Massachusetts Department of Public Health
Division of Prevention and Wellness
Creating a Culture of Health: Organizational Approaches to Promoting and Protecting Employee Health
Results from the 2008 Massachusetts Worksite Health Improvement Survey
Deval L. Patrick, Governor
Timothy P. Murray, Lieutenant Governor
JudyAnn Bigby, MD, Secretary of Health and Human Services
John Auerbach, Commissioner, Department of Public Health
July 2009
Acknowledgements
The staff that prepared this report:
Lisa Erck, MS, Coordinator of Worksite Initiatives
Hilary K. Wall, MPH, Senior Epidemiologist
Letitia Davis, ScD, EdM, Director, Occupational Health Surveillance Program
Katrina D’Amore, MPH, Epidemiologist
Special thanks to Suzanne Nobrega and other colleagues at the Center for the Promotion of Health in the New England Workplace (CPH-NEW) at the University of Massachusetts Lowell who offered invaluable expertise and guidance to the 2008 Massachusetts Worksite Health Improvement Survey.
We wish to express our gratitude to the worksites of MA who participated in this survey, and to Ulrich Research, Inc. for survey implementation, data entry, and data analysis. We also wish to acknowledge the contributions of the staff of the many programs within the MA Department of Public Health who provided topical overviews and reviewed draft sections of this report relevant to their areas of expertise. Thanks also to Gregory Wagner, National Institute for Occupational Safety and Health (NIOSH), Glorian Sorenson, Harvard School of Public Health, and Beth Rosenberg, Tufts University School of Medicine, for their input in designing the survey.
Table of Contents
A Tool For You / 8
How You Can Help / 8
Worksite Health Improvement Survey Results and Suggestions for Taking Action / 8
Making Wellness an Organizational Priority / 8
Health Services and Education / 11
Nutrition and Healthy Eating / 13
Physical Activity Opportunities / 14
Stress Management / 15
Tobacco, Alcohol, and Drugs / 18
Occupational Safety and Health / 20
Emergency Response / 25
Glossary / 27
References / 29
Appendix A / 30
Appendix B / 32
Tables and Figures
Table 1 / Distribution of responding worksites by industry sector and size with statewide comparison / 6
Table 2 / Percent of worksites that offer nutrition information by worksite size / 13
Figure 1 / Percent of worksites with an annual health promotion budget by worksite size / 9
Figure 2 / Common factors used to calculate a worksite health return on investment / 10
Figure 3 / Percent of worksites with preventive services covered by insurance by North American Industry Classification System code / 12
Figure 4 / Type of preventive services included in MA worksite insurance benefits / 12
Figure 5 / Type of stress reduction policies in MA worksites / 16
Figure 6 / Ways in which worksites support new parents / 17
Figure 7 / Places where smoking is permitted during work hours / 17
Figure 8 / Percent of worksites with policies governing employee smoking during the workday by North American Industry Classification System code / 20
Figure 9 / Type of assistance offered to help employees quit smoking / 20
Figure 10 / Percent of worksites with a worksite committee for health and safety hazards by worksite size / 22
Figure 11 / Percent of worksites with policies or procedures for reporting work-related injuries by North American Industry Classification System code / 22
Figure 12 / Percent of worksites reporting audit conduction to identify health and safety hazards by North American Industry Classification System code / 23
Figure 13 / Percent of worksites that maintain a log of illnesses and injuries by worksite size / 23
Figure 14 / Percent of worksites where managers analyze claims and injury data to plan workplace health and safety activities by worksite size / 24
Figure 15 / Percent of worksites with a written seatbelt policy by worksite size / 24
Figure 16 / Percent of worksites with at least one Automated External Defibrillator by worksite size / 26
Introduction
The majority of adults spend a significant amount of their waking hours at work. Thus the impact of worksite wellness programs on adults and their families can be significant considering that 66% of Massachusetts adults, or 3,122,010 people, are in the workforce. [1] Physical activity, healthy eating, managing stress, and avoiding tobacco are essential in lowering the risk of developing chronic diseases such as obesity, type 2 diabetes, heart disease, cancer, and stroke. Promoting a culture of health at the worksite provides opportunities for employees to change their behaviors. Once largely stand-alone enhancements, worksite wellness initiatives should be fully integrated within workplaces.
