2010 Healthy Workforce - acsworkplacesolutions.com · HEALTHY WORKFORCE 2010. U.S. Department of...

C R E A T I N G C H A N G E W I T H H E A L T H Y P E O P L E 2 0 1 0

Fall 2001

Partnership for Prevention

Washington, DC

An Essential Health Promotion Sourcebook for Employers,Large and Small

HEALTHYWORKFORCE2010

U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion Statement:The views expressed herein are solely those of the issuing agency and do not necessarily reflect theofficial positions or policies of the U.S. Department of Health and Human Services. Healthy People 2010documents are online at the Healthy People Website at http://health.gov/healthypeople. For moreinformation, visit the Healthy People Website or call 1-800-367-4725.

T A B L E O F C O N T E N T S

1 INTRODUCTIONThe Promise of Prevention: A Boon to Business

3 SECTION I:Why Invest in Health Promotion

10 SECTION II:Healthy People 2010 Essentials for Business

12 SECTION III:Healthy People Objectives At-A-Glance

15 Healthy Workforce Objectives

25 SECTION IV:Planning A Worksite Health Promotion Program

31 SECTION V:Resources

43 State Healthy People Contacts

52 APPENDIX 1:Healthy People 2010 Objectives Applicable toWorksites

58 APPENDIX 2:Sample Worksite Health Promotion InterestSurvey

61 APPENDIX 3:Worksite Wellness Questionare

63 Endnotes

Healthy People 2010 is aset of national health objectives,with 10-year targets. The overallgoals of Healthy People2010 are to:1) increase qualityand years of healthy life and 2)eliminate health disparities. Thedocument contains 467 objectivesorganized into 28 focus areas. Inaddition, 10 Leading HealthIndicators have been identified—including physical activity, tobaccouse, and overweight and obesity—to help motivate national actionaround major public healthconcerns.The Leading HealthIndicators balance Healthy People2010’s comprehensive set of healthobjectives with a small set ofspecific health priorities.

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At every stage of life, preventive healthservices hold the promise of improvingAmerican lives; making them longer,healthier, and more productive.

The promise of prevention stems directlyfrom evidence that many of the leadingcauses of disability and premature death inthe United States are potentially avoidableor controllable, including most injuries,many serious acute and chronic conditions,and many forms of heart disease, and somecancers.

As shown in Table 1, most of the tenleading causes of premature death in theU.S. are in some way linked to personalbehaviors; behaviors that may eithercontribute to disease development orexacerbate existing health problems.1

What does prevention offer employers?Plenty.

Adults with multiple risk factors for disease(e.g., high blood pressure, smoking, andsedentary habits) are more likely to behigh-cost employees in terms of healthcareuse, absenteeism, disability, and overallproductivity.2 On the other hand, healthy

employees—and especially those withhealthy families, as well—are likely toincur lower medical costs and be moreproductive.

Fortunately, several important risk factorsare controllable, often simply by modifyinghealth habits. In fact, behavior changes atany age can return rewards in health andproductivity. In other cases, the earlydetection of illness can simplify treatmentand increase chances for a completerecovery. And that’s good news forbusinesses because they rely on people.

Many small employers think that only largecorporations can afford to sponsor worksitehealth promotion activities or participate incommunity-wide health promotioncampaigns that benefit both their

employees (past, present, and future) andtheir corporate image. But healthpromotion doesn’t need to cost much. Forabout the cost of the holiday party at year’send, or the installation of new carpet, smallbusinesses can offer low-cost employeebenefits or support broader healthpromotion efforts that can pay bigdividends to companies, employees, and

I N T R O D U C T I O N

The Promise of Prevention: A Boon to Business

Table 1

Actual Causes of Deaths in the United States in 1990Causes Estimated No. of Deaths Percentage of Total Deaths

Tobacco 400,000 19%

Diet/activity patterns 300,000 14%

Alcohol 100,000 5%

Microbial agents 90,000 4%

Toxic agents 60,000 3%

Firearms 35,000 2%

Sexual behavior 30,000 1%

Motor vehicles 25,000 1%

Illicit use of drugs 20,000 <1%

Total 1,060,000 50%

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the community-at-large—an all-aroundwinning situation. Perhaps it is moreappropriate to ask whether smallemployers can afford to skimp on healthpromotion programs.

Whatever the motivation, now is aparticularly opportune time for employersto invest in health promotion at theworksite and beyond. America hasembarked on a major initiative to achieveimportant national health objectives by2010. Businesses large and small have avaluable opportunity to join with thousandsof public and private sector companies toreap the benefits prevention offers whilehelping their communities meet theseobjectives. This ambitious effort is guidedby Healthy People 2010— the preventionagenda for the United States. And it won’tsucceed without private and public sectoremployer participation.

Worksites, where most adults typicallyspend half or more of their waking hours,have a powerful impact on individuals’health. Healthy People 2010 includes twomajor worksite-specific objectives. Thefirst is for most employers (75%),regardless of size, to offer acomprehensive employee healthpromotion program. The second, andrelated, objective is to have mostemployees (75%) participating inemployer-sponsored health promotionactivities. The 1999 National WorksiteHealth Promotion Survey reveals thatemployee health promotion programs arebecoming more prevalent and morecomprehensive. Many employers are alsofinding it rewarding to take part in largercommunity-based health promotioncoalitions that address priority healthissues.

Read on to find out how your company, nomatter what size, can be involved in healthpromotion—and why it should be.

“One of the best ways to attractand retain the best people in theworld is to provide a set of benefitsand rewards that are particularlyappropriate for the people you aretrying to attract.”

—Glenn Gienko, Executive Vice President

and Director of Human Resources,

Motorola

Reason #1: Improve productivity.

Health promotion is an investment inhuman capital. Employees are more likelyto be on the job and performing well whenthey are in optimal physical andpsychological health. They are also morelikely to be attracted to, remain with, andvalue a company that obviously valuesthem. In short, a company’s productivitydepends on employee health.

According to data from the 1999 NationalWorksite Health Promotion Survey(NWHPS), employers are worried abouthealth care costs, but significant majoritiesare also concerned about employees’ on-the-job performance, their recruitment andretention, worksite morale, and the aging ofthe American workforce, as shown in Table2.4 These concerns are an important part ofthe motivation for employers to considerworksite health promotion activities.

Michael P. O’Donnell, editor of theAmerican Journal of Health Promotion,has noted that health promotion activitiesare likely to yield greater returns fromincreased employee productivity than frommedical care cost-savings. Productivity-related benefits are also more likely to beclosely aligned with an organization’s short-and long-term priorities.5 In fact, inaddition to simply keeping employeeshealthy, the top reasons employers give forinstituting health promotion programs areto improve employee morale (mentionedby 77% of (NWHPS) respondents), retaingood workers (75%), attract goodemployees (67%), and improve productivity(64%).4

Worksite health promotion promotes all ofthese goals. After more than two decades ofresearch with data from almost 2 millionworkers, the University of Michigan HealthManagement Research Center reports that,

First Card (First Chicago NBD Corp.)conducted a study to directlycorrelate the productivity of its1,039 telephone customer-serviceagents with health level/diseasestate.The company found that, asthe number of agents’ health risksincreased, on-the-job performancedeclined. Individual health risks anddisease states significantly relatedto low productivity were unhealthyweight, diabetes, digestive andmental health disorders, andgeneral distress.3

Table 2

Employer Concerns Related to Employee Health*

“A healthier workforce is a happierand more productive workforce atwork, at home, and in retirement.It’s that simple.”

—Bill Bunn,VP of Health, Safety and

Productivity, International Truck and

Engine Corporation

S E C T I O N 1

Why Invest in Health Promotion?

* Data are based on responses from 1,544 public and private worksites with at least 50 employees.Source: 1999 National Worksite Health Promotion Survey4

3

“The University of Iowa wellnessprogram and its commitment todeveloping a humane and healthywork environment have served asexcellent recruiting and retentiontools for the university in a highlycompetitive labor market. Thewellness program has helpedidentify the University of Iowa asan employer of choice.”

—Robert Foldesi, Associate Vice President

and Director of Human Resources, UI

4

not surprisingly, individuals with multiplehealth risks (e.g., obesity, cigarettesmoking, and high blood pressure) tend tobe less productive than their peers withbetter health profiles.2

In fact, the explicit connection betweenhealth and productivity has spawnedseveral relatively new health promotionconcepts of particular relevance to businessmanagers. “Health and ProductivityManagement” (HPM), for example, rests onthe belief that an “at risk” workforce is abusiness liability with both direct andhidden costs that affect productivity. Agrowing body of scientific research makesthe case that managing employee health isan essential, but often overlooked,component of productivity management. Aselection of related terms is presented inTable 3.

Overall, worksite health promotion canimprove a firm’s productivity by

■ attracting superlative workers in acompetitive global marketplace;

■ reducing absenteeism/lost time;

■ improving on-the-job decision-makingand time utilization (reduced“presenteeism”);

■ improving employee morale and fosteringstronger organizational commitments;

■ reducing organizational conflict bybuilding a reservoir of good-will towardmanagement; and

■ reducing employee turnover.

The following terms are used to describe various types,facets, or components of worksite health promotionprograms.

Demand Management: A management approach tocontrol the demand for health services. Demandmanagement includes a variety of interventions toreduce unnecessary and/or potentially preventable visitsto healthcare providers by a) decreasing illness and injuryin the first place; and/or b) helping people better discernwhen professional care is necessary.Two major activitiesof demand management are medical self-care andconsumer health education.

Health and Productivity Management (HPM): Amanagement approach to improve the health andproductivity of a workforce. HPM uses a variety ofinterventions to help employees change unhealthybehaviors and create a work/corporate culture thatpromotes health and productivity. In its broadest sense,HPM can include disability management, workers’compensation, health benefits, occupational healthservices, and other health-related employee programs.

Health Risk Appraisal (HRA): A paper-and-pencil orcomputerized questionnaire used to assess self-reportedrisk factors (that is, risk factors that individuals reportthemselves). Often, HRA responses are analyzed tocompile lists of modifiable risk factors, along withrecommendations to change them. Also called a “healthassessment questionnaire” or “health improvementquestionnaire.”

Medical Self-Care: Activities and interventions thathelp individuals identify common self-limiting medicalproblems, apply appropriate home treatments, anddetermine when professional medical advice and/ortreatment is needed. Medical self-care often includes theuse of a reference text, health advice line, or website withhealth information.

Population Health Management (PHM): A newapproach to health promotion and disease preventionthat uses an annual health risk appraisal to create ahealth management database that can be used to helpplan appropriate health promotion activities for targetedpopulations (such as an employee group) and evaluatethe effectiveness of those interventions over time. PHMtypically focuses on changing modifiable risk factors andreducing the number of unnecessary visits to healthcareproviders. It generally employs a “virtual” set ofinterventions that are not linked to the worksite directly,but reach individuals in their homes (via surface mail,telephone, or internet). It is specifically designed to lowerhealthcare costs for defined populations.

Risk Factors: Behaviors and conditions that place anindividual at increased risk for illness or injury. Forexample, being female and having a family history ofbreast cancer are two uncontrollable risk factors forbreast cancer. Smoking cigarettes and leading asedentary lifestyle, on the other hand, are two modifiablerisk factors for heart disease. Although it’s confusing, riskfactors are also called “disease risks” or “health risks” (asin health risk appraisal).

Virtual Wellness: A recently coined term that describesa style of health promotion programming that does notrely on worksite-based interventions. Information andsupport are generally provided to individuals in theirhomes.Virtual wellness typically includes: an annualhealth risk appraisal (HRA), wellness newsletter sent tothe home, health advice line, ability to order self-helpmaterials, a medical self-care text, access to a healthmanagement website, telephone follow-up with highrisk individuals, and targeted mailings based on selectedresponses from the HRA. Virtual wellness interventionscan be integrated with worksite-based interventions tostrengthen their impact on behavior change.

Work Promotion: A term used to emphasize the work-enhancing effects of worksite health promotioninterventions. These effects are usually associated withincreased organizational profitability and workerproductivity.Work promotion encompasses activities to“protect and enhance human capital” to achieve“meaningful employment and meaningful profits.”64

Source: Larry Chapman, SummexCorporation snd George Pfeiffer, TheWorkCare Group

Table 3

Quick Guide to Worksite Health Promotion Terms

5

On the flip side, worksite health promotionprograms also benefit employees (includingmanagers) by

■ improving their physical strength,stamina, and general wellbeing;

■ improving their focus at work;

■ increasing job satisfaction and fostering apositive outlook on life; and

■ bettering relations with co-workers andsupervisors.6, 7

Even though much of the evidencesupporting worksite health promotioncomes from larger companies (i.e., thosewith the resources to conduct rigorousevaluations of their health promotionprograms), benefits accrue to smallemployers, as well. While programoutcomes are dependent on the nature ofhealth promotion activities and theemployee population, health promotionprograms have achieved a number ofproductivity goals in a variety of settings.

The two outcomes that have been mostextensively documented are the reductionof employee health risks and reducedabsenteeism.8

Reduction of Employee HealthRisks

■ The Coors’ 8-week “Lifecheck” programsignificantly reduced employees’ risk forcardiovascular disease. The program,which cost $32 for each of the 692participants, resulted in documentedreductions in blood pressure, bloodcholesterol, and weight. 8

■ Two years after the initiation of aworksite weight control/smokingcessation program, the Minneapolis/St.Paul Metropolitan Area saw workers’weight drop by an average of 4.8 pounds(among program participants), and 24employees quit smoking (a 2% quit rateat a cost of $62.50 per successfulquitter).8

■ Steelcase Inc., a furniture makerconsidered one of the 100 best places towork by Fortune Magazine, experienced

significant declines in on-the-job injury(as much as 50% in one department)after just three months after beginning a20-minute stretching program to helpemployees warm up before startingrepetitive work. Bob Page, manager ofemployee wellness, reported in Business& Health magazine that “workers told(management) their muscles ached less,they felt better physically and they weresleeping better at night” as a result of theprogram.9

Reduced Absenteeism

■ Savings from small decreases inabsenteeism alone can more than offsetthe cost of a health promotion program.For example, a 1998 analysis of fiveabsenteeism studies determined anaverage program savings of almost $5.00for every dollar spent. Days lost to illnessor disability were reduced by 14% (afterimplementation of a health promotionprogram at DuPont) to 68% (as a result ofa rehabilitation program for 180 post-coronary patients at Coors BrewingCompany).8

■ Control Data Corporation estimates thatits Staywell program, evaluated over asix-year period with longitudinal data on50,000 employees, has saved thecompany at least $1.8 million as a resultof reduced absenteeism amongemployees with lowered health riskscores.8

■ A multi-site intervention involving apolice force, chemical company, andbanking firm showed that weeklyparticipation in supervised exercisereduced use of sick leave by an average of4.8 days per person in the year followingprogram implementation.3

Job Satisfaction and EmployeeMorale

Changes in attitude are more difficult toverify objectively than changes in health or individuals’ use of medical leave.Nonetheless, a few studies havedemonstrated an association betweenworksite health promotion and employeedisposition.

“The data supporting the claim thathealth promotion programs canreduce medical care costs andreduce absenteeism is of higherquality than the data mostbusinesses have to support otherinvestments of similar cost.”

—Michael O’Donnell, Editor in Chief &

President, American Journal of Health

Promotion 5

6

■ A survey of employees at a northern stateuniversity with an established worksitehealth promotion program found thatemployees who exercised regularly hadsignificantly greater job satisfaction.Researchers caution, however, that jobdesign and the psychosocial aspects of thework environment may be most influentialin improving work-related attitudes.10

■ A two-year study to compare employeeattitudes at companies participating in acomprehensive health promotionprogram with those of workers atnonparticipating companies foundfavorable changes attributable to worksitehealth promotion. Significant change wasfound in attitudes toward organizationalcommitment, supervision, workingconditions, job competence, job security,and pay and fringe benefits.11

Reason #2: Lower healthcare costs.

Medical cost savings from health promotionprograms may be less evident thanproductivity gains, especially for smallerfirms and those whose health plans are notself-insured. Nevertheless, it is a fact thatmedically high-risk employees aremedically high-cost employees. They bothuse more healthcare and generate higherclaim costs than their low-risk peers.2, 9, 13, 14

For example, a collaborative studyinvolving Chrysler Corporation, and theUnited Auto Workers Union showed that

■ smokers generated 31% higher claimcosts than non-smokers; and

■ workers with unhealthy weights had143% higher hospital inpatient utilizationthan those with healthy weights.14

Other studies demonstrate the lowesthealthcare costs are associated withindividuals with only one to two riskfactors. As the number of risk factorsincreases, so too, do costs.2

If excess disease risks are associated withexcess medical costs, can lowering riskhelp control the high price of healthcare?Dozens of mid- to large-size employers

have found that the answer to this questionis “yes.” A 1998 analysis of eight rigorouslyevaluated health promotion programsdetermined an average reduction inhealthcare expenses of $3.35 for everydollar spent on health promotion.8

Indeed, many studies demonstrate thathealth promotion programs can and doreduce medical expenditures, resulting indirect cost-savings.8 While some companieshave instituted very comprehensive, multi-component health programs, others haveachieved savings with just one or a fewsimple activities to promote healthybehaviors and/or encourage moreappropriate use of health services.

