This presentation examines wellness initiatives in the workplace, including the impact of chronic illness on employees and the benefit of wellness programs for employers.

The objectives of this program are to review the impact of chronic illness on employees and the need for wellness initiatives in the workplace; discuss the current healthcare landscape and increase in health insurance benefits; review specific case studies on wellness initiatives in the workplace and their impact on employee health and provide the audience with a rationale for wellness programs by reviewing the long-term return on investment.

In the first section, we will discuss the growing economic burden of chronic illness in the workplace.

Chronic disease is highly prevalent among US workers, with more than 75% having at least 1 chronic condition and 55% having two or more conditions.1 Most of the healthcare costs paid by employers are for sickness care rather than for illness prevention.2 Many of the prevalent chronic illnesses are caused by modifiable risk factors or lifestyle habits such as smoking, obesity, physical inactivity, excessive alcohol consumption, and stress.2 More than one-third of Americans do not meet the recommendations for aerobic physical activity.3 Nearly 1 in 5 American adults—more than 43 million people—are smokers.3 References US Workplace Wellness Alliance. The burden of chronic disease on business and U.S. competitiveness: excerpt from the 2009 Almanac of Chronic Disease. http://www.fightchronicdisease.org/pdfs/PFCDReport_BurdenofChronicDiseaseon Business.pdf. Accessed August 29, 2010. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323. CDC. Chronic diseases and health promotion. http://www.cdc.gov/chronicdisease/overview/index.htm. Accessed November 2, 2010.

Employer-sponsored insurance provides coverage for approximately 157 million nonelderly individuals, and is the leading source of health insurance in the United States.1 The cost of health insurance, for both employers and employees, continues to increase. Between 2000 and 2010, overall health insurance premiums increased by 114%, from $6,438 to $13,770; similarly, workers’ contributions to premiums increased 147% over the same period.1 To put these increases into context, in 2005, Starbucks spent more on health benefits than on coffee, and the “Big Three” car manufacturers, General Motors, Ford, and Chrysler, spent more on employee health costs than on the steel used in their cars.2 The increase in healthcare’s share of benefit spending parallels the growing prevalence of illness related to modifiable risk factors and lifestyle habits.3 References Kaiser Family Foundation and Health Research and Educational Trust. Employer Health Benefits: 2010 Sumary of Findings. Menlo Park, CA: Kaiser Family Foundation/Health Research and Educational Trust; 2010. US Workplace Wellness Alliance. The burden of chronic disease on business and U.S. competitiveness: excerpt from the 2009 Almanac of Chronic Disease. http://www.fightchronicdisease.org/pdfs/PFCDReport_BurdenofChronicDiseaseon Business.pdf. Accessed August 29, 2010. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323.

Absenteeism is defined as work missed because of illness, while presenteeism is defined as lost productivity due to reduced productivity when an employee comes to work ill.1 Presenteeism can also be described as when the employee is at work but not feeling well, misses hours at work, and/or have their performance be impaired due to health issues. Other performance measurements that fall under the definition of presenteeism include losing concentration, repeating a job, working slower than usual, feeling fatigued, or difficulty completing tasks.2 The chart illustrates that costs for presenteeism greatly exceed costs for absenteeism. Employers cite chronic illness as the greatest cause of presenteeism, and 21% of workers admit going to work an average of at least 1 day per month despite being sick.1 References US Workplace Wellness Alliance. The burden of chronic disease on business and U.S. competitiveness: excerpt from the 2009 Almanac of Chronic Disease. http://www.fightchronicdisease.org/pdfs/PFCDReport_BurdenofChronicDiseaseon Business.pdf. Accessed August 29, 2010. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398-412.

