[Overview] An important strategy for addressing the health-
care crisis is to reduce the need for medical services by keeping people healthy.
Research shows that as health risks increase, costs increase; as health risks
decrease, cost decrease.1,2
Managers and HR professionals offer wellness programs to
lower these risks and achieve other benefits (see table below). Typically, these programs
include health behavior assessments, education, counseling, campaigns, and incentives —
initiatives that encourage employees to become physically active, eat healthier, stop smoking,
manage stress, or adopt some other wellness practice. Employees seem motivated: most (80+%)
attempt some form of lifestyle improvement annually.3
Unless we keep people from migrating toward new health risks,
hoped-for benefits are unlikely to materialize.3
The greatest long-term
health-promoting and cost-saving opportunity is to keep low-risk
individuals from becoming higher risk.
The word [CULTURE]
(from the farming concept of
) refers to the social
forces that shape behavior and
beliefs through mechanisms
such as norms, support,
modeling, training, rewards, and
communication. Strong cultures
offer reliable, consistent guidance
about attitudes and behavior;
weak cultures do not send clear
signals. Cultures work at both
conscious and unconscious
levels, from concrete procedures
(like no smoking policies) to
subtle influences (like peer group
attitudes about exercising during
lunch). Workplace culture is a
key to profitability, sustainability,
and other success measures.7
Making wellness work is well worth it…
Reduce Health Risks Half of all diseases and premature deaths are
attributed to unhealthy lifestyle practices such as
smoking, physical inactivity, unhealthy diets,
and alcohol abuse.
Control Healthcare Costs Wellness plays a role in prevention, proper
self-care, disease management, and cost-effective
use of medical care.
Heal Most illness can best be remedied with treatments
that include healthier lifestyle practices, stress
management, and a positive attitude. Wellness is
a part of healing.
Deliver Peak Performance Productivity and health are closely linked.
Provide Opportunities Helping others is among the best ways to enhance
to Assist self-esteem, deepen wellness commitments, and
reinforce lifestyle change.
Enhance Teamwork/Morale Wellness programs can open new communication
channels, break down prejudices, and demonstrate
how employees are valued. It’s one more good
reason for people to work together.
Improve Image Supporting employee and community wellness is
a strategy for demonstrating good stewardship, a
positive work environment, and corporate citizenship.
Edington, D, Emerging Research – A View From One Research
Center, American Journal of Health Promotion, 2001, volume
15:5, pages 341-349.
Pronk, N, Goodman, M, O’Connor, P, Martinson, B, Relationship
Between Modifiable Health Risks and Short-Term Health Care
Charges, Journal of the American Medical Association, 282(23),
Edington D, Yen L, Witting P, The Financial Impact of Changes
in Personal Health Practices, Journal of Occupational and
Environmental Medicine, 1997; 39: pages 1037-1046.
Allen, J, Building Supportive Cultural Environments, O’Donnell
MP, editor, Health Promotion in the Workplace, Third Edition,
Albany, New York: Delmar Publishers, Inc; 2001, pages
Linman, Laura, Weiner, B, Graham, A, Emmons, K, Manager
Beliefs Regarding Worksite Health Promotion: Findings From the
Working Healthy Project 2, American Journal of Health
Promotion, 2007, volume 21:6, pages 521-528.
Merriam-Webster Online Dictionary, Internet Springfield MA:
Merriam-Webster, Inc. (cited Dec. 3, 2007);
Schein, EH, The Corporate Culture Survival Guide, San
Francisco: Jossey-Bass Publishers, 1999.
Allen R, Allen J, Certner B, Kraft C, The Organizational
Unconscious: How to Create the Corporate Culture You Want
and Need, Second Edition, Burlington, Vermont: Human
Resources Institute; 1987.
Allen, J, Not Alone: Healthy Habits, Helpful Friends,
Healthyculture.com Publisher, Burlington, Vermont, 2007.
Allen, J, Wellness Mentoring Can Help Rebuild the Corporate
Culture, AWHP’s Worksite Health, 1998; Summer: pages 27-30.
Allen, RF, Allen J, A Sense of Community, a Shared Vision,
and a Positive Culture: Core Enabling Factors in Culture Based
Health Promotion Efforts, American Journal of Health
Promotion. 1987; 1(3): pages 40 47.
Allen, J, Hunnicutt, D, Johnson, J, Fostering Wellness
Leadership: A New Model, Special Report from the Wellness
Councils of America: Omaha, Nebraska, 1999.
This white paper was prepared for Health Enhancement
Systems by Judd Robert Allen, PhD, President, Human
Resources Institute, LLC. Contact: 802.862.8855,
Additional copies of Achieving a Culture of Health: The
Business Case – as well as our white papers Keeping Healthy
People Healthy: The Business Case and Employer-Sponsored
Weight Management Programs: The Business Case – are
available online at www.HealthEnhancementSystems.com
or by calling 800.326.2317.
Wellness Committees –
A Special Culture Change Role
Wellness committees can play an important role in health culture planning
and follow-through. They should comprise influential people who are
passionate about wellness and represent a cross section of employees.
