Unhealthy lifestyles are causing a significant proportion of the U.S. workforce to become chronically ill. Sedentary lifestyles, poor nutritional choices, tobacco use and excessive alcohol use have all been identified as contributors to chronic illnesses among workers. Chronic illness has become a major burden on both society and the workplace due to health care costs, absenteeism, and reduced employee productivity when at work.
Many corporations have responded by initiating workplace wellness programs to encourage employees to adopt healthier lifestyles. A wide range of different programs are included in this category. Programs are either implemented directly by the employer or through a program developed by the company's health-care provider.
A report on Workplace Wellness Programs was published by the RAND corporation in 2013 (http://www.dol.gov/ebsa/pdf/workplacewellnessstudyfinal.pdf.) The authors of this report surveyed employers, reviewed databases of health outcomes and reviewed the published scientific literature. The goals of the authors were to describe currently used programs, evaluate the effectiveness of such programs and attempt to identify characteristics of successful wellness programs.
The RAND report found that approximately half of all U.S. employers offer some kind of wellness initiative. Most of the programs combined screening for risk factors with interventions to reduce risk. Data on employee weight, blood pressure, blood glucose levels and exercise habits are commonly collected by employers as part of these wellness initiatives. Interventions offered by employers include smoking cessation programs, on-site Weight Watchers meetings, on-site vaccinations, weight loss competitions, nutrition educational activities, stress management educational activities, substance abuse counseling and fitness promotion programs. About half of the employers with wellness initiatives also offer disease management assistance, with diabetes as the most commonly targeted condition.
Employee uptake and participation in corporate wellness programs was found to be quite low. Less than half of eligible employees completed the screening for risk factors, and even fewer chose to participate in the provided interventions. Fitness interventions were the most popular workplace interventions and smoking cessation programs were the least popular. When the authors of the RAND report analyzed data comparing wellness intervention participants to matched non-participants, the interventions did seem to be somewhat effective for employees who chose to participate.
The majority of wellness programs used incentives such as money and prizes to encourage employee participation in the programs. Prizes were particularly common as incentives, and consisted primarily of novelties such as T-shirts, tickets to events and coffee mugs. RAND analyses found that incentives worth $50 or more were particularly likely to increase participation in screenings for risk factors.
Smoking cessation programs stood out among the other programs as different in character. Most of the wellness programs used by employers rewarded employees for participation instead of for achieving particular goals, and penalties were rarely used. However, smokers were frequently penalized for smoking by employers and were often primarily rewarded for smoking cessation rather than for participating in smoking cessation programs. A review of the medical literature by RAND found conflicting results as to whether financial incentives assisted smokers in achieving long-term smoking cessation.
When asked, employers tended to be confident that wellness programs were effective and cost-saving for the corporations, but surprisingly few companies had made any effort to formally test this hypothesis.
It is clear from the RAND report that one major obstacle in implementing effective corporate wellness programs is getting employees to participate. A survey conducted by the Employee Benefit Research Institute asked employees why they weren't participating (http://www.shrm.org/hrdisciplines/benefits/articles/pages/participate-wellness-programs.aspx.) Reasons given included lack of time, inconvenient location of the program, didn't want the employer to know about their health, felt they were already healthy or could make changes on their own. This survey also found that employees were more likely to participate in plans if participation reduced their out-of-pocket healthcare costs or paid a substantial cash incentive for participation.
The methods used by one company to achieve 100% employee participation are illustrative (http://www.bizjournals.com/cincinnati/news/2014/04/15/how-a-cincinnati-firm-got-100-percent.html?page=all.) One major feature of this program that may explain the high participation rates is that participation was objectively recorded rather than relying on "the honor system." For example, workouts were verified by pedometers or smartphone applications, and completion of risk factor profiles was verified by participating physicians. Oddly, requiring objective verification improved participation. Offhand it might be expected that if employees could just say they did it that participation would at least appear to be high, but requiring objective measurements seemed to motivate the employees. Perhaps requiring objective measurement conveyed the message that the company was serious about the program. Tracking progress towards goals using visual media has long been known to be very effective in motivating people to change behavior, so allowing employees to track their progress online may have encouraged them to participate as well.
Another factor in the success of this company's program may have been the dedication of the executives in implementing the program. One of the senior managers in the human resource department personally explained the program one-on-one to each individual employee. Financial incentives were used. Spouses of employees were invited to participate. The junk food vending machine was replaced, once again emphasizing to the employees how serious the company was about the program.
The company reports the program has paid off in reduced absenteeism and boosted productivity, plus a fairly large discount on its healthcare costs from its healthcare provider.