|Year : 2016 | Volume
| Issue : 4 | Page : 256-261
Health promotion in the workplace
Sultan T Al-Otaibi
Department of Family and Community Medicine, College of Medicine, University of Dammam, Dammam, Saudi Arabia
|Date of Web Publication||12-Oct-2016|
Sultan T Al-Otaibi
University of Dammam, P. O. Box: 2208, Al-Khobar 31952
The objective of this review was to describe the scientific evidence for coordinating health promotion at the workplace and to discuss the required future research in this field. Literature review from March 1990 to November 2014 was performed. Using the keywords 'health, promotion, worksite and workplace', literature was searched in the following databases: Medline, PubMed and Google Scholar; with no time limit. There is emerging evidence that workplace health promotion enhances the effectiveness of effort to promote and protect workers' health. It proves both cost-effective and cost-beneficial to health promotion at the worksite and subsequently further reduces absenteeism. However, future research is needed to identify the impact of other factors such as age, gender and race on workers' exposure. There is also a need to develop valid tests to measure the outcome of these programmes at the workplace. Health promotion should be central to workplace planning and should be recognised as an integral part of proactive occupational health. Indeed, the workplace is viewed as one of the most popular venues for promoting health and preventing diseases among employees.
Keywords: Health, promotion, workplace
|How to cite this article:|
Al-Otaibi ST. Health promotion in the workplace. J Health Spec 2016;4:256-61
| Introduction|| |
Health promotion is defined as 'the art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health and supporting them in changing their lifestyle to move towards a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual and intellectual health. Lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most importantly, through the creation of opportunities that open access to environments that make positive health practices the easiest choice'. 
The World Health Organization defines health promotion as 'the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions'. 
Health promotion is now central to workplace programming and is recognised as an integral part of proactive occupational health. Indeed, the workplace is viewed as one of the most popular venues for promoting health and preventing disease. The workplace is good for health promotion for the following reasons. An adult spends one-third of their day at work; work is a form of motivation-less influenced by emotional ties and also the workplace has defined expectations for attendance and performance. There has been a desire on the part of employers to manage healthcare costs, decrease absenteeism, improve productivity, improve employee morale, recruit and retain employees, enhance the corporate image and contribute to the health and well-being of their human resources. Workplace health promotion is contributing to the achievement of management goals. ,
To rationalise the approach to health promotion at the workplace and to take account of emerging scientific evidence, this paper describes the scientific evidence for coordinating health promotion at the workplace.
The aim of this article was to describe the scientific evidence for coordinating health promotion at the workplace and to discuss the required future research in this field.
| Methodology|| |
Literature review from March 1990 to November 2014 was performed. The literature was searched in Medline, PubMed and Google Scholar using the following keywords: 'Health, promotion, worksite and workplace', with no time limit.
Rational and justification for workplace health promotion
The effect of workplace health promotion programmes on healthcare costs, absenteeism, health outcomes and attitudes towards health through literature review is summarised as follows.
Controlling healthcare costs paid by employers are complex and part of an ever-growing national dilemma. More recent studies continue to add to the body of evidence that health promotion does have an impact on healthcare costs for employers. ,
Citibank conducted a quasi-experimental employee study of 11,194 participants and 11,644 non-participants. They concluded that their return-on-investment was $4.56 to $1 and attributed these results to the high-risk intervention focus of their programme because high-risk employees cost employers more money. 
The work of Pelletier over the last 20 years had reviewed and analysed data which contributed significantly to an aggregate understanding of the studies that have formed the foundation of workplace health promotion's science base. In summary, all of Pelletier's reviews describe a historical perspective of the evolution of the research design, data analysis and intervention that is taking place in workplace health promotion. It is increasingly possible to prove both cost-effectiveness and cost-benefits of health promotion at the worksite. 
Simply stated, employees who are absent from the job are not productive employees. Employers pay the healthcare costs and also the cost of salary continuation when an employee is absent.  Health promotion programmes decrease absenteeism, but this finding may differ depending on the type of employee, and with workers presenting with three or more health risks gaining the most benefit from their participation in programmes. 
Health promotion focusses on the aspects of morbidity and mortality where many years of life are lost due to premature death. Employers have been increasingly promoting employee participation in health promotion programmes. Those initiatives are aimed at reducing cardiovascular disease, diabetes, cancer and smoking-related diseases.
While the body of literature is far too extensive to review comprehensively, there was a risk reduction for high-risk employees within the context of comprehensive health promotion programming. 
Attitudes towards health
Positive attitudes towards the employer and high morale in the workforce are highly valued. Johnson and Johnson found a significant attitudinal improvement in employees participating in live for life programmes. Measures were favourable for organisational commitment, supervision, working conditions, job competence, pay and benefits, and job security.  The findings suggest that while health promotion can positively influence attitudes towards the company, the presence of a programme cannot eliminate the consequences of work-related ambiguity and uncertainty. On the other hand, there is no doubt that programmes contribute to levels of satisfaction.