In 2006 Massachusetts became the first state in the country to accomplish near-universal access to affordable healthcare by passing Chapter 58 of the Acts of 2006, entitled An Act Providing Access to Affordable, Quality, Accountable Health Care. This legislation put much of the burden of insurance on employers. To help alleviate this burden, worksite wellness programs, in coordination with health and safety initiatives, work-life initiatives, supportive environments, and health benefit design programs, are providing more effective ways to deliver information about how to improve health and well-being. In building a comprehensive worksite wellness program, it is essential to address occupational health and safety hazards as well as risk factor prevention to create a worksite environment that is healthier for employees and enables them to more easily engage in healthy behaviors.
2008 Massachusetts Worksite Health Improvement Survey
In April 2008, the Massachusetts Department of Public Health (MDPH) surveyed a random sample of 3,000 worksites with 11 or more employees to assess their practices with regard to promoting and protecting employee health and well-being within their organizations. Eleven was chosen as the cut-off point to be in alignment with the Massachusetts Health Care Reform Act of 2006. The businesses were mailed a paper copy of the survey and respondents were given the option to complete the survey on-line. Follow-up phone calls were made as necessary to ensure adequate sample sizes. Just under 30% of the businesses (890) responded (Table 1), providing a comprehensive picture of how well the Commonwealth’s businesses support health-promoting behaviors. Appendix A contains detailed data on respondents.
The survey’s major findings indicate that employers are doing many things right: prohibiting the sale of tobacco products at the worksite, providing employees with on-site refrigerators and microwaves, implementing policies to support new parents, and implementing the legal requirement to report work-related injuries. The survey results also suggest many ways that worksites can become healthier such as providing on-site access to healthy foods with point-of-purchase information, offering preventive screenings and Health Risk Assessments, and coordinating between health and safety and worksite health promotion.
Table 1. Industry sector and business size with statewide comparison of responding worksites
2008 WorksiteSurvey Respondents / Massachusetts
Worksites With 10 or More Employees
Industry types
Education and Health Services
Manufacturing
Trade, Transportation, and Utilities
Professional & Business Services
Construction
Other Services
Financial Activities
Other / 17%
16%
15%
14%
10%
9%
7%
11% / 2
14%
8%
24%
15%
6%
5%
7%
20%
Business Size (no. employees)
Unknown
11-24
25-49
50-99
100-249
250-499
500-999
1,000+ / --
43%
25%
12%
9%
4%
3%
3% / 4
37%
29%5
21%6
7%
5%
1%
<1%
<1%
Notes: Industry groupings based on the North American Industry Classification System. The 2008 Massachusetts Worksite Health Improvement Survey was not administered to businesses with ≤ 10 employees
2 Source: Quarterly Census of Employment and Wages (QCEW), March 2006 data, Inclusive of all establishments in MA subject to state and federal unemployment compensation laws, U.S Department of Labor, Bureau of Labor Statistics, accessed at http://stats.bls.gov/cew/ew06table4.pdf(private sector data) and http://data.bls.gov/PDQ/outside.jsp?survey=en(public sector data)
4 Source Massachusetts Employment & Wage Program, March 2007, Includes all establishments subject to state and federal unemployment compensation laws, Executive Office of Labor and Workforce Development (EOLWD), accessed at http://lmi2.detma.org/Lmi/sizeclass.asp
5 29% of MA businesses with 10 or more employees have 10-19 employees per EOLWD business size categories
6 21% of MA businesses with 10 or more employees have 20-49 employees per EOLWD business size categories
Worksite Survey Respondents*
Health Insurance Providers
Blue Cross/Blue Shield
Harvard Pilgrim Healthcare
Tufts Health Plan
Fallon Community Health Plan
Health New England
Neighborhood Health Plan
United Healthcare
Other
Do not offer health insurance
*total exceeds 100% due to multiple carriers / 49%
20%
16%
7%
4%
3%
2%
8%
4%
Number of work-shifts
1
2
3 / 73%
15%
10%
Have unionized employees / 13%
North American Industry Classification System (NAICS) Codes
NAICS Code / Industry Sector Title / Examples of MA Industries in Industry Sector11 / Agriculture, Forestry, Fishing, and Hunting / Apple orchards, nursery and tree production, commercial fishing
21 / Mining / Construction sand and gravel mining
22 / Utilities / Electric power distribution
23 / Construction / Highway, street, and bridge construction; roofing and other specialty trade contractors, home builders
31-33 / Manufacturing / Fresh and frozen seafood processing, breweries, textile and fabric finishing mills
42 / Wholesale Trade / Fish and seafood merchant wholesalers
44-45 / Retail Trade / New car dealers, home centers, jewelry stores
48-49 / Transportation and Warehousing / Scheduled passenger air transportation, commuter rail systems, packing and crating
