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Worksite Health Promotion: The Challenge of Work and Family Balance

Pronk, Nico Ph.D., FACSM, FAWHP

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Nico Pronk, Ph.D., FACSM, FAWHP, is vice president of the Center for Health Promotion at HealthPartners health plan in Minneapolis, Minnesota. He is responsible for member, patient, and community-wide health education and improvement programs. Dr. Pronk also is an investigator and co-director of the Population Health Unit in the HealthPartners Research Foundation. He has a broad background in exercise science and behavioral medicine. He has published extensively in the areas of exercise and physical activity, behavior change, and the integration of health risk management strategies in population health initiatives. Dr. Pronk received Fellow status for ACSM and the former Association for Worksite Health Promotion (AWHP).

Work is an extremely important component of people's lives and health. The ability for people to do work represents a multitude of benefits including, for example, an opportunity to earn one's livelihood, to provide for the family, to contribute positively and meaningfully to society, and to satisfy one's own drive for achievement. Such work-related outcomes tend to have a very positive impact on people's outlook on life and overall health status. At the same time, work can create stress due to the difficulty of the tasks involved, the deadlines associated with the tasks, the customers or co-workers employees have to interact with, and so on. Hence it is recognized that although work has many positive attributes, it also may affect people in a negative manner. Both these positive and negative spillover effects of the work in which employees are involved are directly associated to the family life of employees. Whereas work life can affect family life, the opposite also is true. Family-related experiences can impact work in both positive and negative ways.

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Work-Family Balance

It seems reasonable to consider that most people strive toward experiencing happy, healthy, and productive family and work lives. To optimize the likelihood that employees can have both, the work-family interface needs to be in balance. Work-family balance may be considered a subset of the work-life balance and implies that people are fulfilled in both their work and family lives. The work-family interface is most often described as the intersections of social roles that are associated with these two domains of life. It may seem relatively obvious that achieving a balance between these two life domains represents an ongoing and dynamic effort. The result of such efforts is a dynamic balance that involves coping with conflict, stress, or strain, both within the context of family life as well as work life. Another way of looking at this is to consider work-family balance the result of successfully dealing with work-family conflict.

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Work-Family and Family-Work Conflicts

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The two types of conflict involved in the work-family interface are the work-to-family (W→F) conflict and the family-to-work (F→W) conflict. Of these two, the W→F conflict occurs more frequently and suggests that work has more detrimental effects upon nonwork life than family has on work life. It also suggests that the demands placed upon the employee as part of the work-related experience often are met at the expense of time and energy investment for family and self.

Unfortunately, both W→F and F→W conflicts appear to negatively impact employee health factors as well as workplace productivity. In particular, concerns include increased family tension, increased stress of both the employee and other members of the family, increased occurrence of stress-related illness and absence, and increased use of medical care resources including medications, behavioral health services, and clinical tests for psychosomatic illnesses. Moreover, one of the most compelling considerations in the search for solutions related to lack of work-family balance involves the impact of maternal work on children, especially when considered from an economic perspective in the context of the community and society at large. Solutions implemented through the worksite setting may include flexible work hours or on-site childcare and can have an immediate positive impact upon the employee's perception of control over the challenges of scheduling for appropriate childcare, school drop-off and pick-up times, and after-school activities for their children. Such supportive company-initiated solutions have direct benefits for employee well-being and may certainly affect employee performance while at work. Clearly conflict derived from an imbalance in the work-family relationship relates to a variety of social, psychologic, and somatic outcomes. The Table presents several relationships between W→F and F→W conflict and health-related consequences that should be considered.

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The Costs of Work-Family and Family-Work Conflict

The relationships between both W→F and F→W conflict and reduced health and productivity status of employees may be associated with a significant cost to company as well as society. From a company perspective, evidence from studies is needed that quantify the cost of doing nothing to change or improve this situation or from studies that estimate the economic or financial benefits of making successful changes. To date, however, significant gaps remain in the availability of such data. Similarly, from a societal perspective, proponents for governmental interventions rely upon trends in employment without providing an economic justification for why such interventions are needed. In short, the typical arguments are theoretical and intuitive but remain in desperate need of supportive objective data. The arguments include broad observations such as trends in longer working hours and greater female participation in the workforce. Such trends are subsequently related to the notion that the work-family balance in a manner that shifts in favor of work and this rationale is supported by surveys that indicate that significant proportions of respondents are dissatisfied with their work-family balance.

When work-related stress and W→F conflict negatively impact the ability and willingness of employees and their families to actively participate in community life, those local communities also may be impacted negatively. Community and societal economic growth may be affected, which, in turn, affects the local employers. Reduced growth provides fewer opportunities for employment and this affects employees, families, and other community members. From this perspective, it stands to reason that organizational cultures that provide a family-friendly atmosphere also provide benefits that extend far beyond the immediate reduction of potential W→F or F→W conflict.

Whereas there may be little data available to quantify these relationships to costs, more and more data are emerging that indicate organizational approaches to help employees increase their control over work and family matters. These approaches may be considered positive developments in better management of the conflicting demands of work and family.

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What can be done at the Worksite?

It's not easy to identify interventions or changes in company policy that are sure-fire ways to improve the work-family balance profile of workers. In fact, strategies considered may have differential effects on individual workers. For example, it is not at all clear that a reduction in the number of hours worked will necessarily improve an employee's work-family balance or reduce W→F conflict. Furthermore, two employees working the same number of hours may experience very different levels of W→F conflict. However, if the company allows supervisors to work with individual employees to optimize the work schedule to fit with family needs, major improvements may be achieved in the perceptions of W→F conflict.

A number of approaches can be used to address the challenge of work-family balance. These approaches tend to be located at the level of company policies and may include the following strategies:

* flexible scheduling of working hours

* leave policies

* childcare

* family-friendly organizational culture

* supportive supervisors

* supportive coworkers

* tax/benefit policies

* job sharing

* telecommuting.

Of the above, the development of a family-friendly company culture may well be one of the most important strategies to consider. To do so, leadership is an absolute must. The corporate culture will not be able to change unless executive management behaves in a manner consistent with this approach, work-family is viewed as a business concern, employees are educated, attitudes are changed, and innovative strategies are implemented.

© 2005 American College of Sports Medicine

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