For a growing prevalence and impact of chronic diseases on employee health and well-being, the associated loss of productivity due to absence from work (absenteeism) and reduced performance while at work (presenteeism), the rising costs of health insurance, increased frequency of hospital visits, and a fiercely competitive business environment, employers across the high-income countries are adopting diverse health promotion and disease prevention strategies- commonly referred to as workplace wellness programmes. Bangladeshi employers including the government, multinationals, and large national corporate houses are far behind in initiating and spreading such employee wellness programmes.
Disease prevention programmes aim either to prevent the onset of diseases (primary prevention) or to diagnose and treat disease at an early stage before additional complications arise (secondary prevention) over time. Primary prevention addresses health-related behaviours and risk factors-for example, by encouraging daily exercise and recommending a diet with lower fat and caloric content to prevent the onset of diabetes mellitus. Secondary prevention attempts to improve disease control-for example, by promoting medication adherence for patients with asthma to avoid symptom exacerbations that can lead to emergency visits or hospitalisation. A broad range of programmes are offered in high-income countries under the label "workplace wellness," from multi-component programmes to a single intervention, and such programmes can be offered directly by employers, through a contractor, health insurance plans, or a combination of both.
Workplace wellness programmes take advantage of employers' access to a large number of employees typically at a younger working-age when such interventions can instil healthy behaviour and change their long-term health trajectory.
Evidence accumulated over the past few decades shows that well-designed and well-implemented workplace wellness programmes that are founded on research-based principles can attain positive health and financial outcomes.
Chronic diseases and conditions such as heart disease, stroke, cancer, type 2 diabetes, obesity, chronic lung diseases, chronic kidney diseases, and arthritis are among the most prevalent and costly yet often preventable health problems. According to the US Centre for Disease Control and Prevention (CDC), 6 in 10 American adults have a chronic disease and 4 in 10 adults have two or more chronic diseases. With respect to the number of deaths in the US, heart disease and cancer are leading causes followed by chronic lower respiratory diseases, stroke (cerebrovascular diseases), Alzheimer's disease, and diabetes.
Four health risk behaviours -lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol-are causing much of the illness burden, suffering, premature retirement, and early death related to chronic diseases and conditions in the US. According to one study, more than half (52 per cent) of adults did not meet recommendations for aerobic exercise or physical activity. In addition, 76 per cent did not meet recommendations for muscle-strengthening physical activity. According to one estimate, 86 per cent of all health care spending in the US was for people with one or more chronic health conditions.
Decreased productivity associated with a chronic disease includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all. Furthermore, chronic disease is no longer thought to be a problem of older age groups because of its shift toward onset during working age even in Bangladesh. Business leaders in Canada and the US were being called upon to make changes in the workplace to curb the rising costs of insurance premiums and employee medical claims that continued to rise.
A definition for workplace wellness programme has yet to emerge that is formally and universally acknowledged, and the range of benefits offered under this label is broad. Three types of activities that can be offered by the employer include:
n screening activities to identify health risks (e.g., measurement of body weight)
n primary prevention interventions called lifestyle management (e.g., weight reduction counselling) and secondary prevention to improve control of chronic conditions, also referred to as disease management
n health promotion activities to adopt healthy lifestyles (e.g., healthy food options in company cafeterias)
The overall health and wellness strategy of employers can also encompass other benefits related to health and well-being (e.g., occupational health and safety programmes), contextual changes (e.g., smoking bans), and the use of incentives to encourage the uptake of workplace wellness benefits. Those incentives can be tied to programme participation or to changes in health-related standards, such as smoking or body weight.
There is a variety of workplace wellness strategies that ranges from offering vouchers to join a gym in implementing multi-part programmes that combine screening and interventions. Additionally, workplace wellness programmes might be offered directly by an employer as a benefit for all employees or as part of an employer-sponsored group health plan for participants and beneficiaries. The emergence of a workplace wellness industry in some countries in recent years has allowed employers to procure ready-made programmes and interventions and has contributed to the uptake of those programmes, as they demonstrate favourable results.
Many employers now regard workplace wellness programmes as an effective tool to contain health care costs, boost productivity, and as a practical strategy to attract and retain a skilled workforce. Employers continue to show considerable interest in programmes that help employees identify health issues and manage chronic conditions. Many employers believe that improving the health of their workers and their family members can improve their work morale and reduce turnover. Big employers in many countries now offer employee health screening programmes including health risk assessments, which are questionnaires asking employees about lifestyle, burnout, stress, physical health, and biometric screening (when an in-person health examination is conducted by a medical professional).
Research has found that some factors promote wellness programme success: Firstly, effective communication strategies ranging from face-to-face interaction to mass dissemination of programme information to employees; secondly, opportunities for employees to engage in and making wellness activities convenient and easily accessible including flexibility of work schedules; thirdly, leadership engaged at all levels for programme success and senior managers generate excitement and connect employees to available resources; fourthly, use of existing resources and relationships to expand offerings at little to no cost, and finally, continuous evaluation and soliciting feedback from staff.
Big employers in Bangladesh may want to adopt health promotion programmes that use the best and promising provisions and practices to maximise achieving positive results. They may start seeking information on best practices in workplace wellness programme to implement evidence-based programmes and support their wider embracing through corporate-level policy.
Hasnat M Alamgir is a Professor of Pharmacy at East West University.
