CLINTONFOUNDATION.ORG
CLINTON HEALTH MATTERS INITIATIVE
Employee
Health Improvement
Framework
Photo: Christy Porter / HiddenHarvest.org
About the Clinton Health Matters Initiative (CHMI)
The Clinton Health Matters Initiative (CHMI) works to improve the health and well-being of all people by activating individuals,
communities, and organizations to make meaningful contributions to the health of others. The goals of CHMI are to reduce
the prevalence of preventable health outcomes, close health inequity and disparity gaps, and reduce health care costs by
improving access to key contributors to health for all people.
THE PROBLEM
THE IMPACT
The unwell workforce costs employers $153 billion annually,
a figure set to rise to $1.201 trillion by 2023 and $5.668
trillion by 2050. Employees who are thriving or considered
well cost employers 41% less than employees who are
struggling, and 62% less than employees who are suffering.
If left unaddressed, the chronic and preventable diseases
that affect 1 in 2 adults will continue to decrease productivity,
and increase workforce stress, attending work while sick,
absenteeism, and healthcare cost.
By addressing employee health and wellness issues, employers
have the opportunity to create environments where wellness
programs are encouraged, easily accessible, and promoted,
while earning $3.27 for every wellness dollar invested.
THE SOLUTION
The Clinton Health Matters Initiative (CHMI) is committed
to supporting employers in their efforts to create healthier
environments. Through an integrated approach of addressing
employee health through value added benefits design along
with existing employee wellness programs, corporate social
responsibility investments, and core business practices,
CHMI will utilize the Employee Health Improvement
Framework to guide the appropriate evidence-based
implementation.
CHMI’s Employee Health Improvement Framework’s
standards are based on the best available evidence
from effective programs, policies, practices and laws.
Collectively, these show that the greatest way to affect
employee effectiveness and well-being is through on-going,
comprehensive programs that 1) take employees’ needs
and lifestyles into account and 2) are aimed at changing
behaviors. Such evidence has proven that worksite wellness
programs are particularly effective in increasing productivity
and reducing healthcare cost, attending work while sick, and
absenteeism by:
• Reducing stress
• Increasing physical activity and nutrition
• Increasing smoking cessation
• Decreasing workplace injury
With this integrated method of employee health improvement,
CHMI builds on the Clinton Foundation’s innovative efforts
bringing market-based solutions to critical issues including
global HIV/AIDS, climate change, economic development,
and childhood obesity.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Framework Vision
The vision of the Employee Health Improvement Framework is to establish a model of organizational change that supports
employee health through improvements and investments in the physical, social, emotional, and financial health of employees.
The Framework builds on the Clinton Health Matters Initiative’s (CHMI) primary goals of reducing health disparities and
providing a platform for scalable health solutions by helping employers focus on the “how” of the issue – how to realign core
business operations to support health, how to effect sustainable behavioral change among employees, and how to develop a
robust, effective, and comprehensive employee health improvement program.
The Framework’s vision integrates a purposeful focus on three critical factors that are aligned with CHMI’s overall mission of
reducing health disparities across all socio-economic groups:
1. Creating systemic change in business organizations, communities, and industries to support improvements to employee wellbeing;
2. Preventing incidences of chronic diseases, especially in the area of employee population health; and,
3. Improving organizational health by looking at the cost-effectiveness and impacts to productivity of employee health
improvement programs and practices.
By engaging with new and existing partners in all sectors of industry and service, CHMI will shine a much needed spotlight
on needs related to employee health, and will assist organizations of all sizes in purposefully integrating a culture of health
into their operations and programs. CHMI is utilizing this Framework as a tool to affect a system-wide change that would have
transformative and permanent effects on the working population.
The development of solutions to intractable health problems facing employee populations requires employers to integrate a
purposeful focus on creating a culture of health within their organization. The Framework’s embedded approach to process
change provides a proven model for developing the appropriate organizational culture by providing criteria that outlines the tools
that can support, enhance, and sustain a culture of health. Full maximization of the Framework requires the active collaboration
of employers in all sectors. CHMI will work closely with companies and organizations to improve health outcomes, close gaps in
health disparities, and facilitate organizational change in various types of industries across the United States. CHMI serves as a
convener for efforts around important public health issues to engage innovative thoughts and methods from multiple sectors in
improving unique health indicators for this particular population.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Framework Overview
CHMI has prepared the Employee Health Improvement Framework with three goals in mind. The first is to provide employers
with a comprehensive survey of the landscape of employee wellness programs and their effect on employee productivity. The
second goal is to change the conversation around this issue of employee health and emphasize the importance of this matter in
the overall scheme of community, national, and global well-being. The final goal is to motivate employers to improve, innovate,
and lead on the issue of employee health improvement. CHMI encourages employers to identify new programs or policies within
this Framework that can help them expand their organizational capacity to improve health outcomes for their employees.
The Framework has been designed to assist employers in every phase of employee health improvement program development,
from those just beginning to design wellness programs to leaders in the field that are looking for the next best innovation on the
issue. This Framework is intended to support the work of employers in all sectors – private, public, and non-profit – across all
industries, and contains input from key thought leaders, content experts, executive management professionals, and academics.
It is flexible by intentional design to allow employers a menu of options related to employee health improvement, rather than a
proscriptive list of mandates and requirements.
CHMI is committed to working with employers throughout this continuous quality improvement process. Organizations that want
to adopt or enact new employee improvement programs or policies can do so by utilizing the recommendations laid out in this
Framework, through which CHMI and its partners can provide technical assistance and support along the way to an efficient
and well workforce.
Framework Target Audience
The Framework can assist large-, mid-, and small-sized corporations with developing and/or supporting a sustainable culture of
wellbeing within their organization’s infrastructure. CHMI recognizes that the myriad of intractable problems affecting employee
populations requires a diverse array of multi-faceted solutions, each appropriately tailored to address the unique challenges
faced by employers and employees. A uniform solution that can be applied in every organizational setting does not exist, but
this Framework encompasses real-world examples of best practices that result in positive outcomes that are both measurable
and scalable.
DISCLAIMER
This manual is intended solely to provide instructional guidance to employers on the topic of employee well-being. References
within this manual to any specific commercial products, processes, services by trade names, trademarks, or manufacturers do
not constitute an endorsement or recommendation by CHMI.
4
Contents
06
FRAMEWORK METHODOLOGY
10CORE POLICY CATEGORY 1
CORE BUSINESS ALIGNMENT (ROI)
15CORE POLICY CATEGORY 2
VALUE ADDED BENEFITS
22CORE POLICY CATEGORY 3
AT-RISK EMPLOYEE POPULATIONS
28CORE POLICY CATEGORY 4
FAMILY FRIENDLY WORKPLACE –
PROMOTING FAMILY FORWARD
CULTURE
35CORE POLICY CATEGORY 5
EMPLOYEE HEALTH
44CORE POLICY CATEGORY 6
TALENT MANAGEMENT
49CORE POLICY CATEGORY 7
VETERANS AND MILITARY
54CORE POLICY CATEGORY 8
BUILT ENVIRONMENT
CORE POLICY CATEGORY 9
DIGITAL TECHNOLOGY
(FORTHCOMING)
60ENDNOTES
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Framework Methodology & Approach
This Framework focuses on eight key components of employee well-being, as follows:
CORE POLICY CATEGORIES
1. Core Business Alignment (ROI)
2. Value Added Benefits
3. At-Risk Employee Populations
4. Family Friendly Workplace – Promoting Family Forward Culture
5. Employee Health
6. Talent Management
7. Veterans and Military
8. Built Environment
9. Digital Technology
These nine core policy areas cover the many different facets of employee health improvement, and CHMI encourages
employers to view their actions in each policy area with a holistic lens; research and best practices in this field have
demonstrated that these policy areas exert a significant degree of influence over each other and over the productivity,
effectiveness, and efficiency of an organization. CHMI is in the process of compiling the most current and relevant information
related to the integration of digital technology in health improvement programs and will include this new section in future
iterations of this Framework. CHMI also commits to updating this Framework on an annual and as needed basis to provide its
partners with a reliable compendium of the most current health improvement resources.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
FRAMEWORK APPROACH: A SIX-STEP PROCESS OF CONTINUAL IMPROVEMENT
CHMI will work with employers to improve employee health outcomes, decrease health disparities, and reduce healthcare costs
through the development of an evidence-based and comprehensive approach. The Framework’s approach is based on the best
available evidence from effective programs, policies, practices, and laws and supports systemic change at the organizational level.
To implement the Employee Health Improvement Framework, companies and organizations will rely on a six-step cyclical
process. CHMI recognizes that organizations might find themselves within different phases of this process model, and the
model has been designed to allow companies at any point within the readiness continuum to assess, evaluate, and implement
new or revised programs and policies. It is flexible by purposeful design and in alignment with the principle that each
employer and employee population necessitates a tailored and appropriate approach to health improvement. The Framework
is also representative of the comprehensive approach to systems change that is a critical part of embedding health into any
organizational culture.
1.
Build
Support
• M
obilize internal support for
implementing healthy changes
within the workplace and
workforce
• Create a Wellness Task Force
that includes employees at
all levels
6.
Evaluate
and
Revise
• E
valuate wellness policies,
identify and address
complications
• Address and fix those issues that
are not working
• Celebrate successes
2.
Access
Your
Organizational
Capacity
• U
se Employee Wellness
Inventory to assess the strengths
of your existing employee
wellness policy and current
health of employees
5.
Implement
Your
Policy
• T
ake calculated and incremental
steps to achieve your selected
Standards and Best Practices
3.
Develop
Your
Wellness
Policy
• P
rioritize opportunities for
improvement in alignment
with assessment results and
Framework standards and best
practices – both overall and
subject based
4.
Explore and
Connect with
Resources
• Identify third parties that can
assist in the implementation
process
7
USEFUL DEFINITIONS
• “ Wellness is multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the
environment.” 1
• “Well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of
negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning.” 2
• “ Population Health is the health outcomes of a group of individuals, including the distribution of such outcomes
within the group.” 3
• “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 4
SPECIAL CONSIDERATION: AT-RISK EMPLOYEE AND FEMALE EMPLOYEE POPULATIONS
Consistent with CHMI’s focus on reducing health disparities for disproportionately affected populations, this Framework places
an intentional emphasis on opportunities to improve the well-being of employees with the greatest risk of negative health
outcomes – shift workers, health care personnel, public safety employees, manual laborers, and frequent business travelers.
The Framework also makes note of the particular concerns faced by women in the workplace and recognizes that although
non-discrimination gender policies are outside the scope of this issue, they do tangentially exert influence over the effectiveness
and well-being of female employees. A 2009 study found women held only 20% of senior management positions at private
companies, and 35% of private companies have no women in senior management at all. Women head only 2.6% of Fortune
500 companies and hold only 15% of those companies’ board seats. They represent just over 8% of the highest paid positions
among companies in Standard and Poor’s 100 Index. Where feasible and appropriate, this Framework identifies best practices
to further the health of women.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
METHODS OF ENGAGEMENT
CHMI engages with businesses and agencies of all sizes to identify opportunities within their respective employee populations
to improve and support employee well-being. For organizations with a national and/or multi-national footprint, CHMI provides
direct technical assistance in the assessment, implementation, and evaluation of health improvement programs. For small- to
mid-sized organizations, CHMI partners with business associations, trade groups, and economic development agencies in the
four community transformation project areas (Coachella Valley, Greater Houston, Central Arkansas, and Northeast Florida) to
deliver assistance and support to their membership base. CHMI will expand its employee health improvement services to new
CHMI community transformation project areas as they continue to come online in the coming year.
OVERVIEW OF FRAMEWORK CRITERIA
CHMI has developed a comprehensive system of employee health improvement criteria at the organizational level based on
an extensive review of the most current evidence-based research. For each of the nine core policy areas, CHMI has identified
three levels of organizational capacity – beginning, performing, and leading – that span the entire spectrum of employee health
improvement strength and support for that policy area. Each successive level builds on the previous one, with capacity and
support for well-being increasing as organizations advance through each level. This system is not meant to be restrictive or
punitive, but to provide employers with a comprehensive scan of the most effective policies, programs, and processes available.
Armed with this knowledge, employers can then engage with CHMI to identify, tailor, and implement the most appropriate
solutions to the health problems facing their employees.
BEGINNING
•
rganizations at this level
O
provide the essential programs
needed to support employee
wellness. Programs within the
beginning level satisfy regulatory
requirements and minimums
related to health coverage,
safety, etc.
PERFORMING
•
rganizations at this level
O
institute wellness programs that
go beyond mandated minimums
and may offer more generous
and inclusive leave policies,
work-site wellness programs, and
opportunities for personal growth.
LEADING
•
rganizations at this level
O
integrate issues related to
employee health into every
facet of their core business and
operations and have created
wellness programs that can be
scaled and replicated to fit peer
organizations.
