Health and wellness programs: design and implementation

Health and Wellness Programs

Research Proposes

More than Absence

Healthy Habits

Final Diagnosis

Health and Wellness Program examines the hypothesis: Although employees' health and productivity in public agencies in the southwest Georgia region are reported to be regularly enhanced by the impact of Health and Wellness Programs, limitations and delimitations are frequently overlooked or intentionally ignored. Consequently, this presents unanticipated problems as employers and employees may obtain unrealistic expectations and ensuing Health and Wellness Programs may be "set up" to fail.

Positive and negative program components, along with counters to potential failures of Health and Wellness programs are examined and presented in this paper.

HEALTH and WELLNESS PROGRAMS

Research Proposes

More Than the Absence

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."

Constitution of the World Health Organization)

Seventy-five percent of United States health care dollars are spent on diseases caused by unhealthy lifestyles. Unhealthy lifestyles, according to Aetna, not only cost employees, but adversely affect employers, as well.

Research proposes that when employers invest in employee wellness and health promotion, they will also likely receive substantial payoffs. ("Aetna Health Connections (SM)...") "Ninety-one percent of all diabetes cases, 80-90% of all heart attacks and 30-70% of all cancers are completely preventable through lifestyle changes," research purports. According to the Framingham Health Study, individuals who engaged in more physical activity lived 1.3 to 3.7 years longer than those who exercised little, primarily because the development of heart disease was delayed. Employees' clinical depression constitutes another costly problem in the American workplace as more than 19 million American adults (9.5% of the population) were estimated to suffer from this disorder in 2001. A Massachusetts Institute of Technology study discovered that depression costs American industry $43.7 billion each year; estimating $23.8 billion of the total to be from lost work time.".. due to absenteeism and reduced productivity, $7.5 billion in lost earnings due to depression related suicide and $12.4 billion in direct care costs. Costs could mount even further if a worker's untreated depression contributes to alcoholism, drug abuse or other physical or mental disorders." (Paul)

Staying physically and mentally healthy benefits employers and consumers, Meg McCabe, head of the Aetna Medical Product Business Unit contends. "Programs that promote health can impact worker wellness and productivity... can reduce employer costs related to health benefit claims, sick leave, absenteeism, disability and worker's compensation." ("Aetna Health Connections (SM)..." 2006) Other incentives for employers who sponsor Aetna's plan range from "from general wellness counseling and weight management, to a new smoking cessation program." Ibid.

According to the Centers for Disease Control and Prevention (CDC), two thirds of America's adults are overweight while approximately a third of are obese. Diabetes, cancer and heart disease, along with other chronic diseases that adversely affect the lives of 90 million Americans are and generally preventable by eating nutritious foods, engaging in physical activities and avoiding tobacco use. (Conway, et al.) to counter these statistics, employers who sponsor health plans have begun to also adopt wellness programs, offering incentives for employees to lead healthier lifestyles.

Through a 2003 study of nine major employers who implemented a wellness program, the Department of Health & Human Services determined that for every these employers invested into their wellness programs, returns ranged from $1.49 to $4.91. As this paper examines the hypothesis, "Although employees' health and productivity in public agencies in the southwest Georgia region are reported to be regularly enhanced by the impact of Health and Wellness Programs, limitations and delimitations are frequently overlooked or intentionally ignored," the primary problem of health and wellness programs is revealed. Often, research shows, problems employers did not anticipate and/or plan for "set up" programs intended to be positive for failure. The purpose of this study is to examine and study positive and negative components related to health and wellness programs.

Definitions

CDC: Centers for Disease Control and Prevention

Gemeinschaftsgefuehl, a term with no literal translation, which means "social interest"

HRAs: Health risk assessments are also known as health screenings. Insurance plans utilize HRAs to educate individuals about health risk factors to help prevent disease, and assist employers in determining the most beneficial programs to help improve employees' health. Participants are given recommendations for results for improving/decreasing identified risk factors.

WHP: workplace health promotion

WEL: Wellness Evaluation of Lifestyle (WEL

WoW: Wheel of Wellness

II. Literature Review

Healthy Habits

Health is the vital principle of bliss,

And exercise, of health.

