In 1986, the World Health Organization introduced the Ottawa Charter for Health Promotion, which sparked the movement supporting health promotion in the workplace and devising policies and programmes to frame this new dialogue (Whitehead, 2005). To develop such policies, it is necessary to define health promotion. While Seed house (1997) called the term muddled, poorly articulated and devoid of a clear philosophy, the UK government has confidently addressed issues of public health under the umbrella of ‘health promotion’ in papers such as ‘Saving lives: Our healthier nation’ (1999) and ‘Our health, our care, our say’ (2006). For the sake of clarity, this essay will adopt Tones’ (2000) definition, specifically, that ‘health promotion incorporates all measures deliberately designed to promote health and handle disease’. Such promotion could be best put to use in Britain’s workplaces, where concentrated groups of individuals might be influenced and supported to lead healthier lifestyles through their existing workplace structures so that, ultimately, employers will benefit from more able staff and the numbers of those affected by manageable health issues will be reduced. Although Warner et al. (1988) were sceptical of the ability of workplace health promotion programmes to yield financial dividends and generate cost savings for employers, they do not dismiss the possibility that carefully designed policies could prove beneficial to both employees and businesses. A study by Bertera (1990) demonstrated that comprehensive workplace health promotion programmes successfully reduce the number of sick leave absences among blue collar workers of an industrial company. Over 40,000 employees were included in the study; sites where promotion programmes were offered experienced a 14% reduction in the number of days of absence compared to a 5% reduction at non-programme sites. This represented a net difference of 11,726 fewer absence days with an associated financial return of $2.05 for every dollar invested in the scheme.
With studies promoting the benefits, both financial and health-related, of implementing health promotion programmes in the workplace, the question follows how policy can best introduce and support such strategies. Undoubtedly, the development of any such policy must take into account numerous influential factors that will determine the success or failure of subsequent programmes. These factors include wide-ranging issues such as public opinion and funding, and more specific factors such as the organisational structure and culture of businesses wishing to implement such strategies. Noblet and LaMontagne (2006) warned that, by not considering these factors when creating new policy, practitioners risk losing sight of functional solutions, stressing that great emphasis should be placed on identifying and addressing organisational sources of health concerns, rather than on merely dealing cursorily with certain problems. This essay will critically examine the aforementioned factors that should be taken into account when developing policy for health promotion in the workplace and focus on previous policy suggestions and practices, the social and political context of occupational health and, finally, organisational structure and workplace culture.
II. Previous policy suggestions and practices
In the traditional model of workplace healthcare promotion, specific interventions for smoking, diet and exercise are targeted at at-risk individuals through the use of counselling, lifestyle education and medical treatments. Yet LaMontagne (2004) criticised this approach, stating that it does not consider the contribution of job conditions to such behaviours or the contributions that adverse working conditions can have on lifestyle-related diseases such as cancer and heart disease. According to Noblet and LaMontagne (2006, p.347), this traditional individual-centred model should rightly be criticised. They cite as supporting evidence the case of Opticom, a large operator-assisted service provider, where high rates of absenteeism at the company led managers to invite a health promotion business to provide individual health checks and counselling sessions focussed on diet, exercise and fitness. An evaluation of the programme after six months found little improvement in the number of absences, and anecdotal evidence revealed that the working environment was still demoralising and stressful. Ultimately, the initiative was aimed at identifying individuals who were at risk of developing lifestyle-related diseases and encouraging them to adopt healthier lifestyles, rather than looking at the working environment itself and how it was affecting social, organisational and physical conditions.
However, such criticisms should not discourage all forms of individual employee-centred policies. Worker-directed initiatives have been found to be particularly successful at improving health in the workplace through comprehensive programmes that both address the organisational roots of health problems at work and look to treat the symptoms of any issues exhibited by employees. Kompier et al. (2000) felt that just such a holistic approach leads to favourable long-term outcomes in the workplace. On the other hand, Bond (2007) supported policies that balance organisational- and individual-directed interventions that, when combined, ensure the ‘preventative benefits of the former can have a widespread impact across an organisation, whilst the curative strengths of the latter can target those people who have already succumbed to occupational ill health’. Thus, we have established that policies that merely tackle individuals with existing health concerns are significantly less successful than those that approach health promotion at work in a more holistic fashion, appreciating the influence that the working environment can have on employee health. Yet, what of the more specific factors that affect these policy decisions? Let us now address the social and political context of health promotion policy in the UK, as these factors and many more will be instrumental in creating beneficial health promotion strategies for the workplace.
