Promoting Employee Wellness Through Healthier Workplaces
Employers may hold the key to reducing employee health risks; through corporate wellness programs, employers can take aim at new health risks such as workplace stressors.
The traditional wellness model focuses on employees’ personal health behavior that can drive up health risks and medical costs. To reduce the personal health risks of employees that are believed to drive a significant portion of medical costs, these programs incent employees to participate in health screening and behavior risk reduction. Employers sometimes use other methods, such as bans on tobacco or unhealthy foods on their campuses, to send a consistent message about the importance of personal health.
While employers gain medical and lost-time cost reduction through these programs, employees may actually benefit the most. In dramatic cases, lives are saved, and many more lives are enhanced by reducing identified health risks through smoking cessation, exercise, weight reduction, chronic condition management, and other activities.
Long-term behavior change can be difficult at best to maintain, especially for people with entrenched high-risk behaviors. Many deep-rooted psychosocial factors drive habitual high-risk behavior. For example, recent research has shown that bounceback weight gain following weight loss is not just mental or emotional, but has a physiological component as well. People who have lost weight quickly must fight an internal war against their own hormonal and metabolic1 And many wellness programs have observed that people who need help the most are often the most resistant to the challenge of health change.
As a result, many wellness programs have expanded to include non-medical-related factors that can increase stress, which is a major cause or contributor to health problems. Financial wellness with debt reduction, retirement savings, improved options to care for aging parents, and legal services are all popular new stress-busting additions to wellness programs. Many wellness programs have strong links with employee assistance programs (EAPs) to expand the use of EAPs and increase their impact.
All of these approaches assume employees are ready to participate and change, and that they have a robust internal locus of control that will make them the stars of their own health-improvement drama. It’s a wonderful, inspiring narrative that does not always materialize.
The Employer Locus of Control
Employers have other options where they have more control to reduce risk, but these may need more development. Employers may be able to act unilaterally to significantly reduce workplace stress factors that increase employee health risks, according to a February 2017 research study in Health Affairs.2
Most work environments contain a constellation of stress factors that can be reduced. The Health Affairs study found that these may increase the risk of hypertension, one of the leading risk factors for cardiovascular disease. The study of 13,978 blue collar workers in 24 Alcoa aluminum manufacturing plants from 1996 to 2012 relied on worker ratings of social environment, external rating of physical hazards, and psychological hazards in the workplace.
The study concluded that “these broader aspects of the work environment, taken together, represent a potentially large burden contributing to hypertension.”
When the factors were isolated for their impact as independent variables, “psychological demands” of a job was the second most significant factor, with a higher level of demands associated with 15% greater prevalence of hypertension. The only higher correlation with hypertension was a coefficient that measures the impact of living, early in life, in a state with high income inequality, where prevalence of hypertension was 17% higher. The strongest association among physical work factors with hypertension were having a sedentary job which had 7% higher hypertension, and a job that involved a lot of reaching, which had 6% higher hypertension. An earlier study found that working in a job with high psychological demands put employees at “greater risk of serious injury.”3
The authors acknowledged that “it is an open question whether workplace characteristics are easier to change than individual health behaviors — each is a challenge for different reasons.” Part of the challenge in trying to modify workplace characteristics to reduce health risk is to understand how the factors affect each other, and the nature of their relationship to risk.
Some of the findings seem intuitive and therefore relatively simple to apply as criteria for worksite management. Job psychological demand had a clear and significant linkage with hypertension, so reducing psychological demand could be a reliable strategy.
In another example, “better impressions of the company and more meaningful recognition were associated with lower hypertension.” While this does not answer the important question of which types of recognition are most meaningful to employees, it reminds us that meaningful recognition actually can reduce stress.
But some significant factors operated in ways that would appear to make them difficult to manage. For example, the study found that “positive feelings about the supervisor and work-life balance were associated with greater hypertension.” So if an employee likes their supervisor and their work-life balance, is this a stressor? Perhaps if the employee is worried about losing these valued conditions. But how does an organization take steps to reduce the stress that can arise from this scenario? Perhaps continuous positive reassurance by a kind supervisor can make a big difference for an employee.
In looking at how much of hypertension could be explained by groups of factors, the social environment was associated with 40% of the prevalence of hypertension (the study design could establish association but not cause), and the psychological hazards and physical hazards were each associated with about 10% of the hypertension. So the workplace itself appears to be a significant contributor to hypertension — thus making it an important target for changes to improve health.
The Health Affairs study provides a clear indication that modifying workplace culture has potential to significantly reduce stress and thus improve employee health. But what would be the right approach for any individual organization? Companies could survey employees to identify which aspects of the work culture have the highest impact on employees, consider strategies for change, implement changes, and evaluate whether these improve employee satisfaction and result in better health for employees.
- Fothergill E, J Guo L Howard, JC Kerns, ND Knuth, R Brychta, KY Chen, MC Skarulis, M Walter, PJ Walter, KD Hall. Persistent Metabolic Adaptation 6 Years After “The Biggest Loser” Competition. Obesity, Aug. 2016. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/full
- Rehkopf DH, S Modrek, LF Cantley, MR Cullen. Social, Psychological, and Physical Aspects of the Work Environment Could Contribute to Hypertension Prevalence. Health Affairs. Feb. 2017, Vol. 36 No. 2, p. 258-265. Retrieved from http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/content.healthaffairs.org/content/36/2/258.abstract=3fsid=3dde5d8838-974f-4248-98c6-e96c09ab5495
- Cantley LF, B Tessier-Sherman, MD Slade, D Galusha, MR Cullen, M. R. (2016). Expert Ratings of Job Demand and Job Control as Predictors of Injury and Musculoskeletal Disorder Risk in a Manufacturing Cohort. Occupational and Environmental Medicine, 73(4), 229–236. Retrieved from http://doi.org/10.1136/oemed-2015-102831