9
Core Policy Category 1: Core Business Alignment (ROI)
Photo: Adam Schultz / Clinton Foundation
ISSUE OVERVIEW
More than ever before, the global workforce is threatened by aging and non-communicable diseases (NCDs) including cancer,
cardiovascular diseases, chronic pulmonary disease, diabetes, and mental ill-health. In addition, being absent from the job
(absenteeism) or underperforming while working (presenteeism) are estimated to cause productivity losses worth $1.6 trillion
due to mental ill-health and $389 billion due to cardiovascular disease.5 Because approximately half of the working population
spends the majority of their waking hours at work, the workplace provides a unique opportunity to guide and incentivize
individuals to adopt healthier behaviors and develop healthier lifestyles. Fostering a healthy employee population not only
results in positive benefits to the individual employee, but it also supports the organization’s efforts to fulfill its corporate mission,
improve efficiencies in its operations, and demonstrate measurable returns to its investors and/or stakeholders. These benefits
can be realized in organizations across all sectors – private, public, and nonprofit.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
The value of workplace wellness programs can be measured by various types of return on investments (ROI), which include factors
such as program use and adherence, health risk reduction, biometric data, and employee satisfaction. However, the key obstacle
for many companies has traditionally been in moving from the “perceived value” of such interventions to a measured impact that
will ultimately demonstrate monetary or fiscal return. In 2009, the World Economic Forum (WEF) created the Workplace Wellness
Alliance to address the challenges of data collection, knowledge sharing, and the calculation of ROI for workplace wellness
programs. The WEF’s Workplace Wellness Alliance launched the collection of a global baseline of employee metrics covering over
2 million employees and generated responses on employee demographics, health indicators, and information on current programs
employers offer and how they measure success.6 In doing so, the Workplace Wellness Alliance was able to create a compelling
business case for organizations across sectors to invest in their employees’ health.
Two key areas that organizations should focus on when collecting and measuring data are absenteeism and presenteeism, which both
have a significant impact on employee productivity and performance.7 Though challenging, it is vital to translate the intangible aspects
of employee well-being, (i.e., lost productivity due to poor mental health) into tangible measurements that allow companies to determine
best practices for improving their employees’ health. Plans to evaluate the cost-effectiveness of an employee wellness program
must therefore be appropriately designed and tailored to the needs, issues, and constraints specific to the employee population.
As part of the initial mobilization towards building or improving an organization’s wellness program, it is essential that
organizations identify leaders at the executive level and within its governing boards that can serve as strong advocates for
employee wellness. Passionate, persuasive, and persistent leadership is a necessary ingredient in creating the culture of health
necessary to implement and sustain workplace wellness programs.8 The World Health Organization’s (WHO) work on this issue
has shown that wellness programs should be a natural extension of a firm’s identity and aspirations, and since C-suite executives
and board members are responsible for setting organizational direction, they are best suited to serve as the primary advocates
for wellness programs during its conceptual phase.9 It is also important for initial wellness proponents to clearly demonstrate the
linkage between the wellness program and an organization’s core values, as employees will be discouraged from participating in
wellness programs if the employer’s primary motivation is financial profit or gain.
Although the planning and implementation of workplace wellness programs may require significant financial and administrative
resources, it has become increasingly apparent to employers that there is a tangible business case for these interventions. A
2012 presentation by Booz & Company looked at wellness initiatives in six corporations in the technology, service, automobile,
and consumer products industries and found each separate initiative produced a positive return on investment, ranging from a
$226 annual savings per employee for Johnson & Johnson to a savings of $50 million in health care costs over seven years for
General Motors.10 A 2014 report by SafeWell Inc. and Harvard School of Public Health also noted positive returns on investment
in relation to productivity.11 Collectively, the selected initiatives demonstrated the following results:
•
•
•
•
•
A reduction of $2 in worker compensation costs for every $1 invested;
A reduction of $5.82 in absenteeism costs for every $1 invested;
A financial savings of $3.48 in health care costs for every $1 invested;12
A significant reduction of presenteeism among healthy workers resulting from workplace wellness;
A reduction in growth rate of medical care costs by 3.7% from worksite health programs.
In addition to improving employee well-being, productivity, and turnover, such programs can also generate external recognition
and increase its competitiveness in attracting talent.13 To aid organizations that lack adequate resources, certain organizations
such as the WHO have published a number of tools to assist companies in performing basic calculations to determine their own
return on investment. With this substantial increase in knowledge sharing, data collection, and accessible resources, companies
today not only have an ethical responsibility to improve the health and well-being of their employees, but also have a financial
incentive to do so. In sum, incorporating a comprehensive approach to employee health improvement is not only the right thing
to do; it is the smart thing to do.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
CASE STUDY
General
Electric (GE)
Healthcare
The Importance of Evaluation: Evaluations of workplace wellness initiatives are
crucial to identify whether the initiatives are suited to employees and lead to ROI.
General Electric (GE) Healthcare’s HealthAhead program, which began in 2010,
uses Site Certification to drive and measure progress and success. To be certified,
sites must pass a rigorous site audit including more than 50 requirements grouped
under nine elements, a process run by auditors who are volunteers from previously
certified locations. This allows for a dual approach combining centralized
guidelines and local implementation, while maintaining demonstrable standards.14
General Electric (GE) Healthcare HealthAhead Site Certification Program
9 Elements, 50+ metrics:
Leadership &
Wellness
Committee
Wellness/Disease
Education &
Prevention
Healthy
Nutrition
Tobacco-Free
Physical
Activity
Stress
Management
Health
Risk
Questionnaire
Health-Related
Absence
Reduction
Medical &
Safety
Environment
12
ASSESSMENT CRITERIA
The following criteria related to Core Business Alignment are divided into three successive levels – beginning, performing, and
leading. Each level builds on the previous level and meets its requirements. The beginning level represents organizations that are
just starting to integrate employee wellness programs into their mission, business practices, and structure.
BEGINNING
• At
least one member of the C-suite commits to improving employee health and
well-being (i.e., CEO enacts a comprehensive policy that indicates that the wellness
program is part of the company’s business goals and strategies15)
LEADERSHIP
ORGANIZATIONAL
STRUCTURE
•
HR department is in charge of developing and implementing wellness program
• Organizations
are committed to corporate responsibility through various philanthropic
events and initiatives throughout the year that directly benefit the community in which
they operate
CSR
• Return
on Investment (ROI) is estimated before the development of the wellness
program using external data and statistics collected by such organizations as the World
Health Organization (WHO) and the Workforce Wellness Alliance
ROI MEASUREMENTS
•
EMPLOYEE DATA
INTEGRATION
ROI for different interventions is calculated and assessed annually
• Health
Risk Assessments or Appraisals (HRAs) are performed in the early stages
of development to determine the health and well-being baseline of employees;
subsequent HRAs are performed annually
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
The performing level represents organizations that have adopted a more integrated approach to employee wellness, with wellness
program managers and the collection of advanced employee health metrics. Once an organization has reached the leading level, it
has integrated health promotion into every facet of its organizational structure and the surrounding community. PERFORMING
• Multiple
members of the C-suite align with the board of
directors to commit to improving employee health and
well-being (i.e., C-level executive charged with overseeing
distinct and separate wellness program)
LEADING
• Multi-level
leadership: members of the C-suite, board of
directors, and middle managers, promote the integration
of employee well-being into organizational goals and
visions and adopt personal health goals in alignment
•
here is an established wellness team responsible for
T
developing and implementing the program
•
ctively engage employees in the design and
A
implementation of the wellness program by holding
monthly all-staff meetings that include a wellness team
report on current wellness activities and resources, with
the opportunity for employees to offer suggestions for
improvement
•
ellness champions, or volunteer health ambassadors,
W
offer local, on-the-ground encouragement, education, and
mentoring, in addition to organizing and promoting local
health events16
• Organization
has its own wellness program manager who
is an expert in the area and is responsible for developing
and implementing the employee wellness program
excels in creating shared value using all
three of the following methods: reconceiving products
and markets; redefining productivity in the value chain;
enabling supportive industry clusters at the company’s
locations
• Organization
• Organization
publishes annual report on CSR efforts,
including programs that impact employee health
•
rganization creates shared value by using one of the
O
following three methods: reconceiving products and
markets; redefining productivity in the value chain;
enabling supportive industry clusters at the company’s
locations17
• Organization
develops its own system for estimating the
ROI for certain interventions before the development of
wellness program
• Organization
asserts a stronger role in improving
population health through a wellness and prevention lens,
with efforts addressing not only their employees, but also
their customers, suppliers, local communities, and the
general public
• Organization
leads the way in establishing a global
benchmark standard for measuring ROI which can be
replicated by peer organizations operating in one country or
across several markets
• In
• In
addition to HRAs, organization measures employee
participation and employee satisfaction in the wellness
program (at least once a year)18
addition to HRAs and employee metrics, the
organization measures the following organizational metrics:
health care, safety, employee productivity (absenteeism
and presenteeism), and organizational culture (trust in
management, voluntary turnover, etc.)
14
Core Policy Category 2: Value Added Benefits
ISSUE OVERVIEW
As the complexities of everyday life increase, employees are looking to their employers as a trusted resource for information and
tools about their health and welfare. At the core of every employee’s relationship with their employer is the question of benefits,
and most specifically, health insurance. Value-based Insurance Design (VBID), also known as value added benefits, encourages
the use of medical services when the benefits exceed the costs and discourages the use of services when the benefits do not
justify the cost.19 In the VBID approach, copayment rates are set based on the value of the clinical services (benefits and costs)—
not exclusively the costs. As a result, more efficient resource allocation can be achieved.20 The integration of value added benefits
into a comprehensive well-being approach ensures that the provision and payment of care under insurance plans focuses on
preventative measures to reduce long term care and expenses.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
The employment-based market provides coverage for approximately 177 million Americans.21 Still, approximately 39 million
Americans are uninsured in any given year even though about 85% of the uninsured live in families headed by an individual who
works at some time during the year.22 More than 50% of the uninsured are full-time, full-year workers or family members of these
workers; the balance of the uninsured Americans are covered by Medicare, Medicaid,23 or another governmental program, and
thus do not require employment-based coverage.
When faced with the option to receive employer-sponsored health insurance, employees consider such factors as price, service
coverage, and level of choice among the packages offered.24 A significant number of individuals who have access to coverage
through their employer decline it on the grounds that it is too expensive.25 By selecting particular insurance products to offer and
excluding others, employers necessarily influence what services are covered and the circumstances under which those services
can be delivered. Similarly, by selecting particular insurance products, employers effectively dictate the scope and nature of the
cost-quality-access trade-offs their employees can make.26
Employers faced with the paradox of how to provide comprehensive benefits that can ensure a healthy workforce while simultaneously
managing costs in an increasingly expensive healthcare market would benefit from answering the following questions:
• How
can we incentivize the use of benefits that will improve health outcomes and discourage costly medical tests or treatments
that are not proven to contribute to better health while still giving employees power over their health decisions?
• How can we best streamline benefits or at the very least ensure that we can remove inconsistencies between plans and vendors?
• Are
we prepared and do we fully understand the implications of the Affordable Care Act on our immediate and longer term
benefit design? Are there benefits relying on higher deductible plans (HDHPs) and perhaps making other concessions with
healthcare savings accounts?
• Are
there opportunities to look at whether bringing items traditionally included under health care savings accounts make more
sense in covered benefits – like reimbursement for pregnancy supplements?
• Are
we getting the most out of our benefit plans and, most importantly, do we have the numbers to tell us in a manner that we
can all comprehend and translate into policy and practices?
The good news is that there are solutions and best practices to be shared, even on emerging topics like the Affordable Care Act,
that can help organizations of every size and kind to create benefits packages that serve to improve employee health, reduce
costs where appropriate, and lead to a business culture where employees and consumers flourish.
HEALTHIER GENERATIONS BENEFIT
Firms, organizations, and small business owners currently cover 48% of the United States population under employer-based
insurance benefits.27 To this end, companies and organizations are looking for innovative ways to care for their employees and
their families to increase employee well-being while decreasing costs. The topic of healthcare savings has expanded to include
the health of employee dependents: approximately 40% of employer-based insurance rates were for dependent coverage28,
and since 2010, through the Affordable Care Act, an estimated 485,000 dependent children have gained continual insurance
coverage through their parents’ health insurance plans, which some have predicted would lead to an increase in national
healthcare expenditures of 900 million dollars.29 Since dependent coverage now includes children up to age 26, employers have
been considering the potential healthcare costs, and are seeking out methods to prevent expenditures from rising.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
One of the major epidemics that have been affecting the landscape of healthcare cost is domestic obesity. The figures on
its effects are astounding - annual health care costs of obesity-related illnesses are $190.2 billion30, and obese adults spend
42% more annually on healthcare than normal-weight adults.31 Even with the amount of attention on treating obesity, 1 in 3
cancer deaths are still being linked to obesity or lack of physical activity.32 With an ever increasing impact, obesity stands out
as the primary negative correlative factor on the health of future generations. According to the National Health and Nutrition
Examination Survey (NHANES), close to 32% of children and adolescents are obese33, and with these current trends, obese
adolescents are more likely to become obese adults.34 Obese male youths and females youths are more likely to become obese
adults by as many as 18 times and 47 times, respectively.35 Although dependents might not be the ones contributing to the
success of the organization, it’s important to start thinking about preventative measures for obesity in youth as they will become
the leaders and workers of the next generation.
The Healthier Generation Benefit (Benefit), launched in 2009 by the Alliance for a Healthier Generation, is a collaborative effort
between insurers, employers and medical associations to offer comprehensive health benefits to children and families for the
prevention, assessment, and treatment of childhood obesity. Companies agree to provide insurance coverage for at least four
follow-up visits with their primary care provider every year and at least four visits with a registered dietitian per year for eligible
children. The reason for tackling childhood obesity is simple: this preventable health outcome is estimated to cost $14 billion
annually in direct health expenses and has high correlation to school absenteeism for 4-6th grade students.36 As of 2014, 19
insurers and self-insured organizations are offering the Benefit, impacting over 2.8 million children.
