This document summarizes a presentation about creating healthy workplaces. It discusses how poor health costs employers money through increased medical costs, absenteeism, and reduced productivity. Many chronic diseases are caused or exacerbated by modifiable lifestyle factors like obesity, tobacco use, poor nutrition, lack of exercise, alcohol use, and stress. Establishing a culture of health in the workplace through leadership commitment, evidence-based wellness programs, and a focus on modifying risk factors can improve employee health and reduce costs. Case studies show that comprehensive worksite wellness programs have led to reductions in health risks, health care costs, and increases in productivity at successful companies.

1. What Makes For a Healthy
Workplace?
Ron Z. Goetzel, PhD
Institute for Health and Productivity Studies
Johns Hopkins University and Truven Health Analytics
HPCareerNet – HP Live Webinar
June 12, 2015

2. © 2014, Johns Hopkins University. All rights reserved.
The Problem
Poor Health Costs Money
• Medical
• Absence/work loss
• Safety/workers’ comp
• Presenteeism
• Risk factors

3. © 2014, Johns Hopkins University. All rights reserved.
Top 10 Most Costly Physical Health
Conditions
Medical, Drug, Absence, STD Expenditures (1999 annual $ per eligible), by Component
Source: Goetzel, Hawkins, Ozminkowski, Wang, JOEM 45:1, 5–14, January 2003.

4. © 2014, Johns Hopkins University. All rights reserved.
Diseases Caused (At Least Partially) by
Lifestyle
 Obesity: Cholesystitis/Cholelithiasis, Coronary Artery Disease, Diabetes,
Hypertension, Lipid Metabolism Disorders, Osteoarthritis, Sleep Apnea,
Venous Embolism/Thrombosis, Cancers (Breast, Cervix, Colorectal,
Gallbladder, Biliary Tract, Ovary, Prostate)
 Tobacco Use: Cerebrovascular Disease, Coronary Artery Disease,
Osteoporosis, Peripheral Vascular Disease, Asthma, Acute Bronchitis,
COPD, Pneumonia, Cancers (Bladder, Kidney, Urinary, Larynx, Lip, Oral
Cavity, Pharynx, Pancreas, Trachea, Bronchus, Lung)
 Lack of Exercise: Coronary Artery Disease, Diabetes, Hypertension,
Obesity, Osteoporosis
 Poor Nutrition: Cerebrovascular Disease, Coronary Artery Disease,
Diabetes, Diverticular Disease, Hypertension, Oral Disease, Osteoporosis,
Cancers (Breast, Colorectal, Prostate)
 Alcohol Use: Liver Damage, Alcohol Psychosis, Pancreatitis,
Hypertension, Cerebrovascular Disease, Cancers (Breast, Esophagus,
Larynx, Liver)
 Stress, Anxiety, Depression: Coronary Artery Disease, Hypertension
 Uncontrolled Hypertension: Coronary Artery Disease, Cerebrovascular
Disease, Peripheral Vascular Disease
 Uncontrolled Lipids: Coronary Artery Disease, Lipid Metabolism
Disorders, Pancreatitis, Peripheral Vascular Disease

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The Big Picture: Overall Burden of
Illness by Condition
Using Average Impairment and Prevalence Rates for Presenteeism
($23.15/hour wage estimate)
$-
$50
$100
$150
$200
$250
$300
$350
$400
$450
A
llergy*
A
rthritis
A
sthm
a
A
ny
C
ancer
D
epression/S
adness/M
entalIllness
D
iabetes
H
eartD
isease
H
ypertension
M
igraine/H
eadache
R
espiratory
Infections
AnnualCosts
Presenteeism
STD
Absence
RX
ER
Outpatient
Inpatient
Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004)

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Mayo Clinic Study

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Health Risks and Costs
(N = 32,298 – 158,541)

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Risk-Cost Relationships At PepsiCo

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PepsiCo – Overweight / Obese Analysis
(N=11,217)
*At least one difference significant at the 0.05 level
Diff =
29%,
$613*
Diff =
58%,
$111*
Diff =
25%,
$987
Diff =
10%,
$28
Diff =
7%, $49
Diff =
26%,
$186*
Difference between combined overweight/obese categories and normal weight is displayed
Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs among Employees
at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010.
• 74% of the
sample is
overweight
or obese

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Header/Full Bleed Image
Name/Subject Subhead
Title/caption
Title/caption
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Prevalence of Obesity
1990 1996 2006
Prevalence of Diabetes(Among US adults; BRFSS)
No Data <4% 4%–6% 6%–8% 8%–10% >10%

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Vanderbilt – 8-Year Study
11

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Vanderbilt: Obesity and Diabetes
12

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Increased Health & Productivity Risks
MEDICAL
Chest/back pain, heart disease, GI disorders, headaches,
dizziness, weakness, repetitive motion injuries.
PSYCHOLOGICAL
Anxiety, aggression, irritability, apathy, boredom, depression,
loneliness, fatigue, moodiness, insomnia.
BEHAVIORAL
Accidents, drug/alcohol abuse, eating disorders, smoking,
tardiness, “exaggerated” diseases.
ORGANIZATIONAL
Absence, work relations, turnover, morale, job satisfaction,
productivity.

