The Patient Protection and Affordable Care Act of 2010 (ACA, Public Law 111-148) elevates disease prevention to the level of a national priority and provides unprecedented opportunities for health promotion and disease prevention. The ACA established the National Prevention, Health Promotion, and Public Health Council, which has aligned more than a dozen federal agencies to develop a prevention and health promotion strategy for the country, and it created the Prevention and Public Health Fund (PPHF) to support a variety of public health initiatives, including evidence- and practice-based community and clinical prevention and wellness strategies. Furthermore, the ACA requires new health plans to cover recommended preventive services at no charge. In addition, it encourages the adoption of worksite health programs as a vehicle for improving the health of the employed population through programs such as the National Healthy Worksite Program, which is funded through the PPHF. The newly released final rules on incentives in employment-based wellness programs should further strengthen and increase the uptake of workplace interventions described within the act (http://www.hhs.gov/news/press/2013pres/05/20130529a.html). 1
The ACA has brought new national attention to workplace health, but in fact the Centers for Disease Control and Prevention (CDC) and other organizations have been describing key elements of comprehensive workplace health programs for more than a decade. 2–6 Although there are differences between and among these frameworks, each one advocates for evidence-based interventions and strategies that use a coordinated, planned, and integrated approach to reducing health threats to workers both inside and outside the workplace. The various frameworks seek to create “cultures of health” that lead to more opportunities to improve health for workers inside their organizations and within their community environments. These frameworks also recognize that the size and scope of an individual workplace health program may be influenced by and tailored to the company’s size, resources, work sector, employee demographics, and location.
Workplace health programs can be described as a coordinated, comprehensive set of health promotion and protection strategies implemented at the worksite (http://www.cdc.gov/workplacehealthpromotion/pdfs/Workplace_Health_Program_Definition_and_Description.pdf). Ideally, they contain a combination of individual- and organization-level strategies and interventions to influence health. These include health-related programs such as health education and counseling, health-related policies, health benefits, and environmental supports designed to encourage the health, safety, and well-being of all employees. This comprehensive approach addresses multiple risk factors and health conditions simultaneously to influence the organization at multiple levels, including its culture and the worksite environment, all with the ultimate idea of producing behavior change among the employees. The CDC defines culture as the creation of a working environment in which employee health and safety is valued, supported, and promoted through workplace health programs, policies, benefits, and environmental supports (http://www.cdc.gov/workplacehealthpromotion/glossary/index.html). In almost every case, workplace health programs can benefit from links to (and partnerships with) nearby community organizations to enable them to offer health-related programs and services to employees when the employer does not have the capacity or expertise to do so and also to provide support for healthy lifestyles to employees when they are not at work. Within this framework, any number of specific health risks (e.g., physical inactivity, poor nutrition, tobacco use), conditions (e.g., obesity, musculoskeletal disorders, and impaired mental health), workplace factors (e.g., safety hazards, stress, poor working conditions), and diseases (e.g., heart disease and stroke, diabetes, cancer, arthritis) can be addressed.
CDC is committed to using science to improve the health of working adults while addressing the major objectives of today’s employers: to attract and retain workers, improve their health and productivity, and reduce the costs of their health care. Accordingly, CDC has created a number of resources and tools to assist efforts to improve employee health, and the agency has funded a variety of comprehensive health programs for the worksite. These resources, tools, and programs are described here.
Two units within CDC, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and the National Institute for Occupational Safety and Health (NIOSH), have long histories of focusing on the workplace as a setting for health promotion and protection. NCCDPHP’s emphasis has traditionally been on community- and worksite-based health promotion programs, whereas NIOSH has focused on occupational safety and health and improvements in the work environment. As the need for comprehensive workplace health frameworks has emerged, the integration over the past decade of the areas of interest to NCCDPHP and NIOSH has provided a number of opportunities for greater collaboration between these two entities and better alignment among related programs within CDC.