CASE STUDY
University
of Michigan
(UM)
In 2006, the University of Michigan (UM) implemented M-Healthy: Focus on
Diabetes Program for its 2,200 employees and dependents with a diagnosis
of diabetes mellitus. This program provides copayment reductions to targeted
patients (diabetics) for targeted interventions deemed from the medical evidence
as highly beneficial. The targeted services include several drugs that affect
blood sugar, blood pressure, cholesterol, and depression, and that help prevent
or reduce the long-term complications of diabetes. Only people with diabetes,
identified by pharmaceutical claims, are eligible for copayment reductions. In order
to maintain the tiered formulary incentives for use of less expensive medications
(such as generics), the VBID intervention lowers copayments in a graded fashion.
For the medications of interest, tier 1 copays decreased by 100% (from $7 to $0);
tier 2 copays, by 50% (from $14 to $7); and tier 3 copays, by 25% (from $24 to
$18). The program received overwhelming employee support through numerous
e-mail testimonials and virtually no dissent, which suggests that human-resource
concerns can be overcome.37
17
ASSESSMENT CRITERIA
The beginning level represents organizations that offer basic benefits coverage to their employees. The performing level
represents organizations that offer more advanced and non-traditional coverage with lower co-pays to their employees.
BEGINNING
• Employers
BENEFITS COVERAGE
BENEFITS DESIGN
offer dependent coverage for employee’s spouse/domestic partner
and children2
•
mployers ensure that benefits are extended to same-sex and nontraditional couples
E
in states that have same-sex marriages
•
mployers convene an ad-hoc group to assess efficacy of existing benefits or to
E
provide recommendations on revising benefits plan
BENEFITS COST
MENTAL HEALTH
COVERAGE
COMPLEMENTARY AND
ALTERNATIVE MEDICINE
• Management and/or HR officials communicate legal and health-related consequences of abuse
and diversion of prescription/illicit drugs to employees through wellness assistance programs
•
mployer places information on mental health and wellness resources available to
E
employees in highly visible often crowded area in the workplace
• Employers
connect staff to community resources including health advocates, wellness
centers, etc.
REPRODUCTIVE
COVERAGE
HEALTH SAVINGS
ACCOUNTS & CASH
INCENTIVES
• Employers
offer HSAs as optional benefit
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, there are no ceilings on coverage for employees (both traditional and nontraditional services) and employers may offer a lump-sum benefit payment to use as employees see fit.
PERFORMING
LEADING
• Employers
offer enhanced coverage to traditional medical
plans including consumer-driven health plans, disability
income coverage, and critical illness coverage
• Key
stakeholders from all levels of staff and management
will create an active health and safety council that meets
regularly to discuss and plan for overall mental health and
wellness efforts in the office environment
• No
cost to employee for any preventive or medically
proscribed services, procedures, or medication
• Low
co-pays
• No
obligation to submit expense receipts
• Employers
offer coverage that can go with employees if
they leave their employer under certain circumstances
• Health
insurance covers non-traditional methods (e.g.:
acupuncture, herbal medicine, yoga, etc.) with the same
co-pay as any other specialist
• Health
insurance covers reproductive medicine up to
50% of costs incurred
• There
are no ceilings on complementary and alternative
medicine (CAM) coverage with documented medical need
• Health
insurance covers all reproductive medicine costs
incurred with no maximum ceiling
• Employers
offer a lump-sum benefit payment to use as
employees see fit
19
ASSESSMENT CRITERIA
BEGINNING
• Employers
HEALTHIER GENERATION
BENEFIT
offer the Healthier Generation Benefit (Benefit), which includes 4 follow-up
visits with their primary care physician per year, and 4 annual visits with a registered
dietician to dependents between ages of 3-18 with a body mass index (BMI) in the
85th percentile or higher
• Employers
promote the Benefit annually to their employees
•
Employers upload a link about the Benefit on their employee web network
•
Employers upload the Alliance Quarterly Campaign to company intranet site
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
PERFORMING
LEADING
• Employers
• Employers
offer the Healthier Generation Benefit to all
employees and dependents without restrictions
offer the Healthier Generation Benefit to
dependents of ages 3-18 regardless of BMI and
weight status
• Allocate
•
Employers promote the Benefit twice annually
• Create
•
Employers co-host a webinar or a lunch-and-learn
session for employees on the Benefit
• Identify
a budget to promote the Benefit and obesity
prevention to members
customized promotional materials and send directly
to employees
wellness champions for obesity prevention and
wellness advocates within the organization
21
Core Policy Category 3: At-Risk Employee Populations
ISSUE OVERVIEW
This section focuses on employee populations with the highest risk of poor health outcomes with the goal of both highlighting
the specific needs within these populations and identifying points of intervention to advance improvement. There are four at-risk
populations that merit focus and attention:
• Employees
•
•
•
working non-traditional work schedules (e.g. graveyard shifts, on-call shifts, or 24 hour rotations);
Hourly employees;
Manual labor employees; and
Healthcare industry employees.
A 2009 Gallup poll studying engagement across industries found that the least engaged employee populations are shift workers,
including agriculture, food and beverage, hospitality, transportation, care, education, and heavy lift workers.38 This disconnect in
engagement has a direct correlation to health outcomes, as employees with low levels of engagement have been shown to suffer higher
incidences of chronic diseases and report higher levels of workplace stress. Employees within these higher risk populations typically work
in industries that are highly competitive, rely on low-skilled labor, pay low wages, and provide only limited health insurance coverage.39
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
Shift work is considered a risk factor for many health problems including cognitive disorders (e.g., learning and memory deficits,
loss of attention and vigilance) and a higher probability of developing obesity, breast cancer, cluster headache, fatigue, stress,
diabetes, and cardiovascular disease.40 Shift work can also exacerbate symptoms and progression of chronic diseases, such as
sleep disorders, digestive diseases, heart disease, hypertension, epilepsy, mental disorders, substance abuse, diabetes mellitus
type 1, asthma, and health conditions that require medications with circadian changes in effectiveness.41 Specific health risks by
industry include:
• F
armers are at high risk for fatal and nonfatal injuries, work-related lung diseases, noise-induced hearing loss, skin diseases,
and certain cancers associated with chemical use and prolonged sun exposure. Farming is one of the few industries in which
families (who often share the work and live on the premises) are also at risk for injuries, illness, and death.42
• N
onfatal injuries and illnesses among food and beverage workers tend to result directly from their normal job duties and include
sprains, bruises, cuts, lacerations, overexertion, and heat burns. The Bureau of Labor Statistics states that “the manufacturing
industry sector accounted for over 30% of all private industry occupational illness cases, resulting in the highest illness
incidence rate among all industry sectors.”43
• The hospitality industry employs the largest number of young workers. In 1996, hotels and restaurants accounted for about
6.3% of all time-loss claims accepted by the Workers’ Compensation Board (WCB). From 1992 to 1996 24,696 time-loss claims
were accepted, 616,674 days were lost from work due to workplace accidents, and 10 claims were accepted for fatalities.44
• Highway transportation incidents are the leading cause of occupational fatalities in the United States.45 According to the
Bureau of Labor Statistics, transit and intercity bus drivers had the highest rate of injuries and illnesses of all occupations
measured in 2010, with light and delivery truck drivers close behind.46 Bus, truck, and taxi drivers face long hours behind
the wheel, often breathing in exhaust fumes or eating unhealthy fast food. Sleep problems and on-the-job sleepiness are
common among transportation professionals (which can include pilots and train operators). Their largest risk, motor-vehicle
accidents are consistently the leading cause of workplace fatalities in the United States.47
• C
iting scheduling and lack of wellness, as much as 65% of caregivers leave their jobs annually.48 In one study, care workers
reported the frequency of medication errors declined by 50% after prevention activities were implemented in a 700-bed
hospital.49 In a second study, there was a 70% reduction in malpractice claims in 22 hospitals that implemented stress
prevention activities. In contrast, there was no reduction in claims in a matched group of 22 hospitals that did not implement
stress prevention activities.50
• Educators and heavy lifters are among the highest groups for musculoskeletal injuries. In particular, this population as well
as heavy lifters need trainings on proper body mechanics to understand the importance of posture in preventing strain on
the lower back, education in proper lifting and carrying techniques, provision of furniture and fixtures at appropriate adult
heights, regular exercise and stretching for increased strength and flexibility, and maintenance of proper body weight to
prevent straining back muscles.51
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
HOURLY EMPLOYEES
Among industries with high proportions of hourly employees, workers in the hospitality and retail sectors suffer from a variety of
institutional barriers to better health. Workers in both industries perform repetitive tasks for long periods of time, are not covered
by employer provided health insurance, and often work in low moral environments due to high turnover and low levels of job
security.52 Both industries also employ large numbers of populations that are sensitive to shifts in economic activities that leave
them financially and professionally vulnerable; in the hospitality industry, a majority of employees are women, while in the retail
industry a large majority of the employees are younger adults with low skill levels.53
HEALTHCARE EMPLOYEES
One of the most at-risk employee populations that work in unique environments are healthcare workers. Employees in the
healthcare field, as described by the Occupational Safety and Health Administration (OSHA), include workers that provide direct
or indirect health services to individuals.54 Regardless of the worksite or the type of health specialization, healthcare workers face
some of the most serious and complex health hazards. According to OSHA, healthcare professionals are at risk of contact with
blood borne pathogens, biological/chemical exposures, laboratory hazards, x-ray/radioactive hazards, mental health hazards from
stress and violence, and much more.55 The Center for Disease Control and Prevention (CDC) lists additional hazards for healthcare
workers, including back injuries, latex allergy, and needle stick injuries.56 Specific information about the current landscape of
healthcare professionals is listed below:
• In 2010, the healthcare and social assistance industry reported 653,000 injury cases, more than any other industry that year
(152,000 more cases than the manufacturing industry)57
• T
he incidence rate for the healthcare and social assistance industry for nonfatal injuries and illnesses was 139.9; the average
incidence rate for all private industries in this category was 107.7.58
• T
he incidence rate of nursing aides, orderlies, and attendants for musculoskeletal disorders was 249 per 10,000 workers; the
average rate for all workers was 34 per 10,000 workers.59
• T
urnover rate of newly hired nurse graduates falls between 13-70%; a majority of the reasons for leaving work included
psychosocial factors such as work overload, time pressures, necessary non-nurse duties, and low value placed on their
contributions.60
There are many preventative techniques for healthcare workers to hone in on, but does not seem to be enforced by
organizations. Companies, hospitals, and clinics will have to provide assistance and support in order to enhance workplace and
worker wellness.
There is an increasing realization that hours-of-service guidelines alone may not achieve the objective of maximizing wellness,
alertness, fitness for duty or employee engagement for the aforementioned populations. Studies show that employee alertness
depends not only on how many hours are worked, but also on a variety of other factors including, among others, what one does
at work; when one is at work; whether the work environment promotes alertness or fatigue; and whether there are mechanisms in
place to detect excess fatigue.61
24
ADDITIONAL INSIGHT
POOR HEALTH OF HOURLY EMPLOYEES 38
IMPACT TO EMPLOYERS
• Compared to salaried employees, hourly employees
miss work more often and the dominant cause is
health-related.
• O
n average, the cost to U.S. employers due to
higher absence rates is $950 per hourly employee
which translates to almost $5 million annually for a
company of 5000 employees.
Unscheduled absence rates vary from 6-11%
in hourly workplaces compared to 2.1% for all
US workplaces.
The biggest reason for such absences is
personal illness and stress (at least 47%).
• As hourly employees are only paid when they work,
they are more likely to do so while sick, decreasing
productivity.
• U
nscheduled absences also forces employers to
either operate short-staffed or find a replacement,
which could require the employer to pay overtime.
• T
he average cost to U.S. employers due to lower
productivity in the workplace is $180 billion
annually.
More productivity is lost when employees
attempt to work while sick (72%) compared to
being absent (28%).
The major reasons for lower productivity
at work are chronic conditions (58%) like
diabetes, heart disease, chronic back pain.
• Hourly employees represent 59% of the total U.S.
labor market.
• Only 35% of hourly employees have access to
employer sponsored wellness programs compared
to 45% of salaried employees.
From Booz Steering Committee Slides
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
ASSESSMENT CRITERIA
For at-risk populations, the beginning level represents organizations that offer basic educational materials, health measures,
and sick leave policies to their employees. The performing level represents organizations that offer more advanced health
measures and policies.
BEGINNING
• Employers
provide education materials for industry specific risk factors
INDUSTRY-SPECIFIC
RESOURCES AND
ENGAGEMENT TESTS
•
mployers in aligned fields notify employees and recruits about PPACA funded
E
opportunities for education, loan reimbursement, and special recruitment for
healthcare workers
•
mployers enlist personnel or a third party to connect employees to occupation-specific
E
resources such as community centers and other free community-based clinics
INDUSTRY-SPECIFIC
EQUIPMENT
•
mployers subsidize industry-specific equipment at 50% (e.g., ergonomic
E
accessories for heavy lifters, masks, ear plugs, visors, gloves and sunscreen for
outdoor employees)
• Employers
follow shift/rest guidelines for shift workers
GENERAL AND
INDUSTRY-SPECIFIC
HEALTH MEASURES
•
mployers provide industry specific and general health vaccinations in house for
E
employees
•
mployers subsidize industry-specific off-site preventative measures at 50% such as
E
inoculations, physical therapy, and medicines
SICK LEAVE
• Employers
provide unpaid sick leave at no risk to job security
TIME OFF
SHIFT AND WORKPLACE
FLEXIBILITY
FREQUENT BUSINESS
TRAVEL
GENERAL
• Employers adhere to ‘part-time’ and other relevant beginning level standards in framework
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, employers offer engagement tests, advanced workplace flexibility, and
generous business travel policies.
