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Employee Wellness

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Employee Wellness

  1. 1. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 1 Employee Wellness as a COMMITTED TO IMPROVING THE STATE Strategic Priority in India OF THE WORLD Preventing the Burden of Non-communicable Diseases through Workplace Wellness Programmes Report of a Joint Event of the World Economic Forum and the World Health Organization Country Office for India In cooperation with Public Health Foundation of India World Health Organization Country Office for India World Economic Forum September 2009
  2. 2. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 2 This report was written by Ambika Satija and Puja Thakker of the Public Health Foundation of India, with support from Vanessa Candeias Teixeira Rodrigues and Godfrey Carmel Xuereb of the World Health Organization, J. S. Thakur and Kavita Venkataraman of the World Health Organization Country Office for India, and Eva Jané-Llopis, Chronic Disease and Wellness Initiative at the World Economic Forum. The views expressed in this publication do not necessarily reflect those of the World Economic Forum. World Economic Forum 91-93 route de la Capite CH-1223 Cologny/Geneva Switzerland Tel.: +41 (0)22 869 1212 Fax: +41 (0)22 786 2744 E-mail: contact@weforum.org www.weforum.org © 2009 World Economic Forum All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, including photocopying and recording, or by any information storage and retrieval system. REF: 150909
  3. 3. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 1 Contents Executive Summary 2 Commitment from the Meeting 3 1. Introduction: The Burden and Causes of NCDs 4 2. Rationale: Why Invest in Workplace Wellness? 6 3. Evidence: Workplace Wellness Works 8 4. The WHO India/World Economic Forum Joint Event on Employee Wellness as a Strategic Priority in India 10 5. Barriers and Opportunities 11 6. Strategy for a Successful Programme 15 Model for Setting up a Workplace Wellness Programme 18 Monitoring and Evaluation 21 Bringing It All Together: The Power of Comprehensive Interventions 22 7. Conclusions and the Way Forward 25 Outcomes of the WHO India/World Economic Forum Joint Event 25 References 27 Annex 1: Agenda of the Joint Meeting of the World Economic Forum and World Health Organization Country Office for India 29 Annex 2: List of Participants 32
  4. 4. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 2 Executive Summary Background: NCDs and Workplace Wellness coordinated manner: leadership, people, culture and Non-communicable diseases (NCDs) are on the rise process. Only when all of these are addressed in a globally, and the low and middle income countries comprehensive way can an employee wellness (LMICs) are the worst hit – 80% of projected deaths programme be successful. from NCDs in 2005 occurred in LMICs, according to a World Health Organization (WHO) report. India is Model for Developing a Healthy Workplace also on the brink of an NCD epidemic – the burden For workplace wellness programmes to accomplish it faces is high in terms of mortality, morbidity and the above, they must be designed, implemented economic productivity, and it stands to face and evaluated in a systematic manner. WHO India significant loss if effective NCD prevention strategies has developed a schematic model to describe the are not implemented. The good news, however, is process of developing, implementing and evaluating that NCDs are to a great extent preventable, as their workplace wellness programmes. The process starts main underlying causes are modifiable lifestyle- with the formation of a wellness committee that related, behavioural and environmental factors. undertakes the baseline evaluations and situation assessments, on the basis of which health policies Focusing on the workplace for the prevention of are chosen, implemented and then evaluated. NCDs has a double target: health and business reasons. India’s growing working population and the Monitoring and Evaluation of Workplace high NCD burden among its workforce make the Wellness Programmes workplace ideal for NCD prevention. The economic One step in the above-mentioned model is the benefits of NCD prevention at the workplace for monitoring and evaluation of wellness programmes. employers are vast, including reduced absenteeism, It is essential that time and resources are invested in reduced injuries and workers’ compensation costs, this, as it is only through constant monitoring at the reduced healthcare costs, reduced employee baseline during the implementation process, as well turnover, increased productivity and profits, greater as of the outcomes of the programme, that any worker satisfaction, improved morale, and increased improvements can be made in the policies and attraction of talent and potential employees to the processes of the programme and best practices workplace. Thus, focusing on workplace wellness is documented. Also, it is only with the demonstration supported by the ethics of corporate responsibility, of the success of the programme that the as well as by the rationality of corporate profitability. investments made can be justified. Barriers and Opportunities World Economic Forum and World Health Various barriers and opportunities should be Organization Country Office for India Joint considered and analysed while designing and Event implementing employee wellness programmes. The World Economic Forum and the WHO Country Barriers and opportunities are discussed in this Office for India jointly convened a meeting on report with respect to attitudes, employers, “Employee Health as a Strategic Priority in India”. employees and capacity development. While facing This joint event was held in New Delhi, India, on 14- hurdles is disheartening, it must be remembered that 15 November 2008. Participants included key barriers transform over time into facilitators, and that stakeholders from the commercial sector, academia, every barrier has a hidden golden opportunity for non-governmental organizations (NGOs), the United change and transformation – this is why every Nations and other international organizations. perceived barrier has been presented with an Existing barriers and potential opportunities in opportunity to overcome it. workplace wellness programmes in India were discussed, as well as the rationale for workplace Strategy for a Successful Programme wellness investment in India, strategies for To overcome barriers and make optimal use of the successful programmes, how to implement these available opportunities, an employee wellness programmes, their monitoring and evaluation, and programme should follow a “strategy for success”. how to adapt these programmes to small and This strategy has four key elements that must be medium enterprises. incorporated into a wellness programme in a 2|
