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A Global Approach

Pronk, Nico Ph.D., FACSM, FAWHP

doi: 10.1249/FIT.0b013e318229cd7e

A Global Approach.

Nico Pronk, Ph.D., FACSM, FAWHP, is vice president for Health Management and health science officer for JourneyWell at HealthPartners in Minneapolis, MN. Dr. Pronk also is a senior research investigator at the HealthPartners Research Foundation and adjunct professor of Society, Human Development, and Health at Harvard University School of Public Health. He is the current president of the International Association for Worksite Health Promotion (IAWHP), an ACSM affiliate society, the editor of ACSM’s Worksite Health Handbook, 2nd ed., and an associate editor for ACSM’s Health & Fitness Journal®.

Disclosure: Author declares no conflicts of interest.

Worker health protection and promotion are an increasingly important concern to employers and employees alike. This concern relates not only to the productivity, competitiveness, and sustainability of companies, communities, and regional or national economies but also to the safety, readiness to recover from disasters, and overall well-being of individual workers, their families, and their communities worldwide.

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Today, an estimated 268 million nonfatal workplace accidents result in an average of three lost workdays per casualty; 2 million people die each year as a result of occupational accidents and work-related illness or injury; and approximately 8% of the global burden of disease from depression is currently attributed to risks and hazards related to work setting (1). It is obvious that healthy workplaces contribute greatly to overall population health. The impact is not only through prevention and optimization of physical health attributes but also through other dimensions related to overall well-being, including among others, the financial situation of families and communities, prevention of poverty, finding meaning in one’s life through work, and overall happiness.

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The World Health Organization (WHO) considers the worksite to be a primary setting for the protection and promotion of health among workers, their families, and the community. As such, WHO has recently published a “Healthy Workplaces” model, which presents an integrated framework for planning, delivery, and evaluation of programs to protect and promote workplace health (1). The framework is positioned as an action model supporting the WHO Worker’s Health: Global Plan of Action, which was endorsed by member states in 2007 (2). The Global Plan of Action outlines five objectives: to devise and implement policy instruments on worker’s health; to protect and promote health at the workplace; to promote the performance of, and access to, occupational health services; to provide and communicate evidence for action and practice; and to incorporate workers’ health into other policies.

The framework supporting the Global Plan of Action combines four major approaches that employers can consider in adopting and implementing strategies designed to improve health via the workplace. These four major approaches include the physical work environment, psychosocial work environment, personal health resources, and enterprise community involvement. With these four approaches, the goal is to engage leadership and involve workers using a process guided by ethics and values. A continuous improvement approach based on Deming’s plan-do-check-act cycle and the Japanese Kaizen method serves as an axle around which the wheel of process improvement turns to create a generative capacity for health improvement. The model is depicted in the Figure.

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A lot of time has been spent on developing business cases for health promotion, health management, health and productivity management, and other similar strategies. It is paramount that executive leadership actively supports the efforts to protect and promote worker health — certainly if goals include the creation of a healthy culture at the company. However, reasons why a healthy workplace is advantageous go beyond the business case. Today, in many nations across the world, national and local legislation also plays a role. Additionally, the emergence of corporate responsibility and creation of shared value place companies in a more positive light within their communities and also generate important savings (3).

Hence, the rationale for WHO to develop a healthy workplace initiative was based on three basic principles:

* Business ethics: It’s the right thing to do — one of the most universally accepted ethical principles is to “do no harm” to others. In the workplace, this translates into ensuring, first and foremost, the employees’ health and safety.

* The business case: It’s the smart thing to do — companies that promote and protect workers’ health are more likely to be successful, competitive, and enjoy retention of high-quality employees.

* The legal case: It’s the legal thing to do — protecting workers from workplace hazards is a legal requirement in most countries today. Enforcement of occupational health codes and laws has become a significant reason for companies to ensure compliance to avoid costly litigation, negative media attention, and erosion of their market and profitability.

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As depicted in the Figure, four avenues of influence can be selected by employers; these avenues of influence often overlap with each other to create synergistic effects. The Table below describes each avenue of influence briefly.

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Without a doubt, leadership engagement is paramount. An explicit commitment from organizational leaders is necessary to integrate the healthy workplace initiative into the core business strategies and processes. Formal allocation of budgets, permissions to implement protocols and processes, and overall support for workplace health is needed to be able to communicate a genuine and thoughtful strategy to the entire organization. In addition, workers need to be represented in the overall effort, and therefore, a formal approach needs to be designed to gather their insights and let their voice be heard. Wellness and safety committees may present easy options to access for this purpose. Finally, a key ingredient for sustained success is to incorporate an evaluation strategy from the beginning and to learn from experience by integrating a continuous improvement cycle.

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In 2009, as part of the Atlanta Announcement (4), the International Association for Worksite Health Promotion (IAWHP) adopted a definition of worksite health promotion which states: “Worksite health promotion represents the combined efforts of employees, families, employers, communities, and society to optimize worker health and well-being and overall business performance.” Based on this definition, the IAWHP approach supports multi-level (individual, group, organizational, environmental, community, policy, etc.) strategies to pursue creation of healthy workplaces that protect and promote health in an integrated manner. As the WHO has introduced its model, it is clear that major synergies exist between IAWHP and WHO. In fact, IAWHP issued its Anaheim Announcement during the 2011 IAWHP annual meeting in Anaheim, CA, which explicitly addressed support for the WHO Healthy Workplace Model. In addition, a brief column on International Trends in the April 2011 IAWHP journal Worksite Health International reiterated this observation (5).

The WHO is currently working on guidance documents for the implementation of the healthy workplace framework. As this work evolves, additional discussions and exchanges of ideas and experience will become increasingly important. Adapting the framework to meet the unique needs of specific sectors, populations, or cultures will be needed to ensure relevance among potential users. The implementation of various approaches in pilot projects should be encouraged and the results disseminated. Based on an initial experience and early learnings, the development of training materials and guidance documents will allow for a broader dissemination of this model.

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As the WHO Healthy Workplace Model is being disseminated and introduced across the world, many organizations may not recognize the particulars or details but rather focus on what is important for them to achieve through this type of healthy workplace initiative. The model represents an integrated approach to worker health protection and promotion and, therefore, effectively builds collaboration across multiple departments within the organization. For worksite health practitioners, this model will certainly serve as an important professional reference.

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1. Healthy workplaces: a model for action. For employers, workers, policy-makers and practitioners. World Health Organization [Internet]. 2010 [cited 2011 May 2]. Available from:
2. Worker’s health: global plan of action. 2011 [cited 2011 May 2]. Available from:
3. Porter ME, Kramer MR. Creating shared value. Harvard Business Review. January-February 2011: 62–77.
4. IAWHP Atlanta Announcement. 2009 [cited 2011 May 2]. Available from:
5. Kirsten W. A new global framework for creating healthy workplaces. Worksite Health International. 2011; 2 (1): 3.
© 2011 American College of Sports Medicine.