated that for every dollar programs spend on heath promotion they can save $2.73 and reduce absenteeism.

Study Focus Number  of Studies Average Study Length Average ROI
Absenteeism 22 2 years 2.73

Source: Health Affairs 

Workplace health promotion programs have the ability to improve employee health and this can have an impact on whether or not individuals are absent from work. But there is another reason why these programs can have such a large impact on absenteeism. Employees who have high morale are significantly less likely to be absent from work.

6) Workplace Health Promotion Programs Can Help Improve Employee Recruitment and Retention

I confess there is no published scientific data that shows that workplace health promotion programs will make a significant impact on your ability to recruit and retain employees. There are a lot of factors that go into the decision to accept a job offer. It helps if you can offer a good salary and a rich benefits plan.

I had the privilege of visiting the VP of benefits at the Microsoft corporate office in Redmond Washington. If you are fortunate enough to land a job at Microsoft you will get an amazing Microsoft benefits package.

You’ll get free wellness, free gym membership, onsite health clinics of every variety, and NO insurance premium—doesn’t that sound great?  All the large software/tech companies are offering heath promotion with their benefits plans. The do this because they are all fighting with each other to hire and retain the best workforce possible. A rich benefits package makes it easier to get the best employees.

I don’t have any evidence that shows that having a heath promotion program will tip the scales when an employee is considering accepting a job. A Virgin HealthMiles/Workforce survey did find that about 87% of employees said they consider health and wellness offerings when choosing an employer. But compared to other defined benefits, wellness plans just don’t have much sway in the employment decision process.

However, workplace health promotion programs do have a strong impact on retention.  Retention is the ability a worksite has to retain its workforce.  Rich benefits also have a powerful influence on retention, but a good heath promotion program can help keep employees loyal.

Workplace Health Promotion Programs

Personnel is the most important asset in every organization. When an employer offers a heath promotion program to its employees the company is saying, “We think you are an important part of this organization and we want you to be healthy, happy, and employed here for a long time”.  When you offer your employees a heath promotion program,  you are showing them that you care about them.

You are letting them know  you want to do everything you can to keep them in good health and optimal performance. Employees know when they are appreciated. They know when feel welcome and valued as important parts of the organization.  That knowledge can do a long way toward convincing employees to stick around: they can go find another job somewhere, but will they get treated and valued the same way?

7) Workplace Health Promotion Programs Build and Help Sustain High Employee Morale

I’m going to let you in on a little secret. The WellSteps wellness solutions has a performance guarantee. After three years we guarantee that your heath promotion program will have a positive return on investment. The secret is that after three years almost nobody cares about the ROI.

That may have been a good reason to start their heath promotion program, but after employees start to engage, communicate with each other, feel valued and appreciated, the reasons for doing a program change. After three years we have found that our clients like to do heath promotion because they like the way it has changed their worksite culture.

Employees are obviously healthier but more importantly they are happier. This is another reason that doesn’t have scientific research to back it up. We are probably never going to have a good study that can evaluate that question. What we do have, however, is experience with hundreds of clients that have migrated away from the ROI of heath promotion and have moved towards the value on investment (VOI) of heath promotion. I’ve blogged about this previously here.

Workplace Health Promotion Programs

The academic approach to workplace health promotion programs has limitations when we start talking about employee morale. As the CEO of WellSteps, a company with dozens of employees, I see the impact of our own heath promotion program in a very different light. Employee morale is a huge factor in the success or failure of any business and a good heath promotion program helps employees be happy and healthy.

Many of you have probably studied Maslow’s needs hierarchy. The pyramid shown below shows the different needs that we have as humans. The most important and life sustaining needs are the bottom of the pyramid, the base of the pyramid.

These include things like food, water, shelter, social interactions, etc. Without these basic needs being fulfilled we could die or just suffer through life. The top half of the hierarchy shows the kinds of things we’d like to have once our basic needs have been met. Not everyone gets to fulfill these higher needs, and their lives are not as rewarding as they could be.

Workplace Health Promotion Programs

When you offer your employees a heath promotion program you are telling them that you respect them, you trust them, and that you want to help them be successful in life. Employees have high employee morale when they are allowed to be creative,  solve problems, feel safe and appreciated, develop self-esteem, and achieve personal goals and aspirations. Employees are happy when they have a sense of control over their lives and their health.

In my opinion. this is one of the most powerful reasons to have a heath promotion program. Realistically, your employees don’t care about your healthcare cost problem, they care about their own happiness. Your employees don’t share your concerns about productivity or absenteeism. They care about having a fulfilling, enjoyable job.

Your worksite heath promotion program helps employees achieve all of their needs, both physical, social, and emotional. When it is all said and done, your employees want to feel loved and appreciated; really good things happen at work when they do.

Productivity goes up, customer service is outstanding, problems get solved, and people get creative. They like coming to work, they appreciate their employer, they work better with others, and they have high employee morale.

Worksite health promotion programs

What is the financial value of having employees with high morale? It’s probably impossible to make this calculation but reverse the question and ask it again. What does it cost your company when you have employees with poor morale? Complaints will go up, the quality of your product or service will suffer, and problems will multiply because poor employee morale can be contagious. Poor employee morale can be a company killer.

After 30 years of researching all of the benefits of a worksite heath promotion program, I have come to the conclusion high employee morale, while almost impossible to evaluate, is an extremely important benefit of heath promotion. Perhaps this is why many of the companies with outstanding workplace health promotion programs have dramatically better financial performance.

So What?         

There is an enormous amount of research to support the benefits of workplace health promotion programs. A comprehensive program is going to improve employee health and improve your organization’s bottom line. It is not going to make all your problems go away, but it is going to help you create a worksite culture of health. It will boost and maintain employee morale. With an effective workplace health promotion programs you will improve the lives of your employees and help drive the success of your organization.

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About The Author

Dr. Steve Aldana

Dr. Aldana is the CEO of Wellsteps, a worksite wellness solution that leads the nation in wellness program deployment and engagement. Dr. Aldana authored over 75 scientific papers and 7 books on health risk management, healthy living, and health promotion programs. He has given over 350 keynote speeches across the U.S. on the ability of good nutrition and regular exercise to prevent, arrest, and reverse many chronic diseases. Email him at: steve@wellsteps.com