Public Health Worksite Health Promotion
by
Nell H. Gottlieb
  • LAST REVIEWED: 14 October 2016
  • LAST MODIFIED: 24 July 2012
  • DOI: 10.1093/obo/9780199756797-0031

Introduction

Worksite health promotion is a relatively young field, with employee fitness programs in the United States emerging in the 1960s and expanding in the 1980s to include other risk factors and wellness topics. The focus in this development was on personal lifestyle, and a primary driver was the rapid increase in employee health-care costs. In Europe, where health-care costs are not borne by employers, worksite health promotion began with a concern about the organization of work and how this influenced the worker. With the approach of the 21st century, these two threads began to come together in the social ecological model of health promotion in the United States and the settings approach of the World Health Organization, amid increasing concerns about productivity in the global economy. From a public health perspective, the workplace is an ideal setting for improving the health status of the population of workers, with spillover to their families. Social and organizational supports can facilitate well-being, healthful behaviors, and disease detection. The evidence base for worksite health promotion is strong and growing, and there is a deep experience base among large companies. The literature in health promotion reflects these roots, appearing both in scientific and professional journals and in corporate organization reports, such as those of the National Business Group on Health (which may not be generally available). The practice of health promotion has matured with a professional focus, a theoretical base, and planning and managerial frameworks. Worksite health promotion is an interdisciplinary endeavor grounded in health and behavioral science, public health, organizational change, and general management.

General Overviews

The need for health promotion is great. Huang, et al. 2011 found that, among employed adults in 2007–2008, 59.3 percent had no influenza vaccination, 49.2 percent were physically inactive, 27.0 percent were obese, and 19.2 percent smoked. The worksite has great potential to improve the health status of working adults. Linnan, et al. 2008 presents the results of the 2004 National Worksite Health Promotion Survey. Large businesses are much more likely than small businesses to have key elements of a comprehensive program, though only 24.1 percent of large businesses and 6.9 percent of the total sample had all five elements. Over 80 percent of worksites with 750 employees or more had employee assistance and back injury programs, blood pressure and blood cholesterol screening, smoking restrictions, prohibition of drug and alcohol use and firearms, and linkage to related health programs. Few overall had programs for physical activity (19.6 percent), weight management (21.4 percent), or smoking cessation (18.6 percent). The 2010 Health Care Cost Survey (Towers Watson 2010) showed large employers planning to increase employee health management, including health promotion and wellness programs and health risk assessment. The Healthy People 2020 Educational and Community Programs Objectives (US Department of Health and Human Services 2010) call for an increased proportion of worksites of all sizes that offer an employee health promotion program, and of employees who participate in a program. Other organizations, such as the American Heart Association, also recommend wellness programs (Carnethon, et al. 2009). The Commission to Build a Healthier America report Beyond Health Care: New Directions to a Healthier America (Robert Wood Johnson Foundation 2009) notes the importance of healthful work and recommends that safety and wellness be integrated into every aspect of community life, and the commission’s Issue Brief 4: Work and Health (Robert Wood Johnson Foundation 2008) provides a detailed review of the relation of work to health and strategies to improve health. Heinen and Darling 2009 describes the efforts of large US employers to address obesity, with 83 percent offering health risk appraisals and 74 percent offering weight management programs in 2008. The main points of leverage are health benefits design and incentives, environmental supports, a culture of health at work, and community and family connections.

  • Carnethon, M., L. Whitsel, B. A. Franklin, et al. 2009. Worksite wellness programs for cardiovascular disease prevention: A policy statement from the American Heart Association. Circulation 120.7: 1725–1741.

    DOI: 10.1161/CIRCULATIONAHA.109.192653E-mail Citation »

    Gives the American Heart Association’s recommendations for worksite wellness programs with an extensive review of the literature to provide rationale and context for the recommendations. Statement made on behalf of the American Heart Association Advocacy Coordinating Committee; the Council on Epidemiology and Prevention; the Council on the Kidney in Cardiovascular Disease; and the Council on Nutrition, Physical Activity and Metabolism.

  • Heinen, L., and H. Darling. 2009. Addressing obesity at the workplace: the role of employers. Milbank Quarterly 87.1: 101–122.

    DOI: 10.1111/j.1468-0009.2009.00549.xE-mail Citation »

    The authors, from the Washington Business Group on Health, outline the employer perspective on the reduction of obesity and suggest leverage points for intervention.

  • Huang, Y., P. A. Hannon, B. Williams, and J. R. Harris. 2011. Workers’ health risk behaviors by state, demographic characteristics, and health insurance status. Preventing Chronic Disease 8.1.

    E-mail Citation »

    Rates of obesity, physical inactivity, smoking, and no influenza vaccination are reported, using 2007 and 2008 Behavioral Risk Factor Surveillance System data. Disparities in these behaviors are related to income, education, and race/ethnicity. Smoking and lack of influenza vaccination are related to insurance status.

  • Linnan, L., M. Bowling, J. Childress, et al. 2008. Results of the 2004 National Worksite Health Promotion Survey. American Journal of Public Health 98.8: 1503–1509.

    DOI: 10.2105/AJPH.2006.100313E-mail Citation »

    The results of the 2004 National Health Promotion Survey are presented. This is the most recent representative national sample survey.

  • Robert Wood Johnson Foundation. 2008. Issue brief 4: Work and health. Princeton, NJ: Robert Wood Johnson Foundation Commission to Build a Healthier America.

    E-mail Citation »

    Provides an overview of the links between work and health, and of work-based strategies to improve health.

  • Robert Wood Johnson Foundation. 2009. Beyond health care: New directions to a healthier America. Princeton, NJ: Robert Wood Johnson Foundation Commission to Build a Healthier America.

    E-mail Citation »

    Report of the Robert Wood Johnson Foundation Commission to Build a Healthier America. The chapter on “Healthy Environments” reviews opportunities and work-based strategies.

  • Towers Watson. 2010. 2010 Health Care Cost Survey. New York: Towers Watson.

    E-mail Citation »

    Industry survey of large US companies that shows workforce well-being to have increasing importance.

  • US Department of Health and Human Services. 2010. Healthy People 2020 Educational and Community-Based Programs Objectives.

    E-mail Citation »

    Presents national objectives to increase the proportions of worksites that offer employee health promotion programs, and of employees who participate in employer-sponsored worksite health promotion activities.

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