Programme success depends on individualizing any programme to the corporate culture and to the health promotion opportunities and organizational constraints of a particular worksite. Results of most evaluations have supported movement toward stated programme objectives, but more evaluations using scientifically valid designs and methods are needed. In its Health of the Nation policy declaration, the government of the United Kingdom subscribed to the twin strategy to paraphrase their statement of aims of 1 "adding years to life" by seeking an increase in life expectancy and a reduction in premature death, and 2 "adding life to years" by increasing the number of years lived free from ill-health, by reducing or minimizing the adverse effects of illness and disability, by promoting healthy lifestyles and by improving physical and social environments-in short, by improving the quality of life.
It was felt that efforts to achieve these aims would be more successful if they were exerted in already existent "settings", namely schools, homes, hospitals and workplaces. While it was known that there was considerable health promotion activity at the workplace European Foundation , no comprehensive baseline information existed on the level and nature of workplace health promotion. Various small-scale surveys had been conducted, but these had all been limited in one way or another, either by being concentrated on a single activity such as smoking, or restricted to a small geographical area or based on a small number of workplaces.
A comprehensive survey of workplace health promotion in England was undertaken on behalf of the Health Education Authority. There are over 2,, workplaces in England the workplace is defined as a geographically contiguous setting. The survey was originally structured to reflect this distribution by over-sampling the larger worksites in a random sample of all workplaces, including both the public and private sectors and all sizes of workplace; however, those who were self-employed and were working from home were excepted from the survey.
The only other exclusions were various public bodies such as defence establishments, police and prison services. In total 1, workplaces were surveyed in March and April of Interviewing was carried out by telephone, with the average completed interview taking 28 minutes. Interviews were held with whatever person was responsible for health-related activities. At smaller workplaces, this was seldom someone with a health specialization. Figure A succession of spontaneous questions, and questions that were prompted in the course of interviewing, elicited from respondents considerably more information as to the extent and nature of health-related activities.
The range of activities and incidence of such activity is shown in table Some of the activities, such as job satisfaction understood in England as a catch-all term covering such aspects as responsibility for both the pace and content of the work, self-esteem, management-worker relationships and skills and training are normally regarded as outside the scope of health promotion, but there are commentators who believe that such structural factors are of great importance in improving health.
Other matters that were investigated included the decision-making process, budgets, workforce consultation, awareness of information and advice, benefits of health promotion activity to employer and employee, difficulties in implementation, and perception of the importance of health promotion.
There are several general points to make:. Apart from activity on smoking in workplaces with more than employees, no single health promotion activity occurs in a majority of workplaces ranked by size. In small workplaces the only direct health promoting activities of any significance are for smoking and alcohol.
The immediate physical environment, reflected in such factors as ventilation and lighting, are considered to be substantively health related, as is job satisfaction. As the workplace increases in size, it is not just that a higher percentage of workplaces undertake any activity, there is also a wider range of activity in any one workplace. This is shown in figure However, it would be too much to read into these figures any semblance of what might be called a "healthy workplace".
In-depth interviewing suggests that in very few instances is the health activity integrated into a planned health promotion function and in even fewer cases, if any, is there modification of either the practices or objectives of the workplace to increase the emphasis on health enhancement. Public sector workplaces show double the level of incidence for activities of those in the private sector.
This holds across all the activities. In regard to smoking and alcohol, foreign-owned companies have a higher incidence of workplace activity than British ones. In most of the activities the public sector outperforms the other industry sectors with the notable exception of alcohol. Workplaces which have no health promotion activity are virtually all small or medium-size in the private sector, British-owned and predominantly in the distribution and catering industries. The quantitative telephone survey and the parallel face-to-face interviewing revealed a considerable amount of information as to the level of health promotion activity at the workplace in England.
In a study of this nature, it is not possible to untangle all the confounding variables. However, it would seem that size of workplace, in terms of number of employees, public as opposed to private ownership, levels of unionization, and the nature of the work itself are important factors. Communication of health promotion messages is largely through group methods such as posters, leaflets or videos. In larger workplaces there is a far greater likelihood of individual counselling being available, particularly for things like smoking cessation, alcohol problems and stress management.
It is clear from the research methods used that health promotion activities are not "embedded" in the workplace and are highly contingent activities which, in the large majority of cases, are dependent for effectiveness on individuals. Such an indication may be of great benefit in persuading more private sector workplaces to increase their activity levels. There are very few of what might be termed "healthy workplaces". In very few instances is the health promotion activity integrated into a planned health promotion function and in even fewer cases, if any, is there modification of either the practice or objectives of the workplace to increase emphasis on health enhancement.
Considerable benefits to employee health and fitness were ascribed to health promotion activities, as was reduced absenteeism and sickness. However, there is little formal evaluation, and while written policies have been introduced, they are by no means universal.
While there is support for the aims of health promotion and positive advantages are perceived, there is yet too little evidence of institutionalization of the activities into the culture of the workplace. Workplace health promotion in England seems to be contingent and vulnerable.
