Worksite health promotion programs can operate at several different levels. First, individual-level programs, such as phone coaching for tobacco cessation, a walking program, or a Web-based stress management program, can provide access for workers to reduce their health risk factors. Second, group-level programs may provide social support to change behavior and can include programs, such as team competitions or team-based training for a local 5-K fun run. In addition, organizational-level interventions also may be considered. These interventions tend to operate across all employees and cover the entire company. Oftentimes, this level of intervention is linked to company policies, protocols, and procedures - in fact, if this linkage between policy and protocols and procedures is absent, it is highly questionable whether the policy will be effective. If the goal is to engage the entire company in certain aspects of health promotion and health protection, a company policy type of intervention is often a good solution.
WHAT CONSTITUTES A COMPANY POLICY?
A company policy may be defined as a principle or rule created to guide decisions and achieve rational outcome(s). It may be considered a statement of intent or a commitment for the company because it assumes that the activity will be implemented across the entire organization. It also represents something quantifiable against which the company can hold itself (or be held) accountable. A company policy tends to denote the what and the why of the given topic a company wants to address. As such, it is a good idea to connect company policies with formal protocols or procedures that describe and delineate the how, the where, and the when. Policies tend to be formal enough to actually get adopted by the company's board of directors or senior governance body, whereas protocols and procedures would be developed and adopted by senior executive officers.
Policies may be classified as either external compliant or internal compliant (6). An external compliant policy relates to how a company interprets, monitors, and enforces governmental regulations or other regulatory requirements. Examples of such policies include compliance with privacy of health information (Health Insurance Portability and Accountability Act [HIPAA]), safety regulations (Occupational Safety and Health Administration [OSHA]), or the Americans with Disabilities Act (ADA). On the other hand, an internal compliant policy is created and enforced by the company to achieve desired organizational goals. Examples of internal compliant policies include compensation, benefits, substance abuse, and smoke-free policies.
WHEN ARE COMPANY POLICIES NEEDED?
In an ideal world, it would be possible to just communicate to everyone in the company what everyone should be doing and how everyone should behave. Ideally, the communications will be clear and fully understood by all. Of course, this is not the usual experience. In reality, there are a variety of good reasons why company policies are needed so that the expectations are defined clearly and standards of accountability are available. The Table provides some of those reasons and also some examples of the type of company policy that may be able to address the reasons stated.
However, it should be noted that inappropriate behavior or infrequent incidents on the part of a single individual or a handful of employees necessarily do not constitute a reason to institute company-wide policies that affect all workers. Such an approach may well prove to be counterproductive. There are very good reasons not to put everything a company decides to do in the form of a policy or in an employee handbook that is widely distributed to all employees. If it is written down in a handbook or as a formal policy, it is not unreasonable for employees to expect that the company will follow such guidance and enforce such policies. Companies certainly want to have flexibility, where possible, instead of dealing with the challenges of outdated or limiting policies.
HEALTH AND WELLNESS POLICIES
If a company is serious about the health and well-being of its people, a formal wellness policy is a powerful way to explain such a commitment. It can support the commitment to employee health as stated in the company's mission or vision statement. This type of commitment has been associated with elements of highly successful corporate wellness programs (4). However, such statements are likely to be broad and may represent only a general intent to support wellness. Specific policies are likely to be more impactful when they create an environment in which employees are engaged in healthful practices that help reduce health risk factors. Examples of such policy initiatives include, but are not limited to:
* workplace smoking bans
* alcohol policies
* illegal substance use and abuse policies
* time-off or paid time-off policies
* flexible work schedule policies
* ergonomically designed workstation policies
* seat belt use
* incentive programs
* workplace violence
* free preventive screenings
* healthy food subsidy in corporate cafeteria
* healthy food menus from which selections must be made for company functions
AN EXAMPLE: SMOKE-FREE POLICY TO REDUCE TOBACCO USE AMONG WORKERS
The Task Force on Community Preventive Services recently has published recommendations related to the use of a company policy intervention for the purpose of reducing tobacco use among workers (2,5,6). Based on systematic reviews of the tobacco-related literature, the Task Force recommends smoke-free policies implemented by the company based on sufficient evidence of effectiveness in reducing tobacco use among employees. More specifically, smoke-free policies were found to be effective when implemented in single worksites, across multiple worksites, as well as by communities when the ordinances and regulations prohibit smoking in indoor and enclosed workplaces. Furthermore, the Task Force also recommends smoking bans based on strong evidence of effectiveness of these policies in reducing exposures to secondhand tobacco smoke.
When a policy prohibits workers to smoke or use tobacco, it also is reasonable for the company to provide access to tobacco cessation resources to support tobacco users to receive help in their attempts to quit. These additional interventions that support the policy include tobacco cessation group treatment, educational materials, telephone-based smoking cessation coaching, health care provider assistance and counseling, and access (ideally with full financial coverage) to effective pharmacological quit aids.
So, clearly, the implementation of a smoking ban or smoke-free policy supports the worksite health promotion goals and objectives. Furthermore, in many communities and across many states, smoking bans have been enacted that prohibit smoking in all public and private workplaces. This circumstance is a major legal restriction that takes the decision to allow smoking at work out of the hands of many employers. Smoke-free policies help reduce tobacco use, help employees quit smoking, and reduce secondhand smoke exposure for nonsmokers. But besides these relatively direct effects on smoking, they also increase productivity because workers spend more time on task because of fewer smoking breaks and experience less smoking-related absences from work. It also reduces the company's exposure to health-related legal claims especially from nonsmokers who experience secondhand smoke exposure (e.g., OSHA violation, workers' compensation claims). Finally, smoke-free policies associate the company with good health, wellness, and well-being. This provides for a positive and healthy company image.
A good example of a corporate smoke-free policy is the one drafted in March 2003 by the city of New York and signed by then Commissioner of Health, Dr. Thomas R. Frieden, the current director of the U.S. Centers for Disease Control and Prevention. This policy example was attached to an introductory letter that states the legal requirement for employers to adopt and disseminate a written workplace smoking policy, provides guidance for employers around flexibility regarding style and format, and refers to a Web site for further details and information. The policy is organized around key content, including a clearly stated purpose, the specific areas inside the workplace where the policy applies, signage, compliance, resources, and a contact where questions and inquiries may be addressed. This example can be found at: www.nyc.gov/html/doh/downloads/pdf/smoke/tc9.pdf (3).
DOES YOUR HEALTH AND WELLNESS POLICY FIT?
So, implementing a policy can drive major improvement in population health because it reaches all employees across the entire workforce. However, it behooves anyone to be cautious about the language used and avoid unintended consequences. Using the acronym FIT, companies can double-check if their policies are well-designed using the following three steps (1):
* Fact based: is the policy based on credible data (perhaps even evidence based such as the smoke-free policy recommendation of the Task Force?
* Integrated: are all primary stakeholders included in the planning and deliberations that led up to the policy formulation? Are roles for stakeholders clearly defined? Will communications be clear to all employees, and is there a clearly delineated plan for enforcement?
* Targeted: is the policy clearly relevant to a specific organizational need, and will the associated health promotion goals and objectives be achieved?
Worksite health promotion programs that leverage organizational policies are more likely to generate impact. They will support individual-level efforts of employees to improve their health, reduce their risks, and more likely to provide major benefits for the organization as a whole. Just be sure the policy approach is well balanced, considerate, and likely not to generate unintended consequences.