Thompson)

Aetna's (NYSE:AET) current health and medical management strategy includes incentive programs to provide information, personal support and discounts to encourage members, which will consequently also include employees of employers who purchase Aetna's insurance, to actively achieve or maintain optimal health. Along with providing programs facilitating interactions with clinical professionals to increase members' understandings of their current health risks, members will also begin to establish and/or meet personal goals to lower their risks and maintain good health. Wellness Programs, to encourage preventive care, also offer online information and tools. ("Aetna Health Connections (SM)..." 2006) Aetna's plans for 2007 include "Simple Steps to a Healthier Life (R) program which offers an online health assessment, as well as information." (Ibid) Focus will include "how to:

Eat right,

Get in shape,

Lose weight,

Cope better with stress, and Other health issues." (Ibid)

Aetna reports that its 2007 wellness offerings cover four main categories:

1. Wellness Outreach includes: Healthy Body, Healthy Weight Program (R); Smoking cessation program, Wellness Counseling; Informed Health (R) Line (24-hour nurse information communication tool).

2. Online Self-Help Tools include: Simple Steps to a Healthier Life®; InteliHealth (R); Healthwise (R) Knowledgebase and Women's Health Online.

3. Workplace Programs & Mailings include: Onsite health screenings (start October 2006);

Health awareness campaigns; Health education workshops; Preventative Care Mailings

And information on ways to better communicate doctors/health care professionals; expanded workplace; English and Spanish educational, health focused CD-ROM, addressing health and wellness topics.

4. Benefits, Discounts and Rewards include: More incentives for healthy

Lifestyles (discounts for weight loss/health services and products ("Aetna Health Connections (SM)..." 2006)

Paul reports that employee depression presents a current costly and pervasive challenge to today's employers. At a minimum,.".. depression sets up neural roadblocks to the processing of information and keeps us from responding to life's challenges." (Ibid) Although technology and research contribute to understanding some aspects of depression, myths, unknowns regarding specific causes and cures continue to create workplace concerns, which include:

Higher health insurance costs

Higher absenteeism and turnover

Declining productivity

Poor interpersonal relations

Cognitive decline

Reduced information processing

Low motivation and slowed movements

Loss of interest and goal focus

Reduced ability to think and concentrate

Impaired short-term memory

Reduced ability to adapt to change and see alternatives

Increased number and severity of accidents

Higher workers compensation insurance costs

Increased alcohol and drug abuse

Anxiety and overreaction to stress

Reduced morale and job satisfaction

Increased tendency to focus on negative events

Reduced desire to cooperate. (Paul)

Along with saying money for the company or business, increased insight into causes of depression can help employers better help their employees to cope with and counter depression. Although all factors contributing to depression are not clear, potential causes can include personal and workplace environments; stress; individual inherited factors; prior physical or sexual abuse; smoking.

Neither causes of depression or other health concerns, however, cannot be controlled by employers' programs. Successes, as well as, delimitations are contingent on employees participating and adhering to health-related principles.

Future jobs for those who manage health and wellness programs are expected to be plentiful as this field is predicted to expand through 2012. Health care, as well as wellness, management reportedly provides top pay, great benefits and stability due to the current increase focus on preventative care. ("Health Care Managers Are" NA) Just as medical and health services managers need to be familiar with health and wellness programs' principals and practices, employees need to be familiar with what's available from their employers. They also need to utilize what's available. Another limitation, however, could be employee's time constraints.

Minter argues that looking out for employees' best interests in regard to health and wellness begins with employers' managers. He cites Dennis Hussey, Ph.D., director, environmental health and safety for Goodrich Corporation, to state: "If you look at any candid discussion about the health and safety function and how to really create a culture where the employee's health and safety is the critical concern, it always starts with management commitment. My communicating what we want to accomplish, how we want to accomplish it and getting management to endorse it, support it, participate in it -- that's what I mean by communicating the vision." Headaches frequently accompany safety and health programs in the workplace, according to safety pros who claimed to have world-class safety and health programs, Minter also reports. Tight resources, confirmed by a 2005 National Safety Survey, reveal still another limitation of health and wellness programs. This particular online survey, utilizing responses from 1400 plus safety and health personnel revealed the "headache" of having to contend with limited budgets in implementing these programs.

