Workplace Health Promotion

Introduction

Good workplace health practice is a fundamental prerequisite for both economic and social success in Europe. Workplace health promotion has proven to be a successful business asset and strategy for improving the health of employees and the quality of the work environment. Workplace health promotion offers a comprehensive approach to companies for setting up successful health promotion activities.

What is workplace health promotion?

Workplace health promotion has evolved into an independent discipline over the last 20 years OSH research. The approach is closely linked to the understanding of health and health promotion as it is defined in the Ottawa Charter (1986) by the World Health Organisation (WHO) ^[1]. Health was no longer understood in the negative sense as the absence of illness but as a positive interaction of physical, mental and social well-being. The workplace is considered to be an important setting to promote the health of the employees. This has led to a broad concept of workplace health promotion.

Health and health promotion

Health is often defined using the definition from the World Health Organisation: 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.' This view on health is also the basis of the definition of health promotion as it has been put forward in the Ottawa Charter for Health Promotion ^[2]. The charter defined health as 'a resource for everyday life… a positive concept emphasising social and personal resources as well as physical capabilities.' Health is therefore considered as being instrumental for successful living. "Health" clearly goes beyond physical health to include coping and solving skills, a rational balance between self-care and health service use, accomplishment at home and at work, successful social interactions, and a positive attitude and outlook ^[3]. Based on this view on health the WHO’s Ottawa Charter for Health Promotion (1986) proposes a systems approach to health promotion, where public participation, supportive environments, strengthened community action, enhanced personal skills, and reoriented health services are all seen as integral. The Charter led to a refined definition of health promotion, as ‘the process of enabling people to increase control over and to improve their health’ ^[4].

The workplace as a setting for health promotion

Health promotion intends to address humans as individuals and groups in the settings in which they live, work, love and play. With the publication of the Ottawa Charter, public health professionals shifted their language from an educational tone to a ’community development’ tone. Emphasising the importance of living conditions in relation to behaviour, thereby implying that one has to work with the people in contexts in which they are enabled to lead "healthy lives". These "settings" are defined frames of reference for any type of intervention with regard to health promotion and health education.

It is clear that health promotion can and must occur across a variety of settings such as schools, communities, clinical settings, and also workplaces, and that the health of populations elsewhere in the world also affects the health of people back home. This gives a moral as well as self-interested imperative to extend health promotion concepts globally (think global, act locally). But this does not, in any case, justify the “isolation" of each setting. The key to sustainability is the interrelationships that can be created between the different programmes and settings. Health promotion has thus evolved to recognise the influence of broader social policies, environmental and specific workplace factors, not just individual factors in efforts to promote health ^[5].

The workplace is considered to be an important setting for health promotion activity for the following reasons:

• Structures already exist within the workplace for occupational health and health and safety requirements. These can be easily used to deliver health promotion activities.
• The workplace offers enormous potential to reach large numbers of people with information and assistance to improve their health and well-being. Some of these people are in groups, which are otherwise hard to reach.
• It is in the common interest of employers and employees to promote health at work.
• Forward thinking organisations recognise that the management of their human capital is as important, if not more so, than the management of their financial and other resources. Employee health and fitness for work are closely linked and are key factors in any organisations drive towards greater effectiveness, competitiveness and productivity.

All workplaces can be considered as a workplace setting. However, there are many different types of organisations and so the workplace setting is a general title that incorporates the many specific organisational settings, including:

• large organisations
• small and medium sized enterprises
• public administrations
• health service and welfare (e.g. hospitals)
• education and training (e.g. schools)
• labour market and administration ^[6].

The definition of workplace health promotion

Workplace health promotion is defined by the European Network for Workplace health Promotion (ENWHP) as follows: “Workplace Health Promotion is the combined efforts of employers, employees and society to improve the health and well-being of people at work."

This definition is based on the Luxembourg declaration (1997) developed by the members of ENWHP ^[7]. In the Luxembourg declaration workplace health promotion (WHP) is described as a modern corporate strategy, which aims at preventing ill health at work (including work-related diseases, accidents, injuries, occupational diseases and stress) and enhancing health-promoting potentials and well-being in the workforce.

According to the Luxembourg declaration this can be achieved through a combination of:

• improving the work organisation and the working environment
• promoting active participation
• encouraging personal development

Since its development, this definition of WHP has become the most widely accepted definition of WHP across Europe. The vision on WHP of the ENWHP network is based on a broad and comprehensive approach to promoting workplace health (figure 1).

