The Financial Benefits of Health and Wellbeing Programs in the Workplace

Over the past 100 years, the leading causes of death for Americans have shifted from infectious to chronic diseases. The 10 leading causes accounting for 74.1% of all deaths in the United States in 2020 were¹: 

1. Heart disease *
2. Cancer *
3. COVID-19 *
4. Unintentional injuries and accidents *
5. Cerebrovascular disease (stroke) *
6. Chronic lower respiratory diseases *
7. Alzheimer disease
8. Diabetes mellitus *
9. Influenza and pneumonia
10. Kidney disease to include nephritis, nephrotic syndrome, and nephrosis

_{* Indicates condition has preventable or modifiable health risks}

Figure 1

Most of the leading causes of death for adults in the United States have preventable or modifiable risk factors².70% of premature mortality has a modifiable, behavioural, or environmental etiology³. Nearly 50% of Americans have at least one preventable chronic medical condition. Of these, over half have multiple conditions. 86% of the healthcare dollar is spent on treating these mostly preventable chronic diseases⁴. Indeed, the annual medical claim costs for individuals with five or more health risks that cause chronic disease were double the cost of those who had fewer risks⁵. Furthermore, a large study of close to 100,000 workers in seven large companies found that 22.4% of the organizations’ healthcare dollars were spent on conditions related to ten common yet modifiable risk factors.   

Figure 10

Realizing that reducing individual health risks is fundamental to improving health outcomes and preventing some chronic diseases, institutions in the civilian and government sectors alike have considered shifting from a reactive healthcare system to a proactive system for health. To this end, organizations and businesses have turned to wellbeing programs to create a healthy environment where health changes can take place through an integrated health promotion and wellbeing strategy. These wellbeing initiatives have produced sustainable, positive effects on reducing medical utilisation, absenteeism, presenteeism, illnesses, injuries, chronic disease, obesity, alcohol and tobacco use, morbidity, mortality and job and life-related stress while at the same time increased worker strength, flexibility, cardiovascular fitness, weight loss, cholesterol and glycemic control, endurance, fitness, productivity, life and job satisfaction^{17,18,19,20,21,22,23}.

The National Institute for Occupational Safety & Health (NIOSH) has sought to address this growing concern by developing their “Total Worker Health” program which addresses efforts to improve overall worker wellbeing by evaluating health risks and safety issues. Furthermore, CDC has outlined steps to enhance wellbeing and reduce preventable diseases, disability, injury, and premature death through “Healthy People 2030”.  These programs focus on factors and objectives that improve health and wellbeing, especial those that have a modifiable component.

In addition to increasing the health of the worker, employers with proactive health promotion and wellbeing strategies often see financial benefit. There is ample research suggesting that enterprises that implement wellbeing programs can realize reductions in total healthcare expenditures^{24,25,26,27,28,29}. Additionally, specific, and targeted preventive health programs improved health outcomes while also having a positive effect on organisational return on investment³⁰.

Figure 24

In conclusion, current studies suggest the need for a paradigm shift from a reactionary healthcare system to a value-based proactive system of health³¹. Disruptive innovation as a means of promoting an integrated, synchronised, and holistic approach to prevention may be in order to adequately address and improve the physical, mental and social wellbeing of employees through risk reduction.  Evidenced-based lifestyle medicine aimed at reducing health risks and disease prevention is at the core of achieving better overall health, wellbeing and quality of life and can reduce healthcare costs and improve job performance and satisfaction³².

