The workplace offers an opportunity for chronic disease prevention. Chronic diseases largely result from health behaviors (1
), and the workplace helps shape these behaviors through 4 important avenues: health insurance, workplace policies, health promotion programs, and communications. Health insurance affects workers' use of preventive care, such as tobacco use cessation programs and screening for colorectal cancer. Health insurance benefits offered by employers to workers and their dependents cover 158 million US residents and 59% of workers (2
). Workplace policies can reduce harmful environmental exposures, such as exposure to secondhand smoke, and can increase access to physical activity facilities and healthy foods. Workplace programs, such as group physical activity programs and on-site influenza vaccinations, offer workers easy access to and social support for healthy activities. Workplace communications, such as e-mails, pamphlets, posters, and Web sites, can improve knowledge and shape beliefs, attitudes, and perceived norms about health behaviors and the health insurance benefits, policies, and programs aimed at improving them. Workplace communications can reach all workers, regardless of insurance coverage or program participation.
Employers increasingly recognize the financial effect of chronic diseases and the behaviors that cause them (3
). Chronic diseases increase labor costs through many means, including health care costs, but also through productivity losses from missed work, decreased on-the-job effectiveness, and turnover when an employee becomes too ill to return to work (4
). Since 2001, the cost to employers of providing health insurance has increased by 78% (2
). Available data suggest that, for chronic diseases, the cost of productivity losses exceeds the cost of health care by as much as 4-fold (4
To mitigate the effect of chronic diseases on employee productivity and decrease health care costs, employers are increasingly implementing workplace health promotion efforts (5
). Much progress has been made in these efforts (6
), but they can fall short in 2 ways. First, employers often choose interventions that are ineffective or unnecessary. Examples are the widespread use of health risk appraisals to change worker health behaviors and the use of hypertension screening in the workplace. Health risk appraisals alone do not change behaviors (6
). Hypertension screening is so well-implemented in clinical care that very few need it provided elsewhere (7
). (Author analyses of 1999 data from the Behavioral Risk Factor Surveillance System [BRFSS], the most recent available for hypertension screening, show that more than 90% of working adults aged 18 to 64 years, nationally and in Washington State, were screened for hypertension within the previous 2 years [8
]). Second, employers often fail to choose effective interventions that offer the most value, measured in health outcomes and cost-effectiveness, for the preventive care dollar invested. For example, tobacco use cessation treatment and influenza vaccinations offer good return on investment but are fully implemented in less than a quarter of workplaces (5
A public health approach to workplace health promotion can solve both of these problems (9
). This approach is commonly used by the Centers for Disease Control and Prevention (CDC) and public health researchers and practitioners to frame efforts in a variety of public health issue areas. For the workplace, the approach involves 5 stages: 1) defining the problem, in this case, chronic diseases among workers; 2) elucidating risk factors, in this case, behaviors; 3) identifying effective interventions, 4) implementing suitable interventions, and 5) evaluating effectiveness.
For the past 6 years in Washington State, we have worked with employers, health departments, nonprofit organizations, and wellness program vendors to develop this 5-stage approach to preventing chronic diseases via the workplace and to make a compelling business case for its use. We summarize here information from both national and Washington-specific sources about each of the 5 stages and then offer conclusions.