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Introduction: the importance of healthy employees

Work has a major impact on our physical and mental health. Working in a healthy environment boosts the health of employees. Having a job also has great many benefits: it provides an income, offers structure, often contributes to a person’s feeling of self-worth, and can therefore lead to better health. Physical impairments often occur an average of 5 to 7 years later in employees who enjoy a healthy lifestyle, and the number of unhealthy end-of-life years is significantly lower. On the other hand (new) working conditions can negatively affect the health of employees. Flexible working, e-working, working longer, the combination with a busy family life and leisure time: all this can cause employees to suffer from increased pressure and stress at work. In many countries, the number of employees unable to work due to musculoskeletal and mental disorders is on the rise. Employees with health issues take more time off work, are more likely to leave the job market, and retire earlier. Businesses lose all that potential of experienced employees. So healthy employees are important for a variety of reasons.

Occupational medicine services can play an important preventive role that extends further than merely preventing work accidents and job-related illnesses. After all, they are also working to improve employee wellbeing. Wellbeing is a broader concept than health. It covers all aspects of work, ranging from the quality and safety of the work environment to the work experience of the employee. According to the International Labour Organisation, decent work is extremely important, to guarantee not only the health of employees but also a sustainable, innovative and productive economic activity. While occupational health is generally well developed in Western countries, it is far less common in developing countries because of the political and economic challenges. However, the provision of occupational health has enormous potential to reduce inequality, protect vulnerable groups (such as immigrant workers, different ethnicities), and support equal access to healthcare. In many regions, the workplace has the potential to provide good and sometimes the only access to healthcare. In addition, the obligatory nature of some occupational health programmes (such as health screening programmes or fitness for work examinations) can prevent employees who are less aware of or concerned for their health (which can be linked to a lower socio-economic status) from developing more illnesses vis à vis their “healthier” colleagues.

A statement of the issue and the scope of the problem

Traditional disease prevention endeavours to eliminate the causes of certain illnesses or make an early diagnosis so as to reduce the adverse effects for health. However, disease prevention is not a sufficient response to the so-called ‘lifestyle-related diseases’ in Western countries, such as cardiovascular diseases, high blood pressure, obesity, type 2 diabetes, and the growing number of mental disorders. After all, such lifestyle-related diseases are largely defined by lifestyle factors such as smoking, unhealthy diet, alcohol abuse, lack of exercise, and factors in the social and physical environment. The focus on the workplace is therefore being extended from risk prevention to promoting the best possible health of employees in all its aspects. Health promotion is therefore not an alternative to disease prevention but rather a supplement, especially in developed countries.

Health promotion at work: challenges and opportunities

Health-promoting initiatives offer employees a basis from which to make ‘easier’ choices for a healthy (or healthier) lifestyle, and acquire the skills to do so in an adapted workplace. Below we will outline some of the criticisms about health education, an important part of health promotion. We will also look at a number of initiatives.

Health education is still important, but is inadequate.

Given that many employees spend a large proportion of their day at work, the workplace can play an essential role in promoting a healthy lifestyle. Health promotion is aimed at every employee, including those that are often more difficult to reach. Employees with a lower SES take more risks with their health. They smoke and drink more, their diet is unhealthier and they do less exercise and sport. Few other settings in our Western society offer such unique opportunities to implement health promotion.

Nonetheless, we should be aware that (more) information does not result directly in a transition from unhealthy to healthy (healthier) behaviour or a healthy lifestyle. The (expected) outcome of information and explanation is found primarily at the level of ‘health literacy’: employees have to be able to read and critically evaluate the health information, and communicate on an equal footing with healthcare providers. Only then is there a basis for behavioural change. It goes without saying that vulnerable employees, often those with cognitive and physical impairments, are less successful in this area.

Moreover, health promotion at work must connect with the life experience of employees. The employee population in Western companies is becoming increasingly diverse. Health messages at work must take this into account both in terms of form and content. The chance of the information actually being absorbed also depends on how much employees trust the messenger, and the way in which the message is delivered. Characteristics of the organisational culture, such as engagement, leadership, constructive consultation between social partners, and attention to prevention, can all play an important role here.

Finally, effective awareness-raising based on science and facts is important. We should therefore stop using methods that do not fulfil this criterion (e.g. scaremongering information).

Health-promoting measures in the workplace: everybody on board!