This comprehensive approach of WHP is based on the following principles ^[9]:

• Healthy work is a social process and is therefore the result of action by various stakeholders in and outside enterprises. The main drivers are leadership and management practices based on a participative workplace culture
• Healthy work is the result of interplay of various determinants, which include the overall strategies and policies of decision makers, the quality of work environment and work organisation, as well as personal health practices. These determinants can be influenced by a number of processes, which follow the management circle, e.g. building infrastructures, good communication to ensure transparency and participation, implementation and continuous improvement.
• Healthy work has an impact on the quality of working and nonworking life and contributes to the level of health protection of communities and populations (public health). The result is not only better workplace health but also the improvement of company performance that in turn contributes to improved social and economic development at local, regional, national and European level The economic dimension of occupational safety and health management.

Based on this description of workplace health promotion it becomes clear that, although there are strong links with occupational safety and health, there are also differences. Occupational safety and health focuses on health and safety risks in the workplace and develops strategies to control the risks. Workplace health promotion looks upon the workplace as a setting to develop health promotion strategies. Both approaches must be considered as reinforcing each other.

The benefits of workplace health promotion

Companies benefit from workplace health promotion (WHP) because their employees are healthier and better motivated when working in an improved working environment. The consequence is a reduction in sickness-related and other health costs, a higher quality of products and services, more innovation and a rise in productivity. WHP also contributes to the image of the company and makes it become more attractive as an employer. Especially when WHP is aligned with the company’s goals and fits the corporate strategy, philosophy and culture, positive affects and benefits can be gained. The framework presented in the figure below (figure 2) offers an insight into the relationship between the WHP process and the outcomes ^[10]. The framework proposes a concept of workplace health promotion, integrated in the business strategy and aligned with the company goals, influencing both the individual and the organisational components. The WHP programme generates effects and outcomes that influence company performance positively and which contribute to the company goals.

At organisational level, a workplace health promotion programme leads to change by creating better working conditions, improving the social climate and the organisational process. The results are organisational outcomes such as ^[12]

• Less costs: costs due to absenteeism, accidents and diseases reduced
• Improved company image: the company becomes more attractive both to customers and to employees
• Less job turnover and greater staff retention: the human resources management becomes more effective in retaining employees
• Higher productivity

On an individual level, a workplace health promotion programme leads to a greater health awareness (healthier lifestyle) and to improved motivation and commitment. These changes result in several outcomes ^[13]:

• Less accidents and diseases
• An improved state of health
• More job satisfaction

Moreover, the framework shows that important additional effects and outcomes can be obtained since there is a clear link between the different outcomes and between the organisational and individual level. Individual effects such as an improved job satisfaction will have an additional positive impact on the organisation, leading for instance to lowered costs due to absenteeism or a higher productivity.

On organisational level, workplace health promotion can lead to better working conditions, e.g. adapting a workstation in order to prevent back pain, resulting in less diseases, an improved image, less staff turnover, etc. But at the same time, this can have a positive impact on the individual worker improving motivation and job satisfaction.

It becomes clear that the added value of workplace health promotion programmes lies especially in these additional effects ^[14].

Evidence from 55 UK case studies [8] show that WHP programmes result in financial benefits, either through cost savings or additional revenue generation, as a consequence of the improvement in a wide range of intermediate business measures (figure 3).

The scale of the cost savings depends on the situation of the company and the nature and range of the health programmes. According to Aldana ^[16] most WHP intervention studies are evaluated by the impact on absenteeism and health care costs. Reductions in absenteeism rates were found ranging from 12% to 36% for participants in WHP programmes. These reductions are linked with cost savings with ratios ranging from 1:2.5 to 1:10.1 meaning that for every dollar spent on the programme, 10.1 were saved from reduced absenteeism-related expenses.

Setting up WHP initiatives

The basic building blocks of a workplace health promotion programme, as presented below (figure 4), are based on a project management cycle. It provides the most comprehensive and sustainable approach to workplace health promotion.