■ Sunbeam-Oster Co., a producer of smallelectrical appliances with a largely femaleworkforce, attempted to control healthcosts by providing mandatory prenatalcare classes for pregnant employees.(Classes were held on-site during workhours and women received full pay forattending.) The result? Four prematurebirths occurred during the eight yearsafter the program began, compared tofive in the two years preceding theprogram. Sunbeam-Oster saw itsmaternal and newborn care costs declineby 86% in just two years (taking intoaccount the cost of the prenatal classes).Overall, costs fell from an average of$27,243 per employee to $3,792.4

■ The Citibank “Health ManagementProgram” provided a health risk appraisalto 40 percent of Citibank’s 42,000employees, followed by risk-appropriateinterventions to help employees managechronic conditions and to reduce thedemand for unnecessary health services.Over a 38-month period, Citibank spentnearly $2 million and accrued $12.6million in program benefits, most ofwhich came from the difference inmedical expenditures between programparticipants and non-participants.15

■ The Hanford Nuclear Reservation slashedthe number of lost workdays by offeringemployees influenza immunizations atmultiple worksites over a four-weekperiod. The total number of lost

Since the 1980s the KentIntermediate School District (KISD)in Grand Rapids, Michigan, hasbeen involved in worksite healthpromotion, with activities rangingfrom health risk assessments to ahealthy heart program to groupoutings. Dr. George Woons, KISDSuperintendent, thinks the healthpromotion activities have paid offin more ways than one.“Of all ourstaff development programs, thehealth improvement programshave done the most to improveemployee morale,” he asserts.Woons believes part of the reasonis that health promotion programsare a great equalizer.“Schooldistrict staff at all levels—cooksand custodians, and teachers andsuperintendents—often have thesame health risks. And together weparticipate in activities to reducethose risks.We’re all going throughthis together to improve health; themorale boost is an extra bonus.”12

7

workdays attributed to influenza-likeillness was 63 per 100 in theunvaccinated group and just 35 per 100in the vaccinated group. Hanford’ssavings were estimated at $83.84 perperson vaccinated, including productivitygains and reduced use of medical careand prescription drugs.4

■ Duncan Aviation, with 450 employees inBattle Creek, Michigan, began its healthawareness program more than 13 yearsago solely to keep employees healthy.And it has. Duncan has eliminated 60% ofidentified employee health risks (highblood pressure, obesity, smoking, etc.).Of equal importance, while the healthinsurance costs of neighboring companieshave been increasing by 18% to 40% overthe past several years, Duncan’s costshave increased only 7% to 14% eventhough its health plans are morecomprehensive than those of neighboringfirms. The health awareness program hasreceived the prestigious C. Everett KoopNational Health Award, and the companywas recognized by Fortune magazine asone of the top 100 U.S. firms at which tobe employed.16

These and numerous other studies provideevidence that well-designed worksite healthpromotion programs can promote healthand yield a financial return-on-investment.

Reason #3: Enhance your corporate imageand long-term interests bypromoting health beyond theworksite.

Although there is little data to discern theimpact of community-wide healthpromotion activities on business success,there is no disputing that the health of acommunity is related to the economicvitality of the businesses found there. If acommunity’s physical and humaninfrastructure deteriorates, businesseseventually leave. Even with internetcapabilities and overnight mail, locationmatters.

Consider the case of General Motors, Co.,(GM). GM spends about $500 million

annually on healthcare for employees inFlint, Michigan, which is home to thelargest concentration of GM employees inthe country. Even though the cost ofhealthcare in Flint is relatively low (forexample, average hospital charges are 8%percent lower than the state average and asmuch as 45% lower than those inCalifornia), GM’s costs are high becauseemployees use so much healthcare. Thecommunity’s health profile no doubt playsa role. The local population has high ratesof cigarette smoking and alcohol use andlow rates of exercise. The result? Flintresidents use inpatient medical servicesabout 62% more than benchmarkcommunities, and are hospitalized about athird more often. The local death rate fromheart disease and diabetes exceeds thenational average.17

The Washington Business Group on Health(WBGH), a national health policyorganization representing the businesscommunity, has queried its corporatemembers about their basic expectationsfrom “a healthy community.” Results froma survey of WBGH member companies,though not representative of all businesses,are suggestive. While these employers citeda need for a healthy environment, anattractive place to live, safety, andeducation, they most commonly wantedcommunities to provide

■ a pool of healthy, potential newemployees;

■ productive current employees; and

■ basic medical coverage for all localresidents.

These employers understand theconnection between community health andbusiness success.18

“Home Depot feels that “doingwell” and “doing good” areinextricably linked and thereforeencourages its employees tovolunteer for community projects(collectively, millions of volunteerhours), donates millions of dollarsto community concerns, and investsmillions to keep employeeshealthy.”

—Suzanne Apple,Vice President of

Community Affairs The Home Depot

8

Health promotion offers communities andbusinesses an opportunity to move forwardtogether. Business participation makescommunity-wide health promotionefforts—like health fairs and health-oriented media campaigns—more likely tosucceed. On the other hand, public healthagencies, hospitals, and other publicpartners can give businesses access to dataand expert advice on pressing communityhealth problems that probably affect theiremployees. Businesses also gain by

■ demonstrating social responsibility;

■ building public goodwill and a reputationas a good corporate citizen (a neighbor ofchoice);

■ directly and indirectly promoting thehealth of company employees (sincehealth insurance and worksite healthpromotion alone do not ensure individualprotection from diseases, environmentalfactors, and risky behaviors that maylead to illness); and

■ directly and indirectly promoting thehealth of retirees, employees’ families,potential replacement workers,consumers, and/or service providers—allof whom can have an impact on abusiness’s long-term success.

■ influencing managed care organizationsregarding practical benefits for smalleremployers.

Here are two quick examples of businessinvolvement in community health efforts.

■ The Eastman Kodak Company is thelargest employer in the city of Rochester,New York. As part of the RochesterCounty Health Commission, Kodak ispart of an initiative to make Rochesterthe healthiest community in America by2020.18

■ Proctor and Gamble, based in Cincinnati,Ohio, is a member of the HealthImprovement Collaborative of GreaterCincinnati. Its many activities include aregional health status report, a diabetes-focused healthcare study, and a flu shotcampaign.18

Reason #4: Help the nation achieve its healthobjectives for the year 2010.

Employers occupy a prominent andinfluential position in the healthenvironment, with unparalleled access toworking Americans. They are in a uniqueposition to contribute to the health of theiremployees and their communities.Consequently, they are in an essentialposition to help the nation achieve itshealth goals for the year 2010. In fact,without business support, the nationalHealthy People 2010 initiative, describedfurther below, will fall short.

Even well-meaning employers mayunknowingly contribute to a culturalenvironment that does not promote health.For example, employers who do not restrictworksite smoking, by default, put non-smokers at increased risk for respiratoryproblems related to secondhand smokeexposure. Often, the choice is not betweendoing nothing or doing something, butbetween doing something health-promotingor continuing practices that mayunintentionally support poor health habits.

Health experts agree that lifestyle changescan be encouraged by increasing awarenessof health risks, helping people changeproblem behaviors, and creatingenvironments that support good healthpractices. However, of the three,“supportive environments will probablyhave the greatest impact.”5 Since mostadults spend the majority of their daytimehours at work, the impact of workenvironment on health can be significant.

Employers are also the primary source ofhealth insurance for working Americansand their families. It matters whether ornot employers choose or develop healthplans that cover preventive services likecancer screening tests, immunizations, andsmoking cessation counseling. Lack ofinsurance coverage is a major barrier toreceipt of these important clinical services,as those without coverage are only half aslikely to have received a variety ofrecommended preventive health services as

“There are two reasons for using theHealthy People 2010worksite health objectives.The firstis humanistic; knowing thatproviding a safe and healthy workenvironment is the right thing to do.The second is practical. Executivesmust manage the bottom line. Andsince approximately 50% of injuryand illness costs are lifestyle-related—and thuscontrollable—health promotionprovides significant opportunities toimprove productivity and reducecost.”

—Steve Fleming, Director, HSE&R Engines &

Systems, Honeywell

9

their insured peers.19 Employers can alsoplay an important role in holding healthplans accountable for the delivery ofcovered services.

Finally, as mentioned above, businessescan make meaningful contributions tocommunity health programs.

All of these efforts advance the nationalagenda to achieve a healthier population bythe year 2010.

10

Healthy People 2010 is, in essence, theblueprint for a ten-year national initiativeto improve the health of all Americans. Thetwo overarching goals are to increase thelife expectancy and quality of life forAmericans of all ages and to eliminatehealth disparities among different segmentsof the population. It lists the mostsignificant threats to health in the UnitedStates today—including risky behaviors,environmental factors, and inadequateaccess to healthcare—and establishes goalsto reduce these threats.

Healthy People 2010 was developedthrough an exhaustive process involvingmany stakeholders, including businesses. Itis based on the best scientific knowledgeavailable and, as it is organized as a set ofquantitative health objectives. HealthyPeople 2010 serves as a scorecard to gaugeour collective success toward improvinghealth.

States and communities are using HealthyPeople 2010 objectives as the basis of localhealth promotion plans. Congress hasstipulated that Healthy People 2010objectives must be used to assess theimpact of several federal health programs.Of greater relevance to business, Healthy

People 2010 objectives are also being usedto measure the performance of health plansand health care organizations. Forexample, the National Committee onQuality Assurance (NCQA) hasincorporated many Healthy People 2010targets into its Health Plan Employer Dataand Information Set (HEDIS), acompilation of standardized measures tohelp health care purchasers assess theperformance of managed careorganizations.

Employers can use Healthy Peopleobjectives as well, in this case to focusbusiness-sponsored healthpromotion/disease prevention efforts andmeasure worksite and community-wideoutcomes against national benchmarks.

Dozens of objectives in Healthy People2010 specifically call on employers to helpthe nation meet its goals (discussed below).

Partnerships for a HealthyWorkforce

Partnerships for a Healthy Workforce(PHW) is an alliance of employers—representing many industries of allsizes—committed to improving employeeand community health. It encourages

“Building public-private partnershipsis the foundation of Healthy People'ssuccess.We enter the newmillennium as a team workingtogether.Through prevention we canimprove the health of allAmericans.”

—Dr. David Satcher, Surgeon General 20

“At Motorola, our Wellness Initiativesteam was able to demonstrate thatMotorola health care dollars arebeing spent on the same diseasesand disparities listed in the HealthyPeople objectives. We revamped anddeveloped strategic, cutting-edgeprograms that reduce Motorola'shealthcare costs and align with theobjectives set forth by the U.S.Department of Health and HumanServices.”

—Betty-Jo Saenz, Manager of Global

Wellness Initiatives, Motorola.

S E C T I O N I I

Healthy People 2010 Essentials for Business

Healthy People 2010 Resources

Healthy People 2010 For more information about Healthy People 2010 or to access Healthy People 2010 documents online, visit:

www.health.gov/healthypeople or call 1-800-367-4725. Other Healthy People 2010 resources include:

■ The Healthy People 2010 Toolkit: A field guide to health planning at www.health.gov/healthypeople/state/toolkit

■ Healthy People Information Line: Recorded information on upcoming events, ordering Health People publications, and the

Healthy People Consortium. Call 1-800-367-4725

■ Fax-Back System: Faxed copies of the complete list of available publications and updated Healthy People progress reviews, fact

sheets, and recent issues of Prevention Report. Call (301) 468-3028

healthfinder®:The federal consumer health website featuring special information for men, women, parents, kids, seniors, professionals and Spanish

speakers. www.healthfinder.gov

11

action where little has existed by offeringits members opportunities to network andbenefit from organizations and on-goingactivities that support health promotionefforts. In short, PHW is a driving force foremployer involvement and leadership inlocal, state, and national efforts to achieveHealthy People 2010 objectives.

PHW

■ develops and disseminates tools thatemployers can use to create a healthierworkplace;

■ provides a forum for business leaders,national organizations, and state andfederal agencies to share best practices;and

■ recognizes companies that showleadership in the health promotion arena.

Membership in PHW is free-of-charge andopen to any business, business-relatedtrade or professional organization, state orlocal government, or state or local businesscouncil that endorses PHW mission tosupport healthy employees in healthycommunities.

Partnership for Prevention1233 20th St., NW, Suite 200Washington, DC 20036-2362Phone: (202) 833-0009 x 103

Fax: (202) 833-0113www.prevent.org

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Making sense of the 467 HealthyPeople 2010 objectives

The 467 objectives contained in the two-volume Healthy People 2010 report can beoverwhelming to sort through. Fortunately,you don’t have to. This section

■ highlights the two Healthy People 2010objectives that focus specifically on theworksite;

■ discusses Healthy Workforce objectivesrelevant to employers and strategies toachieve them; and

■ catalogues about 50 additional objectivesthat could be adopted as part of aworksite health promotion program.

Two major worksite objectives

Healthy People 2010 includes two majorworksite-specific objectives:

1.) At least three quarters of U.S.employers, regardless of size will offer acomprehensive employee healthpromotion program that includes thefive elements listed in Table 4.

2.) At least three quarters of U.S.employees will be participating inemployer-sponsored health promotionactivities.

Table 5 shows where the nation now standsand how far it has to go to meet theseobjectives.

S E C T I O N I I I

Healthy People 2010 Objectives At-A-Glance

If you wish to browse the complete set of Healthy People 2010 objectives, simply click onhttp://www.health.gov/healthypeople/Publications/

Table 4

Elements of a Comprehensive Worksite Health Promotion Program

A comprehensive worksite health promotion program, as defined by Healthy People 2010, contains five elements:

1. One aspect is health education, which focuses on skill development and lifestyle behavior change along with information

dissemination and awareness building, preferably tailored to employees’ interests and needs.

2. Another is supportive social and physical environments. These include an organization’s expectations regarding healthy

behaviors, and implementation of policies that promote health and reduce risk of disease.

3. Another is integration of the worksite program into your organization’s structure.

4. A fourth aspect is linkage to related programs like employee assistance programs (EAPs) and programs to help employees

balance work and family.

5. The fifth component defined in Healthy People 2010 is worksite screening programs, ideally linked to medical care to ensure

follow-up and appropriate treatment as necessary.20

Partnerships for a Healthy Workforce would add two additional components.

6. Some process for supporting individual behavior change with follow-up interventions.

7. An evaluation and improvement process to help enhance the program’s effectiveness and efficiency. 65

Establishing a ComprehensiveEmployee Health PromotionProgram

Results from the 1999 National WorksiteHealth Promotion Survey (NWHPS) indicatethat a third (34%) of employers with 50 ormore employees offer comprehensive healthpromotion programs that meet HealthyPeople 2010 criteria. And fully half of thenation’s largest employers (those with 750+employees) do so.4

While it would be ideal if all businessesdeveloped comprehensive healthpromotion programs immediately, this goalmay not be realistic. Many employers, andespecially small to mid-sized firms, mayfind it difficult—or impossible—to launch acomprehensive health promotion programall at once. That’s okay. Employers canstart with just one or two of the fivecomponents that comprise acomprehensive program. It is mostimportant just to start. NWHPS data showthat already over 90% of surveyed worksitesoffer at least one health promotion activitythat can serve as a foundation for future

efforts.4 The challenge, and theopportunity, is to use that foundation tobuild a comprehensive worksite healthpromotion program eventually.

Overall, employers are encouraged to offerongoing activities, rather than one-timeevents, such as a half-day smokingcessation clinic with no follow-up. A single,isolated health education activity does notconstitute a health promotion program. Butas more elements are included in a healthpromotion program, the program is morelikely to achieve organizational goals, suchas improving productivity or enhancing afirm’s image.

Whether an employer decides to hire ahealth promotion manager, use currentstaff, or contract with vendors to designand implement a health promotionprogram, the planning process is the same.Section IV, beginning on page 25, providesan overview of this process, and Section V,beginning on page 31, lists manyinexpensive resources to ease the process.

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Table 5

Healthy People 2010 Objectives for WorksitesNo.† Objective

7-5. Increase the proportion of worksites that offer a comprehensive employee health promotion program to theiremployees.

1999 2010Baseline Target

Worksites with fewer than 50 employees (Developmental) ‡Worksites with 50+ employees 34 75Worksites with 50 to 99 employees 33 75Worksites with 100 to 249 employees 33 75Worksites with 250 to 749 employees 38 75Worksites with 750+ employees 50 75

7-6. Increase the proportion of employees who participate in employer-sponsored health promotion activities.

Baseline: 61 percent of employees aged 18 years and older participated in employer-sponsored healthpromotion activities in 1994.Target: 75 percent.

† The number to the left of the objective is the reference number for the full-text version of Healthy People.The number before thedash corresponds to the chapter while the number after the dash matches the objective number. For example—objective 7-5can be found in Chapter 7, objective #5 of the Healthy People 2010.

‡ Developmental objectives are those that currently do not have national baseline data.The purpose of developmental objectivesis to identify areas that need to be placed on the national agenda for data collection. Developmental objectives address subjectsof sufficient national importance to measure their change.

Increasing Participation inEmployer-Sponsored HealthPromotion Activities

Employee participation is essential ifemployers are to realize the health andfinancial rewards of health promotionactivities. Thus, employers are encouragedto develop a system to track programparticipation. The NWHPS found that morethan half (55%) of all worksites with at least50 employees and more than two-thirds(68%) of America’s largest employersalready maintain accurate participationrecords.4

While participation rates vary widelydepending on the size of the worksite andtype of program offered, rates tend to behighest at smaller worksites and lowest atlarger worksites. In addition, specificprogram components, such as awarenesseducation, health screenings, and healthrisk assessment activities, typically havehigher participation rates than lifestylebehavior change programs.4

Since 61% of U.S. employees aged 18 yearsand older now take part in employer-sponsored health promotion activities, thenation is most of the way toward achievingits goal: a 75% participation rate. 20 With alittle help from the business community,this goal is eminently attainable.

Healthy Workforce Objectives

Partnership for Prevention thoroughlyreviewed the 467 Healthy People 2010objectives to identify a small, manageableset of health objectives relevant toemployers. This exhaustive review led tothe identification of the Healthy WorkforceObjectives listed in Table 6 and discussedbelow. These objectives are diverse: some

aim to improve individual behaviors, whileothers focus on physical or socialenvironmental factors or important healthsystem issues. The conditions addressed inthese eight objectives are relevant toemployers because they are responsible fora large burden of illness and injury amongU.S. working-age adults, they are associatedwith business costs, and employers can dosomething about them. Effectiveinterventions are available and can beoffered at the worksite or otherwise besupported by employers. Some are evenlow cost.

HEALTH BEHAVIORSFour of the Healthy Workforce Objectivesfor employers target risky behaviors:tobacco use, alcohol/drug use, physicalinactivity, and overweight/obesity.