Scope of programmes
Programmes can range from health awareness campaigns to educational seminars, biological screenings (samples of blood, urine, etc.) or multiple session behaviour change courses.
Whether the approach is to focus on a single health topic, to address various health risks or behaviours at the primary prevention level, or to implement across the health continuum through primary, secondary and tertiary prevention, the best rule of thumb for choosing the particular intervention is to let the data guide decision-making.
These programmes include the following:
Preventive screening programmes
Screening is central to early detection of a disease and measurement of its progress. One approach is that the screening is actually conducted on-site, and the other approach is that educational programmes are held to encourage employees to see their personal provider. This provides convenience and access for the workforce.
The U.S. Preventive Service Task Force serve as a valuable resource for targeting appropriate populations. 
Cancer screenings are popular workplace programmes where mammography for breast cancer and colorectal screening programmes are beneficial and can be targeted to employees at high risk. , More recently, osteoporosis screening has received a great deal of attention because osteoporosis is now treatable, and screening devices are available. 
More research is needed to determine who should be screened, the best method for screening, and the frequency of screening. No screening is complete without appropriate follow-up.
Smoking-related issues have taken centre stage in recent years. There have been continued research, legal action against tobacco companies and smoking bans imposed on public places. By now, there is no doubt that smoking is the single most preventable lifestyle cause of mortality and disability while current concerns relate to environmental tobacco smoke. 
A well-designed study reported that cognitive-behavioural interventions coupled with pharmacotherapy yield 50% quit rates for the highly motivated addicted individuals, whereas the single programme had a 22.2% quit rate.
Smoking cessation programmes and tobacco control policies evaluation indicated that rated programme processes produce 'indicative' results.
Programme duration can range from 5 to 6 consecutive days to once weekly for 8 - 10 weeks. Programme content should address the physiological as well as the psychosocial and addictive characteristics of smoking. It should also include behavioural therapy, use of incentives, telephone counselling, use of a nicotine supplement, hypnosis, acupuncture and biofeedback. Since no single method works for everyone, offering different programme options, affords each smoker the opportunity to find the programme that works for him/her.
It is reported that smoke-free workplaces reduced the rate of staff smoking from 22.3% to 11.8%. All employees, employers and health authorities perceived tobacco use and environmental tobacco smoke as hazardous to health. 
Sixty percent of US adults are inactive or underactive, making the prevalence of inactivity more than twice that of smoking. It has been shown that physical activity markedly reduces the risk of colon cancer to 20 - 30% and to lesser degrees for endometrial and breast cancer.  Higher levels of physical activity have been associated with reduced incidence of coronary artery disease (CAD). There is also the positive impact on osteoporosis, asthma, depression and stress. Evidence also exists that exercisers cost less in healthcare expenditures.  It is found that exercisers have an average healthcare claim less than the non-exercisers. The workplace can make a significant contribution to this national dilemma by making exercise convenient and accessible for the 'already exercising' as well as providing the motivation and support for non-exercisers to engage in a regular exercise programme. The goal of a fitness programme is to improve cardiovascular fitness, increase strength and improve flexibility. The psychosocial benefits, as well as improved morale, attitude and productivity, also cannot be overlooked. To implement a fitness programme, it is not necessary to have a fully equipped on-site facility. There can be on-site group exercise classes and walking routes and negotiated lower cost rates at nearby facilities.
Exercise screening (risk factor review, personal health history, heart rate, blood pressure and cholesterol) is recommended before entry into any programme, with additional testing (sub-maximal or maximal exercise electrocardiography) as indicated by a protocol that quantifies risk factors. Workplace programmes have yet to demonstrate an increase in physical fitness activity. 
There is a great deal to do in this area. People do not recognise the importance of healthy eating. Employees at the group nutrition sites and the self-paced programme sites modified their behaviours and related risks greater than the employees at the 'education only' sites. In another study, the results showed strong, statistically significant relationships between all of the constructs for fat and fibre intake. Furthermore, it was found that employees improved eating practices and reported feeling better. The intervention included the provision of more fruits and vegetables and meals lower in fat in the cafeteria as well as labelled snacks in the vending machines. 
Approximately, one in two US adults is overweight or obese, representing a 25% increase over the past three decades. The prevalence of two or more chronic conditions increased as the severity of obesity increased. These chronic medical conditions include hypertension, Type II diabetes, cardiovascular disease, gallbladder disease, osteoporosis and certain cancers. Obesity is the second leading preventable cause of death after smoking. There is no single approach to weight management. Behavioural counselling, nutrition advice, exercise, medications, bariatric surgery and long-term follow-up are believed to be important in the management of obesity. The combination of caloric restriction and exercise seems to work best. 
Screening for hypertension is not new to occupational health. Studies have found that the workplace is a useful setting to screen for hypertension. A structured educational component is an essential adjunct to any hypertension detection and treatment programme. Hypertension control requires adequate diagnosis and appropriate follow-up which will enhance compliance in 70 - 80% of cases. A periodic visit to an occupational health professional provides the opportunity for accurate monitoring coupled with counselling. 
