Full-time workers in the United States who are overweight or obese and have other chronic health conditions miss about 450 million more days per year than healthy workers. According to a Gallup poll, this results in an annual productivity loss of $153 billion.

The Gallup-Healthways Well-Being Index finds that full-time workers of normal weight without chronic health conditions make up 13.9 percent of the U.S workforce and average about 4 days a year of absence. Workers of above normal weight with three or more chronic conditions average about 42 days of absence per year.

Another report, the "Thomson Reuters Workforce Wellness Index" finds that a decline in overall population health is contributing to rising healthcare costs and lost productivity for U.S. employers. The report cites an annual cost of unhealthy behavior of $623 per employee.

The index uses six behavioral risk factors to tract collective health of workers who have employer-sponsored health care. The risks are:

• Body mass index
• Blood pressure
• Cholesterol
• Blood glucose
• Tobacco use
• Alcohol use

In 2010, about 14 percent of direct healthcare costs for these employers was directed linked to the six factors. The single biggest factor was body mass index, which is used to measure obesity.

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NIOSH Identifies Strategies

In a report entitled "Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing," NIOSH identifies four key areas employers need to address to improve worker health. We'll present two today, and two tomorrow.

1. Organizational Culture and Leadership

• Develop a "human centered culture." Effective programs thrive in organizations with policies and programs that promote respect throughout the organization and encourage active worker participation, input, and involvement. 

• Demonstrate leadership. Commitment to worker health and safety, reflected in words and actions, is critical. The connection of workforce health and safety to the core products, services and values of the company should be acknowledged by leaders and communicated widely. 

• Engage mid-level management. Supervisors and managers at all levels should be involved in promoting health-supportive programs. They are the direct links between the workers and upper management and will determine if the program succeeds or fails. Mid-level supervisors are the key to integrating, motivating and communicating with employees.

2. Program Design

• Establish clear principles. Effective programs have clear principles to focus priorities, guide program design, and direct resource allocation. Prevention of disease and injury supports worker health and well being.

• Integrate relevant systems. Program design involves an initial inventory and evaluation of existing programs and policies relevant to health and well-being and a determination of their potential connections. Programs should reflect a comprehensive view of health: behavioral health/mental health/physical health are all part of total health. Integration of diverse data systems can be particularly important and challenging.

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• Eliminate recognized occupational hazards. Changes in the work environment (such as reduction in toxic exposures or improvement in work station design and flexibility) benefit all workers.

• Be consistent. Workers' willingness to engage in worksite health-directed programs may depend on perceptions of whether the work environment is truly health supportive. Individual interventions can be linked to specific work experience. For example, NIOSH says that industrial workers who smoke are more likely to quit and stay quit after a worksite tobacco cessation program if workplace dusts, fumes, and vapors are controlled and workplace smoking policies are in place.

• Promote employee participation. Ensure that employees are not just recipients of services but are engaged actively to identify relevant health and safety issues and contribute to program design and implementation. Barriers are often best overcome through involving the participants in coming up with solutions.

• Tailor programs to the specific workplace and the diverse needs of workers. Effective programs are responsive and attractive to a diverse workforce. One size does not fit all—flexibility is necessary.

• Consider incentives and rewards. Incentives and rewards, such as financial rewards, time off, and recognition, for individual program participation may encourage engagement, although poorly designed incentives may create a sense of "winners" and "losers" and have unintended adverse consequences.

• Find and use the right tools. Measure risk from the work environment and baseline health in order to track progress. For example, a Health Risk Appraisal instrument that assesses both individual and work-environment health risk factors can help establish baseline workforce health information, direct environmental and individual interventions, and measure progress over time.

• Adjust the program as needed. Programs must be evaluated to detect unanticipated effects and adjusted based on analysis of experience.

• Make sure the program lasts. Design programs with a long-term outlook to assure sustainability. Short-term approaches have short-term value. There should be sufficient flexibility to assure responsiveness to changing workforce and market conditions.

• Ensure confidentiality. Be sure that the program meets regulatory requirements (e.g., HIPAA, state laws, ADA) and that the communication to employees is clear on this issue. If workers believe their information is not kept confidential, the program is less likely to succeed.

Tomorrow, we'll conclude with the remaining two areas of NIOSH's suggestions for improving worker health, program implementation/resources and program evaluation.