As discussed in Section 1, employees withlifestyle risks, particularly multiple risks,are more likely to use medical services, beabsent from work, and have lowerproductivity than their healthiercolleagues. Employers primarily bear thecost of these outcomes. But employees paya high price too, measured in out-of-pocketmedical expenses, possibly reducedearnings, decreased quality of life, and ashortened lifespan.

Effective employer-sponsored activities willhelp employees make lifestyle changes. Asupportive social and physical environmentwill help employees maintain healthybehaviors.

14

The New Jersey Department of Health and Senior Services offers free cessation programs for smokers whowant to quit.Three different programs are offered: (1) NJ Quitnet, an Internet resource; (2) NJ Quitline, a toll-free telephone counseling service; (3) and NJ QuitCenters, nine sites t hat offer one-on-one counseling. Morethan 19,000 physicians, dentists and health care professionals throughout New Jersey received special kitspacked with information on the Quitnet and Quitline. Posters, fliers and pocket calendars to display anddistribute to patients were mailed to doctor’s offices, hospitals and clinics.This year the program will beexpanded to businesses throughout New Jersey. The program’s goals are linked to several Healthy New Jersey2010 indicators.

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Table 6

Healthy Workforce ObjectivesHealthy Workforce Objective Related Healthy People 2010 Objectives

LIFESTYLE BEHAVIOR

27-1. Reduce tobacco use by adults. † 27-5. Increase smoking cessation attempts by adult smokers.

1997 2010 27-6. Increase smoking cessation during pregnancy.Baseline Target 27-12. Increase the proportion of worksites with formal smoking policies that

27-1a. Cigarette smoking 24% 12% prohibit smoking or limit it to separately ventilated areas.

27-1b. Spit tobacco 2.6% 0.4%

27-1c. Cigars 2.5% 1.2%

27-1d. Other tobacco products Developmental ‡

26-8. Reduce the cost of lost productivity in the workplace due to 26-10c. Reduce the proportion of adults using any illicit drug during the past alcohol and drug use. (Developmental) ‡ 30 days.

26-11c. Reduce the proportion of adults engaging in binge drinking of alcoholic beverages during the past month.

26-12. Reduce average annual alcohol consumption.

26-13. Reduce the proportion of adults who exceed guidelines for low-risk drinking.

22-2. Increase the proportion of adults who engage regularly, preferably 22-1. Reduce the proportion of adults who engage in no leisure-time daily, in moderate physical activity for at least 30 minutes per day. physical activity.

Baseline: 15 percent of adults aged 18 years and older were active 22-3. Increase the proportion of adults who engage in vigorous physical activity for at least 30 minutes 5 or more days per week in 1997. that promotes the development and maintenance of cardiorespiratory

fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 30 percent. 22-4. Increase the proportion of adults who perform physical activities that enhance and maintain muscular strength and endurance.

22-5. Increase the proportion of adults who perform physical activities that enhance and maintain flexibility.

22-13. Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.

19-1. Increase the proportion of adults who are at a healthy weight. 19-2. Reduce the proportion of adults who are obese.

Baseline: 42 percent of adults aged 20 years and older were at a 19-16 Increase the proportion of worksites that offer nutrition or weight healthy weight (defined as a body mass index (BMI) equal to or management classes or counseling.greater than 18.5 and less than 25) in 1988-94.

Target: 60 percent.

PHYSICAL ENVIRONMENT

20-1. Reduce deaths from work-related injuries. 20-5. Reduce deaths from work-related homicides.

1998 2010Baseline Target

Deaths per 100,000 Workers Aged 16 Years and Older

20-1a. All industry 4.5 3.2

20-1b. Mining 23.6 16.5

20-1c. Construction 14.6 10.2

20-1d. Transportation 11.8 8.3

20-1e. Agriculture, forestry, and fishing 24.1 16.9 (Continued on next page.)

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Table 6

Healthy Workforce Objectives, continuedHealthy Workforce Objective Related Healthy People 2010 Objectives

20-2. Reduce work-related injuries resulting in medical treatment, 2-11. Reduce activity limitation due to chronic back conditions.lost time from work, or restricted work activity.

1998 2010 15-19. Increase use of safety belts.Baseline Target

Injuries per 100 Full-Time 20-3. Reduce the rate of injury and illness cases involving days away from work Workers Aged 16 Years and Older due to overexertion or repetitive motion.

20-2a. All industry 6.2 4.3 20-6. Reduce work-related assault.

20-2b. Construction 8.7 6.1 20-10. Reduce occupational needlestick injuries among health care workers.

20-2c. Health services 7.9 (1997) 5.5

20-2d. Agriculture, forestry, and fishing 7.6 5.3

20-2e. Transportation 7.9 (1997) 5.5

20-2f. Mining 4.7 3.3

20-2g. Manufacturing 8.5 6.0

20-2h. Adolescent workers 4.8 (1997) 3.4

CHANGING THE LANDSCAPE FOR BETTER HEALTH

1-1. Increase the proportion of persons with health insurance.

Baseline: 83 percent of the population (under age 65) was covered by health insurance in 1997 (age adjusted to the year 2000 standard population).

Target: 100 percent.

1-2. Increase the proportion of insured persons with coverage for clinical preventive services. (Developmental) ‡

† The number to the left of the objective is the reference number for the full-text version of Healthy People.The number before the dash corresponds to the chapter while thenumber after the dash matches the objective number. For example—objective 7-5 can be found in Chapter 7, objective #5 of the Healthy People 2010 .

‡ Developmental objectives are those that currently do not have national baseline data.The purpose of developmental objectives is to identify areas that need to be placed on thenational agenda for data collection. Developmental objectives address subjects of sufficient national to measure their change.

Healthy Workforce Objective #1:Reduce Tobacco Use by Adults

In 1998, 47 million adults or about aquarter of the U.S. population smokedcigarettes, about the same number as in1990.21 Among future workers, rates areeven higher. On average, about 35% of highschool students smoked cigarettesthroughout the 1990s.22

These stubbornly high rates translate toreal problems for individual smokers,health systems, employers, and society atlarge. Tobacco use is the single leadingcause of preventable death in the UnitedStates and precipitates as many as 26million illnesses every year.

For employers, health and otherrepercussions of tobacco use can besignificant:■ higher health and life insurance

premiums and claims;■ greater absenteeism;■ increased risk for accidents and fires

(plus related insurance costs);23

■ increased maintenance costs due totobacco litter and tobacco smokepollution (which dirties ventilationsystems, computer equipment, furniture,carpets, and other office furnishings);

■ property damage from cigarette/cigar burns;■ risk of legal liability if nonsmokers are

exposed to environmental tobaccosmoke; and

■ reduced worker productivity.

Health education

Supportive social and physical

environments

Linkage to related program

Screening programs

Integration of the worksite

program into the organization’s

administrative structure

(Icon indicates which element(s)of a comprehensive worksitehealth promotion the strategyaddresses.

(See Table 4 on Page 12)

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The good news is that most smokers reportthat they would like to quit; just over twothirds (68%) in 1995. “Kicking the habit,”though, is hard, since nicotine addiction iscomparable to that for heroin, cocaine, andalcohol. Health experts consider nicotineaddiction a chronic condition that requiresongoing treatment to prevent or shortenrelapse.24–25

A 1997 survey by William M. Mercer(funded by Partnership for Prevention)found that about a quarter of very largefirms (with 500 or more workers) providetobacco cessation services for employees atthe worksite. Yet, despite the provensuccess of medical interventions fortobacco use, only 22% of health plansoffered by employers with 10 or moreworkers provide tobacco cessation benefits,and even fewer (12%) cover bothcounseling and pharmaceutical devices ordrugs to help smokers quit.26

U.S. workers face other barriers tocessation services as well. First, while thenicotine patch and gum are availablewithout a prescription, the cost ($390 to$650 for the recommended course oftreatment) can be prohibitive for manyAmericans.27 Second, because nearly a fifthof U.S. workers lack health insurancealtogether, 28 they may not be able to affordexpert health advice.

STRATEGIES

✔ Prohibit smoking at the workplace.

✔ Offer employees and their spouses smoking cessation classes to help them quit.

✔ Offer a health risk appraisal (HRA) to all employees, and follow-upwith tobacco users.

✔ Work with your health plan to ensure coverage for all tobacco usecessation services recommended by theU.S. Public Health Service (USPHS)—including primary care visits for smokingcessation with no co-payment and allcessation pharmaceuticals approved bythe U.S. Food and Drug Administrationwith usual pharmacy co-pays.(Guidelines entitled “Treating TobaccoUse and Dependence” can be found athttp://www.surgeongeneral.gov/tobacco/default.htm)

Healthy Workforce Objective #2:Reduce The Cost of LostProductivity Due to Alcohol andDrug Use

In 1995, alcohol and drug abuse cost theU.S. economy an estimated $276 billion.This sizable sum accounts for the costs ofhealth care, motor vehicle crashes, crime,lost productivity, and other outcomesassociated with substance abuse. However,most of this amount—nearly $200 billion—is attributed solely to lost productivity,reflecting foregone earnings due to poor jobperformance, limited career advancement,and unemployment and incarcerationamong drug and alcohol abusers. 29

Several studies have shown that alcohol-related job performance problems—absenteeism, arriving late to work orleaving early, feeling sick at work orsleeping on the job, doing poor work, doingless work, and arguing with co-workers—are caused not only by worksite drinking,but also by heavy drinking outside of work.For example, one study, using flightsimulators, found impairment 14 hoursafter pilots reached blood alcohol

18

concentrations of between 0.10 to 0.12 %.30, 31

Moreover, those who drink even relativelysmall amounts of alcoholic beverages maycontribute to alcohol-related death andinjury in occupational incidents, especiallyif they drink before operating a vehicle.30-32

Because of these and other concerns, morethan 90 % of worksites with 50 or moreemployees had adopted policies on alcoholand drugs by 1995, exceeding the HealthyPeople 2000 target of 60%.20

Just how widespread is the problem ofsubstance abuse? In 1994, more than 8% offull-time workers (over 6.5 millionemployees) engaged in heavy drinking,defined as five or more drinks on five ormore days in the past 30 days. Theheaviest drinkers were relatively young,between 18 and 25 years of age.33

Almost 15 million Americans (6.7% of thepopulation aged 12 and over) use illicitdrugs, and the majority of these users areemployed in American businesses. As withalcohol, drug use is greatest among thoseentering the workforce most rapidly, menand women aged 16 to 25.34 Although nooccupation is immune from drug use, it isespecially a problem among constructionworkers (15.6% of whom use illicit drugs),sales personnel (11.4%), food serviceworkers (11.2%), laborers (10.6%,), andmachine operators and inspectors(10.5%).35

Unfortunately, the stigma attached tosubstance abuse often increases theseverity of the problem. For example,individuals may be reluctant toacknowledge that they suffer from alcoholor drug dependence and/or may beunwilling to seek treatment, even if it isavailable.

STRATEGIES

✔ Provide employees access to counseling and referrals to treatsubstance abuse.

✔ Participate in community efforts toprevent substance abuse.

✔ Offer a health risk appraisal (HRA) to all employees, and follow-upwith those at risk.

✔ Establish an employee assistance program (EAP) and/or link EAP to healthpromotion initiatives.

✔ Provide drug and alcohol education to supervisors to counteract“enabling” behaviors.

✔ Provide drug and alcohol education to employees to counteract “enabling”behaviors.

✔ Establish worksite alcohol and drug policies.

Healthy Workforce Objective #3:Increase the proportion of adultswho engage in regular, preferablydaily, moderate physical activityfor at least 30 minutes per day.

Hundreds of studies document the healthbenefits of physical activity. The report,Physical Activity and Health: A Report ofthe Surgeon General,36 brings together thecollective results of decades of research onthis topic. Among the Surgeon General’sfindings:

■ People who are usually inactive canimprove their health and well-being bybecoming even moderately active on aregular basis.

■ Physical activity need not be strenuousto achieve measurable health benefits.

■ Greater cardiorespiratory fitness can beachieved by increasing the duration,frequency, or intensity of physicalactivity.

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Regular physical activity (such as a brisk,30-minute walk each day) delivers manyrewards:

■ Reduces the risk of dying prematurely.

■ Reduces the risk of dying from heartdisease.

■ Reduces the risk of developing diabetes.

■ Reduces the risk of developing highblood pressure and helps reduce bloodpressure in people who already havehigh blood pressure.

■ Reduces the risk of developing coloncancer.

■ Reduces feelings of depression andanxiety, and appears to improve mood.

■ Helps control weight.

■ Helps build and maintain healthy bones,muscles, and joints.

■ Helps older adults become stronger andbetter able to move about without falling.

■ Promotes worker productivity.

Yet, despite the benefits, only about 23% ofU.S. adults report regular, vigorous activitythat involves large muscle groups indynamic movement for 20 minutes orlonger 3 or more days per week. Only 15%of adults report moderate physical activityfor 5 or more days per week for at least 30minutes (Healthy Workforce Objective #3).And fully 40% enjoy no leisure-timephysical activity whatsoever.20

Sedentary habits begin in childhood.Almost three quarters (73%) of high schoolstudents fail to engage in moderate physicalactivity for 30 minutes most days of theweek.37

The major barriers most people face whentrying to increase physical activity are 1)lack of time, 2) inadequate access toconvenient and affordable fitness facilities,and 3) lack of safe environments in whichto be active.38

STRATEGIES

✔ Sponsor company fitness challenges.

✔ Support lunchtime walking/running clubs or company sports team.

✔ Create accessible walking trails and/or bike routes.

✔ Provide periodic incentive programs to promote physical activity.

✔ Offer a health risk appraisal (HRA) to all employees and follow-upwith sedentary employees.

✔ Contract with health plans that offer free or reduced-cost membershipsto health clubs.

✔ Provide clean and safe stairwells and promote their use.

✔ Provide facilities for workers to keep bikes secure and provide worksiteshowers and lockers.

✔ Allow flexible work schedules so employees can exercise.

✔ Discount health insurance premiums and/or reduce copaymentsand deductibles in return for anemployees participation in specifiedhealth promotion or disease preventionprogram.

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Healthy Workforce Objective #4:Increase the proportion of adultswho are at a healthy weight

More than half the U.S. adult population iscurrently overweight or obese.39 And thesituation is worsening. The proportion ofobese U.S. adults rose from an estimated12% in 1991 to 18% in 1998, with actualfigures likely higher.40 In fact, the problemis so pervasive, the Centers for DiseaseControl and Prevention declared obesity anational epidemic in October 1999.

Although the causes of excess weight arecomplex and not fully understood, expertsattribute much of the increase in U.S.obesity to the simple fact that adults andchildren consume more calories than theyuse.40-42 In other words, overeating andinsufficient physical activity underlie muchof the epidemic. Between 1977 and 1996,Americans’ average daily caloric intakeincreased significantly.43, 44 Moreover,according to the U.S. Department ofAgriculture’s Healthy Eating Index, only12% of the population aged 2 and older hasa diet that can be called “good;” that is, adiet that meets national guidelines for fatintake and overall variety.43 At the sametime, as discussed above, sedentary habitsare common among U.S. adults andchildren.

It is not surprising that obese employeestend to be absent from work due to illnesssubstantially more than their normal-weight counterparts.45 Almost 80% of obeseadults have diabetes, hypertension,coronary artery disease, gallbladderdisease, high cholesterol levels, and/orosteoarthritis.46 The cost to the U.S. healthsystem? At least $50 billion worth ofmedical treatment annually.47 The cost toemployers? More than 39 million days ofwork time each year.

Yet, the news is not all bad. Researchindicates that a sustained reduction inbody weight of just 10% yields significanthealth and economic benefits.42, 48

STRATEGIES

✔ Provide healthy snacks in vending machines, in break rooms, and atcompany events.

✔ Provide healthy meal choices in cafeterias and at company events.

✔ Disseminate nutrition information toemployees. For example, work with aweight management vendor to provideinformation about the nutritionalcontent of cafeteria foods.

✔ Subsidize healthy foods in the cafeteria or vending machines. (10¢apples may be more appealing than$1.00 candy bars.)

✔ Choose health plans that cover programs to help enrollees with weightmanagement.

✔ Institute flexible work schedules so employees can participate in weight-loss programs.

✔ Offer a health risk appraisal (HRA) to all employees, and follow-upwith those at risk.

✔ Ask voluntary health associations, health care providers,and/or public health agencies to offer on-site nutrition education classes.

✔ If a group of employees are interested in losing weight, offer onsitefitness and weight-managementprograms. (Ask a dietician at your localhealth department or hospital about highquality vendors who offer worksiteprograms.)

✔ Locate dietetics professionals near your worksite as a resource foremployees who want information onhealthy eating/meal planning or weightcontrol. (Use the “find a dietician”service on the American DieteticAssociation website:http://www.eatright.org/finddiet.html.)

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“The goals of the Alcoa Life!program are to enhance thewellbeing and the quality of work-life of Alcoa people and theirfamilies and encourage andsupport personal development. Weare asking people to do more thanjust come and make a living in thecompany.We are asking people tocome and make a life in thecompany.”

—Alain Belda, President, Alcoa

Every Day

■ 900 workers sustain disablinginjuries on the job

■ 17 workers die from work-related injuries

■ 137 workers die from work-related diseases52

21

✔ Assign a fitness center “trainer” to each participant in weightmanagement classes to help overweightemployees meet health and fitness goals.

✔ Offer financial incentives for employee participation in weightmanagement programs. For example,offer full or partial reimbursement forthe cost of the program or discounthealth insurance premiuand/or reducecopayments and deductibles aftersuccessful program completion.

✔ Form a support group to help employees who are trying to lose weight.

✔ Offer individual and group counseling to those struggling withweight loss.

PHYSICAL ENVIRONMENTTwo health objectives for employers focuson the physical work environment:

Healthy Workforce Objective #5:Reducing deaths from work-related injuries; and

Healthy Workforce Objective #6:Reducing work-related injuriesnecessitating medical care orlost/restricted work activity.