PERFORMING
LEADING
• Employers
offer engagement tests that place
employees in the ‘best fit’ positions
• Employers
subsidize industry-specific equipment at 75%
• Employers
subsidize industry-specific off-site preventative
measures at 75%
• Employers
• Employers
offer industry specific preventative
measures for free
• Employers
• Employers
offer paid leave for full time staff and part time staff at
their rate of employment (15 hrs./week = full reimbursement at 50%
of time off (out 2 days, 1 is reimbursed)63
• Employers
provide industry-specific equipment
for free
offer paid sick leave for staff
• Employers
grant extended unpaid time off without
penalty (e.g. for trips to home countries or to take
care of family)
limit shifts to 12 hours 64
• Employers encourage culture of flexibility by: Allowing employees to trade
entire shifts; Allowing employees to pick up shifts; Allowing episodic time
off (last-minute time off without pay granted without penalty); Offering
downtime leave (time off without pay when the operation/business is
slow); Allowing employees to drop and split shifts; Giving employees
advance notification of monthly work hours; Scheduling preference
bidding (or PBS, is a computer program providing crew scheduling)
• Employers
encourage flexibility by: Guaranteed
scheduled time off; Offering floating holidays;
Offering shift time off that can be made up during
the pay period
• Management
enforces a day of rest upon return
from a mission
• Management
assignment
encourages a day of rest upon return from an
• On-site
health professionals contribute training
and guidance for stress management and
maintaining a healthy life balance
• Employer
implements a travel policy that allows
business class for flights of more than 3 hours
27
Core Policy Category 4: Family Friendly Workplace – Promoting Family
Forward Culture
ISSUE OVERVIEW
According to a 2008 report by the Heartland Alliance Mid-America Institute on Poverty, approximately 8.6% of the instances
when households enter into poverty in the U.S. happen when a child is born, and one out of every five temporary poverty spells
for children begin this way.65 The report also found that 12.9% of families with a new baby become poor in the birth month,
increasing to 24.6% when a female heads the household.66 These statistics demonstrate the need for addressing employee wellbeing through policies that support the health of the families and dependents of employees.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
Family leave policies that are not aligned with the needs of employees with children or dependents are increasingly at odds
with an aging population base and the increasing number of female employees who are also heads of households. In the U.S.
more than 19 million families with children now have a mother as the primary or co-breadwinner, and 70% of children live in
households in which both adults are in the labor force.67 An increase in the number of older Americans (aged 65 years or older)
stands to create additional strains on employee capacity, as employers must both replace an aging workforce and accommodate
younger workers who care for elder dependents. The number of older Americans, or individuals 65 and older, is expected to
climb from 41.4 million in 2011 to 92.0 million in 2060, and employers should prepare themselves for the effects of this dramatic
shift accordingly.68
In addition to establishing paid paternal and caregiving leave, flexible scheduling that enhances employees’ ability to decide
when and where they accomplish their work is on the rise. Since 2005, there has been a significant increase in the proportion
of employers allowing at least some employees access to flextime and place.69 Such policies help families to better manage work
assignments and personal responsibilities. As flexible scheduling and workplaces become more common, organizations that fail
to adopt these options where appropriate run the risk of being outperformed by competitors who benefit from lower operating
costs and better adaptation to a global knowledge and service-based economy.
PARENTAL LEAVE
The United States is the only high-income nation without mandatory paid maternity leave. Almost all middle- and low-income
countries offer it with the exceptions of Swaziland, Papua New Guinea—and the U.S.70 Unsurprisingly, the U.S. has 50% more
first-day infant deaths than all other industrialized countries combined, the highest first-day death rate in the industrialized
world.71 This lack of support has dire effects on the child, family, and business. A study of 18 countries spanning more than
three decades found that extending the number of weeks of job-protected paid leave was associated with a significant decrease
in infant mortality.72 Another study of 16 European countries from 1969 to 1994 found that more generous paid parental leave
reduced deaths of infants and young children: a 50-week entitlement to paid parental leave was associated with about a 20%
decline in post-neonatal deaths and a 15% drop in fatalities between ages 1 and 5.73
CAREGIVING LEAVE
Additionally, employers that offer child and eldercare support see higher productivity from employees.74 Employers who do
not offer dependent care supports may feel the drain on work productivity given that respondents who do not have access
to dependent care supports are 62% more likely to experience sleep issues that have an impact on their jobs compared
to respondents who use these supports.75 In organizations where there is little or no room for error, such as patient care,
manufacturing, or transportation, sleeplessness can have dangerous consequences.76 Workers who care for elderly relatives cost
U.S. businesses about $34 billion annually in absenteeism, replacement costs, and lost productivity, according to a survey by the
National Alliance of Caregivers and the MetLife Foundation.77 Employees who do not have access to supportive dependent care
policies reported losing 31% more productivity due to stress during the prior month than the group that had access to supports;
employees with access to such supports spent nearly 20% less time dealing with dependent care issues at work than those who
did not have access to supports.78
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
BREASTFEEDING
Similar to parental leave, there are aggregate benefits at the societal level to supportive breast feeding policies. Recent research
shows that if 90% of families breastfed exclusively for 6 months, nearly 1,000 infant deaths could be prevented.79 Other studies
have shown that the United States would save $13 billion per year from the institution of increased breast feeding of infants, as
medical care costs are lower for fully breastfed infants than infants that have never been breastfeed or were breastfed only for
a short period of time.80 Breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations and require
mothers to miss less work to care for sick infants, promoting lower medical costs to employers.
ADOPTION
The equitable treatment of families that pursue adoption is an integral component to a holistic set of family leave policies.
Employers that provide adoption benefits with visible support and encouragement can realize the following benefits:
• Equity:
Adoptive parents should be treated the same as biological parents in benefits extended – reducing the potential of
discrimination suits brought against the company.81
• Low
cost: Since few workers actually utilize the benefits, the cost to the company is low, assuring compatibility with cost
containment concerns. An informal survey of companies shows that fewer than 2% of all employees use the adoption benefit.82
• Good
will: Organizations receive good will and positive publicity for sensitivity to their employees that pursue adoption.
Additionally, such policies tend to inspire greater loyalty amongst employees when given this extra consideration. Although
difficult to quantify directly, supportive adoption policies can lead to a lower company turnover rate.83
• Social
benefit: Children and families are the beneficiaries of the company’s support of adoption. The benefits may make
the difference in a decision to adopt, which can be particularly meaningful for the growing number of available children with
special needs who live in foster care or institutions.84
• Competitiveness
and Talent Retention: As more and more companies enact adoption benefits packages for their employees,
their counterparts will want to keep pace with their colleagues in order to stay competitive and retain and attract talent.85
30
RELEVANT RESEARCH
BENEFITS TO BUSINESS AND THE ECONOMY OF PAID LEAVE
The benefits to business operations and employee productivity of family friendly leave policies have been demonstrated in
multiple studies. A 2011 CEPR Leaves That Pay report found that an overwhelming majority of respondents found paid family
leave to have no negative impact on productivity, performance, turnover, or morale, with approximately 90% of respondents
indicating their agreement with this statement.86 The same study found that the average percentage of employees who took
advantage of paid leave to be fairly low at 6%, again indicating that usage of paid leave does not negatively impact business
operation and employee productivity. Other notable statistics on the benefits of paid leave are as follows:
• 94%
of leave-takers who received full pay during family leave returned to the same employer, compared to 76% of employees
who took unpaid leave.87
• Paid
leave can avoid the cost of employee turnover, which can range from 20% of annual pay for younger workers to 40% for
more senior employees.
• Instituting
15 weeks of paid maternity leave in countries (such as the U.S.) without paid leave could increase multifactor
productivity by 1.1%.
• Another
study of US women workers found that lengthier childbearing leave (combined paid and unpaid leave) had a strong
deterrent effect against women quitting the labor force or changing jobs postpartum.88
• The
costs of maternity, paternity, and parental leave relative to population and gross domestic product are modest, even in
countries with generous leave policies. Public expenditures on maternity leave are estimated to amount to an average of 0.3%
of GDP for leave payments in countries in the European Union and the OECD.89
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
CASE STUDY
Accenture
Accenture provides its employees with a flexible workplace – giving options for how
and where employees do their work. The company offers programs and tools to
help individuals and teams understand how encouraging flexibility and a balance
between work and personal health enhances, rather than impedes, productivity.
Additionally, Accenture’s LifeWorks Employee Assistance Program (EAP) provides
employees confidential support for challenging issues such as parenting, end-oflife issues, caregiver, and community support. The company also offers Backup
Dependent Care so that employees can easily locate caregivers for their children,
spouse, or relative when regular arrangements don’t work, with subsidized rates.
Finally, Accenture treats expecting parents to a new parents’ toolkit, a nursing
mother’s program, and adoption assistance.90 91
32
ASSESSMENT CRITERIA
The beginning level represents organizations that offer their employees basic parental leave, caregiving leave, breastfeeding, and
adoption benefits and support. The performing level represents organizations that offer more advanced benefits, with a more
flexible workplace and generous Paid Time Off (PTO) policies.
BEGINNING
FLEXIBLE SCHEDULING
AND WORKPLACE
• Employers
offer flextime to students pursuing relevant certifications/degrees at no
risk of unemployment
PAID TIME OFF (PTO)
• Employers
PARENTAL LEAVE
• Employers
offer 12 weeks paid maternity leave for all exempt employees
offer 12 weeks paid maternity leave for all nonexempt employees at
75% pay
employee benefits continue throughout leave at no additional cost
• Full
• Employers
•
CAREGIVING LEAVE
•
•
•
make resources and referral services available
mployers offer subsidies/reimbursements up to 50% (after government subsidies
E
and tax breaks) for child/elder care services (including transportation)
Employers offer emergency flextime
Employers offer parental leave structure
Employers offer affinity groups for employees with children/elders who have special needs
• Employers
provide information hotline
provide a reasonable break time for an employee to express breast milk for
her nursing child for up to one year after the child’s birth
Employers make the break time available each time an employee needs to express breast milk
Employers must provide a space for employees to express milk that is not a bathroom, is
shielded from view, and is free from intrusion from coworkers and the public
Employers provide managers with information on how to accommodate nursing mothers
Employers will not force mothers to ‘punch out’ during breast expression breaks unless
they exceed 30 minutes
Employers provide refrigeration for breast milk
• Employers
•
BREASTFEEDING
ECONOMICS
•
•
•
•
• Employers
offer adoption resources to all employees (literature, contact info, etc.)
offer maternity leave benefits to adopting parents (see Parental Leave)
Employers cover universal adoption-specific expenses at 80% of cost for public agency
adoption and up to 25% (up to $2,500) of cost per adoption excluding unlicensed and
inter-country adoptions
Employers provide reimbursements applicable to inter-country adoptions and are limited to
one child per employee (not family)
Adopted child’s insurance benefits match biological child benefits
Employers home study fees are covered
• Employers
•
ADOPTION
•
•
•
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, employers offer a fully functioning culture of flexibility, on-site childcare, and
a generous allowance for individuals hoping to adopt.
PERFORMING
• Employers
•
•
•
offer flextime, telecommuting and the option of
designing a compressed work week to all employees
Employees offer choices in managing work time
Employers offer a flex career option
Employers offer part-time/full-time flexibility
LEADING
offers PTO averaging 30 days/year (in addition
to sick days, maternity leave, and vacation days) PTO
includes: personal health days, floating holidays, and elder
care days
• Employers
• Employers
offer the option to switch to part-time work
offer fully functioning culture of flexibility
• Employers
offer PTO averaging 40 days/year
• Employers
• Employers
•
offer 36 weeks paid maternity leave for all
exempt employees at: First 6 months 100% pay; Last 3
months at 50% pay
Employers offer 36 Weeks Paid Maternity Leave for all
nonexempt employees at: First 3 months 75% pay; Next 3
months at 50% pay; Last 3 months at 25%
• Employers
•
•
•
offer college readiness programs and educational
assistance for dependents
Employers offer backup child/elder care
Employers offer school holiday care
Employers offer support groups for parents of teens and tweens
•
offer 52 weeks paid maternity leave for all
exempt employees: First 6 months 100% pay; Next 3
months at 50% pay; Last 3 months at unpaid pay
Employers offer 52 weeks paid maternity leave for all
nonexempt employees at: First 3 months 75% pay: Next
3 months at 50% pay; Last 3 months at 25%; Last 3
months unpaid
• Employers
offer before and after hours care
offer sick care
Employers offer business travel and overtime
Employers offer on-site childcare
• Employers
•
•
• Employers
•
•
provide locks for privacy in pumping rooms
Employers provide a calendar for scheduling access to
pumping rooms
Employers encourage breaks so nursing mothers may pump
• Employers
• Health
insurance covers reproductive medicine up to
50% of costs incurred
• Employers
rooms
provide comfortable furniture in pumping
• Health
insurance covers all reproductive medicine costs
incurred with no maximum ceiling
34
Core Policy Category 5: Employee Health
Photo: Adam Schultz / Clinton Foundation
ISSUE OVERVIEW
When designed well, employee wellness programs can yield improvements in health outcomes and cost savings. However, it
should be noted that the latter is not always the best initial indication of the most effective programs. A comprehensive study
by the Center for Studying Health System Change (HSC), “Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies
Widely,” which included literature reviews and interviews with industry experts and employers sponsoring wellness programs,
concluded that wellness programs need to be customized to the individual organization.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
The costs of termination, replacement, and loss in productivity equate to $1,000, $9,000, and $15,875 respectively per
employee. This means that losing one employee due to dissatisfaction, illness, or poor work environment could cost the
organization $25,875 on average.92 A critical meta-analysis of the literature on costs and savings associated with integrated
health and wellness programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and
that absenteeism costs fall by about $2.73 for every dollar spent.93 However, the 2004 National Worksite Health Promotion
Survey showed that only 7% of employers offered comprehensive programs 94 of the type specified in the recommendations of
the influential Institute of Medicine report Healthy People 2010.95 These include health education, worksite screenings linked
to appropriate medical care, and the integration of the program into corporate or organizational structure. Noted difficulties that
restrict employees from engaging and participating in wellness initiatives include:96
• Lack of knowledge of services
• Insufficient space for wellness initiatives
• Limited time
• Program consistency
• Cost of formalized prevention
• Confidentiality concerns
• Lack of interest
• Being overwhelmed with messages and deleting them without reading them
Furthermore, companies struggle with effective ways to increase utilization of these programs and to disseminate information, but
there are some solutions that companies should look to:97
• Long-term commitment is pivotal to engage employees in wellness initiatives.