51 / Information / Newspaper publishers, radio networks
52 / Finance and Insurance / Credit unions, pension funds
53 / Real Estate and Rental and Leasing / Passenger car rental, video tape and disc rental
54 / Professional, Scientific, and Technical Services / Offices of lawyers, payroll services, testing laboratories
55 / Management of Companies and Enterprises / Offices of bank holding companies
56 / Administrative and Support and Waste Management and Remediation Services / Temporary help services, tour operators, solid waste collection
61 / Educational Services / Colleges, universities, and professional schools; fine arts schools
62 / Health Care and Social Assistance / Offices of physicians, HMO medical centers, community food services
71 / Arts, Entertainment, and Recreation / Museums, historical sites, sports teams and clubs, skiing facilities
72 / Accommodation and Food Services / Hotels, full-service restaurants
81 / Other Services (except Public Administration) / Car washes, automotive repair, nail salons, voluntary health organizations
92 / Public Administration / Legislative bodies, police protection
To the Employers of MA
A Tool for You
This report groups information from employers by business size and/or industry sector. Each section highlights certain areas where MA employers are doing well and others where there is room for improvement. Included within each section is an array of possible action steps and resources to making worksites healthier places to work. It is important to remember that while there are proven elements of a successful worksite wellness program, wellness is not one size fits all; resources available to employers vary greatly by business size and industry sector. While this report is meant to help you assess where your worksite is and where your worksite wants to go with regard to worksite wellness, it is most importantly a call to action for employers.
How You Can Help
As you read through the survey results and suggested action steps, consider your role in changing the work environment to protect and promote employee health within your organization. The policies and environmental supports suggested in this report are a guide for you to think about how to change your work environment to encourage employees to engage in behaviors to improve health and reduce the burden of chronic disease. Start small –address specific policies and environmental supports that impact the health risks of your employees and aim for establishing a comprehensive wellness program as outlined in this report. For additional information, you may contact Lisa Erck at the Massachusetts Department of Public Health at 617.624.5409 or .
Worksite Health Improvement Survey Results & Suggestions for Taking Action
1. Making Wellness an Organizational Priority
There is growing evidence that worksite wellness programs improve individual health, reduce absenteeism and workers’ compensation claims, and increase recruitment and retention efforts. Employers are in the unique position to help their employees improve health status and maintain low-risk health status by implementing interventions that are specific to each worksite and the diverse needs of employees and their families. In addition to creating a work environment that supports optimal employee health, choosing appropriate interventions is a critical step in developing and delivering a results-oriented worksite wellness program. The activities implemented in the worksite wellness program should reflect the overall wellness goals, the specific interests of the employees (from an interest survey) and the major health risks that are prevalent within the specific population (from claims data, Health Risk Assessment (HRA) data, and/or health screening results). In addition, using data to make the business case helps to generate continued support for comprehensive worksite wellness programs.
Survey Results
Set an annual budget: 4% of responding businesses had an annual budget for health promotion activities, although this varied greatly by business size (Figure 1).
Establish a wellness committee: 7% of businesses reported having a worksite wellness committee, with a direct correlation to business size.
Offer a Health Risk Assessment: 5% of respondents reported offering a Health Risk Assessment (HRA) to employees in the past year. Of those offering an HRA, 12% used the information to negotiate health insurance plans.
Utilize incentives: 8% of responding businesses offered incentives to employees to engage in healthy behaviors. These incentives included days off, monetary incentives, and incentives tied to insurance premiums.
Use data: 2% of responding businesses calculated a Return on Investment (ROI) for worksite health. Common data sources used to calculate the ROI include workers’ compensation claims and healthcare costs (Figure 2).
Suggestions for Taking Action for Making Wellness an Organizational Priority
Decide whether your goal is to reduce absenteeism, increase employee retention, or to increase worker productivity; be sure that your expectations are realistic; and evaluate progress on a regular basis (semi-annually or annually). In addition, align the worksite wellness program with company-wide goals and objectives.