Although U.S. worksites are becoming safer,the toll of workplace injuries and illnessesis still significant. The U.S. Bureau of LaborStatistics reports that in 1999 about 6,000individuals died from injuries incurred on-the-job. The same year, workers reported5.7 million nonfatal occupational injuriesor illnesses, of which about 2.7 millionrequired recuperation away from work orrestricted duties at work.49

The cost to employers from occupationaldeaths, injuries, and illnesses includes wageand productivity losses, medical costs,administrative expenses (such as the costof time to write up injury reports), anddamage to employer property (notablyfrom fires and automobile accidents). TheNational Safety Council estimates that in1998 the cost of occupational deaths andinjuries alone totaled more than $125billion.50

What are the major causes of workplacedeaths? Highway crashes remain the #1cause of on-the-job fatalities. The #2workplace killer is unintentional falls,especially from a roof, ladder or scaffold.And the #3 cause of death, which hasdeclined from previous years, is workplacehomicides. (In 1999 there were 645 job-related homicides, down 10% from 1998and 40% from 1994.)51

Prominent nonfatal occupational illnessesand injuries include sprains, fractures,noise-induced hearing loss, repetitivemotion disorders (e.g., carpal tunnelsyndrome), lower back problems,respiratory conditions resulting fromexposure to toxins or dust, elevated bloodlead levels, and hepatitis B.49

Many employers, and especially those inhigh-risk industries, already offer ormandate employee education on jobhazards and injury prevention. The mostcommon health and safety policies in mid-size to large businesses (those with 50+employees) address substance use andoccupant protection for vehicular drivers.In addition, about half of these firms (53%)offer back injury prevention programs, and35% have instituted violence preventionprograms.4

The Bureau of Labor Statistics reports thatthe 1999 rate of nonfatal occupationalinjuries and illnesses (6.3 cases per 100equivalent full-time workers) was thelowest since the bureau began collectingthis information in the early 1970s.Similarly, the number of fatal injuries wasslightly down despite an increase in thenumber of employed Americans. Well-designed worksite safety programs willcontinue to reduce the burden ofoccupational health problems for bothemployers and employees.

Many state agencies provide on-site consultation services sothat employers can find out aboutpotential hazards at theirworksites, improve theiroccupational safety and healthmanagement systems.The New Jersey Department ofLabor, Division of Public Safety and Occupational Safety andHealth deliver these services usingwell-trained safety and healthprofessionals. Primarily targeted forsmaller businesses of less than 250employees, the New Jersey safetyand health consultation program iscompletely separate from OSHAinspection efforts.

“By investing in the total well-being of our employees, asthey take on the challenges ofcomplex lives, the laboratory notonly contributes to the success ofindividuals, but we maketremendous stride towardsorganizational excellence.”

—John C Browne, Director, Los Alamos

National Laboratory

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STRATEGIES

✔ Ensure that all employees receive appropriate and regular safetytraining and information.

✔ Conduct ergonomic evaluations and consider recommendedchanges to the worksite.

✔ Develop procedures that encourage employees to report nearaccidents without fear of penalty so thatcorrective actions can be taken.

✔ Offer incentive awards to individual employees and work groupsfor achieving specified safety goals.

✔ Offer an incentive rebate programthat places a projected amount of workercompensation dollars into an incentivepool and disburses to employees half theamount not expended.

CHANGING THE LANDSCAPE FOR BETTER HEALTH

Changing the landscape for better healthmeans equipping people with the resourcesto tend to basic healthcare needs. Twoobjectives address this issue.

Healthy Workforce Objective #7: Increasing the proportion ofpeople with health insurance

The U.S. Census Bureau reports that over 42million Americans lacked health insurancein 1999. Since many children in low-incomefamilies and virtually all U.S. citizens aged65 and older are covered by public healthinsurance programs, most of this coveragedeficit falls on working Americans, andspecifically on those working for smallbusinesses. In fact, while only a tiny fractionof those employed at large firms lack healthbenefits, nearly a third of those working forfirms with 25 or fewer employees do nothave health coverage. Thus, small employerscan play a critical role to reduce the gapbetween insured and uninsured.

The 2000 Small Employer Health BenefitsSurvey found that the high cost ofinsurance is the primary reason manysmall businesses (i.e., those with 2 to 50employees) do not offer health benefits.

However, the same survey identified severalimportant misperceptions on the part ofsmall employers that compoundaffordability problems.53 For example, 57%of small employers were unaware that theircontributions toward employee healthcoverage are tax deductible. Almost half(48%) did not realize that their employeescannot deduct health insurance premiumswhen they purchase coverage on their own.Similarly, many small employers areunaware of new rights granted to themthrough state and federal legislation. Abouttwo thirds (67%) of small employers, forexample, are unaware that insurers cannotlegally deny them group coverage even iftheir employees have pre-existing illnesses(although they may charge higherinsurance premiums).53

Insurance coverage, while costly, is aninvestment with potential for significantpayback. Small employers who providehealth benefits offer sound businessreasons for doing so. A majority of smallemployers who fund health insurancereport that it:

■ helps with employee recruitment;

■ improves employee retention;

■ increases productivity by keepingemployees healthy;

■ reduces absenteeism by keeping workershealthy; and

■ improves employee attitude andperformance.

Health coverage is important because itaffects both Americans’ access to necessaryhealth care and their financial wellbeing.Uninsured children and adults are muchmore likely than those with healthinsurance to skip recommended medicaltests or treatments. Consequently, they arealso more likely to be hospitalized forconditions that might have been avoided inthe first place and to be diagnosed at moreadvanced stages of diseases like cancer. Inaddition, almost 30% of uninsured adultssay that medical bills have had a greatimpact on their families’ lives.54

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Healthy Workforce Objective #8:Increasing the proportion ofinsured persons with coverage forclinical preventive services

In addition to no coverage at all, a secondinsurance problem is inadequate coverageof clinical preventive services (i.e., servicesthat prevent the onset of illness or detect itat the earliest possible moment whentreatment is easiest). Currently, preventivehealth services are underused in the UnitedStates.55 And it is well documented thatindividuals who lack coverage for specificpreventive services are significantly lesslikely to receive them than their insuredpeers.56, 57 As purchasers of most of thenation’s private health insurance,employers are in a position to substantiallyexpand Americans’ access to thesepotentially life-saving services and improveemployee health in the process.58

The U.S. Preventive Services Task Force(USPSTF), a non-federal expert panelconvened by the U.S. Public HealthService, is tasked with identifying a coreset of preventive services known toimprove health. The USPSTFrecommendations are so highly regardedthat they have been called the “goldstandard” to which employers and healthplans should refer when designing benefitprograms.59

Table 7 lists those services recommendedfor healthy adult men and womenaccording to the most recent USPSTFguidelines.60

Table 7

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STRATEGIES

✔ Form or participate in purchasing cooperatives to bargain foraffordable health insurance premiumsand health plans that cover appropriateclinical preventive services.

✔ Fully administer COBRA provisions for those affected by a qualifying event.

✔ Offer group health plan coverage or a medical savings account (MSA) optionthat is fully employee paid (only as analternative for small employers whocannot otherwise offer employees healthbenefits).

50 Optional Health ObjectivesFor Employers

While the eight Healthy WorkforceObjectives for employers (and relatedobjectives listed in Table 6) may be ofprimary interest to most businesses,Partnership for Prevention has identifiedan additional 50 Healthy People objectivesthat specifically call on U.S. employers totake action. Any or all of these could beadopted as part of a comprehensiveworksite health promotion program. These50 objectives are listed in Appendix 1where they are grouped according to theelements of a comprehensive worksitehealth promotion program, as defined byHealthy People 2010 (See Table 4 on page12 for list elements).

Getting Insurance LinksSmall employers can find health insurance coverage for their workers, according to the Consumer HealthEducation Council (CHEC), which suggests the most well known insurance for small business is Blue CrossBlue Shield (BCBS) plans. Small employers can now also get instant quotes over the web. Insurance brokerscan help. Purchasing cooperatives are sometimes an option, and public programs may be an option foremployers whose workers qualify.The CHEC website provides links to various web pages to assist you ingetting health benefits for your workers. (http://www.healthchec.org/employer/employer.html).53

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Planning a worksite health promotionprogram can be a rewarding experience forcompany leaders and other employees.Whether a firm decides to develop acomprehensive worksite health promotionprogram all at once or begin with a just afew ongoing health promotion activities, itwill be helpful to use a planning process.This section presents a simple, 10-stepprocess that can be used by employers of allsizes to increase the success of any healthpromotion program.

1. Establish a planning committee.

2. Assess the interests and needs ofcorporate leaders and other employees.

3. Develop mission statement, goals, andobjectives and design the program.

4. Develop a timeline and budget.

5. Select incentives.

6. Acquire resources.

7. Market the program.

8. Implement the program.

9. Evaluate the program.

10. Modify the program (continuousquality assurance).

Although these steps are presented insequential order, some worksites maymodify the sequence to suit their uniqueplanning environments. In some situations,individual steps may be completely omitted.For example, managers might allocate ahealth promotion budget before the planningcommittee is even established.

Each of the steps is discussed briefly below,and Section V lists sources of more detailedinformation, including several inexpensiveplanning workbooks and a free website.

1. Establish a Planning Committee.

Employee involvement is integral to theplanning process. Therefore, a planningcommittee should be formed as early in theprocess as possible and include:

■ cross-section of potential programparticipants;

■ individuals who may have a role inprogram implementation or evaluation(e.g., middle managers who directlycontrol employee schedules or who havegreat influence on upper management,someone familiar with budgeting, theperson responsible for contracting withoutside vendors, etc.); and

■ someone to represent management (if notalready included in one of the abovegroups).

The planning committee serves severalfunctions. First, an employee-driven advisoryboard encourages “buy-in” from bothmanagement and potential programparticipants. The key to maximizing buy-in isto recruit employees who are enthusiasticabout the proposed program, as well as thosewho are indifferent or perhaps even skepticalto serve on the planning committee.

Second, a representative planningcommittee will help assure that the programis responsive to the needs of all potentialparticipants (possibly including employeedependents and/or retirees).

And third, the committee can be responsiblefor carrying out or overseeing all of thesubsequent steps in the planning process.For example, the full committee ordesignated sub-committee will likely designand conduct an employee interest survey,select the program name and logo, selectspecific health promotion activities, andpresent periodic status reports to seniormanagers. Committee members can alsobrainstorm innovative ideas to market theprogram to co-workers. In general, a groupof people is likely to generate more andbetter ideas than a single individual.

S E C T I O N I V :

Planning A Worksite Health PromotionProgram

2. Assess the Interests and Needsof Corporate Leaders andOther Employees.

■ What are the organizational issues facingthe employer?

■ What is the level of management supportfor a health promotion program?

■ What are the most prevalent employeedisease and injury risks?

■ What health issues are employeesinterested in addressing?

The answers to these questions areimportant to assure that any healthpromotion program has a chance tosucceed. One of the most importantindicators of the success of a healthpromotion program is senior managementsupport. Are managers willing to take partin the program and encourage others to doso? How much are they willing to budgetfor the program? What do they see as thebenefits of the program for employees andthe organization? And what kinds ofactivities are they willing to allow?

Benchmark data from competitors anddescriptions of what other organizationsare doing can help engender managementsupport. Table 8 summarizes the healthpromotion policies, programs, priorities,and intentions of U.S. employers with 50 ormore employees.4 Informal surveys of keycompetitors and other similar organizationscan provide additional information.

Of equal importance, the planningcommittee must consider the needs,interests, and expectations of programparticipants. This task is commonlyaccomplished through a brief survey, suchas that included in Appendix 2. Thequestionnaire may ask about employeeinterest in various types of healthpromotion activities, the most convenienttimes and places to schedule activities,and/or suggested organizational changes topromote a more healthful workenvironment. It might also include a healthrisk appraisal (HRA) to determine currentemployee disease risks, ascertain the level

Table 8

1999 National Worksite Health Promotion Survey Summary4

Health Education †

Element Percent Offering *

Awareness Programs ■ HIV/AIDS 42%

■ Prenatal care 63%

■ Nutrition/cholesterol 43%

■ Work/family balance 32%

Prevention Programs

■ Back injuries 60%

■ Violence 41%

Lifestyle Behavior Change Programs

■ Substance Abuse 65%

■ Stress Management 48%

■ Physical activity 46%

■ Smoking 40%

■ Weight control 38%

Demand Management Programs

■ Nurse advice lines 45%

■ Self-care book and tools 34%

Disease Management Programs

■ Back pain 44%

■ Depression 42%

■ Hypertension 35%

■ Diabetes 34%

■ Cancer 34%

■ Cardiovascular 32%

■ Asthma 28%

■ Obesity 25%

Screening Programs †

■ Blood pressure 61%

■ Cholesterol 59%

■ Cancer 53%

■ Health risk assessment (HRA) 36%

Supportive Social and Physical Environment

Formal Health and Safety Policies

■ Illegal drugs 95%

■ Alcohol 94%

■ Tobacco 79%

■ Occupant protection 47%

On-site Fitness/Exercise Center 13%

* Information from 1,544 worksites with 50 or more

employees in the continental US.

† Offered either at worksite or through health plan

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of interest in changing unhealthybehaviors, and collect baseline data thatcan later be used to help evaluate theprogram (for example, the percentage ofemployees who smoke or the percentage ofemployees who consider themselves ingood health). Several excellent HRAs areavailable on the internet and are brieflydescribed in Section V.

Finally, since the work environment is soinfluential, the planning committee maywish to periodically assess (or recommendthat others assess) how well theorganization is doing to support healthybehaviors on and off the job. An excerptfrom one such survey is presented inAppendix 3. (Additional resources arelisted in Section V.) Repeating the samesurvey over several years can help programplanners evaluate the impact of specificorganizational changes and help maintainmanagement interest in ongoing healthpromotion activities.

3. Develop Mission Statement,Goals, and Objectives andDesign the Program.

Once needs assessment data have beencollected and reviewed, it is time todevelop a mission statement for theprogram and to set specific goals andobjectives.

A program mission statement, like anorganizational mission statement, brieflylists the overarching values that drive theventure and the ultimate goals oraccomplishments that the project willstrive to achieve. It is often a good strategyto develop a mission statement for thehealth promotion program that closelysupports the company mission statement.For example, if a company’s mission is tobe “the best” or “among the best” in aparticular field, then the mission statementfor the health promotion program mightread, in part: “Recognizing that employeesperform their best when they are healthy,and that optimal employee performance isnecessary for the company to be a leader inits field, the health promotion programaims to improve employee health andwellbeing.”

Goals are statements of broad, long-termaccomplishments expected from theprogram. The most effective goals arerealistic and reflect the needs of topmanagers, as well as lower-level employees.Ideally, goals should be unambiguous, time-limited, and stated in such a way that it iseasily possible to determine whether or notthey have been achieved. In fact, assessingthe achievement of goals is an importantpart of program evaluation. Examples are:

■ reduce the prevalence of employeesmoking from 30% to 25% by the end ofthe next fiscal year;

■ reduce the overall use of sick leave by atleast 2% from the previous year, after thefirst full year of program operation; and

■ improve employees’ satisfaction with thecompany, as measured by employeesatisfaction surveys conducted beforeand after the first full year of programoperation. Increase the average score byat least 10%.

Objectives are statements of expectedshort-term accomplishments related to oneor more program goals. Like goals, theyshould be written in such a way thatprogram planners can readily determine ifthey have been met. For example,objectives that might fall under the firstgoal statement listed above are:

■ work with health plan to add smokingcessation benefits (including no-costcessation counseling andpharmaceuticals) at plan renewal time;

■ participate in the American CancerSociety’s Great American Smoke-Outthis November; and

■ implement a smoke-free work policy byDecember 31.

For each objective, a list of more detailedaction-steps must be developed. At thispoint, the planning committee may wish toobtain the commitment of specificindividuals or departments to carry outcertain tasks. Program options, includingcommunications, screening andassessment, interventions (e.g., self-study,group classes, telephonic counseling andsupport groups) are all part of programdesign. Decisions about hiring program staffand/or selecting vendors often is consideredduring this planning phase.

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4. Develop a Timeline andBudget.

Develop a realistic timeline to implementand evaluate the program. The timelineshould incorporate any key target datesembedded in program objectives.

Health promotion programs are commonlykicked off or re-marketed at certain timesof the year: the start of the year (whenpeople are making new year’s resolutions),the spring and the fall. As much aspossible, try to avoid conflicts withestablished company events and seasonalbusy times, such as heavy vacation orholiday periods. Also, allow sufficient leadtime to schedule and adequately promoteplanned events.

The activities themselves should bescheduled at times that are convenient forpotential participants. For example, it maybe necessary to offer multiple sessionsbefore and after work to meet the needs ofshift workers. If family members are invitedto participate, evening sessions may benecessary.

Of course, it takes resources to carry outthe activities necessary to achieve programgoals. Typically, an internal staff person—with input from the planning committeeand management—develops a programbudget. The budget can include salaries forstaff who will implement the programand/or manage health promotion vendors,administrative resources, programmaterials, and vendor costs. An accurateand comprehensive budget will allow theplanning committee to better compareprogram costs and outcomes during theprogram evaluation. The total programbudget could also be translated into a peremployee cost or (eventually) a perparticipant cost.

In the best of all possible worlds, theplanning committee can negotiate a budgetthat is adequate to accomplish the agreed-upon program goals and objectives.Employee cost-sharing for specific activitiesis also an option. Keep in mind thatprograms with moderate costs—$30 to$100 per employee per year—are morelikely to demonstrate cost-savings.61

5. Select Incentives.

Most people know what lifestyle changesthey should make, but lack the motivationto do so. Incentive programs attempt tobuild that motivation by offeringindividuals external rewards for takingsteps in the right direction.

Incentives range from recognition in theemployee newsletter for participating in thecompany baseball team to a certificate ofachievement from management forcompleting a medical self-care class to asmall monetary bonus for quitting smoking.They can also include contributions to a“health promotion medical savingsaccount,” merchandise awards (e.g., cups,t-shirts, etc.), extra time off from work, ortravel awards. A common incentive forimportant behavior changes is a risk-ratedpremium contribution providing a 33% to50% discount off the employee’s premiumcontribution for dependent health care.(Non-smoker status is one of the primaryattributes used in this risk-ratedapproach.)62 Above all, know youraudience; an incentive that will appeal to atruck driver may not appeal to an officeworker.