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The Vast Majority of Chronic Diseases Can Be
Prevented or Better Managed
The Centers for Disease Control and Prevention
(CDC) estimates…
• 80% of heart disease and stroke
• 80% of type 2 diabetes
• 40% of cancer
…could be prevented if only Americans were to
do three things:
• Stop smoking
• Start eating healthy
• Get in shape

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What We Know
• Work = where you spend most of your waking hours
• Unique opportunities for employers to improve
population health
• Benefits of workplace health promotion
• Improve employee health and well-being
• Decrease healthcare costs
• Increase worker productivity/performance

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The Challenge
• Employers are…
• Not convinced of the
health and economic
benefits.
• Unsure about where or
how to begin.
• Unable to discern what
works or doesn’t work.
• Bombarded with
negative press
information.

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The Confusion

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Do Wellness Programs Work or Not?
Yes, if you do it right…
Leaders Managers Champions Employees

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What is the Evidence Base?
 A large proportion of diseases and disorders is preventable. Modifiable health risk
factors are precursors to a large number of diseases and disorders and to
premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993,
McGinnis & Foege, 1993, Mokdad et al., 2004)
 Many modifiable health risks are associated with increased health care costs within
a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992, Goetzel, et
al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999, Goetzel et al. 2012)
 Modifiable health risks can be improved through workplace sponsored health
promotion and disease prevention programs (Wilson et al., 1996, Heaney & Goetzel,
1997, Pelletier, 1991, 1993, 1996, 1999, 2001, 2005, 2009, 2011, Soler et al., 2010)
 Improvements in the health risk profile of a population can lead to reductions in
health costs (Edington et al., 2001, Goetzel et al., 1999, Carls et al., 2011)
 Worksite health promotion and disease prevention programs save companies
money in health care expenditures and produce a positive ROI (Johnson & Johnson
2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998, California Public
Retirement System 1994, Bank of America 1993, Dupont 1990, Highmark 2008, Johnson &
Johnson 2011, Dell 2015)

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Worksite Health Promotion Works!

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CDC Community Guide to Preventive
Services Review – AJPM, February 2010
86 Studies Reviewed
21

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Health Affairs ROI Literature Review
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2).
Published online 14 January 2010.

23. A Review of the Evidence:

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Header/Full Bleed Image
Name/Subject Subhead
Title/caption
Title/caption

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Header/Full Bleed Image
Name/Subject Subhead
Title/caption
Title/caption

26. © 2014, Johns Hopkins University. All rights reserved.
Header/Full Bleed Image
Name/Subject Subhead
Title/caption
Title/caption
ACOEM Winners vs. S&P 500

27. And the Answer is…

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Promoting Healthy Workplaces

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Project Aims and Objectives
• Fill in the knowledge gap about what constitutes an
effective health promotion (wellness) program.
• Identify how organizations are succeeding when
implementing workplace programs.
• Share the ingredients of their “secret sauce” with the
business community.
• Tell “stories with substance” to inspire more
companies to start or improve health promotion
programs at their worksites.

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Approach
• Updated Literature Review
• Expert Roundtable Discussions
• Organizational structure
• Program implementation
• Measurement and evaluation
• Site Visits to nine Companies
• C. Everett Koop Award Winners/Honorable Mentions
• Recommendations

31. © 2014, Johns Hopkins University. All rights reserved.
Expert Panel
David Anderson, Ph.D.
David Ballard, Psy.D., M.B.A.
John Harris, M.Ed.
Rebecca Kelly, Ph.D., R.D.
Craig Nelson, M.S., D.C.
George Pfeiffer, M.S.E.
Bill Baun, EPD, CWP, FAWHP
David Hunnicutt
David DeJoy, Ph.D.
Kate Lorig, R.N., Dr.P.H.
Steve Aldana, Ph.D.
Tre McCallister, EdD, MA
Michael O’Donnell, Ph.D.
Dan Gold, Ph.D.
Kenneth R. Pelletier, Ph.D., MD
Bruce Pyenson, FSA, MAAA
Debra Lerner, Ph.D.
Seth Serxner, Ph.D.