• E
mployees need significant incentives, besides gift cards and health insurance modifications, in order to help them focus on
behavioral change.
• Resources requested by employees include periodical newsletters and seminars.
• R
esources requested by employers include analysis of best practices on program structure and implementation and
connection to resources.
MENTAL HEALTH
One in four adults, approximately 61.5 million Americans, experience mental illness in a given year. One in 17, about 13.6
million, live with a serious mental illness such as schizophrenia, major depression, or bipolar disorder.98 Approximately 6.7% of
American adults − about 14.8 million people − live with major depression.99 Approximately 18.1% of American adults − about 42
million people − live with anxiety disorders, such as panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress
disorder (PTSD), generalized anxiety disorder, and phobias. About 9.2 million adults have co-occurring and addiction disorders.76
Privately insured individuals pay out-of-pocket for 34% of the cost of their ambulatory care and 30% of the cost of prescription
medications.101 102 The average privately insured individual treated for a mental illness spends 3% of his/her total household
income on behavioral healthcare services. Additionally, 5.2% of privately insured individuals spend 20% of their total household
income on behavioral healthcare services.103
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Estimates of the total workplace costs of mental illness and substance abuse disorders range from a low estimate of $79 billion
per year, to a high of $105 billion per year (both figures based on 1990 dollars).104 Serious mental illness costs America $193.2
billion in lost earnings per year.105 Behavioral health problems cause more than 200 million missed work days each year in the
U.S. at an estimated cost of $105 billion (National Business Group on Health). Providing a minimum level of enhanced care
for employees’ depression would result in a cumulative savings to employers of $2,898 per 1,000 workers over five years. Even
though the intervention would initially increase use of mental health services, it leadingly would save employers money, by
reducing absenteeism and employee turnover costs.106 In total, the 217 million days of work loss and work impairment due to
behavioral health disorders cost employers $17 billion annually.107
There are a multitude of mental health programs that employers can institute beyond the standard employee assistance
programs to create supportive internal environments that reduce incidences of mental health illnesses. By offering accessible,
consistent, and high-quality mental health services to employees, employers can both prevent declines in mental health from
occurring and provide employees already suffering from mental illness with the support they need to become healthier. These
programs can include:
• Health professionals or designated, appropriately trained professional staff, contact employees with learning disabilities or mental
health and/or substance abuse issues on an annual basis to recommend and connect them with appropriate resources.
• Regulary accessible, discreet space is available in which peer-based mental health and wellness support groups can meet.
• Referral service where employees may anonymously recommend colleagues for a consultation with a mental health professional.
• Employees have access to employer-hosted mobile applications and online support groups, giving them around-the-clock
access to mental health support.
• Mental health and substance abuse education boosters are offered to all employees during periods of high stress.
SUBSTANCE AND PRESCRIPTION DRUG ABUSE
Approximately 2 million adults age 50 and older (2.1% of adults in that age range) used prescription-type drugs non-medically
in the past year.108 Substance abuse treatment admissions for individuals age 50 or older nearly doubled from 1992 to 2008,
climbing from 6.6% of all admissions to 12.2%.109 A study by Bailey and Covell revealed that experience with daily hassles,
sexual and emotional abuse, and depression were significant predictors of prescription drug abuse.110 A 1999 study in the
American Journal of Public Health found that sexual harassment in the workplace has significant relationships with drinking to
intoxication, frequency of drinking, and prescription drug abuse, in both men and women.111
Botvin et al. reviewed the research about tobacco, alcohol, and drug abuse prevention strategies and found that all studies of
“generic skills training approaches” found significant and large effects on behavior.112 Specifically, reductions were shown in
tobacco, marijuana, and alcohol use. Some of the skills tested in the broad range of studies included ability to increase selfcontrol and self-esteem, and coping strategies for relieving stress and anxiety.113 CDC’s policy recommendations for addressing
the epidemic include: prescription drug monitoring programs (PDMPs); patient review and restriction programs; laws/regulations/
policies; insurers and pharmacy benefit managers (PBM) mechanisms; clinical guidelines; and improved access to substance
abuse treatment.114 ASTHO recommends employers facilitate better access to effective treatment services, address undertreatment of substance abuse, increase parity, reduce stigma and barriers to care, leverage resources to improve service delivery,
and identify performance indicators and outcome targets for opioid treatment services.115
37
SMOKING CESSATION
The total economic burden attributed to tobacco use is $183 billion.116 In the United States from 2001 to 2004, the average
annual smoking-attributable health-care expenditures were estimated at $96 billion per year.117 In that same timeframe,
productivity losses were estimated at $97 billion per year.118 Compared to nonsmokers, smokers miss about 60% more days
due to sickness.119 The effects of smoking are vast. The Organization for Economic Cooperation and Development calculates
that construction and maintenance costs are 7% higher in buildings that allow smoking than in buildings that are smoke-free.120
Employers who provide a smoke-free workplace may save as much as 30% on fire insurance.121 Companies that have tobaccofree policies are more likely to be seen in a positive light by their nonsmoking customers, applicants, and employees. According
to the CDC, the benefits of promoting a “culture of health” include engaged and empowered employees, lessened health care
costs, and increased worker productivity.122
Smoking cessation programs are relatively low in cost when compared with other benefits. According to the CDC,
comprehensive tobacco cessation benefits cost between $1.20 and $4.80 per member annually.123 According to a 2009
study, financial incentives can increase enrollment in tobacco cessation programs and increase completion and abstinence
rates.124 Each employee or dependent who quits smoking reduces annual medical and life insurace costs by at least $192
almost immediately.125 Over time, tobacco cessation policies and benefits generate financial returns for employers in reduced
absenteeism, health care and life insurance costs, and in higher worker productivity. Currently, 78% of the best companies have
a tobacco free campus.126
SLEEP
A person working the night shift, which causes disruption to the circadian rhythm, is at greater risk of various disorders, accidents
and misfortunes, including:
• Increased likelihood of obesity
• Increased risk of cardiovascular disease
• Higher risk of mood changes
• Increased risk of gastrointestinal problems, such as constipation and stomach discomfort
• Higher risk of motor vehicle accidents and work-related accidents
• Increased likelihood of family problems, including divorce
• Probable increased risk of cancer, especially breast cancer
• Sleep deprivation caused by shift work may increase the risk of epilepsy in predisposed people
• Shift workers with diabetes can experience difficulties in controlling their blood sugar levels 127
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
CASE STUDY
Johnson &
Johnson
Johnson & Johnson is particularly focused on implementing effective smoking
cessation programs. The company joined forces with external, similarly-minded
organizations such as the CEO Roundtable on Cancer and the WHO with the goal
of “leading by example” and becoming a completely tobacco-free organization.
Because programs are set at a corporate level but initiated and implemented at
the local level, Johnson and Johnson pays special attention to cultural norms
by utilizing staff members who fully understand the specific issues involved.
Additionally, regional consultation and support is always available from a Wellness
expert if needed.
In 2008, after the company successfully implemented its tobacco-free workplace
policy, it turned its focus to employee smoking cessation efforts. A rigorous
campaign was conducted in order to align with the worldwide No Tobacco Day,
with part of this campaign including offering Nicorette at no cost to employees.
To date, 560 employees have participated in the quit smoking campaign and
the percentage of smokers has declined approximately 2% each year. To
further increase participation, a comprehensive 3-year plan was developed that
focused on healthy lifestyle, stress care, and non-smoking. Ongoing measures to
support employees in smoking cessation efforts now include an e-learning tool to
encourage non-smoking, counseling by Employee Assistance or internal healthcare
staff, group seminars, and financial aid for Nicorette. Also under consideration is
an in-house “non-smoking website” where, among other things, individuals can
share success stories and be informed of a variety of activities that support nonsmoking efforts.128
ADDITIONAL INSIGHTS: WORKPLACE TRENDS IN HEALTH & WELLNESS PROGRAMS 129
FROM
TO
FROM
TO
EmployeeCentric
Segregated Health/
Wellness Programs
Integrated Health
Management
Systems
EmployerCentric
Single Risk
Focused
Interventions
Multi Risk
Focused
Interventions
Treatment
Focused Models
Prevention and
Behavior Change
Focused Models
39
ASSESSMENT CRITERIA
The beginning level represents organizations that offer basic nutrition support, critical illness and disability coverage, mental
health coverage, substance and prescription abuse support, and resources on sleep. The performing level represents
organizations that offer more advanced policies and benefits.
BEGINNING
• Employers
WELLNESS PROGRAM
FEATURES AND
COMMUNICATION
•
•
•
•
•
•
COMPENSATION AND
EQUAL PAY
NUTRITION SUPPORT
CRITICAL ILLNESS AND
DISABILITY
conduct assessment of existing programs/policies (if applicable) and
employee needs before establishing/revamping wellness plan
Employers conduct annual wellness program evaluations
Employers notify employees of screening results and plan manager must follow up
with informing and connecting employee to care plan resources
Employers assign space, time, and staff to help manage the wellness plan
Program must remain consistently active for at least 5 years (independent of
evaluation reports)
Employers must develop confidentiality plan and notify all staff of it
Employers implement participant (not outcome) based recognition program
• Equal
•
pay for men, women, LGBTQ, race, ethnicity, etc.
Minimum wage begins at $10.00/hour for non-exempt employees
• Employers
(if they provide access to snacks) follow the Alliance for a Healthier
Generation (AHFG) food and beverage guidelines
• Employers provide discounts for medical equipment
• Employers provide counseling services
• Chronic illness and disability covered in family insurance
• Prescriptions drug mailing service
• E
mployers
• E
mployers
•
•
•
MENTAL HEALTH
•
•
•
plans
cover mental health as regulated by PPACA
allow mental health providers to be designated as a health home as
designated by PPACA
Employers include in annual health screenings: screening for depression and other
common behavioral health conditions among individuals with chronic medical illnesses
and other comorbidities. (Information from screenings is used to guide employees and
connect them to community resources and is not kept in employees’ files)
Employers ensure that provider partners use the collaborative care model to address
the needs of patients with mental illness and/or substance abuse disorders who are
receiving treatment in primary care
Employers ensure that all outside medical screenings are reimbursed and patient
monitoring is billed as a lab test
Employers review short-term and long-term disability management programs and
instruct vendors to actively manage all behavioral health disability claims
Employers ensure that redundancies between EAPs and health plans by re-structuring
EAPs are reduced
Employers ensure that EAPs do not duplicate services offered through the health plan
(MCOs and MBHOs), but should be re-structured, if necessary, to provide the following
functions: Conduct periodic organizational assessments to evaluate the effects of work
organization on employee health status, productivity, and job satisfaction; Assist in
the design and development of a structured program to deliver health promotion and
healthcare education tools that significantly affect employee and beneficiary health and
productivity and lead the effort to deliver behavioral healthcare education programs;
Employers provide targeted case management, 24-hour crisis services, hotlines,
assertive-community treatment (ACT) programs, and multi-systemic therapy
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, employers leverage social media in their wellness communication
strategies, offer mental health education boosters during times of year associated with high stress, worksite napping, and other
additional benefits.
