Debunking the myths about workplace wellness
Recently, a series of blog posts, newspaper articles, webinars, and conference presentations have asked, do workplace health promotion (wellness) programs work? When people refer to workplace wellness, they use a variety of terms, including health promotion, population health, health and productivity, and employee health management. A recent Kaiser Family Foundation Health Research and Education Trust study reported that 98% of large employers (those with 200 or more workers) offer at least one wellness program. However, when you look more closely at the Kaiser data, and at what employers consider to be their wellness program, the most common initiative is encouraging flu shots, followed by making available an employee assistance program or online wellness resources.
With this as background, I have an answer to the question: do workplace wellness programs work? Workplace health promotion programs do not work! I have another answer. Workplace health promotion programs do work! How can both statements be true? It all depends upon how you define a comprehensive health promotion program and the metrics used to measure its effectiveness.
In the September 2014 issue of the Journal of Occupational and Environmental Medicine, I along with 21 co-authors reviewed the evidence on workplace wellness. Below, I offer some insights drawn from that review. In particular, I address some common myths about wellness programs.
Myth 1: Workplace wellness programs dont work.
We found that some wellness programs perform extraordinarily well while others are ineffectual. The effectiveness of a program depends on whether it is well-designed, properly implemented, and credibly evaluated.
What are some examples of ineffective programs? Those are ones in which employers offer random activities and events, mostly uncoordinated, without a strategic focus, and lacking the commitment to intentionally improve workers health over the long run. Ineffective initiatives include paying employees to complete a health survey, collecting their biometric data much too frequently, or sending them to a third-partys wellness website without a commitment by management to create a healthy workplace environment. These activities by themselves are unlikely to succeed and may even create a backlash from employees who see no clear rhyme or reason for the wellness program. Often the response from workers is apathy, while those drawn to the program may be the worried well or those already committed to personal health improvement.
In contrast, workplace health promotion programs that work do the following:
- Have strong leadership support;
- Establish a healthy company culture founded on humanistic values;
- Make sure employees are involved in building and fine-tuning the design;
- Offer a variety of opportunities for health improvement with multiple entry points;
- Promote scientifically sound biometric screenings (those recommended by the U.S. Preventive Services Task Force) with follow-up counseling and coaching;
- Alter company policies to enable positive health behaviors (such as making available healthy food choices in cafeterias and vending machines);
- Use smart incentives that encourage positive behavior change and dont penalize individuals with poor health;
- Execute effective and consistent communication campaigns;
- Employ evidence-based behavior change interventions; and
- Conduct credible evaluations with built-in feedback loops.
Importantly, effective programs are not built overnight; rather, they require meticulous attention and fine-tuning over many years to gain the trust of workers who need to be the partners in health promotion rather than its targets.
Myth 2: Wellness programs are discriminatory because they shift costs from healthy to unhealthy workers.
There is concern that health promotion programs can be used by employers to charge higher insurance rates to workers in poor health. This is a real worry, especially given new provisions in the 2010 Affordable Care Act that allow employers to charge differential premiums to workers who choose to not participate in workplace programs or fall short on certain health outcomes (for example, continuing to smoke or being obese). It should be noted that regardless of the ACA, laws remain on the books that prohibit employers from discriminating against workers because of their health status or disability.
Wellness programs are discriminatory only if they violate the law by requiring workers to achieve pre-determined health outcomes without offering them an alternative way to participate in the companys program. Employers wishing to implement incentive programs that work should make sure these programs:
- Are practical, ethical, and legal;
- Are not used as a vehicle or excuse for blaming workers for poor health habits, or to penalize them financially for not achieving certain health outcomes;
- Are part of employers shared responsibility for the health and well-being of workers; and
- Dont rely solely on incentives, which, by themselves are not a substitute for a comprehensive and evidence-based program.
Also see: Have wellness incentives gone too far?
Myth 3. Published research proves that wellness programs dont work.
Three recent scientific articles made headlines by supposedly proving that wellness programs are ineffective.(For those interested in a review of those studies from my perspective, I refer you to the above-cited JOEM article as a good source.) Whats missed in the headlines is that each of the studies reported positive outcomes related to employee health improvement and cost savings, but unfortunately those findings were not newsworthy.
It is also important to remember that these three studies should be considered within a larger body of evidence pertaining to workplace health promotion. In science, evidence is weighed by the number of studies on a given topic and the consistency of results. The highly respected Community Guide to Preventive Services, housed at the Centers for Disease Control and Prevention, for example, conducted a systematic literature review of workplace wellness in 2010. A synthesis of the 86 published articles reviewed by the task force found that well-designed wellness programs exerted a positive influence on health behaviors (e.g., smoking, diet, physical activity, alcohol consumption, seat belt use), biometric measures (e.g., blood pressure and cholesterol levels), and financial outcomes (e.g., healthcare utilization and worker productivity).
Also in 2010, a widely cited meta-analysis of the costs and savings associated with worksite health promotion programs was conducted by Harvard economists Baicker, Cutler and Song. These researchers concluded that workplace wellness programs can generate savings and achieve a positive return-on-investment.
Myth 4. Wellness program evaluations are poorly designed and use non-scientific methods.
In health services research, observational studies are common, as opposed to double-blinded randomized clinical trials, the gold standard of other scientific research. There are some randomized trials in the literature where some workers, and not others, were offered screenings and follow-up counseling for specific risk factors, but these trials were generally limited in scope. For example, they often lasted less than a year, used a traditional medical management model as the intervention, and rarely examined attempts to change the culture of an organization alongside the health habits of workers.
In contrast, there are several long-term natural experiments that have tested the efficacy and effectiveness of workplace programs by following workers for many years. These studies were conducted at large employer organizations such as Johnson & Johnson, Prudential Financial, Dow Chemical, Vanderbilt University, USAA, Dell, BP America, and Highmark. These and other organizations have accumulated documentary evidence that their comprehensive and robust programs can improve population health and achieve cost savings. (Evidence of program impacts can be found at www.thehealthproject.com.) Studies of these large employers wellness programs most often applied observational study designs long accepted in the health services research community.
Returning to the question of whether workplace wellness programs work it depends. Similar to traditional medical treatments some work and some dont. As we have found, well-designed programs indeed result in improved health and, in some cases, cost savings. This should be the end point for all health care services (treatment or prevention): Improved health, good quality of life, and lower spending especially spending on avoidable or unnecessary care.
Ron Z. Goetzel, Ph.D. , Johns Hopkins Bloomberg School of Public Health, is vice president of consulting and applied research at Truven Health Analytics.