Incentives and barriers to workplace health promotion

Worksite programs designed to change modifiable health risk factors such as obesity and smoking have lead to better health for employees and decreased health care costs for employers. Yet, barriers to participation in health promotion/disease prevention (HP/DP) programs remain. The role of key stakeholders – employers, employees, and health plans, and the incentives and barriers encountered providing these HP/DP programs – are reviewed in an article in the June issue of the Journal of Occupational and Environmental Medicine, the official publication of the American College of Occupational and Environmental Medicine (ACOEM).

To be most effective, HP/DP programs should be integrated into the traditional health protection mission of occupational health and safety professionals, states Tamara M.K. Schult, M.P.H., of the University of Minnesota and coauthors.

In 1999, some type of health promotion activity was reported by 95 percent of companies with more than 50 employees. Yet barriers to effective HP/DP programs remain. Participation rates are low, programs are not always targeted to the employees who need them most, and smaller companies are unable offer them due to limited purchasing power and resource restraints.

For employers, the need to control continually rising health costs is a powerful incentive to participate in HP/DP programs. In addition, many companies are shifting to a "human capital approach," recognizing that improvements in worker health may lead to gains in corporate performance.

Other barriers to investing in employee health include the fact that the benefits may be intangible or might not be realized for years. Federal insurance regulations can pose barriers as well—for example, employers are restricted from rewarding employees who make positive health changes. Partnering with health plans may avoid some of the confidentiality and other barriers to worksite HP/DP programs.

Ultimately, the success of health promotion programs depends on employee participation. It has been debated that shifting health costs from employers to employees will give workers incentives to decrease their costs, but this has yet to be proven. Despite the obvious benefits of improved health, many people do not want to change their behavior, even if they're aware of the health risks. Several studies have found that other incentives are needed to increase employee participation in HP/DP programs.

Historically, the federal government has provided only modest support for prevention, including HP/DP programs. Signs this may be changing include the National Institute for Occupational Safety and Health's "Steps to a Healthier U.S. Workforce Initiative," designed to integrate healthy lifestyle promotion into workplace safety initiatives.

For professionals in the occupational health fields, HP/DP programs offer an opportunity to expand their role. By broadening their traditional emphasis on environmental health and safety, occupational health professionals can incorporate risk-reduction strategies into a spectrum of services supporting a healthy work environment and managing employee health. "The time is right for occupational and environmental physicians to vigorously collaborate with all the key stakeholders in HP/DP to create the integrated health protection and promotion programs of the 21st century," the authors conclude.

ACOEM, an international society of more than 5,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.