PERFORMING
• Employers
•
•
•
•
•
•
conduct follow up outreach and connect employees with
community resources
Employers utilize diverse communication strategies (including a link on
company webpage)
Employers include free counseling and drug therapy for tobacco cessation
programs to all employees
Employers offer flexible health spending accounts
Employers offer legal insurance
Employers offer strategic engagement in CSR
Employer includes outcomes in annual evaluation
LEADING
• Minimum
wage begins at $12.00/hour for non-exempt employees
• Subsidized
or on-site benefits: Nutrition counseling; Health and lifestyle
coaching; Health Fairs at job site; Stress management/stress reduction
programs; Fitness center subsidy or on-site fitness center; Subsidized weight
loss programs; Quarterly Health Screenings
•
•
•
•
Employers cover medical equipment
Employers strategically place disabled employees in company advertisements
Employers cover ongoing therapy for medically needy employees
Employers provide stipend for high-cost medically necessary medications
• Employers
•
wellness communication
strategies include social media
Employers share evaluation results with
employees
• Minimum
wage begins at $13.00/hour
for non-exempt employees
• Subsidized
or on-site benefits: Stipend
of 1K/ year to spend on any wellness
item; 24 hr access to nurse/doctor/
professional
• Employers
provide prescription drug,
and medical equipment vouchers
(medications above reasonable out-of-pocket cost)
• Employers
provide counseling resources for dependents (under 26)
provide coverage for evidence-based treatment modalities for
seriously mentally ill children and adults, including: targeted clinical case
management services; assertive community treatment (ACT) programs;
therapeutic nursery services; and therapeutic group home services
Employers involve a behavioral health specialist in certification of psychiatric
disability and treatment planning
Employers involve a behavioral health specialist in the review of the
treatment plan
Employers refer employees on disability for a psychiatric condition to EAP for
return-to work assistance
Employers support management in addressing issues of productivity and
absenteeism that may be caused by psychosocial problems
Employers functionally coordinate with other health services including health
plan, disability management, and health promotion
Employers provide stipend for the following care when past coverage period:
Ongoing therapy; Counseling; Prescription drug abuse resources and
counseling
• Employers
•
•
•
•
•
•
• Employers
•
offer mental health
education boosters during times of
year associated with high stress (such
as end of year/holiday season)
Employers provide no limitations on
the following care: Ongoing therapy;
Counseling; Prescription drug abuse
resources and counseling
41
ASSESSMENT CRITERIA
BEGINNING
• Employers
SUBSTANCE AND
PRESCRIPTION
DRUG ABUSE
•
•
provide a comprehensive employer substance abuse program including:
A workplace substance abuse education component; Confidential screening by an
EAP or health professional; Treatment referrals to an EAP or health professional;
Confidential follow-up care to support individuals in recovery
Employers implement a drug-free workplace initiative with written substance
abuse policies, including: Under what circumstances will drug or alcohol testing
be conducted; Employee and supervisor training in identifying impaired behavior
and other signs of substance abuse; Outline of how to deal with impaired workers;
Provisions for assisting chronic substance abusers; Possible disciplinary actions
Employers must maintain an emergency first aid kit, which will contain but not be
limited to an emergency Naloxone administration kit
• Employers
•
•
•
SLEEP
•
•
•
•
•
•
train top executives, managers and/or HR on the effects of insufficient
sleep, ensuring that corporate top management and fiduciary officers are on record
in recruitment materials, new employee materials, and annual reports as supporting
sleep health for all corporate employees and their families. Ideally, this is consistently
presented to reinforce that sleep is the third pillar of health along with diet and
exercise
Employers provide resources on sleep
Employers provide sleep health education to employees
Employers provide in house medical health screenings that include sleep disorders
and connect employees to clinical services to ensure compliance with prescribed
treatment (Co-morbidities are inquired about and noted at during the screening)
Employers cover sleep screenings in health plan (insurance)
Employees receive 15 minute breaks per 2 hour work duration
Employees receive two full day’s off per week
Employers offer ongoing evaluation of sleep policies and investigations into accidents
as they relate to sleep
Employers adhere to shift duration recommendations
Employers provide explicit approval of down time from digital connectivity outside of
normal working hours
ADDITIONAL BENEFITS
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
PERFORMING
• Employers
•
•
•
•
•
offer comprehensive health plan benefits that support a broad
range of services, including: brief intervention; outpatient and inpatient
treatment; medication; peer support groups; illness self-management
programs; treatment and recovery is an alternative or parallel to disciplinary
action if an employee violates the company’s drug and alcohol policy or has
job performance problems related to substance abuse
In the event of a prescription drug overdose or death of an employee,
employers will arrange for the following resources to be made available to all
employees:
Educational and psychological debriefings
Individual and group counseling for affected peers and family of employee
Promote healthy recovery within the community and hold town hall style
meetings to discuss employee needs and concerns
Employers develop Return to Work Agreement Employers offer affinity group
if desired
LEADING
•
offer substance abuse
education boosters during times of
year associated with high stress
(such as end of year/holiday season)
Employers coordinate annual drug
take-back day with local law
enforcement, and other area employers
• Employers
•
•
•
•
•
•
•
identify and mitigate corporate policies and operations that
negatively impinge on sleep health for employees and their families, i.e.,
“sleep stealers.”
Employers normalize online availability free-time from 10pm-6am [no emails
sent/expected]
Employers mandate a minimum of 30 minute breaks daily (logged off) per
four hour shift
Employers provide employees with Jawbone-type personal monitor to track
sleep and other wellness aspects at a discounted price in accordance
with income
Employers adhere to NIOSH workload and shift length restrictions (five
8-hour shifts or four 10-hour shifts per week)
Employers offer discounts on digital devices with apps (like flux.com) which
mitigate the light exposure from devices in the later evening hours (9pm-7am)
When negotiating contracts, employers ensure that there are provisions
in contracts for services from health providers, requiring that: The annual
physical examination protocols include provisions for asking employees and
their dependents about their sleep health and practices; Employees who
screen positively for sleep disorders are referred to clinical services to ensure
compliance with prescribed treatment
Health providers diagnose sleep disorders comorbidities, e.g. obesity,
diabetes, cardiovascular disease, hypertension, depression and stroke (each
can trigger sleep disorder)
• Employers
•
offer worksite napping
(up to 30 min)
Welcome and provide incentives for
employees to participate in scientific
studies regarding sleep health in the
workplace undertaken with academic
research organizations or government
health agencies
• Employers
•
•
•
•
flag employers that are working consistent long hours and work to
achieve balance
Employer offers foreclosure and mortgage assistance counseling programs
Employers offer stipends for phone and home office materials
Employers offer free uniforms
Employers offer public transportation reimbursement
• Employers
• Employers
•
•
offer free employee parking
Employers offer free or subsidized meals
Employers offer sabbaticals
43
Core Policy Category 6: Talent Management
Photo: Adam Schultz / Clinton Foundation
ISSUE OVERVIEW
Opportunities to improve health via strong talent management practices can seem unrelated at first glance, but recent research
indicates a strong relationship between the two. In 2009, Gallup studied employee engagement in 152 organizations across 44
industries and found that employee engagement was positively associated with better customer loyalty, increased profitability
and productivity, improved product quality (i.e., fewer product defects), and reduced employee turnover, absenteeism and
safety incidents.130 Employee engagement continues to be a major concern for employers across all sectors. Developing
employee skills via training and education is needed to drive innovation and productivity and to give workers the ability to access
employment and advancement opportunities that can improve their health and “happiness.” Real-life experiences and mentoring
opportunities also provide the learning that employees need to master a job. Similarly, when employees have the power to make
decisions that are important to their performance and to the quality of their work life, they feel more accountable and connected
to the organization. Power can involve giving employees relatively small opportunities for decision-making or allowing them to
have final authority and accountability for decisions and their outcomes.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
The more transparent managers can make the organization’s operations, the more effectively employees can contribute to the
firm’s success and understand the impact of their work. Managers should strive to provide information pertaining to output,
revenues, and profitability – specifically as they relate to an employee’s particular area of work – so workers can influence these
outcomes by adjusting levels of discretionary effort.
Talent management, although highly effective, can be difficult to implement due to the multiple points of intervention within an
organization that need to be activated to improve the social and financial health of employees. In today’s current environment,
employee engagement plays a crucial role in cultivating a supportive talent management infrastructure. There is sufficient
evidence to demonstrate a clear financial return on investment from managing and developing talent within an organization. A
study by Gallup Inc. reported that companies with engaged workers obtain higher earnings per share, and recovered from the
recession of 2008 faster than other competitors.131 Research by the Kenexa Institute showed similar results, with organizations
that had highly engaged employees achieving a total shareholder return seven times greater than organizations with disengaged
employees.132 The same study also highlighted that the annual net income of the top 25% of engaged organizations nearly
doubled that of the bottom 25% of engaged organizations.
On the other hand, a disengaged workforce can result in decreased productivity at the workplace. In Japan, an estimated
$232 billion is lost every year as a result of low engagement levels that are pervasive throughout the country.133 An engagement
database of 200 major organizations revealed that disengaged employees achieved average sales numbers that were 8% lower
than highly engaged workers.134 Furthermore, the total number of quality errors (external and internal parts per million) in a
Fortune 100 company for low-engagement workers was 5,658 errors, while highly-engaged workers had only 52 errors. A 2012
Gallup report found similar results, with organizations with high engagement levels reporting the following beneficial results:
• 37% lower absenteeism;
• 28% less shrinkage;
• 48% lower safety incidents;
• 10% higher customer metrics;
• 21% higher productivity;
• 22% higher profitibility; and
• 65% lower turnover.135
“The idea of corporate transparency
goes hand-in-hand with offering
rewards for those employees who do
choose to expend extra effort.”
–SODEXO
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
So what can employees do to increase engagement? Accenture has identified several key drivers that can improve engagement
and improve talent management processes – professional development and training, flexible recovery time periods, and
empowering employees by increasing autonomy and influence.136 Employees who seem to be most engaged are those that feel
their work is exerting some influence in their organization’s strategic operations. The report recommends that organizations create
positions that provide opportunities for the employee to make a tangible impact and connect with the goal and mission of the
company.137 According to Accenture, people with no career-growth opportunities are 13 times more likely to disengage at work.138
A survey reported that workers who feel they’re gaining skills and experiences for career advancement are seven times more
likely to be engaged than those who don’t receive such developmental opportunities.139 Lastly, integrating time for recovery from
long continuous periods of work is a great way to retain employees and engage them in a healthy manner. Accenture reports that
employees who have adequate “recharge” times are three times more likely to be highly engaged, and experience decreases in
absenteeism, insurance costs, and employee turnover.140
Talent management can take many shapes and forms, but no matter how it’s presented, engagement is important to organizational
health if it is looking toward long-term success. Motivated employees are the driving force for a successful organization. Focusing
on employee wellness in this way will provide a wealth of opportunities and new ideas to be created as employees become better
and more productive workers and align their professional aspirations with the goals and visions of the organization.
COMPENSATION/EQUAL PAY
Women hold approximately 59% of low-wage jobs.141 Lower average earnings contribute to them being 32% more likely than
men to be poor (based on 2009 data).142 According to the Working Mother’s annual Best Companies for Hourly Workers survey,
women received 47% of the promotions to salaried exempt positions from hourly jobs and 38% of all promotions to non-exempt
manager positions.143 Similarly, the proportion of non-exempt workers earning less than $12 per hour fell to 30% from 46%
among employees at the 2012 Best Companies.144 All of this translates to the decreased ability of women to make the best
possible decisions to manage their health and the health of their families.
CASE STUDY
Facebook
Facebook has a unique set of talent management practices that produce
extraordinary business results. First, the company offers an extended six-week boot
camp orientation or onboarding. During that time, new hires work on teams that
spend their time working on multiple real projects, have full access to the complete
computer code behind Facebook, and are assigned individual mentors. At the end
of this process employees are asked which team and project within Facebook they
wish to join – a powerful tool because when most employees apply to a job they
have no way of knowing which team or project is the best fit for them. Additionally,
Facebook’s Hackamonth process is a self-directed internal movement process that
allows employees who have worked on a project for a year to select their own next
project team and after working with them for a month, they can choose whether or
not they want to remain.145
46
ASSESSMENT CRITERIA
The beginning level represents organizations that provide basic skills training and interdepartmental engagement for
employees. The performing level represents organizations that offer more advanced skills training and engagement programs.
BEGINNING
• Employers
allow employees pursuing educational degrees, certifications, etc.
flexible time
Employers offer a minimum of paid entry and job skills training for current position
(such as basic work skills, problem solving skills, etc.) during working hours if
applicable
RESOURCES AND
TRAINING
•
EMPLOYEE
RECOMMENDATIONS
• Employers
utilize employee recommendations to fill openings when applicable
JOB RELATED
EQUIPMENT
INTERDEPARTMENTAL
ENGAGEMENT
• Employers
schedule activities that provide opportunities for new hires to engage
with team members outside of their department
TRANSPORTATION
SUBSIDIES
COMMUNITY SERVICE/
CIVIC ENGAGEMENT
CULTURAL DIVERSITY
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, employers provide structured mentoring programs, social media training,
and the opportunity to participate in civic engagement.
