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CLINTON HEALTH MATTERS INITIATIVE

Employee Health Improvement Framework

Photo: Christy Porter / HiddenHarvest.org

http://www.clintonfoundation.org

http://www.clintonfoundation.org

EMPLOYEE HEALTH IMPROVEMENT FRAMEWORK | CLINTON HEALTH MATTERS INITIATIVE

THE PROBLEM

The unwell workforce costs employers $153 billion annually, a figure set to rise to $1.201 trillion by 2023 and $5.668 trillion by 2050. Employees who are thriving or considered well cost employers 41% less than employees who are struggling, and 62% less than employees who are suffering. If left unaddressed, the chronic and preventable diseases that affect 1 in 2 adults will continue to decrease productivity, and increase workforce stress, attending work while sick, absenteeism, and healthcare cost.

THE SOLUTION

The Clinton Health Matters Initiative (CHMI) is committed to supporting employers in their efforts to create healthier environments. Through an integrated approach of addressing employee health through value added benefits design along with existing employee wellness programs, corporate social responsibility investments, and core business practices, CHMI will utilize the Employee Health Improvement Framework to guide the appropriate evidence-based implementation.

With this integrated method of employee health improvement, CHMI builds on the Clinton Foundation’s innovative efforts bringing market-based solutions to critical issues including global HIV/AIDS, climate change, economic development, and childhood obesity.

THE IMPACT

By addressing employee health and wellness issues, employers have the opportunity to create environments where wellness programs are encouraged, easily accessible, and promoted, while earning $3.27 for every wellness dollar invested.

CHMI’s Employee Health Improvement Framework’s standards are based on the best available evidence from effective programs, policies, practices and laws. Collectively, these show that the greatest way to affect employee effectiveness and well-being is through on-going, comprehensive programs that 1) take employees’ needs and lifestyles into account and 2) are aimed at changing behaviors. Such evidence has proven that worksite wellness programs are particularly effective in increasing productivity and reducing healthcare cost, attending work while sick, and absenteeism by:

• Reducing stress • Increasing physical activity and nutrition • Increasing smoking cessation• Decreasing workplace injury

About the Clinton Health Matters Initiative (CHMI)

The Clinton Health Matters Initiative (CHMI) works to improve the health and well-being of all people by activating individuals, communities, and organizations to make meaningful contributions to the health of others. The goals of CHMI are to reduce the prevalence of preventable health outcomes, close health inequity and disparity gaps, and reduce health care costs by improving access to key contributors to health for all people.


Framework VisionThe vision of the Employee Health Improvement Framework is to establish a model of organizational change that supports employee health through improvements and investments in the physical, social, emotional, and financial health of employees. The Framework builds on the Clinton Health Matters Initiative’s (CHMI) primary goals of reducing health disparities and providing a platform for scalable health solutions by helping employers focus on the “how” of the issue – how to realign core business operations to support health, how to effect sustainable behavioral change among employees, and how to develop a robust, effective, and comprehensive employee health improvement program.

The Framework’s vision integrates a purposeful focus on three critical factors that are aligned with CHMI’s overall mission of reducing health disparities across all socio-economic groups:

1. Creating systemic change in business organizations, communities, and industries to support improvements to employee wellbeing;

2. Preventing incidences of chronic diseases, especially in the area of employee population health; and,

3. Improving organizational health by looking at the cost-effectiveness and impacts to productivity of employee health improvement programs and practices.

By engaging with new and existing partners in all sectors of industry and service, CHMI will shine a much needed spotlight on needs related to employee health, and will assist organizations of all sizes in purposefully integrating a culture of health into their operations and programs. CHMI is utilizing this Framework as a tool to affect a system-wide change that would have transformative and permanent effects on the working population.