Committee members must be capable of:
I Seeing all the subcultures
I Keeping the culture change effort well organized
I Renewing the culture change vision periodically.
Outside wellness consultants should be available
to guide committee work, conduct objective
research, and introduce best practices.
Creating a Wellness Culture Together
Culture change offers methods for:
I Engaging the entire population
I Preventing new health risk behaviors
I Making it more likely that people will achieve healthy lifestyle goals.
The focus is on collective action — how people can work together to
achieve wellness. Individual strategies (such as health risk appraisals,
online information, wellness coaching, and incentive campaigns) can
be combined with culture strategies to achieve higher lifestyle change
The approach that combines individual initiative
with ongoing support makes good business sense
and is consistent with practices widely appreciated
among business leaders and HR professionals.
P H A S E 4
Renew and Extend
[Systematic] Culture Change
Culture change is a long-term process that is best achieved systematically.8
In most organizations, 4 phases — carried out over a year or more — make up a practical approach:
Health Culture Leadership
Executives, managers, supervisors, peer leaders, wellness enthusiasts, and other stake-
holders must be empowered to support the wellness initiative for a health culture.12
and clear communication
are important functions in mobilizing
effective health culture leaders.
Preparation is done primarily
through culture surveys, focus
interviews, observation, and
assignment of leaders
(see the next section).
Integration emphasizes peer
support initiatives and modifi-
cation of touch points when
new policies, procedures, and
programs are implemented.
measuring results, celebrating
success, and planning a new
round of culture change.
the wellness program vision
to employees and gives
them an opportunity to set
LEADERSHIP FUNCTION LEADERSHIP ACTIONS
Share the Vision Explain the purposes of the program, why they are
enthusiastic about wellness, how employees can
participate, and resources that will be available.
Serve as Role Models Participate in wellness activities, tell employees
how wellness has benefited them personally,
and share their own wellness goals.
Align Touch Points Address health culture influences (such as rewards,
confrontation, and training), give permission to fully
use program, and eliminate barriers.
Monitor and Celebrate Success Acknowledge individual and group progress
P H A S E 1
P H A S E 2
Introduce the Vision
of the New Culture
to All Levels
P H A S E 3
Primary leadership responsibilities:
Unfortunately, less than 20% of
employee lifestyle change efforts reach
Employees tend to make
progress for a few weeks and months only
to return to their prior behavior. How do
employers meet this challenge?
Managers, HR, and wellness professionals
are well aware that little of lasting value,
including health improvements, can be
achieved without a supportive cultural
environment. In a recent manager survey5
only 34% thought information alone would
be enough to promote healthy changes.
And just 41% agreed employers have a
responsibility to encourage employees'
healthy lifestyle choices.4
organizations, health promotion may be
seen as an encroachment on individual
responsibility and privacy.
Fortunately, a health culture can
support positive changes without undermin-
ing individual initiative. Most smokers have
tried to quit. Almost all overweight people
have attempted diets. Most couch potatoes
have set goals for physical activity. The
objective is to create a workplace where
those new positive practices will stick.
Adults are most likely to change a health
behavior when supported by the people
they spend time with, backed by policies
With that in mind, this white paper explores
understanding and changing workplace
culture to support employee health and pro-
I A framework to assess main elements
I Tools and techniques for change
I Various roles in creating healthy cultures.
A[Culture Change] Framework
Cultures are complex systems; they're best understood and evaluated by
adopting a framework – such as Normative Systems, the subject of more than
50 books and journal articles.8
It identifies 5 primary culture elements:
Work Climate Peer Support
Most successful organizations’ cultures value profitability, customer service, and
innovation or some variation on those themes. In a health culture, employee
well-being also makes the top tier of priorities… embracing the idea that
healthy people are essential to overall strategy.
Each organization should examine its story and goals for a compelling wellness
vision. For example, at Johnson & Johnson the company's history and future
are seen as about finding ways to promote health; wellness is embedded in
how people think about their employer. In many businesses, personal growth of
founders can be communicated to highlight how people achieve their dreams
with the support of others. Pulling together to overcome challenges can
become a compelling wellness message.
Opinion surveys are useful in gauging
how highly health promotion is valued.
Employees express a range of
attitudes toward wellness — from
wildly enthusiastic to utterly scornful.
Don’t get preoccupied with
naysayers; let your health culture
soften up this group. Shifting each individual's position
closer to wellness champion is the goal. Use the entire
wellness value proposition. An employee need not
choose among the wellness benefits of containing
health cost, raising performance, enhancing morale,
or improving the company’s image. Wellness can
deliver these benefits and much more.
Norms are social expectations for behavior and beliefs — “the way we do things around
here” — which become apparent only when they change or someone violates them.
(Test this by driving 5 mph below the speed limit. That's likely to result in push-back from
other motorists. Though no law is broken, norms have their own enforcement mecha-
nisms, as we'll discuss under touch points below.)
A wellness culture features norms that make it easier for people to maintain healthy
lifestyles — for example, it could be a strong norm to drink water and eat nutritious
snacks low in fat, sugar, and salt. Freedom of choice still would be honored because
people could bring in their own junk food and soda without being ridiculed. In another
health culture example, the norm would be for employees to use their breaks for
physical activity, healthy eating, stress management, and friendship; the smoking
break would not be the only way to get a time out.