For the last 20 years, the NCCDPHP has engaged in a number of activities focused on health promotion in the workplace. The NCCDPHP coordinates programs to comprehensively address the prevention of chronic disease in the workplace; conducts research and demonstration projects to increase the evidence base for health promotion in that setting; develops tools and resources to support efforts in the workplace aimed at employee health promotion and the prevention of disease; and engages in partnerships to work with and learn from businesses, employers, education agencies, and health departments. Some of the more notable tools developed and resources made available are described in Table 1 .
The CDC’s Worksite Health Promotion Resources and Tools
| Name of Resource | Description | Website |
|---|---|---|
| Diabetesatwork.org (1999–pres- ent) | A product of the National Diabetes Education Program, this partnership of the Cen ters for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and more than 200 public and private organizations helps assess the impact of diabetes in the workplace and assists employees with managing their diabetes. | www.diabetesatwork.org |
| ACS Workplace Solutions (2001) | This program was codeveloped by the University of Washington Prevention Research Center and the American Cancer Society (ACS) in 2001. The program is designed to help employers improve the following five categories of health promo- tion practices: health insurance benefits, health policy, workplace programs, health- promoting communication, and changes in employee health behaviors. | http://www.acsworkplacesolutions.com/ |
| Healthier Worksite Initiative (HWI) (2002–present) | The Web site for the HWI addresses workforce health promotion (WHP), a topic that is receiving a lot of attention in workplace today. The Web site was designed as a resource for WHP program planners in state and federal government. | http://www.cdc.gov/nccdphp/dnpao/hwi/index.htm |
| Successful Business Strategies to Prevent Heart Disease and Stroke (2005) | This toolkit offers suggestions about which health benefits, services, and interven- tions can improve the cardiovascular health of employees, prevent heart disease and stroke, and reduce related costs. | http://www.cdc.gov/dhdsp/pubs/employers_toolkit.htm |
| The Purchaser’s Guide to Clinical Preventive Services: Moving Sci- ence into Action (2006) | The Purchaser’s Guide translates clinical guidelines and medical evidence for over 40 individual health conditions into lay terms, providing employers with informa- tion to select, define, and implement preventive medical benefits. The Purchaser’s Guide was developed in collaboration with the National Business Group on Health and the Agency for Healthcare Research and Quality (AHRQ). | http://www.businessgrouphealth.org/preventive/background.cfm |
| Tobacco Cessation Benefit Cover- age and Consumer Engagement Strategies: A California Perspec- tive (2006–2008) | This report summarizes current coverage among California employers of benefits for smoking cessation. To what degree do large employers in California currently offer such benefits? Of those that offer them, what treatments do they cover? The re- port summarizes knowledge about the use of such services among employees and the barriers that may prevent them from tapping this important resource. Finally, it highlights best practices for employer coverage of support programs and services for tobacco cessation, including promising employer incentive programs to promote their use. | http://www.pbgh.org/storage/documents/reports/PBGH-CDC_TobaccoCessation_06-2008.pdf |
| Investing in Health: Evidence- Based Health Promotion Practices for the Workplace (2008) | This guide, which was developed in collaboration with the Partnership for Preven- tion, provides employers with guidance that can improve employee health by controlling tobacco use, promoting cancer screening and early detection of that disease, and encouraging physical activity and healthy eating. | http://www.prevent.org/Topics.aspx?eaID=1&topicID=52 |
| LEAN Works!—Leading Employers to Activity and Nutrition (2008) | This is a free Web-based resource that offers interactive tools and resources to help employers design effective programs of obesity control at the worksite. | http://www.cdc.gov/leanworks |
| The Guide to Community Preven- tive Services (2009; chapters updated regularly) | The guide offers recommendations on effective workplace health strategies related to tobacco cessation, obesity prevention and control, promotion of physical activity, influenza vaccination, and assessment of health risks with feedback. | http://www.thecommunityguide.org/worksite/index.html |
| Workplace Health Promotion Toolkit (2010) | This toolkit provides information, tools, resources, and guidance to practitioners interested in establishing or enhancing workplace health and safety programs. | www.cdc.gov/workplacehealthpromotion |
| Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace (2012) | The guide provides employers with easy and understandable steps on how to get employees moving. This toolkit includes ideas and suggestions on how employ- ers can create a wellness culture in the workplace by introducing physical activity programs. | http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/pa-toolkit.htm |
| Investing in Workplace Breastfeed- ing Programs and Policies (2009) | This toolkit, developed by the National Business Group on Health, covers the information that employers need to understand the components of breastfeeding programs, get started with such programs, and measure their success. Valuable resources include breastfeeding program options, employer case studies, and materials for employees. | http://www.businessgrouphealth.org/toolkits/et_breastfeeding.cfm |
| CDC’s Flu Information for Businesses | The information on the site offers resources for employers, including guidelines, checklists, e-cards, posters, and other resources. The document “Make It Your Business to Fight the Flu” is a toolkit with recommended strategies for employers and businesses. | http://www.cdc.gov/flu/business/index.htm |
| Leading by Example: Creating Healthy Communities through Corporate Engagement (2011) | This report highlights initiatives sponsored by local and national companies to improve community health. | http://www.prevent.org/Initiatives/Leading-by-Example.aspx |
| The CDC Worksite Health Score- Card (2012) | The CDC Worksite Health ScoreCard (HSC) was designed to help employers as- sess the extent to which they have implemented evidence-based health promotion interventions in their worksites that are aimed at preventing heart disease, stroke, and related chronic conditions among employees. 7 | http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm |
| CDC National Healthy Worksite Program (NHWP) (2012–present) | The NHWP will assist over 100 small, midsized, and large employers in establishing comprehensive workplace health programs. Each program participant will receive intensive support and the benefit of NWHP’s expertise in putting in place a combi- nation of program, policy, and environmental interventions to support physical activ- ity, good nutrition, and tobacco-use cessation. In addition, participants will receive training and technical assistance as well as mentoring through peer relationships. The Web site provides tools, resources, case studies, and success stories from the program. | www.cdc.gov/nationalhealthyworksite |
| National Institute for Occupational Safety and Health (NIOSH) (1970 to present) | The Web portal for NIOSH is a gateway to a full array of workplace safety, oc- cupational health and related resources, research, authoritative guidance, and recommendations. NIOSH is the federal agency that conducts research and creates programs to help ensure that all Americans have access to safer, healthier workplaces. | www.niosh.gov |
| NIOSH Total Worker Health (2011– present) | The Web site for this program provides ongoing research findings, resources, supports, and promising practices to comprehensively address the health and well- being needs of workers both on and off the job. It identifies ways to successfully integrate efforts in worker protection with health promotion interventions to create healthier, happier, and more-engaged employees. | www.cdc.gov/niosh/twh |
| NIOSH Work, Organization and Stress (1970 to present) | The Web site provides meaningful guidance for organizations interested in prevent- ing and addressing workplace stress, a leading cause of diminished health and productivity in American workplaces. | www.cdc.gov/niosh/topics/stress |
* Note: For more information on tools and resources for specific health topics, please see the CDC Worksite Health ScoreCard (http://www.cdc.gov/dhdsp/pubs/work-site_scorecard.htm and www.cdc.gov).
Its participation over the years in so many initiatives aimed at improving health in the workplace has enabled CDC not only to be a leader and role model in the field, but also to translate the experiences and lessons learned into tools and resources for other employers. CDC also offers its staff classes in health education, fitness centers with individual assessments and classes, healthy food choices through cafeterias and vending, a campus-wide no-tobacco policy, and integrated initiatives in health promotion, health protection, and environmental sustainability. In 2002, the agency designed the Healthier Worksite Initiative (HWI) to make CDC a workplace in which “healthy choices are easy choices.” 7 An important goal set forth in the HWI involved sharing lessons learned with other federal agencies and developing tools and resources for others to implement wellness activities. Projects within the HWI included the Stairwell Project (making stairwells more attractive to increase their use by employees), a healthy-vending initiative (which included providing for healthier choices in vending machines across the agency), and a policy of having only healthy foods at meetings.