32. © 2014, Johns Hopkins University. All rights reserved.
Case Studies – Companies That Do It
“Right”

33. The Secret Sauce

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1. Culture of Health
• More than just a wellness
program – It’s a way of life
• Ingrained in every part of the
organization
• Business Mission
• Built Environment
• Performance Metrics
• Programs, Policies,
Health Benefits

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2. Leadership Commitment
• CEO Driven
• Lead by Example
• Middle Management Support
• Budget/business plan
• Empowered workers/unions

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3. Specific Goals and Expectations
• Think big, start small, act fast -- one step at a time
• Set short and long term objectives
• Be realistic about what can be achieved in 1, 3, 5,
10+ years
• Accountability – leaders and employees are
accountable for doing their part to support a culture of
health

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4. Strategic Communications
• Messages need to be:
• Consistent
• Constant
• Engaging
• Targeted
• Two-way dialogue using a
variety of channels
• Wellness champions
Relentless Surround Sound

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5. Employee Engagement in Program
Design/Implementation
• Wellness Committees
• Employee Feedback
Surveys
• Participatory Based
Program Design
• Focus Groups

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6. Best Practice Interventions
• Convenience, removing
barriers
• Many choices
• Making the healthy choice
the easy choice
• Applying behavior change
theory/practice

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7. Effective Screening and Triage
• Health Risk Assessments
with Follow-up -- PLUS
• Biometric Screenings
(USPSTF Guidelines)
• On-site Clinics and
Counselors

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8. Smart Incentives
• Tailoring, and providing alternative
paths to motivate, reward and help
employees achieve their goals
• Tiered Incentive Programs
• Non-Monetary Incentives
• Carrots, Not Sticks
• Voluntary – reasonable dollar
amounts
• Long-term view - retirement

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9. Effective Implementation
• Tailored to the company’s culture
• Integrated solutions
• Flexibility
• Fresh ideas
• Fun

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10. Measurement and Evaluation
What Do We Mean When We Say: A Wellness Program
Works?
• “Make workers aware of their health and how it improves quality of
life.”
• “High participation and engagement.”
• “Lose weight, stop smoking, exercise more.”
• “Medical claims costs should go down.”
• “Less absenteeism, fewer safety incidents.”
• “Attract the best talent.”
• “Happier workers with more energy.”
• “Create a culture of health.”

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What Does Not Work
•HRAs alone
•Health outcome incentive based models disconnected from a
comprehensive health promotion program
•“Under the radar” stuff (provided by health plans)
•Short term campaigns – “biggest loser”
•Asking vendor to “fix the unhealthy people”
•Lots of biometric testing, with little else
•Poor marketing/communications – no customer input

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Culture of Health = Value on Investment
• “It’s the right thing to do; not
everything has to have an ROI”
• “Our people and their unique
individual talents are valued”
• “Happy people, healthy
people”
• Present, engaged, energized,
active, productive, satisfied
• Low turnover
• “Win as a team, lose as a
team”
• “It’s who we are”

46. © 2014, Johns Hopkins University. All rights reserved.
Header/Full Bleed Image
Name/Subject Subhead
Title/caption
Title/caption
Workplace Health Promotion Works –
If You Do it Right!
Financial
Outcomes
Health
Outcomes
QOL and
Productivity
Outcomes
Cost savings, return on
investment (ROI) and net
present value (NPV)
Where to find savings:
• Medical costs
• Absenteeism
• Short term disability
(STD)
• Safety/Workers’ Comp
• Presenteeism
• Adherence to evidence
based medicine
• Behavior change, risk
reduction, health
improvement
• Improved “functioning”
and productivity
• Attraction/retention –
employer of choice
• Employee engagement
• Corporate social
responsibility (CSR)
• Balanced scorecard

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Where We Need to Go…..
• Old Paradigm
• Bad behavior (poor diet)…leads to
• High risk condition (obesity)…leads to
• Disease (diabetes)…leads to
• Death
• New Paradigm
• Good health (physical, mental, emotional, social,
financial, spiritual)…leads to
• Well-being (energy)…leads to
• Purposeful life
AND HIGH VALUE

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Learn More at….
http://www.jhsph.edu/promoting-healthy-workplaces

49. Thank You
www.jhsph.edu/health-and-productivity-studies
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for-health-and-productivity-studies/a0/651/717