To maximise the opportunities offered by interventions to promote employees’ health and well-being, it is important to develop a planned and proactive approach, in which an assessment of need has been undertaken and a prioritized response to the identified need has been constructed. This approach can be described as a series of steps ^[18]: 1. Getting started 2. Assessing needs 3. Planning a programme 4. Implementation 5. Evaluation and consolidation

At the base of 'the getting started' phase lays the question: who is going to drive the WHP process forward? Therefore it is essential to set up a task force that has the responsibility to drive forward the initiatives aimed at the improvement of employees’ health and well being. Ideally the task force would be multi-disciplinary and multi-departmental, and made up of representatives from all, or at least most, of the following groups: - Senior management - The Works Council/Trade Unions/Staff Side Representatives - Human resources department - Occupational health and safety service

Furthermore, the getting started phase is all about commitment: getting the commitment of senior management and the commitment of all employees by setting up communication strategies. To make the commitment visible it has to be included within the organisation's core values, e.g. by drafting or including it in a policy statement.

Assessing the needs is the second phase of a WHP programme. It is aimed at understanding the current situation and the needs of the employees. Several methods and tools exist, e.g. conducting surveys, organising focus groups, analysing data.

Based on the results of the needs analysis, the WHP initiatives can be selected and prepared. Therefore it is essential to make a planning of the WHP programme. The development of the plan enables activities to be undertaken in a structured and coordinated way, meeting identified needs and opportunities and enabling resources to be used in an efficient and effective manner. Plans should be developed around clear, measurable goals with short and long term outcome measures. Identifying outcomes in the planning stage makes evaluation easier and building evaluation into the process is an important part of a successful programme.

The implementation phase requires a thorough preparation ensuring that everything is in place, e.g. training, awareness raising materials, to implement the initiatives. Throughout the implementation phase a continuous communication is needed. Not only to inform everyone about what is going on but also to give visibility to the programme and of the company's commitment.

To enable progress to be monitored and outcomes to be evaluated and consolidated it is imperative to build monitoring and review into the workplace health action plan. Key indicators by which progress can be measured include notes of the task force meetings, the achievement of the desired outcomes, sickness absence, accident and injury rates, and in the longer term, staff turnover data and levels of morale. The key issue is to obtain information on lessons learnt, weaknesses and, as a result, plans can be tailored and fine-tuned. The process works best when it is continuous and an integral part of the planning and implementation processes ^[19].

Conditions for successful WHP programmes

Several studies and reviews concerning the effectiveness of WHP, define the conditions under which WHP programmes are most likely to succeed ^[20].

The first condition, which is important throughout the whole process of developing, implementing and executing a health promotion programme, is the support and involvement from top management. The support for and the involvement in WHP interventions should be visible and can consist in the continuing allocation of necessary resources, the endorsement of goals and objectives concerning health promotion, exemplary behaviour, etc.

WHP programmes have to be tailored to the needs of the company and of the employees. Programmes should be designed to meet the preferences, aptitudes and requirements of a wide variety of participants to be really successful. In general this means that WHP programmes should be based on outcomes from needs and risk assessments concerning WHP executed at the workplace.

Participation and involvement of employees also constitutes a very important condition. On the one hand, employees should receive the opportunity to have a say in the whole process of developing and maintaining a WHP programme and on the other hand they should be stimulated to really participate in these programmes. There should be involvement of employees at all organisational levels in the planning, implementation, evaluation and activities of the intervention.

Workplace health promotion programmes should be characterised by a clear statement of goals and objectives, which align with the corporate mission and are integrated in organisation processes and procedures. To keep WHP in the picture, there should be open and ongoing communication among project members, employees and (senior) management. Every member of the organisation and all other stakeholders should be informed about the WHP programme in each phase of the project.

Based on these conditions for successful WHP programmes and on the quality criteria defined by the ENWHP ^[21], a set of criteria can be established ^[22]. Organisations should incorporate each of these criteria in their health promoting policy and initiatives in order to excel at health promotion at work. WHP has to (be):

• based on the principle of comprehensive workplace health promotion,
• supported by the corporate policy,
• integrated in the corporate strategy, systems and processes,
• supported by and active involvement of management,
• supported by and active involvement/participation from employees,
• supported by ongoing communication between and towards all stakeholders,
• based on a structured approach,
• based on a needs analysis and/or risk assessment,
• supported by the necessary material and human resources,
• provide information and training on WHP,
• based on effective measures and scientific knowledge,
• include evaluation and monitoring of the program,
• characterised by continuous improvement.

These criteria are key success factors for WHP programmes in organisations. WHP programmes build along these criteria offer organisations the possibility for investing in employees' health and to evolve towards successful and healthy organisations.