The development of solutions to intractable health problems facing employee populations requires employers to integrate a purposeful focus on creating a culture of health within their organization. The Framework’s embedded approach to process change provides a proven model for developing the appropriate organizational culture by providing criteria that outlines the tools that can support, enhance, and sustain a culture of health. Full maximization of the Framework requires the active collaboration of employers in all sectors. CHMI will work closely with companies and organizations to improve health outcomes, close gaps in health disparities, and facilitate organizational change in various types of industries across the United States. CHMI serves as a convener for efforts around important public health issues to engage innovative thoughts and methods from multiple sectors in improving unique health indicators for this particular population.

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Framework OverviewCHMI has prepared the Employee Health Improvement Framework with three goals in mind. The first is to provide employers with a comprehensive survey of the landscape of employee wellness programs and their effect on employee productivity. The second goal is to change the conversation around this issue of employee health and emphasize the importance of this matter in the overall scheme of community, national, and global well-being. The final goal is to motivate employers to improve, innovate, and lead on the issue of employee health improvement. CHMI encourages employers to identify new programs or policies within this Framework that can help them expand their organizational capacity to improve health outcomes for their employees.

The Framework has been designed to assist employers in every phase of employee health improvement program development, from those just beginning to design wellness programs to leaders in the field that are looking for the next best innovation on the issue. This Framework is intended to support the work of employers in all sectors – private, public, and non-profit – across all industries, and contains input from key thought leaders, content experts, executive management professionals, and academics. It is flexible by intentional design to allow employers a menu of options related to employee health improvement, rather than a proscriptive list of mandates and requirements.

CHMI is committed to working with employers throughout this continuous quality improvement process. Organizations that want to adopt or enact new employee improvement programs or policies can do so by utilizing the recommendations laid out in this Framework, through which CHMI and its partners can provide technical assistance and support along the way to an efficient and well workforce.

Framework Target AudienceThe Framework can assist large-, mid-, and small-sized corporations with developing and/or supporting a sustainable culture of wellbeing within their organization’s infrastructure. CHMI recognizes that the myriad of intractable problems affecting employee populations requires a diverse array of multi-faceted solutions, each appropriately tailored to address the unique challenges faced by employers and employees. A uniform solution that can be applied in every organizational setting does not exist, but this Framework encompasses real-world examples of best practices that result in positive outcomes that are both measurable and scalable.

DISCLAIMER

This manual is intended solely to provide instructional guidance to employers on the topic of employee well-being. References within this manual to any specific commercial products, processes, services by trade names, trademarks, or manufacturers do not constitute an endorsement or recommendation by CHMI.


Contents

06 FRAMEWORK METHODOLOGY

10 CORE POLICY CATEGORY 1 CORE BUSINESS ALIGNMENT (ROI)

15 CORE POLICY CATEGORY 2 VALUE ADDED BENEFITS

22 CORE POLICY CATEGORY 3 AT-RISK EMPLOYEE POPULATIONS

28 CORE POLICY CATEGORY 4 FAMILY FRIENDLY WORKPLACE – PROMOTING FAMILY FORWARD CULTURE

35 CORE POLICY CATEGORY 5 EMPLOYEE HEALTH

44 CORE POLICY CATEGORY 6 TALENT MANAGEMENT

49 CORE POLICY CATEGORY 7 VETERANS AND MILITARY

54 CORE POLICY CATEGORY 8 BUILT ENVIRONMENT

CORE POLICY CATEGORY 9 DIGITAL TECHNOLOGY (FORTHCOMING)

60 ENDNOTES


Framework Methodology & Approach

This Framework focuses on eight key components of employee well-being, as follows:

These nine core policy areas cover the many different facets of employee health improvement, and CHMI encourages employers to view their actions in each policy area with a holistic lens; research and best practices in this field have demonstrated that these policy areas exert a significant degree of influence over each other and over the productivity, effectiveness, and efficiency of an organization. CHMI is in the process of compiling the most current and relevant information related to the integration of digital technology in health improvement programs and will include this new section in future iterations of this Framework. CHMI also commits to updating this Framework on an annual and as needed basis to provide its partners with a reliable compendium of the most current health improvement resources.

