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Walking the Walk

Jarris, Paul E. MD, MBA; Baird, J. Nick MD

Journal of Public Health Management and Practice: September/October 2012 - Volume 18 - Issue 5 - p 474–476
doi: 10.1097/PHH.0b013e318264e563
State of Public Health

This article discusses about ASTHO's Worksite Wellness Program, which has received HealthLead accreditation. HealthLead provides a quality improvement opportunity for ASTHO, as well as health agencies and other businesses, to continually improve the ways in which they support healthy environments and behaviors among their employees.

Association of State and Territorial Health Officials, Arlington, Virginia.

Correspondence: Paul E. Jarris, MD, MBA, Association of State and Territorial Health Officials, 2231 Crystal Dr, Ste 450, Arlington, VA 22202 (

The authors thank Linda Hermer, Tahra Johnson, Julia Pekarsky Schneider, and Katie Sellers for their contributions to this work.

Disclosure: The authors declare no conflicts of interest.

Public health practitioners have promoted physical activity, nutritious foods, smoke-free environments, and breast-feeding for many years now. Public health agencies have encouraged worksite wellness programs as well. But health agencies have been slow to transform their own practices as employers to effectively promote the health of their employees. During this time of budget cuts to government programs and soaring health insurance and health care costs throughout both the public and private sectors, public health agencies and organizations need to examine their own practices and ensure that they are walking the walk when it comes to supporting healthy environments for employees. Many in public health agree that determinants of an individual's health can be found where the individual lives, learns, works, and plays. Federal, state, and local governments are big employers, and they have a ripe opportunity to influence the environments in which many individuals work.

More than 50% of Americans have 1 or more chronic illnesses, including cardiovascular disease, diabetes, cancer, and depression,1 and managing these illnesses contributes to the high health care costs for employers and employees. Employers pay, on average, 58% of the total costs of chronic disease treatment through covering part of premiums. The Milliman Medical Index predicts that the employer's share of coverage for an average American family of 4 will be $12 144 in health care costs in 2012.2 Worksite wellness programs provide employees with a health-promoting environment, facilitating their adoption of healthy behaviors and thereby reducing their health risks. Benefits to the employer include reduced absenteeism, higher productivity, and lower attrition.3

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US Healthiest, a nonprofit, nonpartisan organization dedicated to improving the nation's health, recently unveiled HealthLead, an employer accreditation program. HealthLead provides the opportunity for health agencies, private businesses, and other governmental and nongovernmental organizations to promote the health of their employees. US Healthiest was created by a coalition composed of the Association of State and Territorial Health Officials (ASTHO), the Centers for Disease Control and Prevention, and the National Association of County & City Health Officials. The leaders of these organizations recognized the need for a third party accreditation that would have a comprehensive worksite wellness evaluation. They reached out to top US workplace wellness experts and employers and collaborated to bring HealthLead to fruition. Accreditation is awarded at gold, silver, and bronze levels. Of the preliminary private businesses that were in the first group of alpha and beta companies, the highest scoring company received the silver designation; standards for this program are high and improvement is always possible. HealthLead is a robust accreditation program and a quality improvement opportunity. The process encourages organizations to continually improve performance in the area of worksite wellness. This quality improvement focus is very different from a program where an entity applies, receives a certificate, and then considers their work complete.

The program measures the organizations’ health management and well-being practices in 3 key areas: (1) organizational engagement and alignment; (2) population health management and well-being; and (3) outcomes reporting. The process has 3 steps including an online assessment, an onsite audit, and an accreditation confirmation and blueprint for action. Organizations that have been accredited with silver and bronze status have praised the HealthLead process for increasing collaboration across the organization, validating the wellness framework, and forging and engaging in new connections.

The HealthLead accreditation process provides organizations with an objective lens that examines their current health management/well-being practices and provides new insights into making value-based investment decisions that can favorably impact their bottom line while protecting, supporting, and engaging their number 1 asset—their people.

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ASTHO's Worksite Wellness Program

ASTHO applied for HealthLead accreditation in 2011 and received provisional status after the onsite visit. We were encouraged to improve performance, particularly in the area of health outcomes reporting. After strong support from the organizational leadership, the wellness committee, and the staff, ASTHO was able to reach a bronze-level accreditation status. Although we recognize this as a success, the organization is continuing to look at ways to reach the silver or gold status in the next round. HealthLead provides a quality improvement opportunity for ASTHO, as well as for health agencies and other businesses, to continually improve the ways in which they support healthy environments and behaviors among their employees.

ASTHO has been continually improving its worksite wellness program for more than 5 years. The organization created a Worksite Wellness Committee in 2006 both to support employee health and well-being and to implement evidence-based strategies as part of a comprehensive employee-sponsored program. Initially, the Worksite Wellness Committee developed a “wish list” of activities that it wanted to implement. This list was extensive and included such items as a smoke-free meetings policy, a healthy foods policy, weekly walks, community events, and a physical fitness challenge—all of which have now been implemented.

