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. Your organization designs these to help recruit and retain qualified employees. What’s missing are workplace health promotion programs.
Yet, there is not one published study that shows that offering these benefits has any measurable effect on a worksite’s ability to recruit or retain 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 shows the benefits of having a well-being program. As one of the many scientists who have published research on the impact of worksite well-being programs, it is not too difficult to support the 7 most popular reasons to have a well-being program.
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, 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 health 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:
Many studies have evaluated the ability of workplace health promotion programs to improve health behaviors. Not every health promotion program is able to show positive results.
The programs that are well-organized and follow effective behavior change models show the best results. Here are the findings of a recently published evaluation. The 1,800 employees at this worksite reported their health behaviors at baseline, one year, and two years after the program began.
Source: Population Health Management article
Just about anyone 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.
When studies go out for two years, the results tend to be more conclusive. 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 health promotion programs. The Rand Report. is the name of this study. 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
Any good health promotion program must focus 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, researchers conducted a randomized clinical trial to help people improve their nutrition and physical activity. They 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, 6 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. Not long ago, we published the results of the Boise School District changes in health risks. After one year, many employees who had elevated health risks at baseline, had reached healthy risk levels.
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 health promotion program participants showed that 5 of 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. A variety of cultural factors cause the obesity epidemic, and helping employees lose weight has proven exceptionally difficult.
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 difficult. 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 suffer from obesity do lose some weight after a few years but not very much.
There is some hope. Recently, the RAND study showed some promising results:
Source: Rand Report
If the focus of your health promotion program is to help individuals reach and maintain a healthy body weight, you should . 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. These studies are not easy to do, they require extremely complicated ROI analyses, and they take years to complete.
In 2001, the most comprehensive review on the financial impact of workplace health promotion programs was published. In that study alone, there are 100 different research papers reviewed. The ability of a health 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 health 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 health promotion, this worksite is actually spending less on healthcare costs than it did before the program began. For every dollar they spent on health promotion, they saved $3.30.
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.
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 social media. 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.
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.
The figure below 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.
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. You can read 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:
- Employees with good health behaviors have lower absenteeism
- Employees who can control their stress have lower absenteeism
- Employees with healthy blood pressure, cholesterol, and glucose have lower absenteeism
- Employees who are not a healthy weight or suffer from obesity 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 health 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 spent on health 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 health promotion with their benefits plans. They 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 health 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.
Personnel is the most important asset in every organization. When an employer offers a health 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 health 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 they feel welcome and valued as important part of the organization.
That knowledge can go a long way toward convincing employees to stick around: they can go find another job somewhere, but will they be 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 health 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 health 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 health 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 health promotion and have moved towards the value on investment (VOI) of health promotion. You can read a previous blog about ROI vs. VOI here.
The academic approach to workplace health promotion programs has limitations when we start talking about employee morale. While difficult to measure, employee morale is a huge factor in the success or failure of any business. A good health promotion program helps employees be happy and healthy.
Many of you have probably studied Maslow’s hierarchy of needs. 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 suffer through life or even die. 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.
When you offer your employees a health 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 health 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 health 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.
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. High employee morale, while almost impossible to evaluate, is an extremely important benefit of health 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 program, you will improve the lives of your employees and help drive the success of your organization.
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