Stress potentially plays a role in cardiovascular disease, asthma, skin disorders and peptic ulcer, among others. Health risk appraisal and other stress assessment tools are readily available to employers as a way to quantify stress in the workplace. Other stress assessment tools help to further define employee's stress. A wide variety of programmes can be planned that address stress and stress management. Effective stress management techniques can improve employees' ability to cope with stress, improve their sense of well-being and reduce the likelihood of stress-related symptoms. 
Employee assistance programme
Employee assistance program (EAP) refers to the efforts at coordinating a variety of services designed to assist employees who have psychological or emotional problems that interfere with their work. Therefore, it provides assistance to the troubled employee with occupational stress, personal problems or substance abuse. EAPs are gaining popularity in Western countries. It is an active, vital part of occupational health. The service is coordinated by an occupational medicine specialist, psychiatrist, psychologist and social worker, who all work to help the troubled employee and lower the cost to the employer. Occupational physicians are faced with the challenge of evaluating workers with substance abuse that may be affecting work performance. In other cases, it may be necessary to request a consultation regarding work capabilities in the light of the presence of a psychiatric disorder. The key aspects of EAPs are confidentiality, appropriate referral and record keeping. The effectiveness of EAPs has been reported in published studies. EAP is valued for the successful treatment, cost-effectiveness, return to work enhancement, reduction of absenteeism and improved work performance. The key to a successful EAP is management commitment, employee involvement and a non-punitive policy on employees seeking the service of EAP. The functions of an EAP are to train supervisors in recognition of troubled employees, appropriate referrals, treatment, monitoring workplace impairment and injury, and also to facilitate employee re-entry to the workplace. ,
During the last decade, employers, motivated by the desire to improve healthcare utilisation patterns and contain healthcare costs, have incorporated medical self-care and consumer empowerment activities into the scope of workplace programmes. The primary goal of the need management is to control medical care costs by enhancing the participants' sense of responsibility for their own health and healthcare decisions. This includes toll-free health advice lines, medical self-care texts, prenatal care, pre-surgery counselling and case management for selected illnesses or injuries known to generate high medical costs. There have been reports that well-resourced workplace health promotion achieved a significant Return-On-Investment (RIO) as a result of need management. These programmes are extremely supportive of the needs of employees and their families when facing symptoms, illness, injury and care decision-making. 
Back pain is the second most common reason for work absence in the United States, with work-related costs of approximately $1.1 billion annually. It was found that back injury prevention through intervention at the workplace is effective. 
A diabetes intervention programme is another good example which costs $45 billion in direct expenditures and $47 billion in indirect expenditures. Findings suggest that incorporation of employee counselling, exercise and weight loss are important in the management of diabetes. It is suggested that losing just 2 - 4 kg a year and keeping it off reduces one's risk of diabetes. 
Asthma, depression and CAD are also popular examples of items worthy of consideration for disease management programmes at the workplace. ,,
Other programmes of interest
Influenza immunisation programmes
For employers, influenza prevention is a major priority because of the potential benefits for workforce health and productivity. The most effective method of controlling influenza is vaccination. Many companies now offer flu vaccines to employees on an annual basis. The goal is to reduce the absence due to flu and flu-related illnesses.
Nichol et al.,  in a randomised double-blind clinical trial found that the vaccination of healthy individuals against influenza is beneficial. It decreases the frequency of upper respiratory attacks by 25% and absenteeism from work due to upper respiratory illness by 43%. In addition, the authors believed that it was associated with a cost savings of $46.85 per person vaccinated. Vaccination against influenza reduces the illness and severity of influenza and clearly saves money.
Campbell and Rumley  found that influenza vaccination of healthy workers is cost-effective. The cost per saved lost workday was $22.36 for a company savings of $2.58 per dollar invested in the vaccination programme.
An author found a statistically significant decrease in sickness absence due to influenza illness among vaccinated workers compared to the unvaccinated. He concluded that his findings support immunisation against influenza in the workplace. 
Occupational health surveillance programmes
Integrating occupational health surveillance as a component of health promotion has many benefits. A study of workplaces concluded that there is a great capacity to lower health risks, utilise the skills of an interdisciplinary team, and emphasise both the environmental and personal factors impacting health. Occupational diseases remain common, and health surveillance is one approach to detecting early deterioration in employee's health, and these programmes include surveillance for respiratory hazards, high noise and lead toxicity among others. ,,
Women's health programmes
Some companies with a high percentage of female employees focus on a targeted women's health programme. Breast self-care, breast examinations, mammography screening, Pap smear More Detailss, as well as gynaecological and pregnancy consultations are generally included. 
| Conclusion|| |
Health promotion should be central to workplace planning and should be recognised as an integral part of proactive occupational health. Indeed, the workplace is viewed as one of the most popular venues for promoting health and preventing disease among employees.
The future research
The literature review indicated that health promotion programmes have a positive effect in the workplace; however, future research is needed to identify the impact of factors such as age, gender and race on workers' exposure. There is also a need to develop valid tests to measure the outcome of these programmes at the workplace.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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