The paradigm for corporate health is morphing from traditional curative services to health protection and promotion. An epidemic of “lifestyle diseases” has developed in the India which warrants an organized integration of company's health, safety and environment policy through a directed wellness program. The current study explored the burden and determinants of lifestyle diseases among an organization.

1.
Trends shaping corporate health in the workplace

2. Original Article
Trends shaping corporate health in the workplace
Rohin Rameswarapu a,*
, Sameer Valsangkar b
, Ariz Rizvi c
,
Upasna Kamineni d
a
Technical Consultant, Apollo Life, India
b
Public Health Consultant, India
c
Head, Institutional Business, Apollo Life, India
d
Executive Director, Apollo Life, India
a r t i c l e i n f o
Article history:
Received 17 July 2014
Accepted 26 July 2014
Available online xxx
Keywords:
Occupational health
Health promotion
Wellness
Non-communicable diseases
a b s t r a c t
Background: The paradigm for corporate health is morphing from traditional curative ser-
vices to health protection and promotion. An epidemic of “lifestyle diseases” has developed
in the India which warrants an organized integration of company's health, safety and
environment policy through a directed wellness program. The current study explored the
burden and determinants of lifestyle diseases among an organization.
Material and methods: A cross sectional study was conducted over 3 months among em-
ployees' at a multinational organization in the field information and technology across 10
cities in India. Data was gathered through a semi-structured questionnaire with socio-
demographic details (age, sex) and occupational characteristics such as duration of
working hours. Biometric measurements such as body mass index, blood pressure, total
cholesterol and random blood sugar were documented. Statistical measures obtained
included descriptives including means, proportions and percentages.
Results: A total of 30,134 employees participated in the study comprising of 16,652 (55.3%)
males and 13,482 (44.7%) females. 15,177 (50.3%) belonged to the age group 18e25 years.
24,414 (81%), 4745 (15.7%), 975 (3.2%) had normal, borderline and high risk values respec-
tively for serum cholesterol. 27,660 (91.8%) had blood glucose under normal range, while
2474 (8.2%) were found to be having abnormal blood glucose values.
Conclusion: Wellness clinics and occupational health centres act as a fulcrum and since
most of the non-communicable diseases could be prevented by modifying the lifestyle
factors and the clinics can provide health coaching, tobacco cessation programmes,
nutrition, disease management programs.
Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Health protection and promotion have been traditionally
confined to healthcare settings (e.g. hospitals, dispensaries,
nursing homes and clinics). But in the recent years there has
been a paradigm shift in the concepts of healthcare and
health promotion activities have been initiated at workplace
through medical rooms or wellness centres. A medical room
* Corresponding author. Tel.: þ91 9989709604.
E-mail address: dr.rohin.r@gmail.com (R. Rameswarapu).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
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Please cite this article in press as: Rameswarapu R, et al., Trends shaping corporate health in the workplace, Apollo Medicine
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0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

3. or occupational health centre or wellness centre is essen-
tially a space located inside of the client establishment
which is created to cater to health needs of the employees'
working in that organization. The medical rooms are
equipped to handle curative component and creates a plat-
form to generate awareness about the preventive compo-
nent of chronic lifestyle diseases. The medical room is
typically staffed by a medical doctor and paramedics who
are available to offer services during the work hours. The
medical room is stocked with basic medications, antibiotics
and emergency drugs which can handle the out-patient
department and treat surgical or medical emergencies. Or-
ganizations both small and large can have employee well-
ness and occupational health awareness programs which
can engage employees in this strategy to enhance their
ability to have a healthier lifestyle (primary prevention),
early diagnosis and treatment (secondary prevention),
identify occupational health hazards and prevent occupa-
tional health injuries, emergency preparedness and promote
healthy work environment. Health promotion and protec-
tion activities have been planned and operated indepen-
dently of each other at workplace, which has led to limited
effectiveness of the program.1
Workplace health protection
and promotion is organized integration of company's health,
safety and environment policy. This is more so evident
among employers' hazardous industries, where occupational
health centres are statutory requirements under Section 41-
C, Factories Act, 1948.2
Workers in hazardous industries are
frequently exposed to chemicals, solvents, toxic fumes,
extreme temperature, repetitive strain injuries and noise
which can cause detrimental health effects and irreversible
damage to health of the workers.
