12 World Health • SOth Year, No. 3, Moy-June 1997
Health promotion - a sound
• investment
Karl Kuhn
he key questions about health promotion are: What keeps people heaJthy? What aspects of the material and social working and living environment serve as resources? What experiences and learning processes enable and moti- vate people to make an effort to stay healthy?
Health promotion at work is intended to help healthier practices and behaviour at work to become easier and more rewarding for all.
Under a corporate policy geared to promoting health, workers, in-house health experts, management and members of the Works Council should design working conditions which are conducive to health and which encourage the workforce to adopt healthy working practices and lifestyles.
The need for better health promo- tion in the workplace is highlighted by the foJJowing findings in Germany.
• Days lost through illness and accidents: in 1994, about 574 million working days.
• Early invalidity: only one-third of
all employees in Germany work right up to pensionable age. This major reduction in earning capac- ity is dominated by diseases of the circulatory system and of bones and muscles, psychiatric disorders, and cancer.
• Diseases of bones, joints and muscles, especially rheumatic diseases: these mostly consist of degenerative disorders which can be largely attributed to wear and strain. After diseases of the res- piratory organs, muscular and skeletal diseases are the second most frequent cause of work incapacity.
• In 1989 there were I 775 132 notifiable accidents in the Federal Republic of Germany, leading to economic losses of resources amounting to DM 43 200 million (about US$ 29 OOO million).
• Demographic development: the proportion of elderly people in relation to the total population will increase sharply, which means there wiJJ be fewer younger people on the Jabour market.
This metal worker in Germany protects himself from occupational dangers by wearing a helmet, goggles and gloves.
Photo Still Pictures/H Schwarzbach ©
Measuring the benefits
Like any other activity, health pro- motion must be examined in terms of its cost-benefit and cost-effec- tiveness, with regard to the com- pany's health as well as its operating objectives. At the planning stage, goal-oriented indicators should be selected which over the course of time can determine to what extent desired changes have taken place.
So in the case of health promotion at work there are always two factors to be assessed: the health benefits and the economic benefits. The main indicators which can be recorded in order to determine the benefits of health promotion wiJJ include: sick leave or periods of incapacity for work; absenteeism; staff turnover;
occupational accidents; increased productivity; quality of output;
company image and sense of belong- ing to the enterprise; and staff partic- ipation in improvements.
The following may be indicators of better working conditions and individual health benefits: improved working atmosphere and communi- cations; the number of jobs with improved ergonomics (chairs, ma- chines, software etc.) and environ- mental strain reduced to a minimum;
the number of workers or groups attending health courses or courses to obtain additional qualifications;
changes in individual attitudes to health and modes of behaviour (such as eating habits in the canteen); a decline in individual risk factors.
The benefit and effectiveness indicators should then be compared with the investment in personnel and material resources devoted to health.
World Health • SOth Year, No. 3, May-June 1997 13
In Singapore, workers toke their morning exercise. Healthy practices and behaviour at work are rewarding for all concerned.
Typeseffing department in a book printing factory in Kharkov, Ukraine.
Employees can readily be fought how lo improve their well-b.eing in the workplace. Photo Still Picfures/H;alte Tim ©
Photo Still Picfures/P. Harrison ©
Approaches
The key characteristics can be sum- marized as follows.
• Health promotion is a process through which healthy and health-inducing practices and types of behaviour are made more rewarding for everyone in the enterprise.
• Health promotion combines strategies for work-oriented and behavioural change conducive to personal development, healthy job design and reinforcement of personal responsibility for health.
• Health promotion is intended to reduce and eliminate disadvan- tages for individuals and speci- fied groups of workers on a permanent basis.
• Humanitarian company aims and a participatory management style create a positive atmosphere for promoting health.
• The aims of health promotion should be set out in terms which are practical, which target spe- cific groups and which are in- formed by an overall concept of health.
• The aims of health promotion in an enterprise become more fo- cused and are more readily ac- cepted when workers are actively involved in all phases.
• Constant monitoring and regular assessment of the costs and bene- fits of health promotion provide arguments in favour of a perma- nent in-house health policy.
A practical example
In a public transport enterprise in the Hamburg area with about 530 work- ers, 80% of the employees work in alternating daytime and night shifts.
A health promotion initiative was started because of a relatively high rate of absenteeism of l 3.5%, as well as a "tense" atmosphere at work which both management and staff urgently wanted to change. A sur- vey among the employees identified such work-related problems as:
strain from alternating shifts and weekend work; opening time of the workers' canteen not orientated to shift work; lack of information and non-participation of workers in management decisions that concern them; differences in the educational level of bus drivers and lack of training for stress management;
physical strain and anxiety because of the possibility of losing their licence as public transport drivers;
unsatisfactory cooperation between drivers and repair workshop staff;
insufficient care and social support, e.g. finding accommodation and dealing with personal problems.
Health became the main topic of regular educational courses in the enterprise. Today all drivers partici- pate in a two-day training seminar where they can acquire competence in the areas of "fitness in the trans- port service", "communication" and
"avoidance and control of stress".
At the expressed wish of the seminar participants, the company is now
offering free courses in meditation, back exercises, heart exercises and so on. Although these take place outside working hours, about 30% of the employees participate.
As a result of this package of health promotional measures, it was possible to reduce the sickness rate in the transport service within five years from 13.5% ( 1989) to under 8.5% (1993) with positive effects on absenteeism in the whole company.
This is between 4% and 5% better than in comparable companies.
Even on a cautious calculation that only 3% of the 5% reduction may be due to the health promotion activi- ties and changes (and not even counting the benefits with regard to morale, greater use of the suggestion book and customer satisfaction), the cost-benefit calculation amounts to DM 1.4 million (US$ 932 000) net savings per year.
As this example shows,
improved employees' participation and promotion of a healthy lifestyle pay off both in economic and in health terms. The more sophisti- cated such arrangements are in an enterprise, the higher the quality of health promotion will be in practice. •
Dr Karl Kuhn is Director and Professor of the Federal lnsfifufe for Occupational Safety and Health, Friedrich-Henkel-Weg 1-25, 44149 Dortmund, Germany.