  5. 5. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 3 Conclusions and Way Forward talented individuals. Such an investment is in Business leaders must join the fight to contain alignment with India’s economic and development NCDs. It is not only altruism but also enlightened priorities as a nation and an essential step in the self-interest. Investing in the health of employees fostering of a healthy workforce, nationally and increases productivity, cuts down spending on globally. healthcare costs, reduces turnover and attracts Commitment from the Meeting At the World Economic Forum and the WHO international organizations such as the World meeting in New Delhi in November 2008, several Economic Forum and the World Health Organization commitments were put forward to advance playing the foremost role of stewardship, was employee health, which was unanimously recognized as the primary course of action. The acknowledged as a strategic priority for India. Public Health Foundation of India was identified as a Multistakeholder action was identified as the single key organization positioned to bring together most effective vehicle for change. In line with this, multiple stakeholders on a platform for action. the creation of a council inclusive of several Annexes 1 and 2 provide the agenda for the ministries, corporate leaders and civil society, with meeting and a list of the participants. |3
  6. 6. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 4 1. Introduction: The Burden and Causes of NCDs As India pursues a pathway of accelerated India is no exception to this trend – the major NCDs, economic development, growth in industrial and including CVDs, diabetes, cancer and chronic service sectors offers more employment respiratory disease, accounted for 53% of all opportunities. Promotion of employee health should projected deaths and 44% of DALYs in India in be recognized as a prioritized need, as it represents 2005. Over the period 2005-2015, while deaths a prudent investment for enhanced productivity and from infectious diseases, maternal and perinatal also signs responsible corporate conduct. The conditions and nutritional deficiencies are expected growing realization that health and economic growth to decrease by 15%, deaths from NCDs are have a bi-directionally reinforcing relationship is now expected to increase by 18%, and, most beginning to foster investment in workplace wellness significantly, deaths from diabetes are expected to in many countries. Workplace health programmes increase by 35%3. The cost of this burden cannot be provide protection against occupational health ignored. hazards and first line treatment for medical disorders. It is important that India adopts In 2005 alone, India lost US$ 9 billion of its national “workplace wellness” as an important pillar of its income due to NCD deaths, and by 2015 is growth strategy. projected to lose US$ 237 billion in national income due to deaths from CVDs, stroke and diabetes4. Burden of Non-communicable Box 1 Diseases What is Health and Wellness? In the preamble to the Constitution of the World Globally, six out of 10 deaths are due to non- Health Organization (1948), health is defined as communicable diseases (NCDs – see box 1). “a state of complete physical, mental and social Cardiovascular diseases (CVDs) are the leading well-being and not merely the absence of disease cause of death in the world, particularly among and infirmity”*. Health and wellness refer to a women1. According to the World Health Organization state of physical, mental, social and spiritual (WHO) report Preventing Chronic Diseases, a vital balance, and the ability to make choices that help investment, 60% of the projected 58 million deaths achieve or maintain such a state of balance. in 2005 and almost 50% of the projected global Workplace wellness in this sense refers to all burden of disease for 2005, as measured by those activities that are designed to help and Disability Adjusted Life Years or DALYs*, in the world support employees and their families follow were due to NCDs, with the four major NCDs – healthy lifestyles that are conducive to achieving CVDs, cancer, diabetes and chronic respiratory such a state of well-being. disease – accounting for most of this burden. While death from infectious diseases, maternal and What is a Non-communicable Disease? perinatal conditions and nutritional deficiencies are A non-communicable disease is an illness that expected to decline by 3% by 2015, deaths from persists for a long duration. It usually progresses NCDs are expected to increase by an alarming 17% slowly, and unlike infectious diseases, cannot be over the same duration2. prevented by vaccinations, nor can it be transmitted from person to person. The major Although the rise in NCD burden is a global NCDs include cardio-vascular diseases (CVDs) phenomenon, it is the low and middle income such as heart attack; stroke; diabetes; cancers countries that face the biggest challenge. WHO such as breast cancer and prostate cancer; reports that a staggering 80% of deaths from NCDs chronic respiratory disease (CRD) such as occur in developing countries2. asthma; bone and joint impairments such as arthritis; vision and hearing impairments; oral disorders, etc. Mental disorders, such as * A measure of the years lost to disease, calculated by combining the healthy years lost due to premature death depression, dementia, schizophrenia and anxiety from the disease, and the number of years spent in ill disorders also fall in this category due to their health due to the disease; one DALY can be taken to chronic nature. mean one lost year of healthy life. 4|
  7. 7. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 5 Tremendous gains can be made with even the smallest of reductions – according to WHO, an additional 2% annual reduction in NCD death rates between 2005 and 2015 would result in an accumulated gain in income of around US$ 15 billion in India2. The Causes One characteristic feature of most NCDs is that they are mainly caused by lifestyle, behavioural or environmental factors, most of which are modifiable. A small number of such modifiable lifestyle-related determinants are accountable for most of the major NCDs. The most important of these are an unhealthy diet and excessive energy intake, physical inactivity (all of which lead to overweight/obesity) and tobacco consumption. Other important changeable risk factors include excessive alcohol consumption, psycho-social factors such as stress, and environmental toxins. In conjunction with the non- modifiable risk factors of age and genetic heredity, these account for most of the NCD burden we see today2. India’s risk factor profile has been worsening over the decades, and is now a cause for concern. Around 17% of males and 15% of females above the age of 15 years have a body mass index (BMI)** above 254, and these figures are even higher in urban areas, being 22.2% and 28.9% respectively5. In fact, some risk factors such as physical inactivity, inadequate fruit and vegetable consumption and unhealthy alcohol consumption have been found to be higher among Indians and South Asians relative to individuals in other regions6. ** BMI is a statistical measure of a person’s weight relative to height. A BMI of 25 kg/m2 is considered the global cut-off for overweight, and that of 30 kg/m2 is considered the global cut-off for obesity. |5