India, is passing through the phase of epidemiological
transition, over the decade, an epidemic of “lifestyle diseases”
has developed in the India. This could be attributed to
sedentary lifestyles, poor nutrition, dependency on alcohol
and substance and work related stress are driving the inci-
dence of non-communicable diseases (diabetes, cardiovas-
cular diseases, stroke, cancer and chronic respiratory
diseases).3
A recent study revealed that tobacco use, hyper-
tension and physical activity were more prevalent in lower
education groups.4
In addition, these medical conditions once thought to be a
problem of geriatric age group is seeing a paradigm shift to-
wards young urban population which is resulting in illness
related loss of productivity due to absenteeism.3
In addition of
the above mentioned, gender distribution has shown rise
among female employees' in the past years. The nature of
occupational health injuries varies with the gender of em-
ployees'; female employees are more prone for injuries about
68.4%.5
These chronic diseases have become a major burden,
as they lead to impaired quality of life, premature death and
disabilities and exponential rise in healthcare expenditure.6
The projected loss of national income attributable to heart
disease, stroke and diabetes in India from 2005 to 2015 is
around 236.6 billion (1.5% of the GDP) international dollars. In
addition to the later, WHO's Global Plan of Action on Workers'
Health 2008e2017, states that “Health promotion and pre-
vention of non-communicable diseases should be further
stimulated in the workplace, in particular by advocating
healthy diet and physical activity among workers and pro-
moting mental health at work”.7
Apollo Life, as an organization is conscientiously focussed
on providing solutions on integrative health and wellness
services for manufacturing and IT sector organizations across
India through occupational health centres and wellness
clinics respectively.
The present article focuses on workplace health concerns
and expounds the benefits of having health promotion mea-
sures at work place.
2. Materials and methods
The present study was conducted at a multinational organi-
zation having a large presence in India, in the field informa-
tion and technology.
A cross sectional study of 3 months duration from
December, 2013 to February, 2014 was undertaken with em-
ployees working with the organization. Consent was obtained
from the concerned department of the organization and the
sample subjects. Professionals working in different de-
partment's such as human resource, software development,
service providers were included in the study. All the em-
ployees' were explained about the purpose of the study and
confidentiality was ensured.
Inclusion criteria: for the study subjects were 1) individuals
who were working as a permanent employee, since past 1
month. 2) Individuals who had given verbal consent were
included in the study sample.
The study was conducted across 10 locations in India
(Hyderabad, Chennai, Bengaluru, Gurgaon, Kolkata, Kochi,
Coimbatore, Mangalore, Mumbai and Pune).
The cross sectional study included questionnaire with
socio-demographic details (age, sex) as well as duration of
working hours. Biometric measurements such as body mass
index, blood pressure, total cholesterol and random blood
sugar were documented. The samples were obtained on-site
in the client organization office space and analysed at a cen-
tral lab at the each location. The reports were also handed
over to the employees and the management.
Statistical analysis was conducted using Statistical Prod-
ucts and Service Solutions (SPSS) version 20. Data was
appropriately coded and entered and numerical data was
entered as such. Statistical measures obtained included de-
scriptives including means, proportions and percentages.
3. Results
A total of 30,134 employees participated in the study.
The study sample consisted of 16,652 (55.3%) males and
13,482 (44.7%) females Tables 1 and 2.
Majority of the subjects 15,177 (50.3%) belonged to the age
group 18e25 years, followed by 7949 (26.3%) of the subjects
belonging to the age group 26e30 years. 4901 (16.2%) re-
spondents belonged to age group 31e35 years, while 1610
(5.3%) subjects belonged to the age group 36e40 years and 497
(1.6%) respondents belonged to the age group of 40 years and
above Table 3.
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4. About 963 (3.1%) respondents had a history of smoking and
2762 (9.1%) had accepted the fact that they were exposed to
second hand smoke. 531 (1.7%) were on treatment for
hypertension.
2017 (6.7%) of the respondents were underweight, 7423
(24.6%) had normal values. 14753 (49%) subjects were over-
weight, while 5111 (17%) subjects were obese and 830 (2.7%) of
them had Grade II obesity.
2202 (75%) employees' recorded normal blood pressure.
6160 (20.4%) were high normal and 1372 (4.6%) were
hypertensive.
For total cholesterol 24,414 (81%), 4745 (15.7%), 975 (3.2%)
had normal, borderline and high risk values respectively.
When checked for random blood sugar 27,660 (91.8%) had
sugars under normal range, while 2474 (8.2%) were found to be
having abnormal blood sugar values Table 4.
4. Discussion
The present study was conducted across 10 locations across
India among 30,134 corporate employees.
Majority of the employees 16,652 (55.3%) belonged to male
gender.6
About 23,126 (76.8%) were 30 years or below.8
A report
on Global Disease Burden, 2010 mentioned that there is a
shifting pattern of disease with increase life expectancy.
Report states that this is associated with people suffering from
disability due to non-communicable diseases for a longer
period starting at younger ages.9
When measured their body
mass, index, the study observed that majority 20,694 (68.7%) of
the respondents were overweight and obese. Obesity has been
an important precursor for developing diseases like diabetes
mellitus, hypertension, dyslipidaemia and ischaemic heart
disease. High mortality rates have been associated with high
degree of obesity.10
Our study findings showed that 7532 (25%),
975 (3.2%) and 2474 (8.2%) of subjects showed elevated levels
in blood pressure, cholesterol and blood sugars respectively.