CORE POLICY CATEGORIES

1. Core Business Alignment (ROI)

2. Value Added Benefits

3. At-Risk Employee Populations

4. Family Friendly Workplace – Promoting Family Forward Culture

5. Employee Health

6. Talent Management

7. Veterans and Military

8. Built Environment

9. Digital Technology

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1.Build

Support

2.Access

YourOrganizational

Capacity

3.Develop

YourWellness

Policy

4. Explore andConnect withResources

5. Implement

Your Policy

6.Evaluate

andRevise

• Use Employee Wellness Inventory to assess the strengths of your existing employee wellness policy and current health of employees

• Take calculated and incremental steps to achieve your selected Standards and Best Practices

• Evaluate wellness policies, identify and address complications

• Address and fix those issues that are not working

• Celebrate successes

• Identify third parties that can assist in the implementation process

• Prioritize opportunities for improvement in alignment with assessment results and Framework standards and best practices – both overall and subject based

• Mobilize internal support for implementing healthy changes within the workplace and workforce

• Create a Wellness Task Force that includes employees at all levels

FRAMEWORK APPROACH: A SIX-STEP PROCESS OF CONTINUAL IMPROVEMENT

CHMI will work with employers to improve employee health outcomes, decrease health disparities, and reduce healthcare costs through the development of an evidence-based and comprehensive approach. The Framework’s approach is based on the best available evidence from effective programs, policies, practices, and laws and supports systemic change at the organizational level. To implement the Employee Health Improvement Framework, companies and organizations will rely on a six-step cyclical process. CHMI recognizes that organizations might find themselves within different phases of this process model, and the model has been designed to allow companies at any point within the readiness continuum to assess, evaluate, and implement new or revised programs and policies. It is flexible by purposeful design and in alignment with the principle that each employer and employee population necessitates a tailored and appropriate approach to health improvement. The Framework is also representative of the comprehensive approach to systems change that is a critical part of embedding health into any organizational culture.


USEFUL DEFINITIONS

SPECIAL CONSIDERATION: AT-RISK EMPLOYEE AND FEMALE EMPLOYEE POPULATIONS

Consistent with CHMI’s focus on reducing health disparities for disproportionately affected populations, this Framework places an intentional emphasis on opportunities to improve the well-being of employees with the greatest risk of negative health outcomes – shift workers, health care personnel, public safety employees, manual laborers, and frequent business travelers.

The Framework also makes note of the particular concerns faced by women in the workplace and recognizes that although non-discrimination gender policies are outside the scope of this issue, they do tangentially exert influence over the effectiveness and well-being of female employees. A 2009 study found women held only 20% of senior management positions at private companies, and 35% of private companies have no women in senior management at all. Women head only 2.6% of Fortune 500 companies and hold only 15% of those companies’ board seats. They represent just over 8% of the highest paid positions among companies in Standard and Poor’s 100 Index. Where feasible and appropriate, this Framework identifies best practices to further the health of women.

• “Wellness is multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment.” 1

• “Well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning.” 2

• “Population Health is the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” 3

• “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 4

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OVERVIEW OF FRAMEWORK CRITERIA

CHMI has developed a comprehensive system of employee health improvement criteria at the organizational level based on an extensive review of the most current evidence-based research. For each of the nine core policy areas, CHMI has identified three levels of organizational capacity – beginning, performing, and leading – that span the entire spectrum of employee health improvement strength and support for that policy area. Each successive level builds on the previous one, with capacity and support for well-being increasing as organizations advance through each level. This system is not meant to be restrictive or punitive, but to provide employers with a comprehensive scan of the most effective policies, programs, and processes available. Armed with this knowledge, employers can then engage with CHMI to identify, tailor, and implement the most appropriate solutions to the health problems facing their employees.

BEGINNING

• Organizations at this level provide the essential programs needed to support employee wellness. Programs within the beginning level satisfy regulatory requirements and minimums related to health coverage, safety, etc.

PERFORMING

• Organizations at this level institute wellness programs that go beyond mandated minimums and may offer more generous and inclusive leave policies, work-site wellness programs, and opportunities for personal growth.