  8. 8. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 6 2. Rationale: Why Invest in Workplace Wellness? NCDs are costly to employers in a direct way. Modifiable risk factors such as smoking, lack of exercise, alcohol use, poor nutrition, obesity and hypertension increase an employer’s healthcare expenditures by 25% and are currently estimated to account for 2.1% of gross domestic product in India. In today’s market-driven, competitive world, a capable and resilient employee is an important resource and fundamental to productivity. NCDs are the prime cause of lost work time in the working-age population. An Indian industry survey identified that lifestyle-related illnesses account for 27% of illnesses among employees. A quarter of the respondent firms lost approximately 14% of their annual working days due to sickness7. In India, productive years of life lost to cardiovascular disease alone will almost double between 2000 and 20302. Being lifestyle-related diseases, NCDs must be tackled at all stages of an individual’s life and in all spaces that an individual occupies – at home, at school and in the workplace. Globally, 65% of the population over the age of 15 is in the productive years and spending one fourth of its time in the Interventions to improve nutrition, encourage regular workplace. In absolute terms, this translates into physical activity and avoid the use of tobacco and 3.18 billion people, a figure that is projected to harmful alcohol use are cost-effective and can increase to 3.68 billion by 20208. In India, 58.5% of reduce up to 80% ill health and premature deaths the population aged 15 years and above is currently due to NCDs. Reducing just one health risk economically active7. Thus, the working population in increases an employee’s on-the-job productivity by India is a huge, concentrated population which is 9% and cuts absenteeism by 2%. In fact, preventive easy to target and, by implication, one in which healthcare activities at the workplace have been results can show quickly and be substantial. found to be related to increased profits of Indian companies7,9. Benefits of Workplace Wellness Programmes NCD prevention through workplace wellness to Companies programmes is also important in the context of the • Reduced absenteeism increasing sedentary nature of work. The service • Reduced injuries and workers’ compensation sector is increasingly becoming the predominant costs employment sector in the world – globally in 2006, • Reduced healthcare costs for the first time the share of employment in the • Reduced employee turnover service sector overtook that of agriculture, with 40% • Increased productivity and profits of employees working in the former9. In India the • Greater worker satisfaction employment share of services has also been steadily • Improved morale increasing, from 18.1% in 1965 to 23.5% in 200010. • Increased attraction of talent and potential The workplace is also full of the pressures and employees to the workplace strains of deadlines and performance, and the high levels of stress and burnout reported by Indian employees confirms this. A recent survey by the Associated Chambers of Commerce and Industry of India (ASSOCHAM) found that work-related stress 6|
  9. 9. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 7 Why the Workplace is Ideal for NCD Prevention • An easy, concentrated population to target • Multiple levels of influence can be used – direct, such as the provision of healthy food, and indirect, such as creating a supportive environment • Possible to link workplace health promotion to other programmes at the workplace, such as occupational safety programmes • Concentration of lifestyle-related risk factors at the workplace • The workplace has been recognized internationally as an important health promotion setting and mental fatigue are common problems reported by Indian employees not only in the areas traditionally associated with work stress such as the IT and BPO sectors, but also in many other sectors, including construction, shipping, banking, media, small-scale industries, trading houses and government hospitals11. The high concentration of lifestyle-related NCD risk factors in the workplace makes it imperative that preventive efforts be focused there. A healthy population is an economically productive population, and it is in the benefit of companies to safeguard public health. Given the heavy contributions of the private sector to the economy, employee wellness programmes are not only a strategic priority for India, but also an economic imperative for corporations. |7
  10. 10. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 8 3. Evidence: Workplace Wellness Works There is considerable evidence suggesting that Behavioural Outcomes workplace wellness programmes aimed at preventing NCDs through lifestyle changes are The three most important lifestyle-related effective, although this evidence is by no means determinants of NCDs are physical inactivity, diet exhaustive. Employee wellness programmes have and substance abuse, in particular tobacco been seen to have various types of effects, with consumption. Workplace wellness programmes have improvements observed in anthropometric*, been found to improve all these behavioural risk behavioural, psychological and economic outcomes. factors. Anthropometric Outcomes Physical Activity A number of techniques have been used to A review of workplace intervention programmes encourage physical activity at the workplace. A focusing on weight control found that these were systematic review of the effectiveness of workplace able to produce a reasonable amount of short-term physical activity interventions found the use of weight loss among the employees12. Similar results pedometers to increase daily step counts, walking to were found by Petersen et al. (2008) for an Internet- work (active travel) and workplace counselling to based employee weight-management programme – have a positive impact on physical activity in fact, increased website use was associated with behaviour16. Counselling as a technique to increase increased weight loss13. The effect of such wellness energy expenditure and cardio-respiratory fitness programmes on other physiological risk factors such was found to be effective in a Randomized Control as hypertension14 and endothelial function**,15 has Trial as well17. Another study found a also been found to be positive. communications-based campaign to be effective in increasing knowledge of physical activity and encouraging walking18. * Anthropometry refers to the measurement of the human body; in this context, it implies all body dimension and Diet physiological measurements such as BMI and blood pressure. A diet high in fats and sugars and low in fruits and ** Endothelial function refers to the functioning of the vegetables has been identified by WHO19, WCRF20 endothelium, which is the layer of cells lining the interior of and many other international organizations as a risk blood vessels and the heart. factor for NCDs. Several interventions at the workplace 8|