This slide reinforces findings presented on the previous slide, as presenteeism and absenteeism comprised the majority of costs for several chronic conditions in the retrospective study. Loeppke and colleagues sought to determine health-related productivity losses for chronic conditions based on medical, pharmacy, absenteeism, and presenteeism costs for 4 large employers. Data from 2005-2006 were available from 57,666 employees to analyze; a total of 15,380 employees provided valid responses to the Health and Work Performance Questionnaire (HPQ) survey. As the bar chart demonstrates, productivity costs for absenteeism and presenteeism (green and silver bars) far exceeded medical and pharmacy costs for most of the chronic conditions listed. Back/neck pain was the most costly condition, followed by depression, fatigue, other chronic pain, and sleeping problems. Loeppke and colleagues maintain that findings from the study should be used to inform decisions on health management interventions in the workplace. Analyzing the broader costs of health conditions from this perspective may help prioritize appropriate interventions and assist employers with targeting and managing specific conditions. Reference Loeppke R, Taitel M, Richling D, et al. Health and productivity as a business strategy. J Occup Environ Med. 2007;49:712-721.

Back disorders and heart disease pose significant work limitations Back disorders and heart disease pose significant work limitations. Data presented are from the National Health Interview Survey (NHIS), a comprehensive source of information on chronic conditions causing work limitations. As the slide above illustrates, back disorders are a major source of work limitation, affecting nearly 4 million people in the United States (representing approximately 21.1% of the main conditions). Heart disease results in work limitations for 2.1 million people (10.9% of the main conditions), while osteoarthritis and related disorders cause work limitations for 1.6 million people (8.3% of the main conditions). The conditions outlined in the slide above suggest important areas for employers to target wellness programs and interventions.   Reference National Institute on Disability and Rehabilitation Research. Chartbook on Work and Disability. http://www.infouse.com/disabilitydata/workdisability/3_2.php. Accessed November 3, 2010.

Now, let’s explore some current trends on workplace wellness programs.

Workplace wellness programs are initiated by employers with the goal of improving their employees’ health and well-being and aim to, shift the focus from treatment to prevention.1,2 Prevention efforts can be classified into 3 categories. The first is primary prevention which is directed toward generally healthy workers. Secondary prevention is directed at workers at high risk for illness because of lifestyle habits, such as smoking or obesity, or medical factors, such as high blood pressure or high cholesterol.1,2 Tertiary prevention, also referred to as disease management, is directed at already-present illnesses such as asthma, diabetes, cancer, and depression.1 Although larger companies may be able to offer these programs more readily, as they are likely to have fewer space limitations and greater financial resources, smaller companies may have the advantage in terms of being able to communicate with individual employees on a personal basis.3 References Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323. Entrepreneur. Wellness programs. http://www.entrepreneur.com/encyclopedia/term/82650.html. Accessed August 29, 2010. McPeck W, Ryan M, Chapman LS. Bringing wellness to the small employer. Am J Health Promot. 2009;23(15):1-10.

Wellness programs can have a substantial impact in all areas of health across a variety of settings and environments. Workplace wellness programs frequently target some of the health conditions and lifestyle habits outlined in the slide above, in addition to encouraging periodic health screenings.1 Wellness programs can also target environmental interventions, such as providing healthy diet choices in the company cafeteria or vending machines, or by making adjustments to the physical environment to either promote exercise, address safety concerns, or avoid potential injury for workers.2 References McPeck W, Ryan M, Chapman LS. Bringing wellness to the small employer. Am J Health Promot. 2009;23(15):1-10. Serxner S, Gold D, Meraz A, Gray A. Do employee health management programs work? Am J Health Promot. 2009;23(4):1-8.

The following points provide a compelling argument for instituting wellness programs. Americans are increasingly spending a significant portion of their time at work. Poor employee health is associated with reduced productivity for many employers. In addition, one worker’s poor health may affect other workers’ performance negatively. The current healthcare environment necessitates increased attention to prevention and wellness, and the workplace is a useful setting for health-promotion programs. Lastly, better health for employees may potentially result in fewer short-term disability or workers’ compensation claims. Reference Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-323.