For the average employee, there are 2080 work hours in a year, and if one has a 45-year career span that totals over 93,000 hours. We likely spend more time with co-workers than family or friends. Given the concentrated dose of time at work logic might dictate that investments in workforce health make sense to impact employee health and wellbeing positively as well as supporting health care cost containment.
In the USA employer wellness is big business, curating a wellness approach involves looking at the population level data and includes demographics, risk profiles and also considers the type of work employees do, for example, is the company a mix of blue and white collar workers? What works for office-based employees may not be the same as those who are out in the field providing services like bus drivers, so any wellness plan needs to account for that blend. Another important consideration is the level of the culture of health a company shares. If the leadership support healthy behaviors and authentically models those, it increases the likelihood employees will engage as well. How well do the companies plan for wellness map their environment? If physical activity promotion is one feature of a plan how well might that work if stairwells are locked or aren’t appealing from a design perspective. If a goal is to promote healthy eating does the company rely on revenue from vending machines and are there healthy options for employees to purchase if those machines are the leading source of snacks for employees? Conducting an environmental assessment is prudent before a company embarks on an employee wellness journey.
A new paper in JAMA by Zirui Song from Harvard Medical School examines the effect of workplace wellness programs on health and economic outcomes. The study used a cluster randomized control method in 32,974 employees at a large warehouse retail company. The authors randomly selected twenty treatment worksites with 4,037 employees and 140 control sites with 28,937 employees which also included twenty control sites with 4,106 employees. The control site did not receive any wellness interventions. The then compared both venues on self-reported health and behaviors and clinical measures derived during biometric screening. The response and participation rates to the surveys and screenings were 36.2% and 44.6% respectively; the control group rates were comparable at 34.4% and 43%. Overall findings showed those who were exposed to the worksite wellness interventions self-reported 8.3% higher levels of health behaviors compared to controls. Over 18 months the intervention group reported engaging in regular exercise (69.8% vs. 61.9%) and reported higher rates of managing weight (69.2% vs. 54.7%). When the authors examined the biometric screening clinical data, they found no significant differences in cholesterol, blood pressure, or Body Mass Index (BMI).
Additionally, pharma spend, utilization measures and job tenure, job performance, and absenteeism levels were similar between intervention and controls. So where does this leave us? Investing in employee wellness is one mechanism to control health care costs. The average age of this population was 38.6 years and comprised 45.9% female employees. One could argue chronic conditions may start in older workforces, but the early markers of chronic and metabolic disease like elevated blood pressure, cholesterol, and BMI are present in this employee population. The utilization measures included ED, urgent care and preventive care, physician visits, and hospitalization levels were obtained from claims data from Cigna.
The literature is clear that moving a population from being sedentary to active (<30 mins/day physical activity to > 30 mins/day) shows a 19% reduction in all-cause mortality. Perhaps the dose of the intervention was insufficient to show changes in health markers? For weight management, a 5% weight loss would be necessary to see changes in health makers like reduction in risk for diabetes. Did the timeline and intervention dose account for the cadence of weight loss and regain?. It is possible that the intervention group lost more weight, but the assessment timelines may have re-assessed when weight-regain was occurring as over 18 months you could see a 6-month weight loss trajectory followed by a slower regain curve. We know there is a legacy effect from initial weight loss from the published literature on diabetes prevention. The initial Diabetes Prevention Program RCT showed 58% of participants delaying or preventing transition to diabetes with a 5% weight loss that held to 29% over a longer time horizon so inital weight loss matters even if regained.. We don’t see the full picture in this study. It also points to the challenge of studying these populations.
Since we spend so much time at work or in workplace environments continuing to understand the levers to pull to promote healthy behaviors that impact health outcomes seems prudent for employers to consider as part of their overall employee offerings. Insufficient intensity of interventions needs to be addressed in program offerings.
Thanks for reading – Trina
(Opinions are my own)
Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial
JAMA. 2019;321(15):1491-1501. doi:10.1001/jama.2019.3307