  11. 11. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 9 are aimed at improving the dietary habits of Economic Outcomes employees. For instance, the Heartbeat Award (HBA) scheme, which is a nutrition labelling scheme in Various types of programmes have been observed England was found to be effective in increasing four to enhance productivity and profitability. One study healthy dietary behaviours – increased fruit found work health promotion to decrease sickness consumption, reduced fried food and sweets absences and enhance work ability29, while another consumption, and a switch to lower fat milk21. Another study found an employer incentive/disincentive comprehensive intervention programme designed to approach to be effective in reducing illness-related target multiple levels of influence22 was found to be absenteeism30. Workplace physical activity effective in increasing fruit and vegetable intake programmes have also been seen to have positive among employees. This increase was much more in effects in this regard, and have been found to the workplace-plus-family intervention relative to the reduce health-related impairments in time workplace-only intervention, highlighting the management, physical work, output limitations, importance of multi-component programmes. overall work impairment and short-term disability workdays lost31. Substance Abuse Programmes targeting substance use/abuse by Another study found workday exercise to improve employees have been found to be effective in white-collar workers’ mood and self-reported reducing tobacco consumption23 as well as alcohol performance32. Overall workplace wellness abuse24. These intervention programmes have also programmes have been found to be economically found to be economically profitable for companies25, beneficial for organizations, brining about reductions particularly since substance abuse can greatly in sick leaves, health plan costs, workers’ hamper an employee’s productivity. compensation and disability costs33. Psychological Outcomes Frequently, workplace wellness programmes have a mental health component aimed at relieving stress and enhancing the feeling of well-being. In a review of workplace interventions to promote mental well- being, it was found that psychosocial intervention courses, stress management training, counselling and therapy, physical exercise and health promotion interventions have a positive impact on mental well- being26. Physical activity programmes at work in particular have been shown to enhance subjective well-being and enthusiasm of the employees at work27, 28. |9
  12. 12. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 10 4. The WHO India/World Economic Forum Joint Event on Employee Wellness as a Strategic Priority in India Following several recent consultations in Davos and Dalian, the World Economic Forum and the World Health Organization jointly convened a meeting on “Employee Health as a Strategic Priority in India” in New Delhi, India, on 14-15 November 2008. Employee wellness was unanimously acknowledged as a strategic priority for India. A clear need for dramatic change was reiterated, through ideas such as creating a new code on public health to be adopted by companies, with interventions extending not only to the employee but also to families and communities. Multistakeholder action was identified as the single most effective vehicle for change. The next sections of this report reflect the scientific evidence presented during the Joint Event, and The immediate course of action identified at this highlight the key aspects discussed by the meeting was the creation of a council inclusive of participants. Annexes 1 and 2 provide the agenda several ministries, corporate leaders and civil society, for the meeting and a list of the participants. with international organizations such as the World Economic Forum and the World Health Organization playing the foremost role of stewardship. The Public Health Foundation of India was identified as a key organization positioned to play a convening role in bringing together multiple stakeholders on a platform for action, with support from organizations such as the Confederation of Indian Industry, the Indian Association of Occupational Health, and the International Labour Organization. 10 |
  13. 13. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 11 5. Barriers and Opportunities The increasing prevalence of NCDs is a relatively unique avenues of initiating and sustaining change. new phenomenon in India, and the concept of The following section details the discussions of the having wellness programmes at the workplace to meeting about barriers and opportunities relevant to prevent them is an even newer one. Barriers to the India context. implementation of workplace health promotion programmes exist. However, many barriers become There are four main types of barriers and facilitators over time, and it is important that we look opportunities – related to attitudes, employers, for opportunities within these barriers, as well as employees and capacity development – in addition aspects of the Indian context that provide us with to some general, overarching ones (see figure 1). Figure 1: Potential Barriers and Opportunities Related to Implementation of Employee Wellness Programmes in India Barriers Opportunities General Barriers and Opportunities 1. High NCD burden Possibility of making dramatic change 2. Global financial crisis affecting Health as an investment Indian companies – global economy will pose a challenge Attitudinal Barriers and Opportunities 3. Lack of awareness of the Growing global recognition of NCDs, their potential impact and the opportunity to implications of the NCD epidemic use national and local media to get the message across to the public a. Health is getting linked to productivity and profitability 4. Health is considered a philanthropic b. Great opportunity to redefine human agenda to talk about human happiness issue and human well-being c. Idea of creating a new code on public health to be adopted by companies and countries 5. Preventive care lacks incentive – a. Scope for appropriate policies and programmes for preventive healthcare the focus is on curative health b. High quality expertise in IT and medicine providing resources for state-of-the-art work interventions Barriers and Opportunities Related to Employers 6. Lack of visibility of leadership – Reach out to chief executives (CEOs): need to reach decision-makers • Through industry employee organizations • Engage CEOs from outset to be champions • Make and show business case • Capture CEOs emotions • Use the right language (tailor messages) • Non-cost, high return, simple interventions (e.g. information, environment) • Use of the media • Goal setting – 10 commandments to implement this year • Incentives – awards systems to best workplaces 7. Concern of employers regarding the How can it be integrated so it does not detract from time? employees time a. Make the case that it is cost effective by being an investment b. Find efficient delivery channels and structural support (e.g. sport, gym) c. Identify a menu of options to choose from (adaptable to workforce at any time) d. Management support medium and high levels e. Identify existing opportunities for health in existing structures rather than adding (e.g. canteen, design) f. Go beyond individual education (environmental change) g. Health as a human right and not just business | 11
