The Future of the Public's Health in the 21st Century (2003) / Chapter Skim
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6. Employers and Business
6. Employers and Business
Pages 268-306
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From page 268... ...
The discussion then addresses the important role that employers play in ensuring quality and accountability for the health care services purchased by and for their employees. The chapter then discusses the rationale for employer investment in the health of employees and how sponsoring health promotion and disease prevention activities in the workplace and improving workplace conditions promote employee health.
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From page 269... ...
According to the Employee Benefit Research Institute and Mathew Greenwald & Associates, Inc.'s Value of Benefits Survey, 60 percent of employees rank health insurance as the most important benefit. Employees also report that benefits (e.g., health insurance and retirement plans)
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From page 270... ...
Increasing health insurance premiums influence whether an employee (as well as dependents) has coverage or joins the ranks of the uninsured.
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From page 271... ...
The expense and competing demands on family income are the main reasons individuals report for declining an offer of employmentbased coverage (Cooper and Schone, 1997; Rowland et al., 1998; Hoffman and Schlobohm, 2000~. Individuals who decline employer-based health insurance are typically covered through a spouse or some other type of coverage, and about 4 percent remain uninsured.
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From page 272... ...
and the Minnesota Health Plan Initiative to Improve Health Care. Many employer groups are also involved in prevention activities sponsored by the Partnership for Prevention, a national nonprofit organization dedicated to increasing the resources for and knowledge about effective disease prevention and health promotion policies and practices.
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. The committee acknowledges the crucial role that employers, particularly large employers, play in creating health security for millions of Americans as providers of employer-based health insurance coverage and purchasers of health care services.
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These critics recommend changes in tax policy so that tax incentives for the purchase of health insurance would not favor employer-sponsored coverage (Pauly, 1986; Congressional Budget Office, 1994; Gruber and Madrian, 1996; Gavora, 1997; American Medical Association, 1999; Health Policy Consensus Group, 19991. Until reforms are enacted to assure access to affordable health insurance for all Americans, the committee urges employers to continue to provide and improve health insurance coverage for their employees.
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From page 275... ...
More than 10,000 peer-reviewed articles in scientific journals show a clear causal relationship between specific modifiable risk factors and adverse health consequences. The following modifiable risk factors increase rates of mortality, morbidity' disability' and, in many cases, productivity loss: tobacco use, alcohol and drug use, sedentary behavior, poor nutrition, being overweight, having elevated serum cholesterol levels and high blood pressure, exhibiting high levels of stress and hostility, a lack of social support networks, and having unsafe sex.
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et al., 2000~. Other conditions had lower prevalence rates but high average treatment costs and high total payments, such as cerebrovascular disease (1.65 percent of total payments)
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et al., 2000~. A clear relationship exists between modifiable risk factors in a typical employed population and the employers' health care expenditures for the treatment of the diseases and disorders caused by these risk factors.
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A similar relationship existed between modifiable risk factors and illness-related employee absenteeism. For an employer, the implications of this research are enormous.
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As a result of this stucly, senior management at Union Pacific Railroad clecicleci that improving the health and productivity of its employees was a priority for the railroad and elevated this initiative to the status of a "big financial clear" in 2001 (Leutzinger, 2001~. Changing the Health Risk Profiles of Employees In many ways, the workplace shouici be an ideal setting for the introcluction and maintenance of health promotion and disease prevention programs.
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Overall Cost Savings and Returns on Investment Employers are concerned not only whether health promotion and disease prevention programs work in the sense that they can change the behavior, psychosocial risk factors, and biometric values for individuals employees but also whether these programs save money overall. They are concerned about whether investment in these activities has a positive rate of return.
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Eligible employees need to be aware, at an individual level, of the importance of health promotion and disease prevention and the availability of programs to address health risk factors. This is accomplished through successful implementation of communications, public relations, and marketing programs.
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et al., 2001; Kessler et al., 2001; Lerner et al., 2001~. Once these tools and systems are perfected, the potential impact of health promotion and disease prevention programs on employee productivity and overall business performance should be easier to document.
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In addition, OSHA's Strategic Partnership Program focuses on safety and health programs and includes outreach and training components along with enforcement (OSHA, 2002a)
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Occupational safety and health programs are specific to the work site and operations. Programs usually focus on basic principles of control technology that include engineering controls, work practices, personal protective equipment, and monitoring of the workplace for emerging hazards.