PERFORMING
• Employers
•
•
•
•
•
•
•
•
•
•
•
•
•
have employee resource groups and affinity networks to support
and strengthen diverse workforce
Employers provide anti-bullying programs
Employers provide continual education coaching
Employers provide career advancement training including mentoring
opportunities
Employers provide life skills training
Employers offer basic technology training
Employers offer language skills training
Employers offer online self-directed training sessions
Employers offer information and training on financial literacy
Employers offer supervisor/team leader preparatory training
Employers offer peer learning/training groups
Employers offer career ladder and lattices (talent management trainings are
aligned with career mapping mobility goals)
Employers offer review courses (CPA, SHRM, when applicable)
Employers offer salary negotiation seminars
LEADING
• Employers
offer subsidized uniforms and other job related equipment
• Employers
offer public transportation subsidies
• Employers
•
participate in community outreach/volunteerism; employees
contribute to opportunity decision making
Employers offer two days paid leave per year for employees to engage in civic
engagement/CSR
• Employers
•
•
•
provide language programs
Employers provide translations for
critical information
Employers provide social media skills
training
Employers provide structured
mentoring program
• Employers
offer one day paid leave
per quarter for employees to engage in
civic engagement/CSR
• Employers
host culture days and celebrate heritage months
offer ethnic dishes in employee cafeteria
Employers provide space/PTO for employees to celebrate international and
religious holidays
• Employers
•
48
Core Policy Category 7: Veterans and Military
Photo: Barbara Kinney / Clinton Foundation
ISSUE OVERVIEW
The current decade-long war in the Middle East has created a vast pool of recent veterans, and coupled with the U.S.’s older
generation of veterans from previous wars, there is an urgent need to address the growing health concerns of our current and
former military men and women. Although the veteran and military population possesses unique skillsets that have demonstrated
value to both private and public agencies, they face obstacles to well-being that merit specialized focus and resources to ensure
optimal outcomes for the employer and the veteran employee.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
A recent Military Medicine study of 809 military personnel living on McGuire Air Force Base in New Jersey found that more than
one-quarter (27.4%) of this population reported suffering from significant job stress.146 The report found that work stress and
depression were both significantly related to impaired work performance, more days of missed work, poorer physical health, and
negative perceptions about the abilities of supervisors and commanders. This trend towards worse health outcomes is especially
alarming when compared with the overall population of the nation. Although military members comprise less than 1% of the U.S.
population, veterans represent 20% of suicides nationally. Each day, about 18 veterans die from suicide.147
Screening efforts to identify mental health concerns in the months following return from combat suggest that up to 42% of
National Guard and Army Reserve troops require mental health treatment, but that less than 10% actually receive care. Many
redeployed soldiers express concerns about interpersonal conflict (14-21%), highlighting the potential impact of war on the wellbeing of family members, as well as friends and employers.148
A survey of 245 Fortune 500 firms indicates that the need for targeted mental health services in the workplace has not gone
unnoticed, with just under 25% of firms surveyed indicating that their EAPs included mental health programs tailored specifically
to support veterans and military personnel short- and long-term needs.149 These tailored programs are significant in that they
signal a commitment on the part of the employer to create a welcoming environment for veterans and assist in breaking down
obstacles to care and access within an organization. Ultimately, organizations need to address the mental health needs of
veterans without stigmatizing its presence; there exists a fine line between unnecessarily scaring colleagues, coworkers, and
supervisors of veterans about the impacts of mental health ailments like PTSD and minimizing the effect of such disorders on
employee health if untreated. Appropriate tone, messaging, and communication are paramount in the successful implementation
of programs geared towards this audience.
As employers continue to develop appropriate mechanisms for supporting veterans in the workplace, there is a growing body of
evidence that demonstrates the worth of their increased inclusion in private enterprise. According to the 2012 Society for Human
Resource Management (SHRM) Poll, Military Employment, organizations continue to place a high value on the skills individuals
with a military background bring to the workplace. Over 90% of respondents that hired military talent in the 36 months preceding
the poll agreed that those employees demonstrated:150
• A strong sense of responsibility;
• Working as part of a team under pressure and with a high degree of professionalism;
• The ability to see a task through to completion;
• Strong leadership and problem solving skills;
• The ability to adapt.
Organizations that engage this talent pool benefit in key measurable ways that directly align to common business goals, such as: 151
• A
workforce with coveted core competencies that consistently fall within the top ten employer desired attributes, including
leadership, teamwork, critical thinking, problem solving, and working under pressure;
• Enhanced brand recognition for the organization that translates into increased market share;
• Increased talent attraction and retention;
• Increased customer attraction and retention; and,
• Opportunities for tax credits.
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
IMPLEMENTATION IN THE WORKPLACE
Federal agencies and many NGOs have prepared guidelines for supporting veterans in the workplace throughout their entire
employment, from the initial transition back to civilian work to continual organizational advancement. Collectively, these programs
can help employers address the entire spectrum of social determinants of health through purposeful interventions in the workplace.
Job Accommodation Network (JAN): The U.S. Department of Labor’s Office of Disability Employment Policy provides free services
to employers via JAN’s digital platform and in-person technical assistance. Although JAN’s primary focus is on supporting inclusive
workforces that accommodate individuals with a variety of disabilities, it has compiled a robust set of recommendations on
addressing the needs of veterans, especially those that suffer from PTSD. The recommendations cover the entire spectrum of
health, inclusive of mental deficits, stress, sleep, time management, and interpersonal relations. The criteria assessment in this
section includes many of the JAN recommendations. (http://askjan.org/media/ptsdvets.html)
Continuing Education for Human Resource Professionals: An initiative of the Secretary of the Army, the OneSource initiative
provides free continuing education to human resources and medical professionals on the topic of veteran health. As of April
2014, OneSource provides four free courses online that cover the impact of deployment on family health, military cultural
competency, building resilience, and the effects of PTSD. The courses count towards continuing education requirements for a
variety of accreditation boards domestically and are administered by an external Army vendor. Detailed course information and
registration can be accessed at: http://www.restofthewayhome.com/page/crack-the-code/
Mentorship & Affinity Groups: The Burton Blatt Institute’s survey found that formal mentorship programs and structured affinity
groups were two key practices that veterans found to be most effective in supporting their well-being in the workplace.152 Providing
mentorship opportunities between junior veteran employees and more senior veteran employees can bridge the gap in services that
often exist once formal onboarding of employees ends. This mentorship can also extend beyond the boundaries of the organization
and into the community, as some Fortune 500 companies have created mentorship programs between their veteran employees and
veterans outside of the organization that are looking for a job or coping with transition to civilian employment. Internal affinity groups can
provide many of the same benefits as mentorship programs, especially for larger firms that can connect greater numbers of veterans
across initiatives, departments, or functions. Military affinity groups can also provide feedback and recommendations on existing
veterans programs and serve in an advisory capacity to organizations as they evaluate the effectiveness of their outreach to veterans.
CASE STUDY
Starbucks
Starbucks recently announced its plan to hire 10,000 military veterans and activeduty spouses over the next five years as part of a global expansion that calls for
500,000 employees companywide, an increase from 200,000 today. According
to Starbucks CEO Howard Schultz, this new hiring program is “good business”
because these skilled, highly trained people have significant leadership capabilities
and will add value to the company. Additionally, various Starbucks locations will
donate a portion of each customer purchase to local nonprofits benefitting military
veterans, such as a Goodwill program called Operation: GoodJobs, which helps
veterans with their post-military job searches. While the company already employs
thousands of veterans in its stores and corporate offices, the new program will
enable Starbucks to identify post-military employees and track their numbers
companywide. One additional component of their program includes specialized
training for hiring managers so that veterans can more easily translate their
experience to the workplace and find jobs.153
51
ASSESSMENT CRITERIA
The beginning level represents organizations that offer basic resource groups and assistance programs to military and veteran
families. The performing level represents organizations that offer more advanced benefits, such as succession plans and family
and social support.
BEGINNING
GENERAL
• Employers
adopt policies that explicitly address the health and wellbeing of veteran
employees
• Employers
RESOURCE GROUPS AND
ASSISTANCE PROGRAMS
PROFESSIONAL
DEVELOPMENT AND
SUCCESSION PLANS
•
offer a military-focused affinity or resource group in place
(determine who in the department will be assigned as the new hire’s buddy)
Dependents of deployed employees have access to EAP and other benefits programs
• Employers
provide dedicated internship programs for veterans or military personnel
FAMILY AND SOCIAL
SUPPORT
PAYMENT
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
Once an organization has reached the leading level, employers become branded as a military ready company and offer pull pay
and bonuses to military employees during employment.
PERFORMING
• Employers
set specific goals regarding the hiring,
retention, and promotion of veteran employees
• Employer
•
•
offers stress reduction benefit stipends to
employees
Employers offer moving assistance upon arrival in
new state
Employer offers support care packages
• Employers
have succession plans for military that may
be called for active duty
• Employer
•
offers relocation assistance for transitioning
spouse
Employers consider social events that include family
members to fully engage with the organization
LEADING
• Employers
establish partnerships with military agencies and
veteran groups to provide definitive paths of transition and
continuous support to veteran employees.
• Employer
•
creates a mentoring program linking the new
military employee with existing veteran employees as well
as military spouses and family members
Employers take pictures of what’s happening at work and
send them to the deployed service member
• Employers
provide targeted training and education
opportunities to veteran employees that address their
specific professional development needs
• Employers
use video conferencing to keep deployed
employees connected, not only with their families, but with
their department or even the whole organization if feasible
• Employer
offers full pay and bonuses during deployment
53
Core Policy Category 8: Built Environment
ISSUE OVERVIEW
There are many factors that influence and trigger stress, but the built environment can act as a stress reliever for outside
stresses, as well as independently trigger positive physiological reactions. A built environment that provides opportunities to
connect with others and engenders a feeling of connectedness, and one that integrates biophilic elements known to promote
optimal health can counteract stress and ill health promoters in the worksite. Biophlic interventions include the presence of
natural elements, such as water, plants, trees, and non-threatening animals. Even artistic depictions of nature in paintings and
murals have been shown to reduce anxiety and discomfort. In a research study in Sweden, hospital patients who were recovering
from open heart surgery experienced the least post-operative anxiety when looking at pictures of natural scenes that included
water, compared with pictures of abstract art, a control picture, or no picture at all. 154
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
RELEVANT RESEARCH
If workers are faced with nowhere to relieve stress in the office, the premature onset of psychiatric, stress-induced, and anxietyrelated illnesses can surface.155 Studies show that our ability to directly access nature can alleviate feelings of stress, thus
bolstering the case for biophilia in the workplace.156 The advantages of biophilic experiences include improved stress recovery
rates, lower blood pressure, improved cognitive functions, enhanced mental stamina and focus, decreased violence and
criminal activity, elevated moods, increased learning rates, decreases in blood sugar secretion, and psychological and eye health
improvements. The incorporation of these relationships into the interior and exterior design of worksites can reap demonstrated
benefits to productivity and effectiveness including, but not limited to, the following indicators:
• Illness and absenteeism
• Staff retention
• Job performance (mental stress/fatigue)
• Healing rates
• Classroom learning rates
• Retail sales
• Violence statistic
When linked to the effects of a renewed connection with nature, these metrics show remarkable gains, upon which companies and
institutions can capitalize.
It merits noting that these environmental elements have direct effects on employer operations – a 2012 study found that 10% of
employee absences can be attributed to architectural elements that did not connect with nature and that a person’s view was the
primary predictor of absenteeism (an average $41,000 in salary costs).157 Similarly, presenteeism costs employers in the private
sector $938 and employers in the public sector $1,250, per employee per year.158
• B
iophilic work environments increase office workers’ productivity. Creating biophilic work environments for many of New York
City’s office workers would result in over $470 million in recouped productivity value.159
• The study reported 52% fewer felonies in the greener buildings, 7-8% of which could be linked to increased access to nature.160
• The Park Prescriptions report states that 10% of the nation’s medical costs, or $150 billion, is attributed directly to obesity, and that
$2,200 per person per year can be reduced if sedentary individuals become more physically active three or more days per week.161
• In 2010, the direct costs of occupational injuries and safety incidents for U.S. companies were more than $53 billion, in
addition to the indirect costs of absenteeism, the hiring of temporary staff, and diminished customer service.162
• In 2010, 62% of the Business Group’s Best Employers for Healthy Lifestyles® Leading winners offered flexible work time for
physical activity.163
• Study participants wanted a place for exercise including walking trains and a coordinator for activities.164
GREEN BUILDINGS
• Energy
•
•
•
Efficient
High-Quality Indoor Air
Recycled/Renewable Building Materials
Low Water Usage
HOLISTIC WORKSITES
• Natural
Lighting
Therapy
Ergonomic Furniture
Integration of Natural Elements
Acoustics
• Color
•
•
•
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
IMPLEMENTATION IN THE WORKPLACE
Possible interventions in the physical environment of the worksite range from the comprehensive development of holistic worksite
campuses to small-scale improvements to building interiors. This Framework recognizes the value in wholesale development of
healthy buildings and worksites, but as a majority of organizations may face constraints in their ability to implement such largescale change, the focus in this section is small to medium scale changes that are low cost but yield significant results.
• C
olor therapy: Research has shown that most individuals exhibit psychological responses to colors that are inherent in the
biology of humans. The color red, for example, is known to trigger more regressive reactions than others in the color wheel. By
contrast, the color green has a restorative effect on physical, mental, and emotional health.
• L ighting: Proximity to windows and natural lighting can increase employee satisfaction and has been shown to moderate stress
levels.165 Where feasible and possible, employers should maximize the amount of natural light allowed into interior workspaces
and position employee workspaces within close proximity to natural light sources. One qualifier to this recommendation is that
the amount of control that employees possess over natural lighting (such as blinds and/or other forms of window shielding
treatments) does influence the positive impact of natural lighting.
• Ergonomic Furniture: Of the five implementation elements outlined in this section, investments in ergonomic furniture have
shown to have the most direct and tangible increase in worker effectiveness. A study from 2000 found that employers
that purchased ergonomic furniture recouped their costs within as little as five months and realized continued gains in
effectiveness beyond that time horizon.166
• Integration of Natural Elements: Several studies within the behavioral psychology field have found a link between increased
stress, anger, and aggression and non-pastoral settings.167 Humans inherently are wired to respond positively to green elements
in their view shed such as forests, plants, flowers, or other naturally occurring settings. Exposure to green images has been
shown to improve both mental health and physical health through increases in attention capacity and memory retention and
decreases in resting heart rate, stress, and anxiety levels.168 Employers can easily translate these findings into their office
environments and realize tangible benefits from small scale interventions such as incorporating potted plants, images of natural
settings on walls, and even encouraging employees to install screensavers or computer desktops that feature green images.