  14. 14. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 12 Barriers Opportunities Barriers and Opportunities Related to Employers 8. Employers are worried about issues Promote trade union leadership – getting unions engaged from the start related to unionism (changing food menus, etc.) 9. Issues related to high attrition in Workplace wellness as an incentive for employees to join the company and stay in it companies Barriers and Opportunities Related to Employees 10.Engaging employees in health Bottom-up approach (increase awareness to create demand for health): programmes is difficult (lack of • Educate employees about their rights visibility and transient, if any); and • Scope for creating healthcare opinion-makers among employees – lack of interest of younger empowerment employees in NCD prevention • Using other employees as vehicles for messages • Employees as champions (incentives) • Personal experience with diabetes and heart diseases • Capitalizing on family ties 11.Issue with annual health check-up – Ensure employee trust in confidentiality fear of losing job due to bad health performance Barriers and Opportunities Related to Capacity Development 12.Capacity gap a. Lack of a conceptual framework that explains why the change should happen b. No Indian data showing that prevention is better than cure c. Lack of more real-life data on the effect of NCDs on companies in India d. Lack of HP material specific to industries e. Create best practices in healthcare f. Network of people for sharing what is being done, barriers faced and how they are being overcome g. Use existing organizations (e.g. CII) to disseminate information h. Create a common set of HP materials to be used by all workplaces 13.Various interventions – what are the Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu different options available and their of programmes: costs? • Screening and medical check-up (tobacco, hypertension, diabetes, alcohol) • Support provision of treatment (as ethical practice) • Information and awareness raising • Health styles change guidelines – health promoting environments (canteen, low salt/sugar food, tobacco, alcohol); include stress and posture as key • Structural and functional changes to workplace • Informal sector: self-help groups sensitization • Reimbursement for prevention/promotion 14.Management barriers – nobody to Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu manage workplace wellness of proNeed to create a cadre of management personnel programmes 15.Environmental barriers: availability Structural and environmental changes are needed – do not only put the and affordability to be physically responsibility on the individual to make this change active and eat healthy 12 |
  15. 15. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 13 The main overarching barrier to implementing programme might introduce (for instance, changing wellness programmes at the workplace is the global food menus to substitute high fat and sugar options financial crisis, which is bound to compromise the with healthier ones might create resentment at the extent to which Indian companies and organizations withdrawal of acquired rights). Most of these can spend on workplace wellness. However, if problems stem from a lack of awareness and workplace wellness is seen as an investment as involvement. It is thus essential that all key payers – opposed to an expenditure, the global economic the top leadership, the employees, the union, etc. – downturn can become an opportunity to enhance are involved from the beginning in the planning, and augment human resources and better secure execution and evaluation of the programme. Lastly, the future of an economy that is increasingly service employers are worried about investing in wellness sector dominated. programmes when turnover rates are high; however, it might be that the high stress and unhealthy The second set of barriers is attitudinal. Being new working conditions are parts of the reason for to NCDs and having faced a disproportionately high attrition. There is an opportunity for companies to burden of infectious diseases, pregnancy-related promote wellness programmes as an incentive to conditions and under-nutrition for a considerable attract new talent as well as retaining it – a powerful period of time, LMICs are only beginning to means for management to show it cares. comprehend the seriousness of the potential negative impact of a high NCD burden. Moreover, On the employee side, the main barrier is the health has traditionally been perceived as a matter of difficulty of encouraging participation in wellness social welfare that lies within the domain of the programmes. Again, the problem is mainly due to a government, and not something in which the private, lack of awareness of the importance of maintaining a corporate sector should be involved. Even where healthy lifestyle; this is particularly true of younger health has been recognized as a priority, almost employees who feel invulnerable to disease and complete focus has been on curative services, with disability. This barrier creates the opportunity to not enough emphasis given to preventive care – high enhance awareness in the workforce regarding health-care costs incurred by corporations attest to NCDs and their risk factors – the employees must that. be educated about their rights and a bottom-up approach must be adopted to create a true sense of However, as more and more evidence highlights the ownership among the employees. The other barrier economic gains to be made by corporations if they faced by employees is a fear of losing one’s job due work towards enhancing the health of workers, the to bad health performance on annual health check- global perception is rapidly changing from health as ups. It is crucial to maintain complete confidentiality social welfare to health as business and an asset to of results, and ensure the employees that the results productivity and profitability. India must align itself of health check-ups are completely separate from with this global thinking, and look at its workforce as their performance appraisals on the job. a vital human resource to be invested in for future productivity. It must create and impart a new code Lastly, there are certain barriers and opportunities on public health, specifically to be adopted by related to capacity development. In the area of business firms and corporations, so that health public health, there is a huge capacity gap – the becomes a part of the value system of all firms in requisite data, studies, personnel and body of the country. knowledge to make the appropriate policy changes are not available. This lack of knowledge creates an There are also several barriers and opportunities ideal opportunity to start gathering data from related to employers, the most important ones being existing sources and disseminating it for others to lack of visibility of leadership in workplace wellness, use. It is no longer sufficient to follow best practices; the perception that health interventions take up a India has the ability to create the next best practices. considerable amount of time of employees, and A key point will be to create a network of concerns about the reaction of union members to organizations, industries and stakeholders so that the drastic changes a workplace wellness there is transparent sharing of experiences and the | 13