6. Acquire Programmatic and/orHuman Resources Support.

Many high quality program materials areavailable free or at low cost from voluntaryhealth organizations, local public healthdepartments, and state or nationalgovernment agencies. In addition,pharmaceutical companies market diseasemanagement programs for manyconditions, including diabetes, high bloodpressure, weight management, anddepression. Small employers can oftenrecruit free speakers for health awarenessactivities (such as a monthly brown baglunch talk) from local hospitals, publichealth departments, universities, voluntaryhealth associations, and private physicianpractices. It may also be practical to offerhealth promotion programs in cooperationwith health plan providers.

A list of select program resources isincluded in Section V.

7. Market the Program.

Marketing a health promotion program isextremely important, both to make peopleaware that the program exists and tomotivate them to take advantage of it.Obviously, company goals and objectiveswill not be met if few or no employeesparticipate.

The planning process itself can be apowerful marketing tool. For example,broad employee involvement in planningfosters a sense of ownership of theprogram. Selection of a creative name ortheme for the health promotion programoften excites interest. A good needsassessment identifies health issues andprogram activities in which workers arealready interested. Dedicated planningcommittee members are natural programspokespersons.

Beyond the planning process itself, specificmarketing techniques will vary, dependingon the size of the worksite, the channels ofcommunication available, and the programbudget. An endorsement of the programfrom the company president, executivedirector, and/or senior manager is aneffective marketing technique and is cost-free. E-mail, bulletin board, and/ornewsletter announcements are also free orinexpensive. Perhaps the best marketingtools of all, however, are pleased programparticipants who advertise for you viaword-of-mouth.

These and other tips to increaseparticipation are summarized in Table 9

8. Implement the Program.

Program implementation involves puttingthe plan into action. It may necessitatemaking arrangements with healthpromotion vendors, recruiting speakers,negotiating with health plans or healthclubs, scheduling health promotionactivities, and more. To some extent,implementation, marketing, acquiringresources, and evaluation can all occursimultaneously. A good rule of thumb is tobegin the program slowly and to lead offwith those activities most likely to succeed.

Table 9Tips to Increase Participation

Involve people in planning. Ensuring good participation starts with the programplanning process. Broad employee involvement stimulates interest and ownership of theprogram; it’s contagious. Encourage advisory committee members talk up the programinformally, even before a program starts.Word of mouth is often the best marketing device.

Ask people what they want and give it to them. A needs assessmentsurvey builds a sense of anticipation and excitement that can help increase participation.Failure to understand the needs and interests of potential program participants will almostassure low program participation rates.

Make the program fun. People enjoy doing what is fun. Use balloons, flowers, andmusic to create a festive atmosphere for health fairs or health screening activities.

Provide incentives. Well-conceived incentives can be expected to increase programparticipation rates by 12% to 35%. Incentives can also encourage the completion orattendance at multiple program sessions and help participants adhere to long-termbehavior change.62

Publicize the program all different ways. Use multiple upbeat methods topromote the program to potential participants including bulletin boards, pamphlets, payrollinserts, voicemail messages, electronic billboards, etc. A creative program name and logo willhelp to create a positive image that can help increase utilization.

Wow, the boss is doing it! Small business owners or top managers whoparticipate in a program encourage others by their example.The general manager for a largerefinery in Joliet, Illinois, frequently told employees that anyone can talk with him while heis working out on the treadmill where he works out virtually every morning. Cultivatesupport from all levels of management.

Remove barriers. Make health promotion and related activities easy to sign-up forand conveniently located.

Provide program choices. Don’t just offer a group smoking cessation groupprogram; also offer guided self-help programs like video or audiotapes and workbooks thatemployees with a long commute can use privately.

Ask how you’re doing. Routinely measure program participants’ satisfaction withthe program content, instructors, logistical arrangements, and other program components. Asimple evaluation can determine what participants liked best about the program what theyliked least and also get suggestions for program improvement or new topics to address.

Why not? Ask some of the people who don’t participate, why not? The answers to thissimple question can help formulate strategies to help insure participation of non-participants.

For more ideas to increase participation search the online archive of Health PromotionPractitioner articles. Enter the term "participation" for many tips andideas.http://www.hesonline.com/index.html 66

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9. Evaluate the Program.

A good program evaluation is not anafterthought, but is built into the planningprocess and into the budget. Ideally, itlooks at information to examine both howwell the program is working (processmeasures) and whether or not it isachieving expected results (outcomemeasures).

Process measures, such as participationcounts and participant evaluations ofindividual activities, answer manyquestions about the basic operation of theprogram.

■ Were all activities implemented asplanned? If not, why not?

■ Who is using the program?

■ Which activities are most popular?

■ Did the program meet the participants’needs?

■ Are participants happy with classinstructors, program materials, incentivechoices, etc?

This information can be used to modify theprogram to enhance participation andparticipant satisfaction.

Outcome measures, on the other hand,gauge the extent to which specific programgoals have been achieved. Did theprevalence of employee smoking decreasefrom 30% to 25% by the end of the fiscalyear? Did it decrease at all? Did thenumber of employees who file disabilityclaims because of lower back problemsdecline from an average of 3/month to anaverage of 1/month after health promotionactivities were in place for 18 months?

Outcome data that demonstrate programsuccess help to secure continuedmanagement support for the program.Outcome data that show program goals arenot being achieved point to the need forchanges.

Generally, if outcomes are not as expected,there are three possible causes.

1) The program was not implemented asplanned (for example, no oneparticipated).

2) The program was not well-designed toachieve the desired results (although itmay have achieved other unintendedpositive results, such as improvedemployee morale).

3) Program goals were unrealistic given theresources available.

Whatever the reason(s), this information isvaluable and can be used to ensure futureprogram success.

Finally, program costs and outcomes canbe compared. For example, if a firm spends$3,600 on a health promotion program thatreduces the number of employee sick daysfrom 48/year to 12/year, the company hasspent $100 for each day of unused sickleave (not considering any other positiveprogram outcomes).

(Self-insured firms, those that pay directlyfor employee healthcare, can also compareprogram costs to healthcare costs.)

Check Section V for a list of workbooksthat discuss practical strategies to addressevaluation challenges.

10. Modify the Program AsNeeded.

Health promotion programs are not static,but change along with the needs andinterests of employees and employers. Bothevaluation data and periodic needsassessment surveys provide crucialinformation to guide program changes. Inaddition, it is useful to ask people who arenot participating in health promotionactivities why they are not participating.

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

31

This section lists many resources related toworksite health promotion program.Included are textbooks, workbooks, andmanuals that provide detailed informationto help plan, implement, and evaluate acomprehensive health promotion program.Contact information for several nationalnon-profit health organizations and federalagencies that provide worksite healthpromotion materials and programs is alsoincluded. For the most part, resourcelistings include the URL for internet accessto product or ordering information.Contact information is also provided forfederal, state, and non-profit organizationsthat offer helpful information and/ormaterials. Most resources include a briefsummary.

Inclusion in the resources section shouldnot be construed as endorsement byPartnerships for a Healthy Workforce. Thislist is intended merely as a helpfulsampling of known materials and

organizations pertinent to worksite healthpromotion that can be used as a startingpoint for identifying and gathering otherhelpful resources. Organizations listed maydiscontinue or revise materials from timeto time; all of the items listed may not bereadily available, or offered in the pricerange cited. All additions or correctionsshould be brought to the attention of:

Healthy Workforce 2010Partnerships for a Healthy WorkforcePartnership for Prevention1233 20th St., NW, Suite 200Washington, DC 20036

Partnerships for a Healthy Workforce staffare familiar with and have personally usedmany of the resources included in thissection, but the listing is by no meanscomplete. Readers are encouraged to usethis section as a starting point to discoveradditional resources.

S E C T I O N V :

Resources

Approximate price information is includedas a convenience for readers. Please note,however, that approximate prices excludeshipping and handling and reflect theinformation available as of June 2001.

Comprehensive WellnessProgram ManualHope HealthThis free manual, posted on the corporateside of the Hope Health website, providesbrief, but practical recommendations forwellness programming at the worksite.

350 E. Michigan Ave., Suite 301, Kalamazoo, MI 49007(616) 343-0770http://www.hopehealth.com/Price Category: 0

Design of Workplace HealthPromotion Programs, 5thEditionBy Michael P. O’Donnell This workbook describes a comprehensiveprocess for designing workplace healthpromotion programs. Many useful figuresand tables are included: best programs forspecific health and organizationalproblems, questions to pose in interviewswith top management, sample employeequestionnaires, etc. The fifth edition hasbeen updated to reflect the characteristicsof the best workplace health programsidentified through a nationwidebenchmarking study.

1660 Cass Lake Rd., Suite 104, Keego Harbor, MI 48320-1036(248) 682-0707http://healthpromotionjournal.com/publications/index.htm Price Category: 1

Health Promotion Program Planning Publications

32

Guidelines for Employee HealthPromotion ProgramsAssociation for Worksite Health PromotionA guide for corporate health promotionprofessionals that describes four phases ofan employee health promotion initiative:initial planning, conceptual definition,implementation, and evaluation. Alsodiscusses 10 quality standards for asuccessful program, with an emphasis onprograms that include fitness facilities.

Human Kinetics PublishersP.O. Box 5076, Champaign, IL 61825-5076(800) 747-4457http://humankinetics.com/products/books/index.cfmPrice Category: 1

Health Promotion in theWorkplace, 3rd EditionEdited by Michael P. O’DonnellThis textbook is a top professional healthpromotion reference. It will be mostvaluable to professionals working inbusiness settings to develop, manage, orsupervise health promotion programs. Thebook is also used as a college text.

American Journal of Health Promotion(248) 682-0707http://healthpromotionjournal.com/publications/index.htm Price Category: 2

Health Promotion Sourcebookfor Small BusinessesThis 200+ page manual contains practicaladvice and many resources to build awellness program in a small businesssetting.

Wellness Councils of American (WELCOA)(402) 527-3590 http://welcoa.org/Price Category: 1

Human KineticsPublishes a wide variety of resourcesabout all aspects of physical activityprimarily for health professionals. HumanKinetics is the official publisher for theYMCA resources on various fitness topics.

P.O. Box 5076, Champaign, IL 61825-5076(800) 747-4457http://humankinetics.com/

Planning Wellness: Getting off toa Good StartBy Larry S. ChapmanPractical and time-tested advice onvirtually every important aspect ofworksite wellness programming isincluded in this workbook. Much of thecontent comes from more than 400employee wellness programs in a widevariety of public and private employersettings.

Summex CorporationP.O. Box 55056, Seattle, WA 98155(206) 368-9719www.summex.com/guides.htmlPrice Category: 1

Small Employers: Options forImplementing WellnessBy Larry S. ChapmanWhile this workbook is geared primarily tosmall businesses, the information isrelevant to employers of any size who areinterested in low-cost program options.


Worksite Health PromotionBy David H. ChenowethThis textbook presents an integrated, step-by-step approach to plan, implement, andevaluate worksite health programs in avariety of settings. Four sections includean overview of the historical developmentof health promotion, a planningframework to set up and manage asuccessful program, ideas addressingspecific health needs (mental health,smoking cessation, etc.), and informationspecifically for small and multi-sitecompanies.

Human Kinetics PublishersP.O. Box 5076, Champaign, IL 61825-5076(800) 747-4457Price Category: 1

Health Promotion Program Planning Publications, continued

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

33

Critical Issues in WorksiteHealth PromotionBy David M. Dejoy, Mark G. WilsonThis textbook focuses on several criticalissues associated with worksite healthpromotion programming: integratinghealth promotion into an organization'stotal health care strategy, addressingspecific programming challenges, anddealing with the ongoing and unforeseenchanges in American workplace healthbenefits.

Available at www.amazon.comPrice Category: 1

Economic Impact of WorksiteHealth PromotionBy Joseph P. OpatzAn excellent reference for professionals inthe workplace responsible for worksitewellness. This book was developedthrough the expertise of the Association forWorksite Health Promotion (AWHP) and isalso used as a college text.


Health Promotion for All:Strategies for Reaching DiversePopulations at the WorkplaceBy Stephen RamirezDiscusses how health promotion anddiversity are linked and what can be doneto remove the barriers that prevent racialand ethnic employee groups fromparticipating in your worksite wellnessprogram.

Wellness Councils of American (WELCOA)(402) 527-3590http://welcoa.org/Price Category: 1

Health Promotion Ideas That WorkBy Timothy Glaros Discusses 84 inexpensive and easy-to-implement ideas to boost programparticipation. Each idea in the book ispresented in an easy-to-reference layout.Also includes ideas that are great forvarious holidays and seasons.


How to Beg, Borrow and Barterfor Low-Cost Wellness ProgramsBy Julie A. FriedmanLooks beyond ordinary ways of supportinghealth promotion programs and focuseson low-cost ideas for employers.

Growing Health Publications.(310) [email protected] Category: 1

Key Documents: Useful Formsfor Your Wellness ProgramBy Larry S. ChapmanProvides ready-to-use program documentsthat help reduce program developmenttime.


Mental Wellness: AddressingMental and Spiritual Health atWorkBy Larry S. ChapmanPresents practical tips for adding amental or spiritual component to wellnessprograms.


Other Worksite Health Promotion-Related Publications

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

34

Population Health Management:Optimal Approaches forManaging the Health of DefinedPopulationsBy Larry S. ChapmanProvides a framework and detaileddescription of the new technology andassociated methods available toproactively manage the health of anygroup, including employees, familymembers, and members of health plans.


Program Evaluation: A Key toWellness Program SurvivalBy Larry S. ChapmanReviews the fundamentals of programevaluation and explores practicalstrategies to evaluate worksite wellnessprograms.


Using Wellness Incentives:Positive Tools for HealthyLifestylesBy Larry S. ChapmanOver 250 creative ideas to effectively useincentives as part of a wellness program,including an in-depth discussion ofoptions for linking wellness with employeebenefits.


Worksite Wellness: Presentingthe Business CaseBy Larry S. ChapmanProvides ideas for presentation visualsand suggests comments to be made inpresentations to senior managers oradministrators making the business casefor worksite health promotion. Thematerials are applicable to both privateand public employers.


Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Other Worksite Health Promotion-Related Publications, continued

Journals/Newsletters/Magazines

AWHP’s Worksite HealthThis is the first magazine written forpracticing worksite health promotionprofessionals. Published by the Associationfor Worksite Health Promotion (AWHP), itincludes how-to articles, case studies,business analyses, industry news, andproduct/service information, plus aspecial section for peer-reviewed researcharticles. A free subscription is providedwith AWHP membership.

60 Revere Drive, Suite 500, Northbrook, IL 60062Telephone: (847) 480-9574http://www.awhp.org/Price Category: 2

Business & HealthPublished 10 times a year, Business &Health analyzes and advises on the designand delivery of health benefits and thecreation and maintenance of healthy andproductive workplaces. Typical topics arequality-of-care measures, workplacesafety, cost-effectiveness, diseasemanagement, health plan design andadministration, and the impact of lawsand regulations affecting employeebenefits.

Five Paragon Drive, Montvale, NJ 07645-1742www.businessandhealth.comPrice Category: 2

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The American Journal of HealthPromotionThis peer-reviewed journal is devotedexclusively to health promotion. Publishedbimonthly, it presents original research,literature reviews, editorials, and casestudies on the full spectrum of healthpromotion topics: fitness, nutrition, weightcontrol, stress management, smokingcessation, medical self-care, demandmanagement, mind/body health, healthpolicy, employee assistance programs,underserved populations, and much more.

1660 Cass Lake Road, Suite 104, Keego Harbor, MI 48320(248) 682-0707www.healthpromotionjournal.comPrice Category: 2

The Art of Health PromotionA quarterly newsletter that bridges the gapbetween health promotion research andpractice. Includes information that is bothscientifically sound and applicable to realworld situations. Sure to be helpful tohealth promotion program managers.

1660 Cass Lake Road, Suite 104, Keego Harbor, MI 48320(202) 682-0707www.healthpromotionjournal.comPrice Category: 2

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Journals/Newsletters/Magazines, continued

Organizations and Helpful Websites

AARPOffers many articles, tips and resourceson a variety of health promotion topics formidlife adults, including Activating Ideas:Promoting Physical Activity Among OlderAdults and Fitness After 50. Websiteincludes many useful links.

601 E St., NW, Washington, DC 20049 (800) 424-3410http://www.aarp.org/healthguide/

American Association for ActiveLifestyles and Fitness (AAALF)AAALF's mission is to promote activelifestyles and fitness for all individuals byfacilitating the application of diverseprofessional interests through knowledgeexpansion, information dissemination,and collaborative efforts.

1900 Association Drive, Reston, VA 201291-1599(800) 213-7193http://www.aahperd.org/aaalf/aaalf_main.html

American College of SportsMedicine (ACSM)Many resources geared to employees andfamily members and health promotionprofessionals. Single copies of manybrochures are available free of charge bysending a self-addressed, stamped,business-sized envelope. Titles includeEating Smart, Even When You’re Pressedfor Time, Exercise Your Way to LowerBlood Pressure, Fitting Fitness in, EvenWhen You’re pressed for Time and manyothers. Professional resources such asHealth/Fitness Facility Standards andGuidelines provide guidelines and criteriafor establishing and maintaining a safeand proper fitness facility.

401 W. Michigan St., Indianapolis, IN 46202-3233(317) 637-9200http://www.acsm.org/

Association for Worksite HealthPromotion (AWHP)A not-for-profit organization that linksworksite health promotion professionalswilling to share the methods andtechnologies necessary to initiate asuccessful health promotion program.

60 Revere Drive, Suite 500, Northbrook, IL 60062Telephone: (847) 480-9574http://www.awhp.org/

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Cooper Institute Founded in 1970 by Kenneth H. Cooper,M.D., M.P.H, the Cooper Institute isinvolved in preventive medicine researchand education. It offers training andcertification programs for fitness leadersand health professionals. Also designs anddelivers worksite health promotionprograms to corporations, school systems,and public safety organizations TheWalking Handbook, covers seven steps forplanning and implementing a personalwalking program

12330 Preston Road, Dallas Texas 75230(972) 341-3200http://www.cooperinst.org/default.asp

Health Enhancement ResearchOrganization (HERO)A national coalition of employersinterested in employee healthenhancement and disease managementresearch and the association betweenemployee health and productivity.