III. Social and political context of occupational health
The very foundations of workplace health promotion policy are bound up with current government strategies, healthcare targets and public opinion. Discussing these factors alone would provide ample material to address the question set; however, such an approach would exclude an analysis of other, more specific, influences on policy, such as organisational structures in the workplace and corporate culture; these factors will be considered later in this paper. First, we address the comments that McGillivray (2002) made regarding current government policy; he found inherent tensions between government policy rhetoric and the organisational and cultural reality of Britain’s workplaces. For example, the government’s aims to improve occupational health have been ‘misguided’, and policy has tended to reinforce existing inequalities with regard to those who have access to health promotion programmes. McGillivray (2002) concluded that this indirect discrimination in the workplace due to non-participation in healthcare programmes has meant that reducing absenteeism and reaching the goals outlined in policies of improving the health of the nation’s workforce will remain a distant pipedream. This policy document specifically addresses the need to reduce inequalities in access to occupational health and promotes working environments that present healthier employment settings. However, other suggestions such as forming links with bicycle providers to encourage people to cycle to and from work still look set to favour employees of large businesses capable of supporting such schemes through existing organisational structures (2004). It seems that factors affecting the ability of the majority of businesses in the UK to implement healthcare promotion programmes continue to be ignored by policymakers.
The positive benefits of instances where public opinion and government policy merge forcefully can be seen in the recent prohibition of smoking in public places. Whilst unpopular with a small minority, widespread support for the ban, encouraged by statistics released by Action on Smoking and Health demonstrating that 1,200 people die per year from passive smoke inhalation at work, has drastically improved occupational health (ASH, 2003). Presently, a multitude of workplace health promotion programmes exist as a result of government targets aimed at reducing the number of smokers in the UK; overall, the objectives outlined in ‘Choosing Health’ (2004) had successfully come to fruition. Despite the success of policy at influencing healthcare promotion initiatives in the case of smoking, obstacles remain that must be taken into account when forming future policies in this area. For example, the issue of funding or a lack thereof is cited by many commentators who feel this factor alone is negatively influencing the government’s ability to form meaningful policies that can adequately address health promotion in the workplace. Speaking in 1992, but in conditions that resonate with the current economic climate in the UK, Hill (1992) suggested there exists a need to create a comprehensive database of all health promotion activities so that, through collaboration and coordination, the present meagre resources available for such workplace strategies can be best used by allowing policymakers to view current activities and assess how best to improve them. Having addressed some factors that appear to be considered when forming wide-ranging health promotion policy, such as public opinion, as well as those that seem to create barriers to forming a better system such as the lack of funding, let us now turn to assess the finer details of what influences act on the development of policy in this area.
IV. Organisational structure and workplace culture
No policy regarding health promotion in the workplace will succeed unless it takes into account the organisational structure of the businesses that the policy aims to target. DeJoy and Wilson (2003) felt particularly strongly that any efforts to improve the health of the UK’s workforce must begin with an assessment of the targeted organisation. They even coined the phrase ‘organisational health promotion’ (DeJoy and Wilson, 2003) to describe this particular brand of policymaking, which they believe takes account of this most influential factor when it comes to making successful strategies. Ultimately, the basic organisational and structural fabric of the workplace will determine whether healthcare promotion will succeed or fail. Such a view is supported by Sparks et al. (2001) who propose that the managerial style and structure of a business is one of the most important factors that affect health promotion in the workplace and that, as a result, managerial organisation should be deemed a vital component to be considered in the development of any related policy. Similarly, Danna and Griffin (1999) highlighted the importance of appreciating existing organisational structures in the workplace when addressing health and well-being in this arena. Thus, given the above-mentioned strong beliefs that to-be-incorporated health promotion strategies must consider the organisational structure of the relevant working environment, this factor should be deemed of great importance by policymakers looking to design functional programmes.
As far as workplace culture, this factor has previously been downplayed and overlooked as a phenomenon capable of affecting healthcare policy. However, Airhihenbuwa (1994) was adamant that appreciating the influence culture can have on policy decisions deepens and extends the possibilities of progressive approaches to policymaking that will ultimately be more beneficial to individuals. McPartland (1991) found the corporate culture of the business implementing a health promotion programme to be influential in its success. By contrast, the effectiveness of such programmes is minimised if the work atmosphere was highly stressful and dehumanising for the workers. On a similar vein, Allegrante and Sloan (1985) recommend that health promotion policies should not only cover behaviour change strategies, but also encompass the entire working environment and management practices. Therefore, considering the managerial and organisational structure of the business setting is vital in making policy decisions, as is taking into account the broader culture of the setting, especially corporate cultures that induce stressful settings or those that encourage unhealthy competition amongst staff and lead them to work in a ‘dehumanising’ environment (McPartland, 1991).
