Occupational Health

by Anna Harrington

Workplace health promotion

The following health promotion definition came from the first international meeting on health promotion. It implies that health promotion is about giving individuals control and the ability to make healthy choices about their lifestyles.

Definition

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment.

Health is, therefore, seen as a resource for everyday life, not the objective of living.

Health is a positive concept emphasising social and personal resources, as well as physical capacities.

This definition is taken from the European Network for Health Promotion.

Definition

Workplace Health Promotion (WHP) is the combined efforts of employers, employees and society to improve the health and well-being of people at work.

Workplace health promotion can be achieved through a combination of

  • Improving the work organisation and the working environment
  • Promoting active participation
  • Encouraging personal development.

The workplace provides a positive setting for health promotion: it is a place where individuals spend large amounts of time and it is a community that demands expected behaviours of its members. Health education is about the provision of information and material that informs individuals about recommendations for healthy lifestyles. Health promotion, on the other hand, is much more about creating the right environment and influences to make it easier for individuals to make healthy choices.

Note

Health education teams can be brought into workplaces to deliver information about healthy lifestyles, but unless individuals are influenced by their community and healthy choices are made easy, they are unlikely to take up these messages.

Benefits of health promotion in the workplace

Benefits include

  • Reduced work-related ill-health, sickness absence and benefit costs
  • Reduced absenteeism
  • Reduced staff turnover
  • Increased productivity
  • Being viewed as a caring employer
  • Improvements in morale.

The business benefits of promoting health in the workplace have not been robustly researched, but it is highly probable that all of the above apply, and it may well be that a healthy workforce is likely to be more resilient.

Well-designed interventions, with a specific work-related purpose, are more easily evaluated than such activities as the collection of physical health data (blood pressures, height and weight, cholesterol testing), which may not relate to a specific business objective. An example of a well-designed health promotion is given below.

Example

Purpose

  • To reduce time lost from musculoskeletal injury through improving the muscular strength and joint mobility of road menders

Driver (reason)

  • Ageing workforce
  • Sickness absence figures suggest a high number of musculoskeletal problems
  • Productivity is declining

Intervention

  • Physio or fitness instructor to design a programme of physical activities which improve strength and joint mobility; attendance needs to be linked with incentives

Evaluation

  • Numbers attending sessions
  • Improvements in performance measures taken at the sessions

Longer-term measures – improvements to the number of jobs teams are able to complete in a day, reduction in musculoskeletal sickness absence

Characteristics of workplace health promotion

The workplace can prove an excellent environment in which to promote healthy lifestyle choices:

  • It’s ‘healthy environment’ and not a ‘sick environment’, like a hospital
  • Health interventions can be delivered during the working day, when workers can attend
  • There’s a high proportion of healthy working-age clients in the workplace
  • There’s the possibility of peer support from colleagues
  • Depending on the industry, there may be a high proportion of men, who can tend to avoid seeing health professionals
  • There’s a captive audience and easy-to-follow-up interventions
  • Health promotion can be linked to existing health and safety and other programmes
  • There are obvious economic benefits to having healthier workers.

The employer has control over the work environment and culture of the organisation. Employers who create cultures which encourage employee engagement will also be having an influence on the choices that workers make in respect of their lifestyles. For instance, an employer who recognises and demonstrates that taking regular breaks, with access to physical activity, such as walking, will benefit because their employees will be refreshed and will find it easier to concentrate and focus.

An organisation needs to consider what is going to engage their employees and how are they going to create a culture which promotes employee engagement. An organisation that is built on trust and commitment will be a thriving organisation, both in the business sense and in the personal wellbeing of employees.

Why would people want to make a positive change to their health? The reasons behind making changes are individual, but generally relate to influences and pressures. For example, there is increasing social pressure on smokers and it is becoming less socially acceptable to smoke, especially in public, which makes it uncomfortable to continue smoking. Individuals will react differently and at different speeds. Some may find the pressure intolerable and so will make a change quickly (although it may not be to cease smoking); others may become resentful, so may continue with the same behaviour and may even adopt provocative behaviour.