Ensuring that ASTHO fund and support events that supported healthy lifestyles has been a key goal from the beginning. The first accomplishment was passing a smoke-free meetings policy, in accordance with standards developed by Americans for NonSmokers’ Rights, stipulating that we would only contract with those hotels and venues that had passed smoke-free policies. At the time, this was still quite a challenge, as many jurisdictions had not yet passed clean indoor air legislation and many hotel chains were just beginning to shift to a smoke-free environment. ASTHO's home state of Virginia did not have a comprehensive clean air law in effect until January 2010, and many nearby hotels were not smoke-free.

Another key component of the Worksite Wellness Committee was to ensure healthy food options at our meetings and events. To be good stewards of the federal funding we receive, as well as to facilitate healthy lifestyles among our members, employees, and partners, we do not serve the high-calorie, non-nutritious options that have become standard meeting fare in this country. We developed a healthy foods policy that is required in every meeting vendor contract. Vendors must be able to meet our standards, which include low-fat, low-calorie, low-sodium options; attention to portion sizes; limiting sugar-sweetened beverages; and meeting various dietary needs such as vegetarian and kosher options. This has proved to be an effective strategy, and ASTHO members know to expect healthy food options at all ASTHO-sponsored events. Other organizations have recognized the importance of a healthy food policy and have used ASTHO's policy for their meetings; the National Quality Forum incorporated it almost verbatim, and Target is using it to develop its policy as well. When evaluating meetings, ASTHO asks participants to what extent they agree that the food was healthy and that it was satisfying. Typically, about 97% of respondents “agree” or “strongly agree” that the food is healthy and 90% or more “agree” or “strongly agree” that they are satisfied with the food.

It is imperative that state public health agencies themselves consider such policies, whether it is a statewide procurement policy like Massachusetts has, or contracts with vending machine vendors, nutrition standards for state cafeterias, or working with state agencies that procure foods, such as departments of corrections and others. ASTHO is working with a number of states such as Delaware, Montana, Indiana, Arkansas, and North Carolina that are exploring various procurement strategies.

In 2009, then ASTHO President, Dr Judy Monroe, worked with ASTHO staff to launch the first ASTHO Presidential Challenge: she challenged all ASTHO members to adopt health-promoting policies within the state health agencies they direct. Dr Monroe was the Commissioner of the Indiana Department of Health at the time and is now the Deputy Director of the Centers for Disease Control and Prevention and the Director of Centers for Disease Control and Prevention's Office of State, Tribal, Local, and Territorial Support. She explained her choice of focus for the Presidential Challenge as follows: “Improving the public's health begins with health departments leading by example. In the words of Albert Schweitzer, example is not the main thing in influencing others it is the ONLY thing.” As part of her commitment, the Indiana State Department of Health closed its smoking room and converted it into a fitness room for employees; strengthened its tobacco policy, prohibiting the use of tobacco during work breaks and anytime while wearing a work badge or clothing with the agency name or logo; implemented a worksite wellness policy that included having a “healthy foods corner” in the onsite snack shop and weekly walks; launched ISDH Olympics and had a walking challenge; and convened Indiana employers at an INShape Indiana summit to discuss the benefits of worksite wellness programs.

ASTHO's Worksite Wellness Committee also made a commitment to support our growing number of new mothers and expanding families. ASTHO's offices include 2 rooms that are designated as shower rooms/lactation rooms. These rooms include a shower, bench, sink, lactation chair, and refrigerator. The showers are meant to make physical activity more convenient, but the other components provide a private space for new mothers to express their milk or to breast-feed their babies. ASTHO has also adopted a new parental leave policy, which includes 2 weeks of paid leave for new parents, in addition to the existing short-term disability benefits that were already in place. This has created a culture that supports healthy parenting.

ASTHO encourages all state health agencies to consider the emotional and physical well-being of their employees and to consider how worksite wellness programs can help support this effort. As organizations promoting the health of their citizens, it is imperative that we are taking care of our employees, serving as a model for other agencies and businesses in our communities, and “walking the walk.” By serving as models of success, we will help our nation move from an unhealthy worksite culture to one focused on healthy employees who are eating well, moving around, and contributing to the overall effectiveness and productivity of our organizations. We encourage health departments to apply for HealthLead accreditation and to promote this accreditation initiative to employers in their jurisdictions.

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1. DeVol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, CA: The Milken Institute; 2007.
3. Berry LL, Mirabito AM, Baun WB. What's the hard return on employee wellness programs? Harv Bus Rev. 2010;88(12):104–112, 142.
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