LEADING

• Organizations at this level integrate issues related to employee health into every facet of their core business and operations and have created wellness programs that can be scaled and replicated to fit peer organizations.

CHMI engages with businesses and agencies of all sizes to identify opportunities within their respective employee populations to improve and support employee well-being. For organizations with a national and/or multi-national footprint, CHMI provides direct technical assistance in the assessment, implementation, and evaluation of health improvement programs. For small- to mid-sized organizations, CHMI partners with business associations, trade groups, and economic development agencies in the four community transformation project areas (Coachella Valley, Greater Houston, Central Arkansas, and Northeast Florida) to deliver assistance and support to their membership base. CHMI will expand its employee health improvement services to new CHMI community transformation project areas as they continue to come online in the coming year.

METHODS OF ENGAGEMENT


Core Policy Category 1: Core Business Alignment (ROI)

ISSUE OVERVIEW

More than ever before, the global workforce is threatened by aging and non-communicable diseases (NCDs) including cancer, cardiovascular diseases, chronic pulmonary disease, diabetes, and mental ill-health. In addition, being absent from the job (absenteeism) or underperforming while working (presenteeism) are estimated to cause productivity losses worth $1.6 trillion due to mental ill-health and $389 billion due to cardiovascular disease.5 Because approximately half of the working population spends the majority of their waking hours at work, the workplace provides a unique opportunity to guide and incentivize individuals to adopt healthier behaviors and develop healthier lifestyles. Fostering a healthy employee population not only results in positive benefits to the individual employee, but it also supports the organization’s efforts to fulfill its corporate mission, improve efficiencies in its operations, and demonstrate measurable returns to its investors and/or stakeholders. These benefits can be realized in organizations across all sectors – private, public, and nonprofit.

Photo: Adam Schultz / Clinton Foundation


The value of workplace wellness programs can be measured by various types of return on investments (ROI), which include factors such as program use and adherence, health risk reduction, biometric data, and employee satisfaction. However, the key obstacle for many companies has traditionally been in moving from the “perceived value” of such interventions to a measured impact that will ultimately demonstrate monetary or fiscal return. In 2009, the World Economic Forum (WEF) created the Workplace Wellness Alliance to address the challenges of data collection, knowledge sharing, and the calculation of ROI for workplace wellness programs. The WEF’s Workplace Wellness Alliance launched the collection of a global baseline of employee metrics covering over 2 million employees and generated responses on employee demographics, health indicators, and information on current programs employers offer and how they measure success.6 In doing so, the Workplace Wellness Alliance was able to create a compelling business case for organizations across sectors to invest in their employees’ health.

Two key areas that organizations should focus on when collecting and measuring data are absenteeism and presenteeism, which both have a significant impact on employee productivity and performance.7 Though challenging, it is vital to translate the intangible aspects of employee well-being, (i.e., lost productivity due to poor mental health) into tangible measurements that allow companies to determine best practices for improving their employees’ health. Plans to evaluate the cost-effectiveness of an employee wellness program must therefore be appropriately designed and tailored to the needs, issues, and constraints specific to the employee population.

As part of the initial mobilization towards building or improving an organization’s wellness program, it is essential that organizations identify leaders at the executive level and within its governing boards that can serve as strong advocates for employee wellness. Passionate, persuasive, and persistent leadership is a necessary ingredient in creating the culture of health necessary to implement and sustain workplace wellness programs.8 The World Health Organization’s (WHO) work on this issue has shown that wellness programs should be a natural extension of a firm’s identity and aspirations, and since C-suite executives and board members are responsible for setting organizational direction, they are best suited to serve as the primary advocates for wellness programs during its conceptual phase.9 It is also important for initial wellness proponents to clearly demonstrate the linkage between the wellness program and an organization’s core values, as employees will be discouraged from participating in wellness programs if the employer’s primary motivation is financial profit or gain.