  16. 16. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 14 lessons to be learned. Certain key organizations, such as the Confederation of Indian Industries (CII), the Public Health Foundation of India (PHFI), can act as nodal agencies for collecting, synthesizing and disseminating information in the form of best practices. There are still many questions that need to be answered – how can interventions be translated into other industry sectors? How can India tackle health promotion in its large, unorganized sector? How can we address issues of sustainability? These and other questions cannot be dealt with by companies alone – there is an urgent need for multistakeholder discussions and collaborations. It is only when the various government departments, civil society, the corporate sector and academia come together that we can begin to find solutions. 14 |
  17. 17. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 15 6. Strategy for a Successful Programme To overcome the above-mentioned barriers and make optimal use of the available opportunities, an employee wellness programme should follow a strategy for success – it should appropriately take into account and influence the leadership, people, culture and processes deployed in the making of a programme34 (see figure 2). The lack of leadership, participation of employees, a health-promoting culture and environment or effective processes can threaten and weaken the effectiveness of a programme. Thus, it is important to adequately address each of Health Education the four elements to infuse commitment, efficacy Small lifestyle changes such as regular exercise and and sustainability – essential ingredients required for healthy eating can prevent diabetes and the success of a wellness programme. cardiovascular disease, yet awareness of them is poor. Health education, through the dissemination of Leadership health-related materials, seminars and talks delivered Leaders are essential for the success of any by experts can help raise the profile of these endeavour. Leadership lends visibility and sustainability avoidable conditions and motivate employees to to workplace wellness programmes, and can entirely adopt healthy behaviours (see box 2). determine the extent to which such programmes operate within an organization. The lack of awareness Box 2 of workplace wellness among senior leadership is Through Knowledge Comes Power: Health often a barrier to committed action towards the health Education at Reliance of employees. Getting top leadership involved and Health awareness and education forms a key engaged to advocate change and be committed to component of the health and wellness initiatives at employee wellness is an essential component of a Reliance. Reliance has medical teams that regularly successful workplace wellness programme. conduct awareness campaigns, educating employees about lifestyle-related diseases and People stress management through exhibitions, lectures In general, people want to be healthier, provided and camps. These medical teams regularly there is an environment that allows it. High rates of conduct health promotion activities for advocating participation are key to success and easier to and bringing about improvement in the achieve if the right strategies are deployed to reach environment of the workplace. The Project CASHe, out to employees. Change Agents for Safety and Health, is an endeavour to bring about a change in the attitudes Figure 2: Key Elements of a Strategy to and behaviour of employees, to pave the way for a Implement Workplace Wellness Programmes healthier life. The project aims to bring about improvement in occupational health practices and Leadership has been found to reduce work-related diseases and injuries, decreased the rate of absenteeism and improved productivity. The main result of this project has been to bring about a change in organizational culture – today, health and wellness are priorities in themselves at Reliance. References: People Process 1. http://www.ril.com/html/aboutus/health_safety_environment. html#policy (Last accessed January 2009) Culture 2. Health, Safety and Environment, Reliance Industries Ltd 2004-05 3. Health, Safety and Environment, Reliance Industries Ltd 2005-06 | 15
  18. 18. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 16 advisory groups in which employees are represented, such as employee-led walking clubs and peer coaching, are some examples35. Counselling Private counselling of high-risk individuals has proven to be an effective method of prevention (see box 4). Culture Culture plays an important role in conditioning the way individuals think about their health. As demonstrated in the previous section, several barriers and opportunities are attitudinal due to the prevailing socio-cultural perceptions. Inculcating a Tailored Programmes positive attitude towards prevention and wellness In corporations, the pool of employees is often among employees and creating an environment diverse, including people of different ages, sex and conducive to health-promoting activities are health profiles. Thus, wellness programmes cannot challenging yet desirable for an organization. Below be one-size-fits-all; they need to be tailored to target are some examples. different audiences. Age-specific programmes are such an example. In Box 3 general, younger people (low-risk) assume a state of good health, whereas the elderly (high-risk) are more Prevention is the Key: Medical Diagnostic serious about prevention. Interest in different Screening and Targeted Interventions at activities also differs by age group. Adventure sports Reliance and team sports, for example, can be used to The Occupational Health Centres (OHCs) at the attract the participation of younger employees. manufacturing divisions of Reliance are equipped Programmes may also be disease-specific, or be with state-of-the-art facilities and apparatus, as designed to protect employees from potential well as competent health professionals who occupational health hazards (see box 3). conduct medical examinations of their prospective employees and of their workers post-employment Incentives on a regular basis. The results are used to create Provision of incentives to employees who participate and implement targeted interventions among can be extremely useful in increasing enrolment individuals and groups of individuals with similar rates. Some corporations offer, for example, risk factor profiles. These OHCs are equipped to wellness allowances which employees can use perform certain specialized tests, such as towards the purchase of fitness equipment. biological monitoring, health risk assessment However, incentives need not be financial – reward studies and audits for exposure to various and recognition are also powerful tools. materials. The investment in the infrastructure and manpower required to maintain such OHCs has Engaging Employees paid off, as it has translated into at-risk-employees A workplace wellness programme is most effective taking necessary preventive measures long before when it caters to the precise needs of the employee. crippling lifestyle-related diseases are able to rob Engaging the employee at each stage from them of their efficiency and productivity. development to delivery not only provides the constructive feedback needed in the eventuality of References: applying mid-course corrections, but also hands 1. http://www.ril.com/html/aboutus/health_safety_environment. html#policy (Last accessed January 2009) over ownership of the programme to the employee, 2. Health, Safety and Environment, Reliance Industries Ltd 2004-05 thus ensuring greater responsibility towards 3. Health, Safety and Environment, Reliance Industries Ltd 2005-06 individual health. The creation of managerial or 16 |