• Acoustics: The U.S. Occupational Health and Safety Administration (OSHA) sets forth a series of recommended intervention
strategies to reduce physical harm from noise exposure, including engineering controls (low noise machinery and adequate
physical sound buffers), administrative controls (off-shift operation of noisy machinery and restrictions on amount of time
exposed to noise), and hearing protection devices.169 OSHA’s recommendations have been designed to comply with the
National Institute for Occupational Safety and Health’s (NIOSH) baseline noise exposure level of 85 dBA per eight hours,
and OSHA mandates employers whose worksites exceed this baseline to implement a comprehensive Hearing Conservation
Program that encompasses all appropriate intervention strategies.
• O
ffice Worksites: While OSHA’s standards are applicable to all employment sites, they primarily address noise
issues that arise at sites where heavy machinery and tools are used on a daily basis, such as manufacturing plants
or construction sites. For workers employed in office or campus settings, noise typically impacts mental health
more so than physical health, as collective noise arising from conversation, office equipment, and other common
activities can increase stress levels and decrease attention span.170 As both of these outcomes can negatively impact
an employee’s personal health and effectiveness in the workplace, employers would benefit from implementing
solutions to mitigate office noise. Small-scale interventions include installing rubber mats underneath computers,
printers, and other office equipment as well as making noise cancelling headphones available to employees, while
large scale interventions include the provision of a variety of work spaces with differing noise levels and the usage of
sound absorbing materials within the office interior.171
56
CASE STUDY
Heifer
International
In 2007, Heifer International, a non-profit organization based in Little Rock,
Arkansas, constructed a new office building to house their headquarters on
the site of an abandoned brownfield. The new office complex, which has since
been certified as LEED Platinum, was designed with the explicit goal of creating
a worksite that minimized environmental impact and maximized efficiency.
The building incorporates a wide array of sustainable best practices, including
harnessing natural light for heating and lighting needs, recycling rain water for
irrigation and air temperature control needs, and using locally sourced and/
or renewable building materials throughout. Heifer extended this attention to
sustainability to its office interior by providing open office interiors that provide
employees with clear vistas to external greenery, installing white noise machines
that help mitigate standard noise sources, and ensuring that all interior spaces
receive a significant portion of natural light throughout the day.172
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
ASSESSMENT CRITERIA
The beginning level represents organizations that incorporate nature into space design, ensure that employees make better food
and drink choices, and participate in community-wide wellness activities.
BEGINNING
• Employer
HEALTHY DESIGN
•
ensures that healthy built environment culture is reflected in the workplace
(i.e. bike factories have bikes visible)
Employer ensures that worksite is wheelchair, walker, cane, etc. accessible when possible
LIGHTING
• 25%
ERGONOMIC
FURNITURE
• S
tanding
ACOUSTICS
(MANUFACTURING &
CONSTRUCTION)
of interior square footage has access to natural lighting source
desks, walking desks, and ergonomic furniture are available only for those
employees that are prescribed such treatments by their physician
• E
mployers
utilize one of the following types of controls to mitigate noise: engineering,
administrative, or personal
ACOUSTICS (OFFICE
ENVIRONMENTS)
• E
mployers
INTEGRATION OF
NATURAL ELEMENTS
• E
mployer
HEALTH BEHAVIORS
COMMUNITY
INVOLVEMENT
install rubber mats under common computer equipment and make mats
available for personal equipment
purposefully integrates green elements (potted plants, images of greenery) into
interior design
• E
mployer
ensures that vending machines adhere to AFHG HS guidelines
offer hot and cold water dispensers on every floor
• E
mployers
• E
mployer
wellness activities engage the greater community
MORE AMENITIES
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE
The performing level represents organizations that have implemented more advanced elements such as behavioral economics
into workplace design to encourage employees to adopt better health behaviors. Once an organization has reached the leading
level, employers offer on-site health facilities and other amenities to employees.
PERFORMING
LEADING
• Worksite
offers open and closed office space, closed
meeting space at a 5:1 ratio
• 50%
of interior square footage has access to natural
lighting source
• 75%
• Standing
• Standing
desks, walking desks, and ergonomic furniture
are available for all employees that request them
of interior square footage has access to natural
lighting source
desks, walking desks, and ergonomic furniture
are standard for all employees
• Employers
have adopted and implemented
comprehensive Hearing Conservation Program that
includes engineering, administrative, and personal
interventions
• Employers
utilize two of the following types of controls to
mitigate noise: engineering, administrative, or personal
• Employers
make noise cancelling headphones available to
all employees
• Worksite
•
uses biophilia (construction with nature in mind)
Company incorporates ‘Nature Analogues’ design
are visible as an option (when accessible)
place point-of-choice messages strategically in
front of stairwells, vending machines and in cafeterias, to
encourage employees to make healthy food choices and
be physically active
• Employers
provide both private and common working
space to all employees, including those without personal
offices
• Worksite
uses Nature of the Space design (theatre,
outdoor play, galleries) and integrates green
environments (courtyards, terraces)
• Stairs
• Employers
• Worksite
offers on site health facilities (gyms, pools,
etc.)
• Employers
will seek out opportunities to positively influence
the community landscape.
• Worksite
•
offers meals, haircuts, chiropractic services, dry
cleaning, etc.
Worksite offers on site medical resources, childcare,
café, etc.
59
Endnotes
(2014). The Six Dimensions of Wellness. National Wellness Institute.
Retrieved from http://www.nationalwellness.org/?page=Six_Dimensions
1
2
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18 Chernew, M. E., A. B. Rosen, and A. M. Fendrick. “Value-Based Insurance
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19 3
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20 Hyman, David, and Mark Hall. “Two Cheers For Employment-Based Health
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22 6
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Hyman, David, and Mark Hall. “Two Cheers For Employment-Based Health
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23 7
Berry, Leonard L., Ann M. Mirabito, and William B. Baun. “What’s the Hard
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24 8
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9
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13 World Health Organization. WHO Healthy Workplace Framework and
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14 World Health Organization. WHO Healthy Workplace Framework and
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16 17
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49 National Institute for Occupational Health and Safety. Stress... At Work.
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50 34
“Staff Health in Early Care and Education Programs.” California Childcare
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51 Ibid.
52
36
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37 “Q12® Meta-Analysis.” Q12® Meta-Analysis. N.p., 2009. Web. 07 Jan. 2014.
38 39
Booz & Company. Clinton Health Matters Initiative Steering Committee.
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40 53
54
55
Booz & Company. Clinton Health Matters Initiative Steering Committee.
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56 57
“Healthcare.” Occupational Safety & Health Administration. United States
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58
Ibid.
59
Ibid.
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60 “Workplace Safety and Health Topics: Agriculture.” Centers for Disease
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61 41 42 “Workplace Injuries and Illnesses – 2010.” The Bureau of Labor Statistics.
20 Oct. 2011. Web. 12 Aug. 2013.
43 Workers’ Compensation Board of British Columbia. Preventing Injuries to
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44 Pratt, Stephanie G., PhD, and Rose L. Rodríguez-Acosta, PhD.
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62 45 U.S. Department of Labor Bureau of Labor Statistics. Nonfatal
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46 Occupational Health and Safety Administration. Guidelines for Employers
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47 Sturgeon, Jodi, and Ai-Jen Poo. “Fair pay for 2.5 million home care aides
facing industry opposition.” New America Media. 16 Feb. 2012. Web. 12
Aug. 2013.
48 “Staff Health in Early Care and Education Programs.” California Childcare
Health Program. 2006. Web. 12 Aug. 2013.
63 “Shiftwork- health effects.” Better Health Channel. State Government of
Victoria. 3 Apr. 2013. Web.12 Aug 2013.
64 Rynell, Amy. “Causes of Poverty: Findings from Recent Research.”
Heartland Alliance Mid-America Institute on Poverty. Oct. 2008. Web. 12
Aug. 2013.
65 Rynell, Amy. “Causes of Poverty: Findings from Recent Research.”
Heartland Alliance Mid-America Institute on Poverty. Oct. 2008. Web. 12
Aug. 2013.
66 61
Endnotes
Failing Its Families: Lack of Paid Leave and Work-Family Supports in the
US. Rep. N.p.: Human Rights Watch, 2011. Print.
67 United States. U.S. Department of Commerce. U.S. Census Bureau News.
Washington, D.C.: U.S. Census Bureau, 2013. Print.
68 Ibid.
85 Appelbaum, Eileen, and Ruth Milkman. Leaves That Pay. Rep. N.p.: Center
for Economic and Policy Research, 2011. Print.
86 Bell, Lisa and Sandra Newman. “Paid Family & Medical Leave: Why
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87 Matos, Kenneth, and Ellen Galinsky. 2012 National Study of Employers.
Rep. N.p.: Families and Work Institute, 2012. Print.
69 Finnegan, Annie. “Everyone but U.S.: The State of Maternity Leave Working
Mother.” Working Mother. Working Mother Media. N.d. Web 12 Aug. 2013.
70 Surviving the First Day: State of the World’s Mothers 2013. Rep. N.p.:
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Glass, Jennifer and Lisa Riley, “Family Responsive Policies and Employee
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88 71 Tanaka, Sakiko. “Parental Leave and Child Health Across OECD Countries.”
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72 Lohmann, Henning, Peter H. Frauke, Tine Rostgaard, and C. Katharina
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91 “Enhanced Employee Health, Well-Being, and Engagement through
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74 “Enhanced Employee Health, Well-Being, and Engagement through
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Loftness, Vivian, Volker Hartkopt, Beran Gurtekin. “Building Investment
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92 75 Ibid.
76 McNamara, Melissa. “Elder Care Benefits.” CBS Evening News. CBS
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77 “Enhanced Employee Health, Well-Being, and Engagement through
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78 “Why Breastfeeding Is Important.” Womenshealth.gov. U.S. Department of
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79 “Why Breastfeeding Is Important.” Womenshealth.gov. U.S. Department of
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80 “Adoption Benefits.” Adopting.org. 1994. Web. 13 Aug. 2013.
81 “Adoption Benefits.” Adopting.org. 1994. Web. 13 Aug. 2013.
82 Ibid.
83 Ibid.
84 Baicker, Katherine, David Cutler, and Zirui Song. “Workplace Wellness
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93 Linnan, Laura, Mike Bowling, Jennifer Childress, Gary Lindsay, Carter
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94 U.S. Department of Health and Human Services. Office of Disease
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95 Shinogle, Judith, and Lina Martinez. “Healthiest Maryland Business
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Research. University of Maryland: Baltimore County. Nov. 2012. Web. 13
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96 Shinogle, Judith, and Lina Martinez. “Healthiest Maryland Business
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Research. University of Maryland: Baltimore County. Nov. 2012. Web. 13
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97 “Any Disorder Among Adults.” National Institute of Mental Health. National
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98 “USA [State & County QuickFacts].” United States Census Bureau. U.S.
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“The Numbers Count: Mental Disorders in America.” National Institute of
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100 “USA [State & County QuickFacts].” United States Census Bureau. U.S.
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“Preventing Prescription Drug Misuse, Abuse, and Diversion Across the
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114 101 “The Numbers Count: Mental Disorders in America.” National Institute of
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102 “Preventing Prescription Drug Misuse, Abuse, and Diversion Across the
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115 “Tobacco Use.” Centers for Disease Control and Prevention. Centers for
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103 “Tobacco Use.” Centers for Disease Control and Prevention. Centers for
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104 Ibid.
118 Mid-America Coalition on Health Care. Promoting Tobacco Cessation
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119 Wang, Philip S., et al. “The costs and benefits of enhanced depression care
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120 Hertz Robin P., and Christine L. Baker. The impact of mental disorders on
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121 105 106 107 Substance Abuse and Mental Health Services Administration, Results
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108 Office of National Drug Control Policy. A Response to the Epidemic of
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122 “Planning a Tobacco-Free Campus Initiative.” Centers for Disease Control
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123 109 Bailey, S. Jeffrey, and Katherine Covell. “Pathways among abuse, daily
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110 Mid-America Coalition on Health Care. Promoting Tobacco Cessation
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124 Fitch, Kate, Kosuke Iwasaki, and Bruce Pyenson. Covering Smoking
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113 Shinogle, Judith, and Lina Martinez. “Healthiest Maryland Business
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128 Booz & Co. “Hourly Health and Wellness.” Steering Committee Meeting.
129 63
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135 What Executives Really Need to Know about Employee Engagement,
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136 Ibid.
137 Ibid.
138 Ibid.
139 Ibid.
140 Kim, Marlene. “Women Paid Low Wages: Who They Are and Where They
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148 Competitive Edge Services and Barton Blatt Institute (2013). Veterans in
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149 2012 SHRM Poll, Military Employment. Rep. N.p.: Society for Human
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150 http://www.shrm.org/templatestools/toolkits/documents/12-0177%20
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144 “The Economics of Biophilia: Why designing with nature in mind makes
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170 Ibid.
171 Personal Communication. Tracey Meyer Chesser. April 8, 2014.
172 65
Credits
The Clinton Health Matters Initiative would like to thank Willa Wolfson and Shammara Wright for their assistance and research
for this Framework.
For questions and assistance on implementation of the Framework, please contact Alex Chan and Rain Henderson via
[email protected]
EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE