CDC Grand Rounds: New Frontiers in Workplace Health

Abstract

Approximately 150 million Americans go to work each day, and where and how they work are closely linked to health and disease. Thus, workplace health promotion programs provide an opportunity to affect the health of the nation. Workplace health promotion programs traditionally rooted in occupational safety and health focus on preventing injury and illness resulting from the workplace environment. As gains have been made in reducing workplace hazards, and the prevalence of disease has shifted toward chronic diseases, employers have encountered rising health care costs. In the United States, chronic diseases are responsible for approximately seven in 10 deaths and account for 86% of health care costs (1,2). Approximately 20% of employer health care spending is associated with 10 modifiable health risks in the U.S. workforce: depression, high blood glucose, high blood pressure, obesity, tobacco use, physical inactivity, high stress, high cholesterol, poor nutrition and eating habits, and high alcohol consumption (3). Many employers have sought to establish workplace health promotion programs to improve employee health and lower health care costs; results of these efforts have been mixed. For example, some employers, especially smaller firms with limited resources, report barriers to implementing workplace health promotion programs, including lack of knowledge of program design, difficulty identifying credible information, and lack of awareness of program benefits (4,5). Evaluation and research continue to increase knowledge about workplace health promotion program design and identify ways to overcome the challenges of establishing effective programs. State health departments can provide assistance to employers and employees. In 2017, the CDC Workplace Health Resource Center was launched as a source for reliable evidence and best practices to improve worker health and productivity, address research gaps, and potentially reduce health care costs. This is another in a series of occasional MMWR reports titled CDC Grand Rounds. These reports are based on grand rounds presentations at CDC on high-profile issues in public health science, practice, and policy. Information about CDC Grand Rounds is available at https://www.cdc.gov/grand-rounds. Workplace health promotion programs are popular with both employers and employees, although programs offered by employers vary considerably. Healthy People 2010 established five elements for a comprehensive workplace health promotion program, including 1) health education; 2) supportive social and physical environments; 3) integration of the worksite program into the organization's culture; 4) links between health promotion and related programs like employee assistance; and 5) screenings with follow-up (6). A 2017 study based on two independent, nationally representative surveys of U.S. employers and employees (7) found that 81% of 705 surveyed employers offered some type of workplace health promotion program (Figure). The most frequently offered program elements were screenings with follow-up (70.4%), health education (64.3%), a supportive environment for health improvement (63.7%), and links to other employee services (50.4%). Using these same five elements, the 2015 Harris Poll Nielson survey found that a minority of employers (13.3%) offered comprehensive workplace health promotion programs (7). The existence of a workplace health promotion program, however, guarantees neither its use nor any resulting health and economic benefits. Among 1,833 employees surveyed by the 2015 Harris Poll Neilson survey, fewer than half (45%) reported being offered some form of workplace health promotion program, and 55% of those who were offered such a program reported participating (7). This gap between what employers offer and what employees perceive or use might reflect the variability in what program elements employers offer, or more likely, improperly designed programs that are not based on best or promising practices, or are underresourced or poorly implemented or both. Workplace health promotion programs that do not follow best practices, including assessing needs, often have low employee participation (7,8). However, accumulating evidence in the workplace health promotion program literature suggests that when these programs are well executed they benefit both employees and employers (5,9,10). In the 2015 Harris Poll Neilson survey, approximately three quarters of employers with a workplace health promotion program in place reported positive impacts from their wellness programs, including improved workers' health (83.6%); performance and productivity (83.3%); and reduced health care costs (73.6%) (7). Survey results did not shed light on what made particular programs successful. A meta-analysis found that for every $1.00 spent on wellness programs, $3.27 was