Letters to the Editor: Response to Letter to the Editor
I wish to thank Drs Mattke and Liu for their letter. I am heartened to hear they agree that the workplace is an appropriate setting for instituting programs aimed at improving employees' health and well-being. I am perplexed, however, by their statement that the approach taken by employers to create health-promoting work environments can achieve the goal of improving health behaviors, but that it “does not make good business sense.”
I believe that is the wrong conclusion to be drawn from the more than 30 years of research on this subject, much of which was chronicled in our article. There is ample evidence that organizations with long-standing and successful programs (eg, winners of the C. Everett Koop Health Award) have improved workers' health and achieved cost savings. Furthermore, when workers participate in programs that help them achieve healthy habits (eg, managing weight, eating a nutritious diet, being physically active, managing stress, quitting smoking, and getting sufficient sleep) that, in turn, influences their performance on the job, lessens their likelihood of being ill or absent, and increases their willingness to stay with their jobs rather than look for work elsewhere. I would think that all of the above outcomes do make good business sense, for both the employer and the employee.
I worry that medical cost savings is the only metric used when judging whether a health promotion program is a good business investment. I believe that there is greater opportunity to see improvements in business metrics resulting from positive employee relations, higher worker productivity, and increased retention rates than from cutting health care costs. Furthermore, the emphasis should be on the value-on-investment from these programs. I question an ROI requirement for prevention when that requirement is not applied to treatment.
Mattke and Liu claim that health promotion programs achieve modest behavior change and risk reduction. In their RAND report, the authors found that at baseline an equal proportion of program participants and nonparticipants (36%) were obese and that 5 years later only 27% of participants were obese compared with 40% of nonparticipants—a net difference of 13 percentage points favoring participants. I find those results meaningful. Similarly, when comparing smoking rates for smokers who participated in cessation programs compared with those who did not participate, quit rates were 21% to 29% higher for participants in 3 of the 4 years studied. That finding is also compelling. Formidable improvements in physical activity were also noted for program participants compared with nonparticipants.
The authors cite the PepsiCo study as an example of a program that did not lower health care costs or absenteeism even after 7 years. The analyses separated the effects of lifestyle and disease management. I would argue that a well-designed program would not separate these components, but rather combine them in a holistic fashion to achieve the best outcomes. Indeed, Mattke and Liu found that employees who joined both lifestyle and disease management achieved the greatest savings, $1920 per year. Also, of note, the authors found a significant program impact from lifestyle management on self-reported absenteeism, although the dollar value associated with this reduction was modest.
Finally, I agree with the authors that an outdated medical model involving only biometric testing and one-on-one counseling is not the ideal way to achieve a culture of health at an organization. We need to create new workplace models that address organizational health alongside individual health so that workers and their employers can reap the benefits of health promotion and disease prevention.
Ron Z. Goetzel, PhD
Truven Health Analytics
Institute for Health and Productivity Studies
Johns Hopkins Bloomberg School of Public Health