Criteria for effective workplace health promotion

According to the European Network on Workplace Health Promotion (ENWHP) the following criteria are necessary for quality and effective workplace health promotion.

  1. Workplace health promotion (WHP) should be a management responsibility with:
  • Support and integration of management and executive staff
  • Integration in company policy
  • Provision of sufficient financial and material resources.
  1. Employees should participate in planning and implementation of the WHP measures.
  2. WHP should be based on a comprehensive understanding of health.
  3. WHP should be based on accurate analysis and continually improved.
  4. WHP should be professionally coordinated and information should be made available regularly to all the staff.
  5. The benefits of WHP should be evaluated and quantified on the basis of specific indicators.

The main principles are that the senior management team should ensure an organisational culture that encourages a positive health-promoting work environment.

The production of a wellbeing strategy will go some way towards demonstrating commitment. This will need to be embedded into the organisation; for example, through integrating it with core business, such as employee performance. There should be a clear business objective: what is the strategy contributing towards and how will implementation achieve this?

A health champion

The ENWHP guidance also recognises the importance of engaging employees in the planning and implementation of workplace health promotion. One way to achieve this is to appoint a ‘health champion’.

A health champion is an individual within the organisation who is able to influence the leadership team and engage employees. Health champions need to be good communicators and role models; they should have resources available to them and be able to conduct focus groups and collate employee opinion. They can be responsible for developing interventions that will empower employees and assist them to make changes. To this end, they need to be aware of health promotion methods and behavioural change.

Employees need to be given the right information and the freedom to make informed choices about their health. There could be health education events, posters and talks from specialists. The organisation needs to consider what barriers prevent employees from making healthy choices and whether anything can be done to take the barriers away. It might, for example, be possible to provide storage facilities for bicycles or encourage lunchtime activities. The DiClemente Cycle of Change model (see below) suggests that programmes of health promotion that are integrated, multi-faceted and long running are likely to be more successful than those that occur as one-off events.

The cycle of change by DiClemente and Proscheka

This model was developed by psychologists in the 1970s to describe the change process that people go through before adopting a new health behaviour. It is used to assist individuals to stop negative health behaviours, such as smoking, excessive alcohol consumption and drug abuse. It describes five stages that people go through before successfully cementing the change:

  • Pre-contemplation (not yet acknowledging that there is a problem behaviour that needs to be changed)
  • Contemplation (acknowledging that there is a problem, but not yet being ready or sure of wanting to make a change)
  • Preparation/determination (getting ready to change)
  • Action/willpower (changing behaviour)
  • Maintenance (maintaining the behavioural change).

Relapse (returning to older behaviours and abandoning the new changes) is normal. The stages are returned to and individuals will progress and relapse as they try to leave old behaviours behind and adopt new ones.

Another psychologist (Dr Kern) added an additional stage – transcendence –which is about the changes in the way the old and new behaviours are viewed. Once this stage has been reached, it is unlikely the individual will relapse.

Behavioural factors – attitudes to work and health

An attitude is a state of mind that affects behaviour. Attitude is formed from beliefs, values and feelings. It will affect performance and behaviour at work and lifestyle choices. Attitudes can change as a result of experiences that challenge the belief that formed the attitude. Attitudes are associated with communities, societies and groups; an example of this is the change in people’s attitudes to smoking, which has resulted in behavioural change. So, attitudes can be changed and will change, depending on what the individual is exposed to and the groups/societies and communities of which he/she is a member. This is important in the workplace, as group beliefs will affect attitudes and behaviour. For example, poor management of attendance can create the belief that it is not important to the employer and that it therefore does not matter if ‘an odd day off is taken occasionally’. This group attitude can be changed by being clear and consistent in the management of attendance.

Note

If you want to promote health in your workplace, it is important to understand the many Lifestyle factors that affect individuals.