AHA Forum: Healthy Workplace, Healthy Workers

WASHINGTON, May 10 -- An employee health program incorporating a fitness center, health education, and incentives improved workers' cardiovascular health and workplace safety, investigators reported here.

Employees who availed themselves of those services improved blood pressure control by 9% and diabetes control by 15%, found Sharon A. Clark, D.H.Sc., of JEA, the municipal utility company in Jacksonville, Fla., and colleagues.

On-the-job accidents also dropped by nearly 70%, they reported at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

The rising cost of medical care and an aging, predominately male, employee population (median age 47) spurred the utility company to do more to foster employee health, Dr. Clark said.

Their efforts began in 1989, when a dozen JEA workers approached the company to create a fitness center so they wouldn't have to walk the city's bridges to get their exercise. The company agreed to provide space while the employees provided the equipment and day-to-day administration.

Over time, the program expanded to seven other JEA facilities.

The company also got its health insurer, Blue Cross/Blue Shield of Florida, and the Pfizer Global Pharmaceuticals division in Jacksonville involved in developing a comprehensive wellness initiative. It included health education and screenings, coaching, and an incentive program.

Employees who did three safety and one health activity through the program accrued two hours of leave--adding up to an extra vacation day each year--or a gift certificate.

The utility did a three-year follow-up study of its 2,100 workers to quantify the accruing health benefits, using screening data from Health Risk Assessments and absenteeism data from the Wellness Inventory Survey.

The risk assessments screened blood pressure and blood glucose and cholesterol levels. They also included a 60-question survey on current health status, family history, diet, physical activity, alcohol and tobacco use, seat belt use, stress and depression, and other health-related issues.

In each assessment, the participants were asked about their willingness to make changes. Coaching was provided through the health insurance company to help them accomplish the changes.

Less than half of employees participated in the risk assessments (47.9% in 2004 and 44.9% in 2006) and an even smaller percentage participated in the wellness survey (9.7% and 42.6%, respectively). About 100 of the workers who were found to have hypertension or diabetes attended a six-month educational program through Pfizer.

But those who did participate "were all very pleased with what they came out with," said Dr. Clark.

Comparing results in 2004 with 2006, Dr. Clark and colleagues reported:

• The proportion of employees with normal blood pressure increased (37% versus 28%, P<0.001).
• The proportion of employees with normal blood glucose increased (58% versus 43%, P<0.001).
• More employees were nonsmokers by 2006 (89% versus 86%, P=0.043).
• The percentage reporting "excellent" or "very good" overall health status increased by the end of the study as well (50.5% versus 41.7%, P=0.026).
• Absenteeism among workers with high blood pressure declined significantly (15.6% versus 25.8%, P<0.001).
• Absenteeism among employees with diabetes dropped also dropped significantly (16.9% versus 50%, P<0.001).

The health program was also integrated into the company's safety program, Dr. Clark said. The majority of employees work out in the field.

"We've literally got everything from ditch diggers to pole climbers," she said. "So the better shape they are in physically the less chance for injuries."

And, indeed, study results showed workplace accidents down from 83 incidents in 2003 to 25 in 2006 with fewer resulting in lost time from work (20 incidents versus seven).

"Studies have shown that healthier employees are more safety conscious, as well," Dr. Clark said. "The two kind of go hand in hand."

While the study looked only at one company program, Dr. Clark suggested that similar results could be expected for other workplace health initiatives.

"Any of the programs that we do could be replicated in other worksites," she said. "The partnership we have through Blue Cross/Blue Shield is offered to other member companies, so they are replicating those types of programs in other companies as well."

For patients whose employers do not offer such a program, Dr. Clark suggested they start a routine of walking at lunchtime similar to the original group who initiated the JEA health program.

Another possibility, she said, would be to start a Weight Watchers-style weight management initiative in the office.

"Those who participate in group programs are more successful than individuals doing it themselves," she noted.