V. Factors involved in designing and implementing a strategic policy plan
Hill (1992) underlined the fact that, whilst health promotion should be concerned with reducing inequalities in healthcare, a large majority of British workplaces have little or no access to appropriate occupational health services and health promotion services remain the concern of large corporations with suitable existing facilities. Given the opinions of Hill and others, it appears that any policy regarding health promotion in the workplace must consider matters of implementation. Specifically, policies that do not take into account the day-to-day functioning of the majority of Britain’s small businesses or not-for-profit charities will be immediately obsolete, as any attempt to implement healthcare strategies must benefit the majority through thoughtful planning rather than by making sweeping suggestions that only tie in with the functioning systems of a handful of large corporations. Yet, McPartland (1991) was more positive, identifying that, although many small businesses lack the funds or manpower necessary to assign a staff member to health promotion, it is still possible to make effective and efficient use of their existing resources. In addition, allowing staff to become active in the decision-making and organisational processes often inspires them to create particularly successful health promotion programmes (McPartland, 1991). The Washington Business Group on Health (1985) also reported that, with power resting in the hands of employees, staff in many workplaces has acted with impressive organisation. For example, Employee Wellness Committees have built fitness centres, weight-loss programmes, smoking cessation support groups, and nutrition awareness classes (McGinnis, 1986). Similarly, a study by O’Donnell (2002) demonstrated that a strong programme budget was only moderately important when determining whether policies for healthcare promotion strategies in the workplace would succeed; other factors such as strong management and enthusiastic participation from both employers and employees were more influential.
Whilst some commentators argue that financial capacity is not an important factor in forming healthcare policy for the workplace, it would perhaps be foolish to completely disregard funding when creating a strategic plan. It has been demonstrated that, when staff have control over a budget, however small, for the design and direction of health promotion programmes, employee-centred initiatives can be highly successful (McGinnis, 1986). For this reason, O’Donnell (2002) suggested that policymakers should take into account the following questions when developing strategies for health promotion: How ready is the organisation to develop a health promotion programme?; Are the programme outcomes realistic?; How participative a process does the organisation desire? and How extensive and holistic a programme does it wish to create? By answering these questions, healthcare promotion policy might be more likely to provide a successful framework for future programmes, as policy makers will have sufficient information regarding the factors that are most important and influential to a particular business. Even though such an approach may not assist in forming wider national governmental policy, which would be unable to account for the factors affecting each individual targeted workplace targeted, it would still guide the specific design and implementation of local policy and practices.
The concept of ‘health promotion in the workplace’ embraces two main streams of thought as to the definition of health and what factors influence it. The first ideology sees health as a product of individual behaviour and genetics. In this sense, the workplace is viewed as a venue in which various programmes can be delivered such as smoking cessation groups and fitness courses. The second ideology sees health as being affected by a number of different factors, some of which are outside the control of the individual. The role of the surrounding environment in influencing health is seen as particularly important; commentators such as Shain and Kramer (2004) who support this latter concept promote the need to address the organisational and cultural structures in the workplace as a means of positively impacting physical and psychological health. Bond (2000) certainly believed that a combination of individual-centred approaches and strategies that improve the overall working environment might be most successful because these take into account factors that concern both individual staff members, such as their lifestyle choices, and the overall influence that a person’s environment can have on his or her health. On the other hand, LaMontagne (2004) considered it vital that healthcare promotion policy for the workplace addresses changes that must be made to the working environment as a whole. In addition, the factors that make up these environments, such as their organisational structure and culture, are vital components that are more relevant than individual-centred problems. Whichever view is correct, this essay has demonstrated that, despite the existing disagreement about the overall approach that should be used regarding factors to consider when forming healthcare policy, finer details such as the organisational setup of businesses, available funding and the established corporate culture are all widely considered to be pivotal in determining appropriate and successful policy. Quick fixes in terms of creating an agreed and consistent healthcare policy for the workplace are not realistic according to O’Donnell (2002), who believed that the design and implementation of any healthcare promotion programme usually takes between six and eighteen months. As a result, it is suggested that policy should take this timescale into account and incorporate short-term goal-oriented stages that ultimately culminate in the creation of a successful healthcare strategy (O’Donnell, 2002). Overall, the factors that affect the development of successful healthcare promotion policies are widespread and contested. However, given the disparate nature of influences that affect our health, from personal medical histories to culture and environment, it is vital that policy take into account the varied nature of these influences and adapt strategies that are sympathetic to the wide range of needs in existence.