According to Zoller, scholars and/or practitioners proponents of workplace health promotion (WHP) generally assume that employees universally welcome the programs. Perhaps, the primary delimitation that could be contributed to health and wellness programs would be that one of the other would not be wanted by employees. Consequently, health promotion literature that deems the programs to be "pro-social" endeavors designed in employees' best interests frequently fail to engage employees' participation.

Additional delimitations incorporate:

Failure to adequately engage employee needs

The development of divisive gender issues and Reliance on disciplinary models of health contributed to negative reactions and lower employee participation." (Zoller)

Smoking, Diet and Exercise in 1996, approximately nine out of ten major employers offered health promotion programs which ranged from fitness centers; health testing; health education programs; incentive/disincentive programs to increase health behaviors like dieting or cease smoking; health outcomes (lowering body fat levels and/or cholesterol). By changing employees' voluntary habits (including smoking; diet; exercise), some employers purport they can reduce health care costs.

Zoller, however, disagrees. Even though.".. literature suggests that health programs boost morale, produce employee cohesiveness and teamwork, and improve employee health through the promotion of self-discipline and lifestyle change," Zoller presents contradictions these positive assumptions in his study and cites.".. how choices made in constructing this WHP facility and program fostered employee morale problems, divisiveness, and alienation among some employees."

Claims by WHP that workplace initiatives improve employees' mental and physical health, with ensuing improvements in efficiency; morale; commitment; loyalty and help secure more profits for employers have not always proven true, Zoller stresses. Even though some studies show health promotions decrease health care and disability costs; other reports confirm delimitation, as health and wellness programs may trigger increases in unneeded tests and doctor visits. Reports of improved resting heart rates, blood pressure, and total cholesterol levels or individuals, who exercise in corporate programs, Zoller argues, are apt to.".. be young, white-collar workers who are healthy, affluent, and already exercising, while those most in need of exercise to improve their health are less likely to participate." Real experiences and negative reactions to health and wellness programs are sometimes ignored and/or "overlooked" when researchers are seeking measurable outcomes.

Gemeinschaftsgefuehl, one of Adler's terms with no reported literal translation, means "social interest." (Myers, Luecht, and Sweeney) Rather than this term or social support as an extenuating factor for positive mental health, relational wellness may be deemed nearer to Adler's concept.

Spiritual connectedness, also derived from Alder, additionally serves to motivate individuals. Myers, Luecht, and Sweeney include these concepts, along with the wellness model, contrasted to the medical or illness model emphasizing disease and disability. The wellness model has become more popular as a strengths-based, positive, integrative, and holistic approach to human functioning understanding. In the study completed by Myers, Luecht, and Sweeney: "The 5F-Wel was administered to 3,993 volunteers over a 4-year period. The data were collected in conjunction with various research projects; clinical counseling assessments; wellness workshops; and both undergraduate and graduate courses in counseling, helping skills, and life-span development (i.e., the data were codified across multiple sources). All participants were volunteers who agreed to allow their data to be used for research purposes." One factor not yet addressed in wellness assessment, this study noted, consists of contextual factors influence on human functioning. A strong relational factor presence, incorporating aspects of one's environmental connection, implies, as this study hypothesized, that context does, in fact, affect an individual's well-being, one more delimitation that can be connected to health and wellness programs. The authors of this study, however, admit that currently, ways wellness differs among nonclinical and clinical samples is not known.

According to the "State Employee Wellness Initiatives" brief published in 2005, because state government constitutes the biggest single employer and health coverage purchaser in numerous states, state employee wellness programs are serve as pilots for health initiatives. Wellness and prevention programs primarily promote healthy habits, an understanding of particular lifestyle risks managing diseases and engaging in regular exercise. "Citing rising health care costs and alarming health statistics, several governors have implemented wellness and prevention programs in their states in the last few years."