REFERENCES

1. Murphy SL, Kochanek KD, Xu JQ, Arias E. Mortality in the United States, 2020. NCHS Data Brief, no 427. Hyattsville, MD: National Center for Health Statistics. December, 2021
2. Johnson NB, Hayes LD, Brown K, et al. CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioural Risk and Protective Factors—United States, 2005–2013.  MMWR 2014;63(Suppl-4):1-27.
3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–1245.
4. Chronic Conditions: Making the Case for Ongoing Care. September 2004, Update to Chronic Care in America: A 21st Century Challenge, a Study of the RobertWood Johnson Foundation & Partnership for Solutions. Baltimore, MD: Johns Hopkins University; 2004.
5. Edington DW. Emerging research: a view from one research center. Am J Health Promo. 2001;15:341–349.
6. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000;343:16-22.
7. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001;345.
8. Perspectives in Disease Prevention and Health Promotion Smoking-Attributable Mortality and Years of Potential Life Lost -- United States, 1984. MMWR 1997;46:444-51.
9. Dall TM, Zhang Y, Yaozhu J, et al. Cost Associated With Being Overweight and With Obesity, High Alcohol Consumption, and Tobacco Use Within the Military Health System's TRICARE Prime–Enrolled Population. American Journal of Health Promotion: November/December 2007, Vol. 22, No. 2, pp. 120-139.
10. Cohen and Yu, The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009.
11. Merrill RM, Hyatt B, Aldana SG, Kinnersley D. Lowering employee healthcare costs through the Health Lifestyle Incentive Program. J Public Health Manag Pract. 2011;17:225–232.
12. Aldana SG, Merrill RM, Price K, et al. Financial impact of a comprehensive multisite workplace health promotion program. Prev Med. 2005;40:131–137.
13. Serxner SA, Gold DB, Grossmeier JJ, Anderson DR. The relationship between health promotion program participation and medical costs: a dose response. J Occup Environ Med. 2003;45:1196–1200.
14. Collins JJ, Baase C, Sharda C, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47:547–557.
15. Henke RM, Carls GS, Short ME, et al. The relationship between health risks and health and productivity costs among employees at pepsi bottling group J Occup Environ Med. 2010;52:519–527.
16. Curkendall S, Ruiz KM, Joish V, Mark TL. Productivity losses among treated depressed patients relative to health controls. J Occup Environ Med. 2010;52:125–130.
17. Merrill RM. A Small Business Worksite Wellness Model for Improving Health Behaviors. JOEM, Vol 55, Number 8, August 2013. P895-900.
18. Institute of Medicine. Integrating Employee Health: A Model Program for NASA. Washington, DC: National Academy of Sciences; 2005. Available at http://www.iom.edu/Reports/2005/Integrating-Employee -Health-A-Model-Program-for-NASA. Accessed August 26, 2013.
19. Mattke S, Liu H, Caloyeras JP, et al.  Workplace Wellness Programs Study Final Report. 2013. Rand Health.  www.rand.org/health.
20. Osilla, KC., K Van Busum, et al. Systematic review of the impact of worksite wellness programs. The American Journal of Managed Care. 2012. 18(2): 68–81.
21. Campbell, M. K., I. Tessaro, et al. Effects of a tailored health promotion program for female blue-collar workers: health works for women. Preventive Medicine, 2002, 34(3): 313–323.
22. MacKinnon, D. P., D. L. Elliot, et al. Long-term effects of a worksite health promotion program for firefighters. American Journal of Health Behavior, 2010,34(6): 695–706.
23. Koertge J, et al. Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project. Am J Cardiol. 2003 Jun 1;91(11):1316-22
24. Edington DW. Zero Trends: Health as a Serious Economic Strategy. Ann Arbor, MI: Health Management Research Center; 2009
25. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang SH, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting US employers. J Occup Environ Med. 2004;46:398–412.
26. Pronk NP, Goodman MJ, O’Connor PJ, Martinson BC. Relationship between modifiable health risks and short-term health care charges. JAMA. 1999;282:2235–2239.
27. Goetzel RZ, Carls GS, Wang S, et al. The relationship between modifiable health risk factors and medical expenditures, absenteeism, short-term disability, and presenteeism among employees at Novartis. J Occup Environ Med. 2009;51:487–499
28. Goetzel RZ, Anderson DR, Whitmer RW, et al. The relationship between modifiable health risks and health care expenditures—an analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med. 1998;40:843–854.
29. Pronk N. An optimal lifestyle metric: four simple behaviors that affect health, cost, and productivity. Am Coll Sports Med. 2012;16:39–43.
30. Naydeck, B. L., J. A. Pearson, et al. (2008). The impact of the highmark employee wellness programs on 4-year healthcare costs. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine 50(2): 146–156.
31. MacStravic, Scott. "Pricing and paying for proactive care: the allure of cost savings from proactive health care has given rise to a new way of thinking about healthcare prices and payment." Healthcare Financial Management, vol. 60, no. 10, Oct. 2006, p. 82+. Accessed 12 Aug. 2020.
32. Hyatt NB, Merrill RM, Kumpfer KL. Longitudinal outcomes of a comprehensive, incentivized worksite wellness program. Eval Health Prof. 2011;34:103–123.
33. Trogdon JG, Finkelstein EA, Hylands T, et al. Indirect costs of obesity: a review of the current literature. Obes Rev. 2008 Sep;9(5):489-500.