3500 Blue Lake Drive, Suite 270, Birmingham, AL 35243www.the-hero.org

National Business Coalition onHealthProvides expertise, resources, and a voiceto nearly 100 member coalitions acrossthe country, collectively representing morethan 8,000 employers. “Value-basedhealth care,” that is, obtaining the highestquality health care at the most reasonablecost, is a primary focus.

1015 18th Street, NW, Suite 450, Washington, D.C. 20036(202) 775-9300www.nbch.org

National Wellness Institute(NWI)Formerly called the National WellnessAssociation, NWI’s mission is to serve theprofessionals and organizations thatpromote optimal individual andcommunity wellness. NWI offers manyworksite wellness materials and sponsorsthe national wellness conference heldannually in Stevens Point, WI.

P.O. Box 827, Stevens Point, WI 54481-0827(800) 244-8922www.nationalwellness.org

Shape Up America! Involving a broad-based coalition ofindustry, medical/health, nutrition,physical fitness, and related groups,Shape Up America! is a national initiativeto promote healthy weight and increasedphysical activity. The website offers handytools to assess individuals’ activity andfitness levels, as well as information aboutthe benefits of exercise, and tips toovercome common barriers to increasedphysical activity.

http://www.shapeup.org/

Society for Prospective Medicine(SPM)SPM members come from corporatemedical and health promotiondepartments, health maintenanceorganizations, health departments, laborgroups, colleges, and other settings.Members share an interest in healthassessment and risk reduction program.Publishes the Handbook of AssessmentTools, which, according to the SPMwebsite, is an objective comparison ofcommercially available health assessmenttools.

http://www.spm.org/default.htm

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Organizations and Helpful Websites, continued

37

Washington Business Group onHealth (WBGH)A non-profit membership organization of160 large national and multinationalemployers. WBGH works to fostercorporate leadership to promoteperformance-driven health care systemsand competitive markets that reallyimprove the health and productivity ofcompanies and communities.

50 F Street, NW, Suite 600, Washington, DC 20001(202) 628-9320www.wbgh.org

Wellness Councils of America(WELCOA)WELCOA offers a step-by-step blueprint tohelp employers design and implementworksite wellness programs, and alsorecognizes excellence in worksite healthpromotion via its prestigious awardsprogram.

9802 Nicholas Street, Suite 315, Omaha, NE 68114(402) 827-3590www.welcoa.org

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Organizations and Helpful Websites, continued

Society for Prospective Medicine(SPM)Sponsors and publishes the Handbook ofAssessment Tools, which according theSPM website is an objective presentationand comparison of commercially availablehealth assessment tools

http://www.spm.org/default.htm

Health Risk Appraisals

Self-Care Handbooks

Self-care books provide information to helpwith most basic decisions aboutprevention, self-care, and when to call adoctor. Books commonly cover commonhealth problems with easy to use chartsthat show you how to treat problems athome as well as when you should see adoctor. Most books cover emergencies,common injuries, and problems with ears,nose, throat, eyes, and mouth. Informationon skin problems and childhood diseases,bones, muscles and joints, chest andabdominal symptoms, generalized problemslike fever, stress and addictions, women'shealth and sexual problems and questionsare also addressed in many self-care texts.Ask publisher for special prices for bulkquantities for distribution to employees.

Health at Home: Your CompleteGuide to Symptoms, Solutions& Self-CareBy Don R. Powell and the American Institutefor Preventive Medicine

American Institute for Preventive Medicine Press30445 Northwestern Hwy., Suite 350, Farmington Hills, MI48334-3102(248) 539-1800e-mail: [email protected] Category: 1

Healthwise Handbook: A Self-Care Guide for YouBy Donald W. Kemper

Healthwise, Incorporated2601 North Bogus Basin Road, Boise, Idaho 83702(800) 706-9646http://www.healthwise.org/p_self-care.htmlPrice Category: 1

38

Informed AdvantAge: A Resource Guide for HealthyAgingBy George J. Pfeiffer

WorkCare PressP.O. Box 2053, Charlottesville, VA 22902(804) 977-7525Price Category: 1

Take Care of Yourself: TheComplete Illustrated Guide toMedical Self-CareBy Donald M. Vickery and James F. Fries

http://www.amazon.comPrice Category: 1

Wise Health Consumers:Resources and Tools for EmployersBy Larry S. ChapmanIncludes practical insights and identifiesresources to help plan and implement acost-effective, wise consumer componentto a worksite health promotion program.


Workcare: A Resource Guide forthe Working PersonBy George J. Pfeiffer and Judith A. WebsterThis manual is intended to increaseawareness of occupational-related issuesthat effect employees today.

WorkCare PressP.O. Box 2053, Charlottesville, VA 22902(804) 977-7525Price Category: 1

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Self-Care Handbooks

There are hundreds and hundreds of healthpromotion websites that provideinformation and resources for employersand employees interested in virtually anyarea of health. This is both a boon and abane, as it can be difficult to separate outthe quality sites with credible, scientificinformation. A good place to start is withofficial governmental agencies andnationally-known organizations, such asthose listed below.

Governmental Websites

Centers for Disease Control andPrevention (CDC)National Center for Chronic DiseasePrevention and Health PromotionDivision of Nutrition and Physical ActivityNational Center for Chronic DiseasePrevention and Health PromotionOffers many physical activity and health-related electronic or printed publicationsthat can be obtained on the website,including: Physical Activity and Health: A

Report of the Surgeon General, thatspecifically addresses physical activityand health. Employees and familymembers can benefit from The PersonalEnergy Plan or PEP, a 12-week self-directed, worksite program to promotehealthy eating and moderate physicalactivity. The program materials includeworkbooks for healthy eating and physicalactivity targeting employees based on theirreadiness to change. A coordinator’s kit,promotional brochures, and posters arealso included in the program.

4770 Buford Highway, NE, MS/K-24, Atlanta GA 30341-3717(770) 488-5820http://www.cdc.gov/nccdphp/dnpa/index.htm

Combined Health InformationDatabase (CHID)Disease Prevention FileCHID is a bibliographic databaseproduced by health-related agencies of thefederal government that provides titles,abstracts, and availability information forhealth information and health education

Health Promotion Websites

39

resources. A wealth of health promotionand education materials and programdescriptions can be found on this site.New records added quarterly and currentlistings are checked regularly to helpensure that entries are up to date and stillavailable from their original sources.

http://chid.nih.gov/welcome/welcome.html

Federal Trade Commission(FTC) The FTC Consumer Response Center hasseveral publications, including SettingGoals for Weight Loss, that containinformation on proven weight lossstrategies and programs.

Consumer Response Center, 600 Pennsylvania Avenue, NW,Washington, DC 20580(202) FTC-HELP http://www.ftc.gov/bcp/menu-health.htm

Healthfinder®A free guide to reliable health informationprovided by the U.S. Department of Healthand Human Services with links to manyhealth-related websites.

http://www.healthfinder.gov

MEDLINEplusThis site is a gold mine of up-to-date,quality health care information from theworld’s largest medical library, theNational Library of Medicine at theNational Institutes of Health.MEDLINEplus is for anyone with amedical question. Both healthprofessionals and consumers can dependon it for accurate, current, medicalinformation. Access extensive informationabout specific diseases and conditions;links to consumer health information fromthe National Institutes of Health,dictionaries, lists of hospitals andphysicians, health information in Spanishand other languages, and clinical trials.There is no advertising on this site, nordoes MEDLINEplus endorse any companyor product.

http://medlineplus.gov

National Heart, Lung, and BloodInstitute (NHLBI)Offers publications for patients and thepublic on a variety of health topics,including, asthma, cholesterol, heartdisease, high blood pressure, obesity andphysical activity, smoking and manyresources on women’s health issues.Check out NHLBI’s publication list at:

http://www.nhlbi.nih.gov/health/pubs/pub_gen.htm

National High Blood PressureEducation Program (NHBPEP) The NHBPEP’s redesigned website hasseveral new resources to help consumerscontrol their blood pressure, includinginteractive quizzes, healthy eating tips,and information on other behaviors thatcontribute to high blood pressure. TheNHBPEP is coordinated by the NationalHeart, Lung, and Blood Institute (NHLBI),part of the National Institutes of Health.

http://www.nhlbi.nih.gov/hbp

National Institute of Diabetesand Digestive and KidneyDiseases (NIDDK)Access the NIDDK website for healtheducation programs related to diabetesand weight control.

31 Center Drive, Bethesda, MD 20892http://www.niddk.nih.gov/

National Center for ChronicDisease Prevention and HealthPromotionTobacco Information and Prevention Source(TIPS)Get Surgeon General reports, informationon how to quit smoking, and othereducational materials. Find out aboutstop-smoking campaigns and events, andsearch the smoking and health database.Many useful related links.

http://www.cdc.gov/tobacco/index.htm

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Health Promotion Websites, continued

40

Office on Women's Health(OWH)In the Department of Health and HumanServices, OWH is the champion and focalpoint for women's health issues andsupports culturally sensitive educationalprograms that encourage women to takepersonal responsibility for their ownhealth and wellness. Publishes fact sheets,resource papers and articles for thescientific and popular press on a varietyof issues concerning women's health.

200 Independence Avenue, SW Room 730B,Washington, DC 20201(202) 690-7650http://www.4woman.gov/owh/index.htm

U.S. Department of Agriculture– Center for Nutrition Policyand PromotionOne click of your mouse will downloadthe official Dietary Guidelines forAmericans. This is a public domaindocument, which means that you canprint out copies for employees as part of anutrition education activity. The websitealso includes the “Interactive HealthyEating Index,” a dietary assessment tool,and the food guide pyramid, whichvisually illustrates healthy food choices.

http://www.usda.gov/cnpp/

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Health Promotion Websites, continued

Other Health Websites

More than 22 million adults in the UnitedStates used the Internet to search forhealth and medical information as ofDecember 1998. Twenty-nine percent of allAmericans use the Internet for medicalinformation, with about 70 percent of thisgroup doing so prior to visiting the doctor.Most of these users search for informationabout diseases. While the internet providesa powerful tool for finding healthinformation, the Federal Trade Commission(FTC) warns that hundreds makedeceptive, unproven and fraudulent claims.The FTC suggests consumers use thefollowing tips for evaluating any healthclaim. If it sounds too good to be true, itprobably is. Be on the lookout for thetypical phrases and marketing techniquesfraudulent promoters use to deceiveconsumers.

■ The product is advertised as a quick andeffective cure-all for a wide range ofailments.

■ The promoters use words like scientificbreakthrough, miraculous cure,exclusive product, secret ingredient orancient remedy.

■ The text is written in “medicalese” —impressive-sounding terminology todisguise a lack of good science.

■ The promoter claims the government;the medical profession or researchscientists have conspired to suppress theproduct.

■ The advertisement includesundocumented case histories claimingamazing results.

■ The product is advertised as availablefrom only one source.63

Consumer education information isavailable from the FTC’s websitehttp://www.ftc.gov

Check out medical products or servicesoffered on the internet with physicians,pharmacists and other health careprofessionals, or use sites that areassociated with known credible medicalorganizations. Most health plans havewebsites that offer health promotion andother resources such as self-care and nurselines.

41

The Benfield Group. LLCAllows one-stop-shopping for informationabout online health management. Acomprehensive vendor and productinventory can be downloaded free.

www.thebenfieldgroup.com

Take Action!Take Action! is a 10-week worksite healthprogram free to businesses compliments ofthe California Health PromotionCollaborative, a group of local andregional health promotion organizationsthroughout California. Visit the website toreview the program and download one ofthree program packets. The coordinator

packet covers procedures to launch andevaluate the program. All of the TakeAction! materials available on this site areformatted for easy and attractive printingin color or black & white from your officeprinter. The pages are 8.5 x 11 in size,and each packet contains approximately15 pages, including introductorymaterials, goal-setting worksheets, ideas,reporting forms, and evaluation forms.The site includes other useful links such toreview abstracts of current research onthe strong relationship between health andproductivity.

www.ca-takeaction.com

Price Scale:

0 = Free

1 = $50 or less

2 = $51 to $100

3 = More than $100

Other Health Websites

Nonprofit Voluntary Health Organizations

Non-profit voluntary health organizationsoffer high quality, credible information, andresources addressing virtually all of theHealthy Workforce Objectives foremployers. Resources range fromeducational materials that can bedistributed to employees, to packagedworksite health promotion programs, toguest speakers. And best of all for smallemployers, the materials are often free orinexpensive.

For example, the American HeartAssociation offers a state-of-the-art, web-based product called “One of a Kind.” Theprogram helps people identify factors thatplace them at risk for future illness andthen provides individually-tailoredinformation to address those factors.

Non-profit health organizations usuallyhave both a national office and localchapters or affiliates. Employers cancontact either one for more information.

American Cancer Society Prevention and awareness materialsavailable to the general public on earlydetection, tobacco and other topics.

1599 Clifton Road NE, Atlanta, GA 30329(800) ACS-2345http://www.cancer.org/

American Dietetic AssociationProduces nutrition fact sheets and otherpublications, such as Dieting forDummies.

Consumer Education Team216 West Jackson Boulevard, Chicago, IL 60606(800) 877-1600, ext. 5000 for other publications or (800) 366-1655 for recorded food/nutrition messageshttp://www.eatright.org/

42

American Heart Association(AHA)Get accurate information on heart diseaseand stroke, America’s leading killers. Afamily health section includes informationon nutrition and exercise, programs andbooks. The risk awareness section helpsdetermine personal risk. The “One Of AKind” personalized health managementprogram can help employees’ lower risk ofheart attack and stroke. The program isfree and is tailored to individual needs.

http://www.americanheart.org/

American Institute for CancerResearch (AICR)AICR's Educational Services programprovides reliable, accurate and currentinformation on a variety of subjectsrelated to diet, nutrition, and theprevention and treatment of cancer.

1759 R Street NW, Washington, DC 20009(800) 843-8114 (202) 328-7744 in DC)email: [email protected]://www.aicr.org/aicr.htm

American Lung Association(ALA)Click on “Occupational Health” fortobacco control information for employers,including a fact sheet on workplacesmoking policies and resources to helpemployees quit smoking. Hotlinks to otherhelpful sites are also included.

1740 Broadway, New York, NY 10019(212) 315-8700http://www.lungusa.org/

National Council on Alcoholismand Drug Dependence (NCADD)Founded in 1944 by Marty Mann, the firstwoman to find long-term sobriety inAlcoholics Anonymous, NCADD provideseducation, information, help and hope tothe public. It advocates prevention,intervention and treatment through officesin New York and Washington, and anationwide network of Affiliates.

20 Exchange Place, Suite 2902, New York, NY 10005(212) 269-7797 HOPE LINE: 800/NCA-CALL (24-hour Affiliate referral)[email protected] http://www.ncadd.org

Nonprofit Voluntary Health Organizations, continued

43

Every U.S. jurisdiction (including states,territories, and the District of Columbia)has a health official designated as a“Healthy People” contact. This person isgenerally a health promotion expert,responsible for encouraging healthpromotion activities within the jurisdictionand for tracking progress toward achievingthe Healthy People objectives (both thenational objectives discussed in thissourcebook, as well as specially adaptedstate objectives).

How can state Healthy People contacts helpbusinesses? In three ways:

1. Offer expert advice and/or materialsrelated to specific health promotionchallenges (or refer you to anappropriate health expert who can).

2. Direct employers to local healthpromotion resources, such as worksitehealth promotion providers.

3. Identify opportunities for involvementin community-wide health promotionactivities.

Think of your Healthy People contact as ahealth promotion ally. They want to helpyou.

The following list of Healthy Peoplecontacts is listed alphabetically by stateand include website if available.