Programs traditionally are categorized as:

Programs offering health assessments and monitoring

Health insurance incentives, ranging from discounts for nonsmokers to financial rewards for enrollees who reach personal health and fitness goals.

Healthy work environment initiatives, such as banning smoking near state office buildings and recognizing healthy worksites with awards

Fitness challenges and events, such as weight loss challenges, wellness expos, walking programs, and programs in which employees receive pedometers if they participate in a fitness challenge or health screening." ("State Employee Wellness Initiatives.")

State governments, the brief purports, serve as models to the private sector. Implementing a prevention and wellness program can help improve employees' health; augment productivity and morale. (Ibid) Some research strongly supports this supposition, while other works challenge the positives proposed through implementing wellness programs.

State Employee Wellness Initiatives")

After making a public announcement to become healthier, Georgia's Governor Sonny Perdue began the "Governor's Challenge: Fitness on My Mind," also, referred to as the "Capitol Challenge." 1,800 state employees reportedly accepted Perdue's health challenge. ("LOCAL PROFESSIONALS CONTRIBUTE...")

Public and private employers' reasons reported for starting wellness programs may stem from CEOs' personal health experiences, to vice presidents' agendas wanting to counter continuing yearly increases in health insurance premiums to... Whitson argues, however, that no matter the reason, the value for wellness programs is generally double:

1) There are tangible benefits to be gained, such as cost-savings; and 2) There are intangible benefits, such as improvements in employee morale." (Whitson)

Tangible benefits include the usual reports of:

Improved productivity

Reduced sick leave/absenteeism

Reduced use of health benefits

Reduced workers' compensation

Fewer injuries

Control of health insurance premiums

Lower turnover." (Ibid)

Whitson reports intangibles benefits to include the usual:

Improved employee morale

Increased employee loyalty

Reduced organizational friction

Better employee decision making." (WHITSON)

WHITSON, on the other hand does go a bit further than citing usual benefits as he presents suggestions to counter limitations generally accompanying health and wellness program. Same basic program "Do's and Don't's:

1) Make the program voluntary;

2) Continually market it to employees;

3) Be sensitive to age and body limitations as well as cultural differences;

4) Make the program as flexible as possible;

5) Evaluate the program frequently;

6) Make sure the management staff is modeling healthy behavior;

7) Reward the people who have helped put the program together;

8) Keep good records in order to properly evaluate the program;

9) Provide a balance of fun programs and those that are clinically significant;

10) Personalize the program to the workers' needs."

To measure a health and wellness program's success, fitness classes' participation levels need to range from 40 to 80%, with new member regularly joining. Individuals who are replacing unhealthy habits with more positive ones should measure from 10 to 35%, as evidenced by healthier food choices; exercising regularly; maintaining ideal weight; ceasing smoking.

Absentee rates should decline between 20 to 70%. Although monitored measurements will be dependent on employees' following through with program, as well as, program's intensity, health care costs should decrease between five to 25%. (Ibid)

The Wellness Policy presented on the website for the Southwest Health District, a 14 county public health district for over 300,000 citizens cites their mission.".. is to prevent disease, injury, and disability; promote health and well-being; and prepare for disasters." ("Wellness Policy.") the District Health Director encourages employees to make positive mental and physical lifestyle choices. Wellness breaks throughout the workday are also authorized help employees meeting their health-oriented goals.

Guidelines for use of wellness breaks include:

maximum of 30 minutes in a given workday may be used to engage in wellness activities, generally in the form of two 15-minute breaks or one 30-minute break

Employees will sign out and/or clock out for wellness breaks as appropriate to their work site

With sufficient justification and accountability, supervisors may allow staff to combine wellness breaks with lunch breaks or to use wellness break time at the beginning or end of the day

Wellness breaks cannot be taken in addition to other breaks

Wellness breaks may be used for activities including but not limited to:

Walking or jogging

Swimming

Workout at gym

Meditation and other activities to improve emotional/mental health

Counseling, educational training, and support functions for behavioral modification (i.e. tobacco and other addictions)." (Ibid)

The above four components: Proper Nutrition; Increase Physical Activity; Stress Reduction; Smoke Free are repeatedly stressed for major focus of Health and Wellness Programs.