Also in 2002, CDC continued to build on its long history of working closely with employers in areas such as reducing chronic and infectious disease, promoting coverage of clinical preventive services, and enhancing worksite wellness and preparedness efforts by establishing a cooperative agreement with national business and public service organizations. Specifically, CDC funded and developed partnerships with the National Business Group on Health (NBGH), the National Business Coalition on Health (NBCH), and the National Safety Council (NSC). All three organizations applied evidence-based practices to their members to (1) improve the coverage and use of clinical preventive services and appropriate utilization of health care; (2) leverage their role as influencers, policy makers, and national leaders to market and deliver health promotion and protection messages and information to their members or constituents; and (3) evaluate the outcome of these efforts.
In 2008, the NCCDPHP created the CDC Workplace Health Model 2 ( Figure 1 ), which describes a systematic process for building a workplace health promotion program. This model emphasizes four main steps: assessment, planning/workplace governance, implementation, and evaluation.
Workplace Health model
In 2010, CDC collaborated with the AARP (formerly the American Association of Retired Persons) to develop its online Workplace Health Promotion Toolkit (www.cdc.gov/workplacehealthpromotion). The Toolkit contains information, tools, guidelines, and resources designed to give employers a self-guided approach to creating or improving their own workplace health activities. The Toolkit provides a stepwise process that includes (1) assessment to understand the key health problems and cost drivers affecting employers; (2) planning and infrastructure building; (3) implementation to describe evidence-based interventions and strategies for 14 individual health concerns; and (4) evaluation of workplace health activities, which includes measures to assess program effectiveness.
“The CDC defines culture as the creation of a working environment in which employee health and safety is valued, supported and promoted through worksite health programs, policies, benefits and environmental supports.”
NIOSH and the Occupational Safety and Health Administration, or OSHA, were created by the Occupational Safety and Health Act of 1970 with the mandate to assure, so far as possible, every working man and woman in the nation safe and healthful working conditions and to preserve our human resources (OSH Act of 1970, Public Law 91-596). Today, NIOSH conducts research on the integration of health protection and health promotion through a number of partnerships and mechanisms, both internal and external. In 2004, NIOSH held the Steps to a Healthier U.S. Workforce Symposium, which brought together experts to explore current knowledge and experience regarding health protection and health promotion, to share research and success, and to stimulate commitments of action to further the effort. The symposium was developed around the themes of research, practice, and policy related to the integration of health promotion and health protection. These early efforts gave rise to the NIOSH WorkLife Initiative in 2005, which served to promote related research, policy, and practice in the areas of science, economics, and coordinated health protection and health promotion efforts to improve the health of workers. A white paper in each of these areas was developed to examine the state of the science, stimulate discussion, and improve communication between researchers and practitioners in the fields of health promotion in the worksite and occupational safety and health. These documents were updated and published as a NIOSH document in 2012, The Research Compendium: The NIOSH Total Worker Health Seminal Research Papers, available at http://www.cdc.gov/NIOSH/docs/2012-146. 8
In 2011, NIOSH launched the Total Worker Health (TWH) program. In addition, since 2006, NIOSH has funded, through extramural grants, Centers of Excellence to Promote a Healthier Workforce. These academic centers are dedicated to ground-breaking research, translation, and the development of best practices in integrative approaches to protecting and promoting health in the workplace. In 2009, the NCCDPHP and NIOSH collaborated with Emory University Institute for Health and Productivity Studies (Atlanta, Georgia) to create the CDC Worksite Health ScoreCard (HSC), which was released in August 2012.
2. CDC workplace health model Centers for Disease Control and Prevention Website. http://www.cdc.gov/workplacehealthpromotion/model/index.html. Updated August 30, 2012. Accessed May 6, 2013.
3. Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing National Institute for Occupational Safety and Health Website. http://www.cdc.gov/niosh/TWH/essentials.html. Updated May 4, 2012. Accessed May 6, 2013.
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