TOUCH POINT QUESTIONS TO CONSIDER
Modeling • Do leaders and other opinion makers model healthy behavior or something else?
• Who could serve as new wellness role models?
• How can the visibility of negative models be reduced?
Rewards • Are unhealthy practices mistakenly being rewarded or recognized?
and Recognition • If someone behaved in healthy ways, would their behavior be acknowledged?
Confrontation • Are unhealthy practices mistakenly confronted?
• Would there be push-back from the culture if someone behaved in a healthy way?
Recruitment • Do those seeking work know this is a health-oriented culture?
and Selection • Are new recruits open to and enthusiastic about a wellness lifestyle?
Orientation • What is the early experience of employees related to healthy lifestyle choices?
• Are new people informed about the wellness program vision and invited to become wellness champions?
Training • Are people taught the skills they need to be good at healthy lifestyle practices?
• Are people mistakenly being taught how to get by with an unhealthy lifestyle?
Rites, Symbols, • Are there special events, daily/monthly activities, and symbolic reminders that wellness is important?
and Rituals • Are unhealthy practices such as overeating featured in special events?
Communication • Are people given the information they need to make good decisions about wellness?
• Are people given regular feedback about personal wellness and wellness within their workgroup?
• Do unhealthy practices get all the attention?
Relationship • Are work friendships and teams formed during healthy activities?
Development • Are work relationships formed around unhealthy practices such as overeating, complaining, and smoking?
Resource • Do people have the time, equipment, food, childcare, and other resources needed for a healthy lifestyle?
Commitment • Does the use of time, money, and other resources demonstrate a commitment to supporting
healthy lifestyle choices?
These touch points are the mechanisms for establishing and maintaining norms. They operate in formal policies, procedures, and
programs as well as informal, unwritten social mechanisms. Policies of sticking to a 40-hour work week and taking regular breaks,
for example, can be overpowered by praise for going “the extra mile.”
Establishing new wellness norms
(in general, 2-4 a year) is an important
function of a health culture — after
surveying to learn perceptions and
preferences. Sample priorities include:
I Not smoking
I Exercising daily
I Healthy eating
I Getting enough sleep
I Focusing on other health behaviors
based on organization specifics, such as
substance abuse or medical self-care.
Changing cultural norms and touch points
requires a deep understanding of the
current culture as well as a creative eye
for tweaking existing influences. Focus
groups with decision makers and a cross
section of employees can help identify
existing strengths and opportunities for
improvement. For example, workers could
share the best mechanism to implement
a new financial reward program so that it
isn’t perceived as a bribe or unfair.
These principles are useful in adjusting
I Build on existing strengths by seeing
what’s positively influencing behavior
now (remember, touch points already
function in any culture; the key is to
adjust, not replace them — acknowl-
edging senior managers have the
most power to do this)
I Address enough touch points to tip the
balance toward wellness — using only
1 or 2 frequently backfires and rarely
achieves lasting results
I Consult those most affected by touch
point changes… often.
In a wellness culture, peer support is
assistance from friends, family, cowork-
ers, and supervisors to achieve a healthy
lifestyle. Wellness programs often include
peer support initiatives in the form of
12-step programs, weight control groups,
sports teams, recreation events, yoga
classes, and running/walking/biking
competitions. These activities can be
open to employees’ families and friends
for even stronger support.
Although the support role is being
increasingly relegated to external profes-
sionals (therapists, wellness counselors,
coaches), an effective culture change
strategy is to enhance the quality and
quantity of informal, internal peer support
For instance, the Wellness
approach teaches employees
I Establish a mentoring relationship
I Set goals using the stages of change
I Locate effective role models and the
right wellness buddies
I Eliminate barriers to change
I Find or create supportive environments
I Work through relapse
I Celebrate success.
These methods offer numerous benefits
for a health culture; they:
I Have staying power
I Create natural allies and wellness
champions throughout the organization
I Reinforce self-change skills and raise
I Are a way to engage others in the
employee's support system.
The 3 cultural climate factors described
have been found to play important
roles in the intersection of organizational
development and individual wellness.
Where these factors are absent, employ-
ees may be so distracted by distrust,
anger, and negativity that they can't focus
on their own well-being:
Sense of Community. Wellness
programs can play an important role in
fostering a sense of belonging, trust,
caring, and mutual understanding in
Shared Vision. When everyone has
a role and a stake in achieving success,
the message is clear and inspirational.
Wellness programs can support this by
being responsive to new initiatives and
Example: when a railroad must reduce
accidents related to fatigue and
substance abuse, the wellness program
can respond by bolstering healthier
norms for work-life balance, more
sleep, and less drinking.
Positive Outlook. Workplaces and
individuals thrive with optimism and
enthusiasm. Wellness programs can
encourage a positive outlook through a
focus on productive potential, thriving,
reaching health milestones, and overcom-
ing obstacles. The emphasis is on
strengths over weaknesses and investing
in productive people over seeing people
as risks or a cost of doing business.