Health Promotion in the Workplace

In this column over the past year I have written about the various ways that chiropractors can assist industry in the prevention of on-the-job musculoskeletal injuries. I have personally spent a great deal of time working with individual companies in an effort to accomplish a reduction in injury frequency, severity and cost. As the burden of health care and the costs of injuries continues to rise I have seen an increasing interest on the part of American industry in cost containment through injury prevention. In this issue of Dynamic Chiropractic I would like to address another dimension: health promotion in industry.

As evidence that industry is finally ready to take health promotion and wellness seriously, a recent US Public Health Service publication described the following goals:

1) establish in 50 States either public health or labor department programs that provide consultation and assistance to small businesses to implement safety and health programs for their employees; 2) increase to at least 50% the proportion of worksites with 50 or more employees that provide nutrition education and/or weight management programs for employees (baseline: 17% nutrition education, 15% weight control in 1985); 3) increase to at least 75% the proportion of primary care providers who provide nutrition assessment and counseling and/or referral to qualified nutritionists or dietitians; 4) increase the proportion of worksites offering employer sponsored physical activity and fitness programs; and 5) increase to at least 50% the proportion of primary care providers who routinely assess and counsel their patients regarding the frequency, duration, type, and intensity of each patient's physical activity practices (baseline: 30% in 1988) (Healthy People 2000: National Health Promotion and Disease Prevention Objectives).

The wellness movement is viewed by some companies as the latest management fad, by others as an expensive bit of unnecessary fluff. Critics often view it as a cheap public relations gimmick. It should, however, be seen as a solid investment. For every dollar spent on health promotion, the savings to industry may range from $2 to nearly $7.

Wellness may be defined as a process of being aware of and altering behavior toward a more successful physical, mental, emotional, psychological, occupational, and spiritual existence. Roger B. Smith, CEO of General Motors, stated that "American industry can't afford not to expand the wellness movement in the workplace ..." In The Healthy Workplace, Kizer suggested a three pronged approach to getting health care costs under control: 1) instituting wellness programs; 2) revamping health insurance policies (i.e., increasing deductibles and having employees pay more for coverage); and 3) changing the structure of the health care delivery system. As chiropractors, we may not have any direct influence over the health insurance policies or the health care delivery system, but we are definitely able to assist companies institute wellness programs. No other profession has addressed the issue of health and wellness with the intensity of the chiropractic profession. Who better to provide such information to industry?

Let's look at some of the health care costs to employers. It has been stated that nearly $2,000 of the cost of every new car sold goes to pay for the health care costs of automobile workers. Overuse and abuse of health care alone is said to account for more than $600 of the price of each new car sold. In 1985, the total cost for health care in the United States was more than $1 billion per day, with U.S. companies paying over $87 billion in health insurance premiums. Health care is the nation's second largest employer and for many companies, represents one of the largest single expenditures, second only to payroll.

While some larger companies have instituted wellness programs, smaller companies with less resources struggle to combat rising health care costs. In the United States, 99.5 percent of all businesses are small businesses. Many Americans work for companies with less than 10 employees, and a full half of all employed people work for firms with less than 100 employees. While many of these companies may not have the financial resources to make elaborate changes, the bottom line is that companies can get started in wellness with a small investment or no investment at all! Let's take a look at ways that companies can move towards a healthier work force.

Steps companies can take to promote better nutritional habits in employees: 1) put a picnic table outside; 2) invite Weight Watchers to use meeting rooms; 3) print a better health shopping list; 4) buy a microwave oven; 5) put a scale by the coffee pot; 6) provide salt and sugar substitutes; 7) offer alternatives to coffee; 8) start a vending machine awareness program; 9) announce a "healthy lunch box day"; 10) substitute bran muffins and fresh fruit.

Steps companies can take to promote activity and exercise; 1) encourage employees to park at the far end of the parking lot; 2) hold exercise sessions after work and at lunch; 3) buy aerobic exercise cassettes or videotapes for employees; 4) encourage employees to use the stairs; 5) schedule regular stretch breaks; 6) buy or supplement memberships in health clubs; 7) arrange corporate discounts for exercise equipment; 8) provide maps of walking and jogging areas near work; 9) organize noontime walking programs; 10) encourage employees to ride bikes (install bike racks); 11) form a group called "Exercisers Anonymous"; 12) support volleyball, baseball, softball, bowling leagues, etc.

Stress management: 1) create a quiet room; 2) buy a blood pressure machine and train someone to use it; 3) buy relaxation tapes and self-help cassettes.

Health promotion in general: 1) designate a bulletin board for health information only; 2) subscribe to health magazines; 3) build a library of self-help books and cookbooks; 4) form support groups for employees health information; 5) provide workshops on better health; 6) hold brown bag lunches once a month and invite local experts to speak on the topics of nutrition, weight control, stopping smoking, alcohol abuse, first aid techniques, balancing career and family, etc.; 7) put together a mobile exhibit to travel around to different plant sites or work locations; 8) offer noontime workshops on women's health issues; 9) conduct health risk appraisals and medical screenings (glaucoma, high blood pressure, diabetes, sickle cell anemia, etc.); 10)support a health fair and encourage employees to attend.

A study published in 1972 (Belloc and Breslow) looked at healthy octagenarians in an attempt to identify common denominators that would account for their longevity and health. The study found the individuals had the following in common; 1) did not smoke; 2) ate three regular meals a day; 3) always ate breakfast, 4) slept 7-8 hours each night; 5) maintained normal weight; 6) drank alcohol only in moderation; and 7) exercised moderately 2-3 times a week. In other words, these individuals lived moderate lives and used common sense. How much could the chiropractic profession benefit the lives of corporate America if we took on the challenge of improving the health and well-being of American workers? What if we spent our time in a serious attempt to help others instead of battling ourselves?

Editor's note: if you have any questions, suggestions, or comments please write to Dr. Paul D. Hooper c/o Injury Prevention Technologies, 21343 Cold Springs Lane, Suite #443, Diamond Bar, California 91765

Paul Hooper, DC
Diamond Bar, California

DC