Measures concerning health promotion can be implemented easily and relatively cheaply at work. For example, an effective way of encouraging employees to use the stairs and do more exercise is the use of ‘point-of-decision prompts’ (e.g. cartoons, signs next to the lift and stairwell). Exercise breaks and available sports infrastructure enable employees to be active during the working day, and also increase the chance that employees will opt for an active form of home-work travel. A sustainable mobility policy (stimulating cycling, walking and the use of public transport to and from work) also helps increase the number of fit(ter) employees. A healthy and varied range of foods in the canteen makes it easier for employees to avoid eating unhealthy snacks every day. Putting water in the fridge at eye level makes us reach for the soft drinks less frequently. And don’t limit the offer of non-alcoholic drinks at work parties to the usual fruit juice; offer alcohol-free alternatives such as mocktails.

However, be careful to avoid one-shot campaigns: they are not enough to make employees do more exercise, eat healthier, or drink less alcohol. Systematic and comprehensive is the message. Good planning increases the chance of more effective interventions. Evaluation is also equally important. It tells us why certain interventions work or not, and gives us leads on where to make improvements. There is often a lack of evaluation, especially process evaluation.

Health-promoting initiatives are often action-oriented (e.g. reducing alcohol consumption), when the employees being targeted don't yet have any intention of changing ('What's the problem?’). Such initiatives are doomed to fail. Intention is necessary for behaviour to change, and it only comes about if you are sufficiently motivated. Motivation is defined by knowledge (e.g. I know that exercise has a positive effect on my health) and a high degree of self-efficacy (e.g. I can do sport during my lunch hour, even if it’s raining). Finally, the effect of environment is also important (my colleagues, managers, think it's great that I’m doing sport). So motivation can be improved by providing knowledge and working on attitude, employees’ own efficacy and social support. Furthermore, communication and cooperation are also needed to facilitate health promotion. So, small and medium-sized enterprises in a business park can hire a joint exercise coach.

Management support is crucial not only for starting up initiatives concerning health promotion, but also for sustaining them in the long term. In addition to providing an adequate budget, managers must also lead by example (e.g. participate in the weekly jog; drink an alcohol-free drink at the New Year reception). It is also important for businesses to have a certain return on investment (ROI).

In addition, participation among employees in health-promoting activities must always be voluntary. It is important to make employees aware of the benefits of a healthy diet, regular exercise, sufficient sleep, limited alcohol consumption, no smoking: it is in their best interests. For example, let employees do sport, rather than forcing them to, but show them what the options are. Effective initiatives require motivation and an active input from both sides: employers offer healthy organisational conditions and a healthy work environment, and employees actively participate in health promotion at work.

Finally, political policymakers must also take on their role by issuing supportive legislation, a higher prevention budget and offering infrastructure. One good example is stimulating home-work travel by bike. Apart from its positive health on employee health, it also solves numerous other problems (e.g. congestion and environmental pollution). Drastic changes to infrastructure are needed for this, e.g. bike highways, but these must then connect up with the city cycle networks. Copenhagen is a pioneer in this area. Here, most people choose to cycle simply because it’s the fastest way to get to work.

A new challenge: personal (e-) health empowerment

The availability and personal use of information and communication technologies has increased dramatically over the last two decades, especially in Western countries. Nowadays, practically every employee has a smartphone. New technologies are being promoted as a cost-effective means of delivering behavioural health interventions and consequently preventing non-infectious diseases. This technical digital revolution has led to an increase in the amount of research into electronic health (eHealth) and mobile health (mHealth). The research is mainly aimed at the efficacy, engagement and acceptability of different technologies such as mobile phones and/or text messages, digital games, internet, smartphone and/or tablet applications, social media, gamification functions and fitness trackers with regard to exercise, sedentary behaviour and diet.

Important obstacles to the implementation of these new technologies in the workplace include the high cost price, the limited usability, and the lack of standardisation and evidence on the efficacy. There is also some concern as to whether all employees will be able to correctly process and interpret this overload of information. Finally, there are a great many questions about the privacy and use of the data being collected. Employees are worried that all this available data, in addition to health and physical activity parameters, could also be used to monitor how hard they are working. The challenge is to introduce this to the workplace in a correct deontological, ethical and legal way. One possible solution is, for example, to make these data available to the employee, with a direct link to the occupational health file, allowing for confidential monitoring and coaching by an occupational doctor. These data would then be protected by medical confidentiality.

Concluding recommendations

• Provide health education that connects to the life of your employees
• Provide info to create or to enhance the motivation to change
• The support of management for health-promoting measures in the workplace is crucial
• Work systematic and comprehensive
• Use the new e-health technologies as an opportunity