These parameters are crucial for cardiometabolic risk, espe-
cially among south Asians; starting at an early age.11
Em-
ployers have understood the course of chronic lifestyle
diseases and the long latent period between exposure and
onset of pathological changes. This phenomenon could only
be prevented by placing primordial and primary prevention
strategies, which can build healthier workforce and to contain
direct medical costs. World Economic Forum Report in
collaboration with World Health Organization, states that
Workplace Health Promotion (WHP) programmes are needed
to contain these medical conditions and improving health
related outcomes.12
It is important to note that even small
changes in behaviour, observed across entire populations, are
likely to show significant effects on disease risk.13
In soaring
trend of health spending, employers are showing interest in
health promotion and preventative activities in methods of
improving health, while reducing the associated costs. Many
studies have concurred with the findings that every dollar
invested in the program, the employer saves more than the
dollar spent.14
Many research studies indicate towards the
fact that incentives would increase the employee participa-
tion rates.15
4.1. Way forward
The wellness clinics or occupational health centres act a
fulcrum to implement these strategies in workplace.
Table 1 e Gender distribution.
Gender Count Percentage (%)
Male 16,652 55.3
Female 13,482 44.7
TOTAL 30,134 100
Table 2 e Location wise gender distribution of employees'.
S.no Location Gender distribution of employees'
Male Female
Count Percentage (%) Count Percentage (%)
1 Kochi 303 1 240 0.7
2 Coimbatore 1467 4.8 1342 4.4
3 Mangalore 186 0.6 103 0.3
4 Chennai 4279 14.1 6596 21.8
5 Pune 2548 8.4 1059 3.5
6 Kolkata 1799 5.9 520 1.7
7 Gurgaon 272 0.9 74 0.2
8 Hyderabad 1908 6.3 879 2.9
9 Mumbai 492 1.6 761 2.5
10 Bengaluru 3398 11.2 1908 6.3
TOTAL 16652 100 13482 100
Table 3 e Age group distribution.
S.no Age group in years Count Percentage (%)
1 18e25 15177 50.4
2 26e30 7949 26.4
3 31e35 4901 16.3
4 36e40 1610 5.3
5 >41 497 1.6
TOTAL 30134 100
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5. Since, most the non-communicable diseases could be
prevented by modifying the lifestyle factors, the clinics
can provide health coaching, tobacco cessation pro-
grammes, nutrition, disease management programs, acute
medical and surgical management and vaccinations. The
success of the wellness programs is multifactorial and
depends upon
1. Leadership e employee driven health initiatives
2. Wellness committees e to form and exchange ideas
3. Communication e E-flyers, emails, stairwell messages
4. Supportive environment e healthier food at cafeteria,
physical activity promotion.
5. Incentives e to increase participation, build and maintain
motivation of employees'.
6. Monitoring and evaluation e to strengthen the wellness
programs
4.2. Recommendations
To alter the course of lifestyle diseases, it necessary to
intervene and deploy measures to increase physical activ-
ity, proper nutrition, weight loss and combat work stress.
Workplace wellness takes advantage of employers' access
to employees at an age when interventions can still change
their long-term health trajectory. Although majority of or-
ganizations are complying with the Factories Act, 1948
with regards to biometric screening annually or biannually,
there has been little effort by the employers in preventing
health and wellness. Our experience as an organization in
preventive and promotive healthcare shows that there is
large gap which could be utilized to prevent the lifestyle
diseases. Understanding the elements which make them
most beneficial and the blockades to their wider adoption
could help smooth the path for future investments in this
very promising avenue for improving health and
productivity.
4.3. Limitations
Selecting the study sample is a limitation, which is biased.
The study also cannot address the challenge of how pro-
grams should be designed to attain optimal results for the
employer and employee, since each organization has
unique characteristic workforce. Organizational values, in-
centives, participation rates are all likely to affect return
on investment. Further study is also needed to estimate
the cost benefit and effectiveness of the wellness
programs.
Conflicts of interest
All authors have none to declare.
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Table 4 e Clinical parameters.
S.no Parameter Category Count Percentage (%)
1 Body mass index Underweight 2017 6.7
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Overweight 14753 49
Obese 5111 17
Grade II obesity 830 2.7
2 Blood pressure Normal 22602 75
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Hypertension 1372 4.6
3 Total cholesterol Normal 24414 81
Borderline 4745 15.7
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4 Random blood sugar Normal 27660 91.8
Abnormal 2474 8.2
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(2014), http://dx.doi.org/10.1016/j.apme.2014.07.010

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