  19. 19. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 17 Promoting Work-Life Balance the clock, even when at home. Such a high-stress Today, the hours an employee spends at work are lifestyle is a major risk factor for NCDs, and can lead getting longer, as fixed working hours are fading to productivity losses due to mental exhaustion. away. With recent technological advances and Corporations can thus promote a healthy lifestyle gadgets such as laptops, cell phones and handheld through defined working hours and offerings such as devices, employees are essentially working round social gatherings and on-site exercise and recreational facilities. Box 4 Healthy Cafeteria Offering a Helping Hand: Wipro’s “Mitr” Unhealthy food choices and a sedentary lifestyle, Wipro, one of the leading global corporations often exacerbated by job profiles, are risk factors for based in India, has a number of wellness NCDs. Offering healthy options at workplace programmes running in both its IT and BPO cafeterias is an effective and immediate approach to sectors. Essential components of the programmes reducing risk factors among employees. are, for example, nutrition counselling, cafés offering low-calorie foods, health centres, medical Reaching the Family camps, regular medical lectures and employee Inclusion of the family in adopting healthy behaviour well-being events. One of its most successful influences the employees’ broader social context. initiatives has been the in-house counselling Family support and participation in making healthy programme called “Mitr”, launched in 2003. changes increase the reach of such programmes Literally meaning “friend”, the programme trains and enhance sustainability due to greater adherence employees to provide counselling services to (see box 5). colleagues that are facing stress at work or in their personal lives. The employees trained for this Extending Outreach to the Community/Unorganized purpose are volunteers, thereby ensuring high Sector motivation and a desire to help. The selection of It is not enough to invest in the health of one’s counsellors from among the employee volunteers employees and their families – it is essential that is stringent, ensuring that adequate motivation and companies go into the community in which they commitment are accompanied by the necessary reside and which sustains them. Such a holistic skills required to be a counsellor. As a programme approach allows wellness initiatives to grow beyond “for Wipro employees, by Wipro employees”, it is the boundaries of the corporation and impact highly sustainable and provides employees with a surrounding areas. Some companies also offer sense of ownership. The programme is highly subsidized healthcare to contractual workers and publicized within the company, to ensure that as clients, in addition to their own workers, as part of many employees as possible are aware of an corporate social responsibility. available helpline, not only for work-related issues but also for personal problems. Certain key Effective Messaging elements of the programme have made it highly Communicating the goals of the programme and successful – the use of technology such as the messaging effectively so that it cascades throughout intranet, the involvement of key people and in the organization is essential. Effective and frequent particular of top management, which gives it the messaging lends visibility to the programme and necessary support and backing needed for gradually gets absorbed and accepted as an integral sustainability and further scalability, and interaction part of organizational culture. with external public health agencies and companies dealing with specific diseases, as well as with individual consultants. References: 1. Working towards wellness: An Indian perspective. 2007, PricewaterhouseCoopers | 17
  20. 20. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 18 Box 5 Process Reaching Out to the Family: The TCS Maitree While engagement of leadership, involvement of Initiative people and promotion of a culture conducive to Under the leadership of Mala Ramadorai, wife of S. health are necessary for the success of an employee Ramadorai, Chief Executive Officer of Tata wellness programme, they alone cannot guarantee Consultancy Services (TCS), Maitree was initiated results – it is essential that adequate attention is in February 2003 to “weld TCSers and their given to ensure that the processes to implement and families” together. The main objective of Maitree evaluate the programme are appropriate, efficient has been to reduce alienation and stress at work and cost-effective, and are put in place in a timely and increase a sense of empowerment and and systematic manner. The following sections deal belonging among employees and their families. with the process of setting up a workplace wellness This is done by holding regular social gatherings to programme in detail. promote common interests and have a relaxed, healthy atmosphere at work. Events include clubs and workshops on diverse hobbies such as music, Model for Setting up a Workplace dance, yoga, trekking, origami, flower arrangement Wellness Programme and theatre. The events are open not only to TCS employees but to their families as well – in It has been clearly established that workplace particular, the focus is to encourage the spouses wellness programmes have great potential to benefit of TCS employees to become a part of the TCS not only the employees that are or potentially could family. The company has open days during which be suffering from debilitating NCDs, but also the an employee’s family can visit the office to get a organizations they work for in terms of increased feel for the work environment. An effort is made to productivity and profitability. However, the question involve the children of employees as well, for that remains is how such a wellness programme whom special workshops and camps are may be designed, implemented and sustained, and organized. In addition, TCS Maitree provides its benefits measured over time. Although there are counselling services to the 30,000 employees and numerous types of such workplace programmes, their families, and there are several self-help each targeting different aspects of health and groups within the organization that anyone can wellness, there are certain basic steps in launching join. The idea is to build bridges between the such a programme, as developed by WHO India, company and its employees and their families, to which must be followed in order to have a programme encourage healthier, more meaningful lives. that is successful, sustainable and scalable. These steps have been illustrated in figure 3. References: 1. “Saying tata to tedium”, The Hindu, Monday, July 23, 2003 2. http://www.careers.tcs.com/CareersDesign/Jsps/ Once the concept of having a workplace wellness WorkingatTCSMaitree.jsp (last accessed January 2009) programme has been endorsed by industry and 3. Navare, S. Counselling at work place: A proactive human health departments, and the decision to implement resource initiative. Indian Journal of Occupational and Environmental Medicine, April 2008, 12(1), 1-2 one has been taken by the management of the organization, a workplace wellness committee should be established, with representatives from all levels – employees that are potential participants, individuals that might be involved in the implementation and evaluation of the programme, and top management36. In addition, a wellness coordinator can be appointed to take charge of all programme activities. This step is essential to a successful programme, as research has shown that programmes that have such committees and/or coordinators in place to oversee them have more 18 |