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Data from a survey of businesses in 1994-1995 found that about one-third of all work-related deaths occur at workplaces with 10 or fewer employees, although they employ only 15 percent of all workers in private industry. The challenges to ensuring safe workplaces and healthy workers include a lack of onsite occupational safety and health professionals, difficulties in recognizing the magnitudes of specific hazards, and a lack of strategies for dealing with hazards in a small-business environment (NIOSH, 2002c)
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EMPLOYERS AND BUSINESS 287 response efforts at WTC. Box 6-6 provides a summary of OSHA activities performed to identify and abate serious hazards and to protect the workers in WTC site operations.
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The committee encourages a greater sharing between large and small employers of the best practices and strategies that can reduce workrelated mortality, injuries, and diseases and protect workers' health. Other Workplace Policies That Promote Health Employers implement a number of policies related to family leave, flexible work practices, and other benefits and organize work (e.g., through the creation of teams and the assignment of multiple tasks)
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From page 289... ...
ROLE OF BUSINESSES AND INDUSTRIES IN PROMOTING A HEALTHY ENVIRONMENT The private and public sectors significantly influence health when their goals are incompatible with conditions that promote healthy behaviors or physical environments. When such goals are in conflict and significant health hazards arise, governmental agencies have a responsibility to act.
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An example of a company initiative to improve community health is described in Box 6-7. Thus, investing in community and environmental health not only is an example of corporate responsibility but also can provide economic returns to the business or industry.
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Company mission and vision statements, such as "becoming the preferred employer in the community," "attracting and retaining the best and brightest," and "emphasizing worker safety above all else," can be leveraged by champions of health promotion and disease prevention programs to, very simply, "help the company achieve its mission and vision." Beyond the theoretical, philosophical, or even emotional reasons for supporting investments in employee and community health, there are practical reasons for these investments. A company, especially one that is large and dominant, that assumes a leadership position in improving community health and emphasizing disease prevention, health promotion, and accountability is likely to stand out in that community and is likely to affect the norms and practice patterns of health care practitioners for the better.
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Corporate investment in an improved community health infrastructure can create a larger pool of healthy and productive employees who are better able to face the physical and mental challenges of today's work environment. Many corporate leaders seek to present an image of their companies as caring and responsible employers, and many companies try to distinguish themselves by being the preferred place to work (Johnson & Johnson, 1989; Levering and Moskowitz, 1994; Goetze!
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It has embraced its role as a participant in the public health system by strategically aligning itself with the Kaiser Family Foundation to launch a major media campaign to foster HIV awareness and prevention domestically and internationally (www.kif.org)
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EMPLOYERS AND BUSINESS 295 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ~ 'Th' '-'-'M' '1-1' ' -'-'B-' ' 'k'-'Ch-i' f'-'-E' ' ' ' ti' -'-Offi' ...................
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296 THE FUTURE OF THE PUBLIC'S HEALTH i~ j 1 -- t - Iit l ............................................................................................................................
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For example, corporate leaders should be invited to participate in community assessments and health planning and promotion activities (see Chapter 4~. Such communication with corporate leaders and the participation of corporate leaders would allow the exchange of data on employee health as well as population-based health data from the community that are interpreted in ways that are meaningful to both public health officials and corporate health leaders.
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Strong communications strategies must be developed to disseminate information on the costs (to employers and businesses) of modifiable health risk factors and the evidence-based interventions available to reduce these risk factors.
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Everett Koop National Health Award, sponsored by the Health Project,2 has been presented to U.S. companies that have documented improved employee health and cost savings from the health promotion and disease prevention programs at their work sites (fully, 1995; Ziegler, 1998, 1999~.
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July 1999. Rethinking health insurance: the AMA's proposal for reforming the private health insurance system.
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2000. Employment-Based Health Insurance Coverage.
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1997. How Health Insurance Mandates Misdiagnose the Disease.
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1989. The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status.
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2001. Low wage and health insurance coverage: can policymakers target them through their employees?
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1997. Health Benefits at Work: An Economic and Political Analysis of Employment-Based Health Insurance.
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1996. Guide to Clinical Preventive Services, 2nd edition.
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