AlaskaAlice RarigChief of the Data Evaluation UnitDivision of Public HealthAlaska Department of Health and Social

ServicesAlaska Office BuildingPost Office Box 110618Juneau, AK [email protected]: 907-465-1285Fax: 907-465-8637http://www.hss.state.ak.us/dph/deu/projects/

healthy/healthy.html

AlabamaJim McVayDirector of Health Promotion and Chronic

DiseaseAlabama Department of Public HealthPost Office Box 303017Montgomery, AL [email protected]: 334-206-5600Fax: 334-206-5609Voice: 334-271-6996Fax: 334-317-9792http://www.alapubhealth.org/

ArkansasChristine PattersonDirectorOffice of Minority HealthArkansas Department of Health4815 West Markham, Slot 22Little Rock, AR [email protected]: 501-661-2193Fax: 501-661-2414

State Healthy People Contacts

Healthy Arizona 2010 has an online partnership registration for businesses, community groups and others toregister their local projects for affiliation with the state initiative. Projects must state how they related to thegoals and objectives of the Healthy Arizona 2010 plan and agree to share their evaluation data. Seehttp://www.hs.state.az.us/phs/healthyaz2010/submit.htm

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American SamoaJoseph TufaDirectorDepartment of Public HealthGovernment of American SamoaPago Pago, AS [email protected]: 011-684-633-4606Fax: 011-684-633-5379

ArizonaGeri TeboHealthy Communities CoordinatorArizona Department of Health Services2927 North 35th Avenue, Suite 100Phoenix, AZ [email protected]: 602-542-1918Fax: 602-542-1265http://www.hs.state.az.us/phs/

healthyaz2010/

CaliforniaFred RichardsResearch AnalystCenter for Health StatisticsDepartment of Health Services304 S Street, 3rd FloorSacramento, CA [email protected]: 916-445-6338Fax: 916-324-5599

ColoradoChuck BayardAdvisor, Executive DirectorColorado Department of Public Health and

EnvironmentOffice of Health4300 Cherry Creek Drive South,

OH-05 EDODenver, CO [email protected]: 303-692-2015Fax: 303-691-7702

ConnecticutMichael J. Hofmann, Ph.D.Director, Research and PlanningOffice of Health Policy, Planning and

EvaluationConnecticut Department of Public Health410 Capitol Avenue, MS #13PPEPost Office Box 340308Hartford, CT [email protected]: 860-509-7120Fax: 860-509-7160

District of ColumbiaPatricia TheissPublic Health AdvisorDistrict of Columbia Department of Health825 North Capitol Street, N.E., Suite 2100Washington, DC [email protected]: 202-442-9039Fax: 202-442-4833 http://www.phf.org/HPtools/state/DC/

DC-HP2010-Plan.pdf

DelawareTerrence Zimmerman, Ph.D.Chief of AdministrationDelaware Division of Public HealthDelaware Department of Health and Social

ServicesJesse Cooper BuildingPost Office Box 637Dover, DE [email protected]: 302-739-3034Fax: 302-739-3008http://www.healthydelaware.com/

hp20101.htm

FloridaWilliam AlfredOperations Management and Consultant

ManagerFlorida Department of Health4052 Bald Cypress Way, Bin #A05Tallahassee, FL [email protected]: 850-245-4009Fax: 850-921-1898

State Healthy People Contacts, continued

45

Federated States of MicronesiaEliuel K. Pretrick, M.D., M.P.H.Health OfficialGovernment of the Federated States of

MicronesiaPost Office Box PS70Palikir StationPohnpei, FM [email protected]: 011-691-320-2619Fax: 011-690-320-5263

GeorgiaMichele MindlinDirector for Grant Development and

ManagementGeorgia Division of Public Health2 Peachtree Street, 15th FloorAtlanta, GA [email protected]: 404-657-2758Fax: 404-657-2715

Jack KirbyDeputy DirectorDivision of Public HealthGeorgia Department of Human Resources2 Peachtree Street, N.W., Suite 15-470Atlanta, GA [email protected]: 404-657-2700Fax: 404-657-2715

GuamDennis G. RodriguezDirectorGuam Department of Public Health and

Social ServicesPost Office Box 2816Hagatna, GU [email protected]: 011-671-735-7102Fax: 011-671-734-5910

HawaiiBetty J. Wood, Ph.D., M.P.H.Director, Healthy Hawaii 2000Hawaii Department of Health1250 Punchbowl Street, Room 227Post Office Box 3378Honolulu, HI [email protected]: 808-586-4438

IowaLouise Lex, Ph.D.Program Coordinator, for Healthy IowansDivision of Substance Abuse and Health

PromotionIowa Department of HealthLucas State Office Building, 3rd FloorDes Moines, IA [email protected]: 515-281-4348Fax: 515-281-4535http://www.idph.state.ia.us/sa/h_ia2010/

contents.htm

IdahoRichard H. Schultz, M.S.Administrator, Division of HealthIdaho Department of Health and Welfare450 West State Street, Box 83720Boise, ID [email protected]: 208-334-5945Fax: 208-334-6581

IllinoisPatti KimmelChief, Division of Health PolicyIllinois Department of Public Health525 West Jefferson StreetSpringfield, IL [email protected]: 217-782-6235Fax: 217-785-4308

IndianaHazel Katter, R.N., H.S.D., B.S.N., M.S.N.Director, Local Liaison OfficeIndiana State Department of Health2 North Meridian Street, Section 8BIndianapolis, IN [email protected]: 317-233-7679Fax: 317-233-7761


46

KansasDeborah Williams, M.P.A., M.P.H.Director, Special StudiesBureau of Health PromotionKansas Department of Health and

EnvironmentLandon State Office Building, Room 901N900 Southwest Jackson StreetTopeka, KS [email protected]: 785-291-3743Fax: 785-296-8059

Kentucky Charles KendellManager, Health Policy Development

BranchDivision of Epidemiology and Health

PlanningKentucky Department of Public Health275 East Main Street, HS 1EBFrankfort, KY [email protected]: 502-564-9592Fax: 502-564-9205http://chs.state.ky.us/publichealth/

healthy%5Fky%5F2010.htm

LouisianaDarlene W. SmithHealthy People 2000 CoordinatorHealth Policy BranchDivision of EpidemiologyLouisiana Office of Public Health325 Loyola Avenue, Room 515New Orleans, LA 70112Voice: 504-568-5004Fax: 504-568-8744http://www.legis.state.la.us/leg_docs/99rs/CV

T9/OUT/0000FRQ3.pdf

MassachusettsJulia BonavitaDirectorDivision of PreventionBureau of Family and Community HealthMassachusetts Department of Public Health250 Washington Street, 4th FloorBoston, MA 02108Voice: 617-624-5483Fax: 617-624-6062

MarylandJeanette Jenkins, M.H.S.DirectorOffice of Health PolicyCommunity and Public Health

AdministrationMaryland Department of Health and Mental

Hygiene201 West Preston Street, Room 316Baltimore, MD [email protected]: 410-767-5045Fax: 410-333-7703http://mdpublichealth.org/ohp/html/

proj2010.html

MaineDora Anne Mills, M.D.State Health OfficerBureau of Health, Programs OfficeMaine Department of Human Services157 Capitol Street, State House Station #11Augusta, ME [email protected]: 207-287-3201, Fax: 207-287-4631http://janus.state.me.us/dhs/boh/healthyme

2k/pdf/Introduction%20.Pages.pdf

MichiganLonnie Barnett, M.P.H.Manager for the Community Assessment

SectionHealth Legislation and Policy DevelopmentMichigan Department of Community

Health320 South WalnutLansing, MI [email protected]: 517-241-2966Fax: 517-241-0084http://www.mdch.state.mi.us/dch/chi/index.

htm


47

MinnesotaDebra BurnsSection ManagerDivision of Community Health ServicesMinnesota Department of HealthPost Office Box 64975St. Paul, MN [email protected]: 651-296-8209Fax: 651-296-9362http://www.health.state.mn.us/divs/chs/phg/

intro.html

MissouriLois HeldenbrandStrategic PlanningMissouri Department of Health912 WildwoodPost Office Box 570Jefferson City, MO [email protected]: 573-751-6001Fax: 573-751-6041

MississippiDavid M. Buchanan, J.D.Director, Policy and PlanningMississippi State Department of Health576 East Woodrow Wilson DrivePost Office Box 1700Jackson, MS [email protected]: 601-576-7428Fax: 601-576-7208

MontanaTodd HarwellDiabetes Program CoordinatorMontana Department of Public Health and

Human ServicesCogswell Building, 1400 BroadwayPost Office Box 202951Helena, MT [email protected]: 406-444-1437Fax: 406-444-7465http://www.dphhs.state.mt.us/hpsd/pubheal/

healplan/pdf/hadraft4.pdf

North CarolinaMary Bobbitt-Cooke, M.P.H.Director, Office of Healthy CaroliniansDivision of Public HealthNorth Carolina Department of Health and

Human Services1330 St. Mary's Street, Suite G1-1031915 Mail Service CenterRaleigh, NC [email protected]: 919-715-0416Fax: 919-715-3144http://www.healthycarolinians.org/GTF2010

/hlthgoals.htm

North DakotaDarleen BartzChiefHealth Resources SectionNorth Dakota Department of HealthState Capitol-Judicial Wing600 East Boulevard AvenueBismarck, ND [email protected]: 701-328-2352Fax: 701-328-1890

NebraskaDavid PalmHealthy People 2000 CoordinatorOffice of Public HealthNebraska Department of Health and

Human ServicesPost Office Box 95044Lincoln, NE [email protected]: 402-471-2337Fax: 402-471-0180

New HampshirePatricia BaumProgram ManagerBureau of Health PromotionNew Hampshire Health and Human

Services Department6 Hazen DriveConcord, NH [email protected]: 603-271-4828Fax: 603-271-4160http://www.healthynh2010.org/


48

New Hampshire, continuedMartha WellsAdministrator for Disease Prevention &

Health PromotionOffice of Community and Public HealthNew Hampshire Health and Human

Services Department6 Hazen DriveConcord, NH [email protected]: 603-271-4549Fax: 603-271-4160

Gwen Grossmiller, M.S., R.D.Advisor, Bureau of Health PromotionDivision of Disease Prevention and Health

PromotionNew Hampshire Department of Health and

Human Services6 Hazen DriveConcord, NH [email protected]: 603-271-8326Fax: 603-271-4160

New JerseyRuth CharbonneauDirectorOffice of Policy and ResearchNew Jersey Department of Health and

Senior ServicesCN360, 8th Floor, Room 601Post Office Box 360Trenton, NJ [email protected]: 609-984-2177Fax: 609-984-5474http://www.state.nj.us/health/

healthy2010.htm

New MexicoDr. Doris FieldsDirector, Public Health DivisionNew Mexico Department of Health1190 St. Francis DrivePost Office Box 26110Santa Fe, NM [email protected]: 505-841-4844Fax: 505-841-4839

NevadaMary E. Guinan, M.D., Ph.D.State Health OfficerNevada State Health DivisionNevada Department of Human Resources505 East King Street, Room 201Carson City, NV [email protected]: 775-684-4200Fax: 775-684-4211

New YorkMichelle Cravetz, R.N-C.MCHSBG CoordinatorDivision of Family and Local HealthNew York State Department of HealthCorning Tower Building, Room 890Empire State PlazaAlbany, NY [email protected]: 518-474-6968Fax: 518-473-2015

OhioTom MooreHealth Planning ManagerOffice of Policy and LeadershipOhio Department of Health246 North High Street, 7th FloorPost Office Box 118Columbus, OH [email protected]: 614-644-7184Fax: 614-644-8526

OklahomaNeil Hann, M.P.H., CHESDeputy Chief, Health Promotion and Policy

AnalysisOklahoma State Department of Health1000 N.E. 10th StreetOklahoma City, OK [email protected]: 405-271-5601Fax: 405-271-2865


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OregonJennifer WoodwardHealthy People 2000 ContactHealth StatisticsOregon Health Division800 Northeast Oregon Street, Suite 225Portland, OR [email protected]: 503-731-4109Fax: 503-731-3076

PennsylvaniaDarlene B. SampsonExecutive Assistant to the Secretary of

HealthPennsylvania Department of HealthPost Office Box 90Harrisburg, PA [email protected]: 717-787-6436Fax: 717-772-6959http://www.health.state.pa.us/pdf/ship/

documen8.pdf

Puerto RicoGabriel Diaz Rivera, M.D., M.P.H., F.A.A.F.P.State CoordinatorPuerto Rico Department of HealthBuilding ACommonwealth of Puerto RicoSan Juan, PR [email protected]: 787-274-5500Voice: 787-274-5642Voice: 787-274-5641Fax: 787-274-5523

Rhode IslandRobert J. Marshall, Ph.D.Assistant Director of HealthRhode Island Department of Substance

AbuseCannon Building, Room 4013 Capitol HillProvidence, RI [email protected]: 401-222-2331Fax: 401-222-6548

William J. Waters, Jr., Ph.D.Deputy DirectorRhode Island Department of HealthThree Capitol Hill, Room 401Providence, RI [email protected]: 401-222-2231Fax: 401-222-6548

South CarolinaJoe KyleCoordinator of Planning ResearchSouth Carolina Department of Health and

Environmental Control2600 Bull StreetColumbia, SC [email protected]: 803-898-0777Fax: 803-898-3335

Paula M. Fendley, M.Ed., L.M.S.W.Deputy DirectorOffice of PlanningSouth Carolina Department of Health and

Environmental Control2600 Bull StreetColumbia, SC [email protected]: 803-898-3316Fax: 803-898-3335

South DakotaJerry C. HoferDirector, Division of AdministrationSouth Dakota State Department of Health600 East CapitolPierre, SD [email protected]: 605-773-3361Fax: 605-773-5683

TennesseeKeith R. Williams, M.P.A.Public Health AdvisorCommunicable and Environment Disease

SectionTennessee Department of Health4th Floor Cordell Hull Building425 5th Avenue, NorthNashville, TN [email protected]: 615-741-7510Fax: 615-741-4911


50

TennesseeAnn Duncan, R.N., M.P.H.Deputy Commissioner for the Department

of HealthTennessee Department of Health3rd Floor, Cordell Hill Building425 5th Avenue, NorthNashville, TN [email protected]: 615-741-3111Fax: 615-741-2491

TexasDan SmithCommunity Development CoordinatorPublic Health PromotionTexas Department of Health1100 West 49th Street, Suite M631Austin, TX [email protected]: 512-458-7405Fax: 512-458-7476

UtahDr. Lois HaggardDirectorBureau of Surveillance and AnalysisUtah Department of Public HealthPost Office Box 142101Salt Lake, UT [email protected]: 801-538-6108Fax: 801-536-4346

VirginiaHenry MurdaughHealthy People 2000 ContactVirginia Department of HealthPost Office Box 2448, Room 227Richmond, VA [email protected]: 804-371-8619Fax: 804-371-0116http://www.vdh.state.va.us/hv2010/

index.html

U.S. Virgin IslandsJose F. Poblete, M.D., FACS, FICSCommissionerVirgin Islands Department Health ServicesGovernor's Office21-22 Kongens GadeSt. Thomas, VI 00802Voice: 809-776-8311Fax: 809-776-0610Voice: 807-777-0117

VermontBurton W. Wilcke, Jr., Ph.D.Director, Division of Health SurveillanceVermont Department of Health108 Cherry StreetPost Office Box 70Burlington, VT [email protected]: 802-865-7701Voice: 802-863-7246

Linda Fox DoreyPublic Affairs DirectorVermont Department of Health108 Cherry StreetPost Office Box 70Burlington, VT [email protected]: 802-863-7281Fax: 802-865-7754

Nancy EricksonPublic Affairs DirectorVermont Department of Health108 Cherry StreetPost Office Box 70Burlington, VT [email protected]: 802-863-7281Fax: 802-865-7754http://www.state.vt.us/health/_admin/pubs/

2000/hv2010/pdf/hv2010cover.pdf


51

WashingtonJuliet VanEenwykState Epidemiologist Non-Infective DiseasesEpidemiology, Health Statistics and Public

Health LaboratoriesWashington Department of Social/Health

ServicesPost Office Box 47812Olympia, WA [email protected]: 360-236-4250Fax: 360-236-4255

WisconsinMargaret Schmelzer, R.N., M.S.Public Health Nursing DirectorChief, Wisconsin Turning Point InitiativeDepartment of Health and Family ServicesWisconsin Division of Public Health1 West Wilson StreetPost Office Box 2659Madison, WI [email protected]: 608-266-0877Fax: 608-266-8925

West VirginiaTom SimsDirector, Division of Health PromotionPublic Health BureauWest Virginia Health & Human Resources

Department350 Capitol Street, Room 319Charleston, WV [email protected]: 304-558-0644Fax: 304-558-1553http://www.wvdhhr.org/bph/hp2010/

default.htm

WyomingJimm MurrayAdministratorDivision of Community and Family HealthWyoming Department of Health, Public

HealthHathaway Building, Room 4792300 Capitol AvenueCheyenne, WY [email protected]: 307-777-6004Fax: 307-777-3617


52

NO. † PHYSICAL ACTIVITY AND/OR FITNESS PROGRAMS OR ACTIVITIES

22-1. Reduce the proportion of adults who engage in no leisure-time physical activity.Target: 20 percent.Baseline: 40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997.

22-2. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30minutes per day.Target: 30 percent.Baseline: 15 percent of adults aged 18 years and older were active for at least 30 minutes 5 or more days per week in1997 ‡

22-3. Increase the proportion of adults who engage in vigorous physical activity that promotes the development andmaintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.Target: 30 percent.Baseline: 23 percent of adults aged 18 years and older engaged in vigorous physical activity 3 or more days per weekfor 20 or more minutes per occasion in 1997 ‡

22-4. Increase the proportion of adults who perform physical activities that enhance and maintain muscular strength andendurance.Target: 30 percent.Baseline: 18 percent of adults aged 18 years and older performed physical activities that enhance and maintainstrength and endurance 2 or more days per week in 1997 ‡

22-5. Increase the proportion of adults who perform physical activities that enhance and maintain flexibility.Target: 43 percent.Baseline: 30 percent of adults aged 18 years and older did stretching exercises in the past 2 weeks in 1995 ‡

NO. † NUTRITION OR CHOLESTEROL EDUCATION

12-13. Reduce the mean total blood cholesterol levels among adults.Target: 199 mg/dL.Baseline: 206 mg/dL was the mean total blood cholesterol level for adults aged 20 years and older in 1988-94 ‡

12-14. Reduce the proportion of adults with high total blood cholesterol levels.Target: 17 percent.Baseline: 21 percent of adults aged 20 years and older had total blood cholesterol levels of 240 mg/dL or greater in1988-94 ‡

19-5. Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit.Target: 75 percent.Baseline: 28 percent of persons aged 2 years and older consumed at least two daily servings of fruit in 1994-96 ‡

19-6. Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables,with at least one-third being dark green or deep yellow vegetables.Target: 50 percent.Baseline: 3 percent of persons aged 2 years and older consumed at least three daily servings of vegetables, with atleast one-third of these servings being dark green or deep yellow vegetables in 1994-96 ‡

A P P E N D I X 1

Healthy People 2010 Objectives Applicable toWorksites

Component 1: Health EducationFocuses on skill development and lifestyle behavior change in addition to information dissemination andawareness building, preferably tailored to employees interests and needs.

† The number to the left of the objective is the reference number for the full-text version of Healthy People.The number before the dashcorresponds to the chapter while the number after the dash matches the objective number. For example—objective 7-5 can be found in FocusArea (Chapter) 7, objective #5 of the Healthy People 2010.

‡ (Age adjusted to the year 2000 standard population).