Sonia Muchnick-Baku and Leon J. The rationale for worksite health promotion and protection programmes and approaches to their implementation have been discussed in other articles in this chapter. The greatest activity in these initiatives has taken place in large organizations that have the resources to implement comprehensive programmes. However, the majority of the workforce is employed in small organizations where the health and well-being of individual workers is likely to have a greater impact on productive capacity and, ultimately, the success of the enterprise.
Recognizing this, small firms have begun to pay more attention to the relationship between preventive health practices and productive, vital employees. Increasing numbers of small firms are finding that, with the help of business coalitions, community resources, public and voluntary health agencies, and creative, modest strategies designed to meet their specific needs, they can implement successful yet low-cost programmes that yield significant benefits. Over the last decade, the number of health promotion programmes in small organizations has increased significantly.
This trend is important as regards both the progress it represents in worksite health promotion and its implication for the nation's future health care agenda. This article will explore some of the varied challenges faced by small organizations in implementing these programmes and describe some of the strategies adopted by those who have overcome them. By way of example, it will highlight some organizations that are succeeding through ingenuity and determination in implementing effective programmes with limited resources.
While many owners of small firms are supportive of the concept of worksite health promotion, they may hesitate to implement a programme in the face of the following perceived barriers Muchnick-Baku and Orrick :. However, some firms provide programmes by making creative use of free or low-cost community resources.
This comprehensive and much-needed resource helps health care ethicists to meet the demand of challenges such as managed care, medical technology, and . Organizational Ethics in Health Care: Principles, Cases, and Practical Solutions J-B AHA Press: zwalabaparis.ga: Philip J. Boyle, Edwin R. Dubose, Stephen J.
For example, the New York Business Group on Health, a health-action coalition with over member organizations in the New York City Metropolitan Area regularly offered a workshop entitled Wellness On a Shoe String that was aimed primarily at small businesses and highlighted materials available at little or no cost from local health agencies. However, small firms can begin their efforts very modestly and gradually make them more comprehensive as additional needs are recognized.
This is illustrated by Sani-Dairy, a small business in Johnstown, Pennsylvania, that began with a home-grown monthly health promotion publication for employees and their families produced by four employees as an " extracurricular" activity in addition to their regular duties. Then, they began to plan various health promotion events throughout the year. Unlike many small businesses of this size, Sani-Dairy emphasizes disease prevention in its medical programme.
Small companies can also reduce the complexity of health promotion programmes by offering health promotion services less frequently than larger companies. Newsletters and health education materials can be distributed quarterly instead of monthly; a more limited number of health seminars can be held at appropriate seasons of the year or linked to annual national campaigns such as Heart Month, the Great American Smoke Out or Cancer Prevention Week in the United States.
They are forced to rely on anecdotal experience which may often be misleading or on inference from the research done in large-firm settings. When they show that they're saving money, we believe the same thing is happening to us. Many of the governmental and voluntary health agencies provide free or low-cost kits with detailed instructions and sample materials see figure In addition, many offer expert advice and consulting services.
Finally, in most larger communities and many universities, there are qualified consultants with whom one may negotiate short-term contracts for relatively modest fees covering onsite help in tailoring a particular health promotion programme to the needs and circumstances of a small business and guiding its implementation.
Members of small units are more dependent on each other. Administrative Science Quarterly 6 1 : Lebensanfang — Dilemmas in der Fortpflanzungsmedizin. Reinstein, X. International Journal of Social Robotics , 8 4 , Miller is the largest employer in this small community and provides group health insurance for its employees and their 2, dependants. Inclusion of DHCP with minimal exposure risks e.
The employer can "buy into" programmes offered in the neighborhood by local hospitals, voluntary health agencies, medical groups and community organizations by subsidizing all or part of any fees that are not covered by the group health insurance plan. Many of these activities are available outside of working hours in the evening or on weekends, obviating the necessity of releasing participating employees from the workplace. While small businesses do face significant challenges related to financial and administrative resources, they also have advantages. These include Muchnick-Baku and Orrick :.
The smaller the organization, the more likely it is that employers know their employees and their families. This can facilitate health promotion becoming a corporate-family affair building bonds while promoting health. Small organizations have less diversity among employees than do larger organizations, making it easier to develop more cohesive programmes. Members of small units are more dependent on each other. An employee absent because of illness, particularly if prolonged, means a significant loss of productivity and imposes a burden on co-workers. At the same time, the closeness of members of the unit makes peer pressure a more effective stimulant to participation in health promotion activities.
In a smaller organization, management is more accessible, more familiar with the employees and more likely to be aware of their personal problems and needs. In a small firm, that key person is more apt to provide the top-level support so vital to the success of worksite health promotion programmes. Because they are usually so limited, small businesses tend to be more efficient in the use of their resources.
They are more likely to turn to community resources such as voluntary, government and entrepreneurial health and social agencies, hospitals and schools for inexpensive means of providing information and education to employees and their families see figure The smaller the firm, the less likely it is to provide group health insurance to employees and their dependants.