  21. 21. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 19 Figure 3: Model for Developing a Healthy Workplace Endorsement by Industry Healthy Workspace Committee and Health Departments (All stakeholders) Evaluation of NCD Risk Factor Profiling by Current Status a Standard and Short Performance e.g. IDRS + TA Workplace Level Situation Employees’ Level Health Analysis Policies, Infrastructure Behaviour Survey – on a sample Assessment of Mental Health Status Plan of Action Assessment of Occupational Health Specific for the Industry Health Promotion Policies: Commitment from Management (HR) Physical Work Environment Psychosocial Work Environment Promoting Healthy Practices • Healthy canteen • Counselling facilities • Tobacco and alcohol free workspace • Facilities for recreational activity • Social club formation and • Promotion of healthy lifestyle • Reduction of occupational hazards improving co-worker relations • Health education messages on stress • Availability of basic sanitary • Defined working hours reduction techniques facilities • Periodic seminars to update • Periodic screening • Availability of child care facilities knowledge • Frequent follow up of high-risk individuals • Waste management • Healthy employer-employee • Access of health services by family • Safety of employees relationship members of the employee • Supportive work environment Developed by World Health Organization Country Office for India policy support to bring about environmental and Assessment36, profiling the risk factors of the behavioural changes promoting healthier lifestyles employees for NCDs, on the basis of which an among the employees37. overall organizational profile can be created. Such a profile will indicate priority areas, as well as help The wellness committee is encouraged to: identify high-risk individuals for targeted interventions. It should also include an • Undertake a detailed analysis of the situation at assessment of the mental health status of each the workplace, also called an organizational employee. health survey36, 37, to assess the extent to which • Depending on the nature of work, perform an the organization has the necessary prerequisites occupational health assessment specific to the in terms of its physical and psychosocial industry and type of work involved. environment, work policies, management • Conduct an Individual Interest Survey36 to get an relations, etc., to pursue a healthy life. idea of employee preferences for how they want • Assess the physiological, behavioural and to receive information (e.g. electronically or psychological characteristics of the employees pamphlets), the kind of group activities they themselves, to ascertain the kinds of problems would be most interested in joining (e.g. dance or and behaviours the programme should focus on, yoga), etc. This would ensure greater participation both in terms of prevalence and perceived need. and commitment from employees. Such an exercise should include a Health Risk | 19
  22. 22. Employee Wellness-India:Layout 1 09.09.09 17:24 Page 20 This preliminary analysis will determine the type and extent of intervention chosen. The forthcoming plan of action for the ensuing wellness organizational culture of the company and the programme. The recommendations will be used by constitution of the workforce will also play a role in the workplace wellness committee and/or top this decision. Small and medium enterprises, for management to formulate the goals, strategies and example, may alter certain components of the policies that will constitute the wellness process and still accomplish health goals (see box 6). programme37. It must be ensured at this stage of design that the formulated policies have the full Box 6 support of top management, human resources and the decision-makers of the organization. This is one Workplace Wellness Programmes for Small of the key components of any successful workplace and Medium-sized Organizations wellness programme. Small and medium-sized organizations do not have the same managerial and monetary The plan of action will consist of the basic capabilities as large organizations to focus on overarching goal or mission statement declaring employee wellness programmes. Nevertheless, what the programme aims to achieve. Under this will there are several cost-effective interventions that be the main goals or objectives through which the can be easy to implement: programme will achieve the overarching goal – these • Outsource health check-ups and screenings to objectives must be made measurable, with specific, save on full-time, on-site health facilities realistic timelines so that it is possible to assess • Provide vouchers for use at local gyms rather whether they have been achieved. Alongside this, a than on-site recreational facilities, or negotiate budget should be developed so that the costs can be corporate rates at gyms easily compared to the benefits of the programme • Distribute information on healthy eating and and the feasibility of the programme determined. nutritional seminars in the absence of a canteen offering healthy food choices The mission statement and goals of the programme • Partner with community centres and local will determine the kinds of health promotion policies events (e.g. marathons, exercise classes) open that should be adopted to accomplish them. As the to employee enrolment identified goals and objectives will come from the • Disseminate health information at the workplace situation analysis, the policies selected on the basis of these goals will be specifically designed to address the particular needs of the workforce and the organization, thereby allowing for tailor-made interventions. According to the specific needs of the organization, a committee can pick and choose from a number of available policy options listed in figure 3. These can be classified into three broad categories: 1) Changing the physical work environment 2) Changing the psychosocial work environment 3) Promoting healthy behaviours and/or discouraging unhealthy behaviours These are not mutually exclusive and might be chosen in combination to have a multilayered intervention for maximum effect on the targeted problem. The level of commitment by the company, the resources available, and the seriousness of the health issue targeted will in tandem determine the 20 |

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