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NO. † NUTRITION OR CHOLESTEROL EDUCATION

19-7. Increase the proportion of persons aged 2 years and older who consume at least six daily servings of grain products,with at least three being whole grains.Target: 50 percent.Baseline: 7 percent of persons aged 2 years and older consumed at least six daily servings of grain products, with atleast three being whole grains in 1994-96 ‡

19-8. Increase the proportion of persons aged 2 years and older who consume less than 10 percent of calories from saturatedfat.Target: 75 percent.Baseline: 36 percent of persons aged 2 years and older consumed less than 10 percent of daily calories from saturatedfat in 1994-96 ‡

19-9. Increase the proportion of persons aged 2 years and older who consume no more than 30 percent of calories from fat.Target: 75 percent.Baseline: 33 percent of persons aged 2 years and older consumed no more than 30 percent of daily calories from fat in1994-96 ‡

19-10. Increase the proportion of persons aged 2 years and older who consume 2,400 mg or less of sodium daily.Target: 65 percent.Baseline: 21 percent of persons aged 2 years and older consumed 2,400 mg of sodium or less daily (from foods, dietarysupplements, tap water, and salt use at the table) in 1988-94 ‡

19-11. Increase the proportion of persons aged 2 years and older who meet dietary recommendations for calcium.Target: 75 percent.Baseline: 46 percent of persons aged 2 years and older were at or above approximated mean calcium requirements(based on consideration of calcium from foods, dietary supplements, and antacids) in 1988-94 ‡

NO. † WEIGHT MANAGEMENT OR COUNSELING

19-1. Increase the proportion of adults who are at a healthy weight.Target: 60 percent.Baseline: 42 percent of adults aged 20 years and older were at a healthy weight (defined as a body mass index (BMI)equal to or greater than 18.5 and less than 25) in 1988-94 ‡

19-2. Reduce the proportion of adults who are obese.Target: 15 percent.Baseline: 23 percent of adults aged 20 years and older were identified as obese (defined as a BMI of 30 or more) in1988-94 ‡

19-16. Increase the proportion of worksites that offer nutrition or weight management classes or counseling.Target: 85 percent.Baseline: 55 percent of worksites with 50 or more employees offered nutrition or weight management classes orcounseling at the worksite or through their health plans in 1998-99

NO. † SMOKING CESSATION CLASSES OR COUNSELING

27-1. Reduce tobacco use by adults.Target and baseline: 1997 2010

Baseline TargetCigarette smoking 24% 12%

27-5. Increase smoking cessation attempts by adult smokers.Target: 75 percent.Baseline: 41 percent of adult smokers aged 18 years and older stopped smoking for a day or longer because they weretrying to quit in 1997 ‡

27-6. Increase smoking cessation during pregnancy.Target: 30 percent.Baseline: 14 percent smoking cessation during the first trimester of pregnancy in 1991 ‡

NO. † BLOOD PRESSURE CLASSES OR COUNSELING

12-10. Increase the proportion of adults with high blood pressure whose blood pressure is under control.Target: 50 percentBaseline: 18 percent of adults aged 18 years and older with high blood pressure were taking action to control it in1998 (preliminary data; age adjusted to the year 2000 standard population)

Component 1: Health Education, continued

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NO. † BLOOD PRESSURE CLASSES OR COUNSELING, CONTINUED

12-11. Increase the proportion of adults with high blood pressure who are taking action (for example, losing weight,increasing physical activity, and reducing sodium intake) to help control their blood pressure.Target: 95 percent.Baseline: 82 percent of adults aged 18 years and older with high blood pressure were taking action to control it in1998 (preliminary data; age adjusted to the year 2000 standard population)

NO. † STRESS MANAGEMENT CLASSES OR COUNSELING

20-9. Increase the proportion of worksites employing 50 or more persons that provide programs to prevent or reduceemployee stress.Target: 50 percent.Baseline: 37 percent of worksites with 50 or more employees provided worksite stress reduction programs in 1992

NO. † ALCOHOL OR DRUG ABUSE SUPPORT PROGRAMS

26-8. Reduce the cost of lost productivity in the workplace due to alcohol and drug use. (Developmental)Potential data source: Periodic estimates of economic costs of alcohol and drug use, NIH, NIAAA and NIDA.

26-10c. Reduce the proportion of adults using any illicit drug during the past 30 days.Target: 2.0 percent.Baseline: 5.8 percent of adults aged 18 years and older used any illicit drug during the past 30 days in 1997

26-11c. Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.Target and Baseline: 1997 Baseline 2010 Target

Adults aged 18 years and older 16 6

26-12. Reduce average annual alcohol consumption.Target: 2 gallons.Baseline: 2.18 gallons of ethanol per person aged 14 years and older were consumed in 1996

26-13. Reduce the proportion of adults who exceed guidelines for low-risk drinking.1992 Baseline 2010 Target

Females 72 50Males 74 50

NO. † WORKPLACE INJURY PREVENTION PROGRAMS

2-11. Reduce activity limitation due to chronic back conditions.Target: 25 adults per 1,000 population aged 18 years and older.Baseline: 32 adults per 1,000 population aged 18 years and older experienced activity limitations due to chronic backconditions in 1997. ‡

15-19. Increase use of safety belts.Target: 92 percent.Baseline: 69 percent of the total population used safety belts in 1998.

20-2. Reduce work-related injuries resulting in medical treatment, lost time from work, or restricted work activity.1992 Baseline 2010 Target

Injuries per 100 Full-Time Workers Aged 16 Years and Older20-2a. All industry 6.2 4.320-2b. Construction 8.7 6.120-2c. Health services 7.9 (1997) 5.520-2d. Agriculture, forestry, and fishing 7.6 5.320-2e. Transportation 7.9 (1997) 5.520-2f. Mining 4.7 3.320-2g. Manufacturing 8.5 6.020-2h. Adolescent workers 4.8 (1997) 3.4




55

NO. † WORKPLACE INJURY PREVENTION PROGRAMS, CONTINUED

20-3. Reduce the rate of injury and illness cases involving days away from work due to overexertion or repetitive motion.Target: 338 injuries per 100,000 workers.Baseline: 675 injuries per 100,000 full-time workers due to overexertion or repetitive motion in 1997.

20-10. Reduce occupational needlestick injuries among health care workers.Target: 420,000 annual needle-stick exposures.Baseline: 600,000 occupational needle-stick exposures to blood among health care workers in 1996.

NO. † WORKPLACE VIOLENCE PREVENTION PROGRAMS

20-5. Reduce deaths from work-related homicides.Target: 0.4 deaths per 100,000 workers.Baseline: 0.5 deaths per 100,000 workers aged 16 years and older were from work-related homicides in 1998.

20-6. Reduce work-related assault.Target: 0.60 assaults per 100 workers.Baseline: 0.85 assaults per 100 workers aged 16 years and older were work-related during 1987-92.

NO. † MATERNAL OR PRENATAL PROGRAMS

16-6. Increase the proportion of pregnant women who receive early and adequate prenatal care.Target: 90 percent.Baseline: 83 percent receive adequate prenatal care in first trimester of pregnancy and 74 percent receive early andadequate care.

16-17. Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant womenTarget and Baseline: 1996–97 Baseline 2010 Target16-17a. Alcohol 86 9416-17b. Binge Drinking 99 10016-17c. Cigarette smoking 87 (1998) 9916-17d. Illicit drugs 98 100

NO. † HIV OR AIDS EDUCATION

13-5. Reduce the number of cases of HIV infection among adolescents and adults.Potential data source: HIV/AIDS Surveillance System, CDC, NCHSTP(developmental)

13-6. Increase the proportion of sexually active persons who use condoms.Target: 50 percent.Baseline: 23 percent of unmarried females aged 18 to 44 years reported condoms used by partners in 1995. Data onmales aged 18 to 49 years will be collected and reported by 2003.

NO. † CANCER PREVENTION

3-9b. Increase the proportion of adults aged 18 years and older who follow protective measures that may reduce the risk ofskin cancer.Target: 75 percent of adults aged 18 years and older use at least one of the identified protective measures.Baseline: 47 percent of adults aged 18 years and older regularly used at least one protective measure in 1998(preliminary data). ‡

3-11. Increase the proportion of women who receive a Pap test.Target: 97% of women 18 years and older who have ever received a Pap test and 90% of women aged 18 years andolder who received a Pap test within the preceding 3 yearsBaseline: 92 percent have ever received a Pap test and 79 percent received a Pap test within the preceding 3 years.

NO. † OTHER POSSIBLE HEALTH EDUCATION PROGRAMS

5-2. Prevent diabetes.Target: 2.5 new cases per 1,000 persons per year.Baseline: 3.5 new cases of diabetes per 1,000 persons (3-year average) in 1994-96.

12-2. Increase the proportion of adults aged 20 years and older who are aware of the early warning symptoms and signs of aheart attack and the importance of accessing rapid emergency care by calling 911. (Developmental)

12-8. Increase the proportion of adults who are aware of the early warning symptoms and signs of a stroke. (Developmental)


56

NO. † FORMAL POLICY FOR TOBACCO

27-12. Increase the proportion of worksites with formal smoking policies that prohibit smoking or limit it to separatelyventilated areas.Target: 100 percent.Baseline: 79 percent of worksites with 50 or more employees had formal smoking policies that prohibited or limited itto separately ventilated areas in 1998-99.

NO. † FORMAL POLICY FOR ALCOHOL

26-8. Reduce the cost of lost productivity in the workplace due to alcohol and drug use. (Developmental)Potential data source: Periodic estimates of economic costs of alcohol and drug use, NIH, NIAAA and NIDA.

NO. † EMPLOYER-SPONSORED NUTRITION/WEIGHT-MANAGEMENT

19-16. Increase the proportion of worksites that offer nutrition or weight management classes or counseling.Target: 85 percent.Baseline: 55 percent of worksites with 50 or more employees offered nutrition or weight management classes orcounseling at the worksite or through their health plans in 1998-99.

NO. † EMPLOYER-SPONSORED PHYSICAL ACTIVITY AND FITNESS

22-13. Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.Target: 75 percent.Baseline: 46 percent in 1988-99:

Worksite Health Plan Worksite or Health PlanWorksites with fewer than 50 employees (Developmental)Worksites with 50+ employees 36 22 46Worksites with 50 to 99 employees 24 21 38Worksites with 100 to 249 employees 31 20 42Worksites with 250 to 749 employees 44 56 56Worksites with 750+ employees 61 27 68

NO. † CHANGING THE LANDSCAPE FOR BETTER HEALTH

1-1. Increase the proportion of persons with health insurance.Target: 100 percent.Baseline: 83 percent of the population was covered by health insurance in 1997 ‡

Component 2: Supportive Social and Physical Work EnvironmentEstablished norms for healthy behavior and policies that promote health and reduce risk of disease, such asworksite smoking policies, healthy nutrition alternatives in the cafeteria and vending machines, andopportunities for obtaining regular physical activity.



Component 3: Integration of worksite program Into the organization’s structureThe longevity of workplace health promotion programs in part is related to the degree that health promotionis integrated into the organization’s structure. Successful worksite health promotion programs are designedto help achieve organizational goals and have the support of top management or the owner(s) of a smallbusiness. At a minimum, having dedicated staff, an office and budget are part of being integrated into thecompany structure.Worksite health promotion must also have well designed programs that attract andretain participants.

NO. † SCREENING PROGRAMS

12-12. Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and canstate whether their blood pressure was normal or high.Target: 95 percent.Baseline: 90 percent of adults aged 18 years and older had their blood pressure measured in the past 2 years and couldstate whether it was high or low in 1998 (preliminary data; age adjusted to the year 2000 standard population).

12-15. Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years.Target: 80 percent.Baseline: 67 percent of adults aged 18 years and older had their blood cholesterol checked within the preceding 5years in 1998 (preliminary data; age adjusted to the year 2000 standard population).

57



Component 4: Related ProgramsThere are no Healthy People 2010 objectives that directly address the fourth component of a comprehensivehealth promotion program. However, over the years worksite health promotion has evolved from, or may beintegrated with, other workplace programs. Some common linkages include:

■ Employee Assistance Program (EAP)

■ Work/Family Programs

■ Occupational Health and Safety (safety meetings, bloodborne pathogens

■ Occupational Medicine or Medical Services (medical surveillance programs, executive fitness, etc.)

■ Human Resources Programs (training, productivity improvement programs, performanceplanning and development, etc.)

■ Benefits (growing out of employers concern for rising cost of medical benefits)

■ Workers Compensation/Disability Management Programs

Component 5: Screening ProgramsPreferably linked to medical care delivery to assure follow-up and appropriate treatment as necessary andencourage adherence.

58

We are examining the possibility of developing an employee health promotion program, and would like tolearn about your interests in health promotion and health related activities. Please take a few minutes tocomplete this anonymous survey. Please check those items that apply.

First Tell Us About Yourself!I. ❑ Male ❑ Female

II. Age Group: (Please check the age group in that you belong.)❑ Under 21 ❑ 21-30 ❑ 31-40 ❑ 41-50 ❑ 51-60 ❑ 60+

III. Your worksite: ____________________________________________________________________

______________________________________________________________________________

IV. Your Department/Work Unit:____________________________________________________________

______________________________________________________________________________

Your Current Health HabitsThe following questions are about your current health habits and interest in pursuing a healthier lifestyle.

Yes No Complete if appropriate

1. I exercise vigorously for at least 20 ❑ ❑ I would if:minutes three or more days a week.

2. I regularly smoke cigarettes. ❑ ❑ I would stop if:

3. I am more than 20 lbs. over my ideal ❑ ❑ I would lose weight if:weight.

4. I avoid eating too much fat. ❑ ❑ I would if:

5. I practice some type of stress ❑ ❑ I would if:management on a regular basis.

6. I have had my blood pressure ❑ ❑ I would if:checked within the last year.

7. I wear a seat belt all the time when ❑ ❑ I would if:I am in a motor vehicle.

8. I have had a bout of low back pain ❑ ❑ I would do more to preventin the last six months. it if:

9. I have at least three drinks containing ❑ ❑ I would drink less if:alcohol every day.

10. I usually consult a medical self-care ❑ ❑ I would if:book when I’m sick.

11. I make an effort to eat enough fiber ❑ ❑ I would if:from whole grains, cereals, fruits,and vegetables.

12. I eat breakfast every day. ❑ ❑ I would if:

A P P E N D I X 2

Sample Worksite Health Promotion InterestSurvey

59

13. If you could receive written information for five of the health topics listed below, which five would you select? (Check only five!)

❑ Tips for reducing cholesterol ❑ Parenting tips❑ Information on HIV/AIDS ❑ Controlling high blood pressure❑ Weight management techniques ❑ Headache prevention❑ Starting a walking program ❑ Preventive dentistry❑ Spiritual wellness ❑ Auto safety❑ Health effects of cocaine use ❑ Back care❑ Alcohol tips ❑ Foot care❑ Asthma management ❑ Video Display Terminal safety❑ Starting to exercise ❑ Home safety❑ Avoiding sports injuries ❑ Vitamin facts❑ Stress reduction tips ❑ Prescription drug tips❑ Nutritious cooking tips ❑ Low salt tips❑ Medical self-care ❑ Heart disease prevention❑ Dealing with your doctor ❑ Cancer detection/prevention❑ Pre-menstrual tension tips ❑ Diabetes❑ Questions for your doctor ❑ Nutrition and cancer prevention❑ Second-hand smoke ❑ Hospitalization kit❑ Prevention of sexually transmitted disease ❑ Smoking reduction tips❑ Preventing carpal tunnel disorders ❑ Breast self-exam❑ Sleep disorders ❑ Men’s health❑ Recreational safety ❑ Women’s health❑ Eldercare issues ❑ Use of antioxidants❑ Testicular exam for cancer ❑ PMS tips❑ Personal violence protection ❑ Health issues for shift workers

14. Would you personally participate in a health promotion program if we offered one? ❑ Yes ❑ No

15. Would you participate in any of the following wellness activities on a regular basis if they were offered at work? (Check all those that apply.)

❑ Aerobic exercise classes ❑ Medical self-care training❑ Weight management program ❑ Monthly wellness seminar❑ Confidential health screening ❑ Smoking cessation program❑ Sports league activity ❑ Blood pressure screening❑ Health fair ❑ Pot-luck of nutritional foods❑ Fitness or wellness contest ❑ Blood test for cholesterol❑ Walking event or club ❑ Workshop on self-esteem❑ Parenting skills and support ❑ Join a support group❑ Consumer health training session ❑ Complete a personal fitness contract❑ Watch enjoyable movies during lunch ❑ Annual health management session

16. If you would like to volunteer to help with the program please write your name, phone number, and any special interestyou might have, in the space provided.

Name: ____________________________________________________________________

Work Unit: __________________________________________________________________

Phone: ____________________________________________________________________

Mail Stop or E-Mail Address: ______________________________________________________

Your wellness interests: __________________________________________________________

________________________________________________________________________

________________________________________________________________________

17. Would you like a financial incentive to help motivate you to take better care of your own wellness ? ❑ Yes ❑ No If yes, what kind of incentives would motivate you? ________________________

________________________________________________________________________

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18. Which of the following categories would you place yourself? (Please check only one!)

❑ I’m not interested in pursuing a healthy lifestyle.❑ I have been thinking about changing some of my health behaviors.❑ I am planning on making a health behavior change within the next 30 days.❑ I have made some health behavior changes but I still have trouble following through.❑ I have had a healthy lifestyle for years.

19. In the last twelve months, how many days have you been absent from work due to personal illnesses or injuries?____________

20. In the last twelve months, how many times have you visited the doctor? ____________

21. In the last twelve months, how many days were you in the hospital as a patient? ____________

22. Would you be interested in completing a confidential health survey that would give you a set of personal healthrecommendations? ❑ Yes ❑ No

23. Any additional comments or suggestions for a health promotion/wellness program for employees?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Thanks for completing this survey!

Source: Larry S. Chapman, Summex Corporation, Seattle, WA 2001

61

A P P E N D I X 3

Worksite Wellness Questionnaire

FPO

62

FPO

63

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Endnotes

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24. Fiore M, Bailey W, Cohen S. TreatingTobacco Use and Dependence. ClinicalPractice Guideline. Rockville, MD: U.S.Department of Health and Human Services.Public Health Service; 2000. p. 1-179.

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45. Tucker L, Friedman G. Obesity andAbsenteeism: An Epidemiologic Study of10,825 Employed Adults. AmericanJournal of Health Promotion 1998; 12 (3):202-08.

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