Although the planning and implementation of workplace wellness programs may require significant financial and administrative resources, it has become increasingly apparent to employers that there is a tangible business case for these interventions. A 2012 presentation by Booz & Company looked at wellness initiatives in six corporations in the technology, service, automobile, and consumer products industries and found each separate initiative produced a positive return on investment, ranging from a $226 annual savings per employee for Johnson & Johnson to a savings of $50 million in health care costs over seven years for General Motors.10 A 2014 report by SafeWell Inc. and Harvard School of Public Health also noted positive returns on investment in relation to productivity.11 Collectively, the selected initiatives demonstrated the following results:

• A reduction of $2 in worker compensation costs for every $1 invested; • A reduction of $5.82 in absenteeism costs for every $1 invested; • A financial savings of $3.48 in health care costs for every $1 invested;12 • A significant reduction of presenteeism among healthy workers resulting from workplace wellness; • A reduction in growth rate of medical care costs by 3.7% from worksite health programs.

In addition to improving employee well-being, productivity, and turnover, such programs can also generate external recognition and increase its competitiveness in attracting talent.13 To aid organizations that lack adequate resources, certain organizations such as the WHO have published a number of tools to assist companies in performing basic calculations to determine their own return on investment. With this substantial increase in knowledge sharing, data collection, and accessible resources, companies today not only have an ethical responsibility to improve the health and well-being of their employees, but also have a financial incentive to do so. In sum, incorporating a comprehensive approach to employee health improvement is not only the right thing to do; it is the smart thing to do.

RELEVANT RESEARCH

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CASE STUDY

The Importance of Evaluation: Evaluations of workplace wellness initiatives are crucial to identify whether the initiatives are suited to employees and lead to ROI. General Electric (GE) Healthcare’s HealthAhead program, which began in 2010, uses Site Certification to drive and measure progress and success. To be certified, sites must pass a rigorous site audit including more than 50 requirements grouped under nine elements, a process run by auditors who are volunteers from previously certified locations. This allows for a dual approach combining centralized guidelines and local implementation, while maintaining demonstrable standards.14

General Electric (GE) Healthcare HealthAhead Site Certification Program 9 Elements, 50+ metrics:

General Electric (GE) Healthcare

Leadership & Wellness

Committee

Wellness/Disease Education & Prevention

Healthy Nutrition

Tobacco-FreeStress

ManagementPhysical Activity

Health Risk

Questionnaire

Health-Related Absence

Reduction

Medical & Safety

Environment


BEGINNING

LEADERSHIP• At least one member of the C-suite commits to improving employee health and

well-being (i.e., CEO enacts a comprehensive policy that indicates that the wellness program is part of the company’s business goals and strategies15)

ORGANIZATIONAL STRUCTURE

• HR department is in charge of developing and implementing wellness program

CSR• Organizations are committed to corporate responsibility through various philanthropic

events and initiatives throughout the year that directly benefit the community in which they operate

ROI MEASUREMENTS

• Return on Investment (ROI) is estimated before the development of the wellness program using external data and statistics collected by such organizations as the World Health Organization (WHO) and the Workforce Wellness Alliance

• ROI for different interventions is calculated and assessed annually

EMPLOYEE DATA INTEGRATION

• Health Risk Assessments or Appraisals (HRAs) are performed in the early stages of development to determine the health and well-being baseline of employees; subsequent HRAs are performed annually

ASSESSMENT CRITERIA

The following criteria related to Core Business Alignment are divided into three successive levels – beginning, performing, and leading. Each level builds on the previous level and meets its requirements. The beginning level represents organizations that are just starting to integrate employee wellness programs into their mission, business practices, and structure.

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The performing level represents organizations that have adopted a more integrated approach to employee wellness, with wellness program managers and the collection of advanced employee health metrics. Once an organization has reached the leading level, it has integrated health promotion into every facet of its organizational structure and the surrounding community.

PERFORMING LEADING

• Multiple members of the C-suite align with the board of directors to commit to improving employee health and well-being (i.e., C-level executive charged with overseeing distinct and separate wellness program)

• Multi-level leadership: members of the C-suite, board of directors, and middle managers, promote the integration of employee well-being into organizational goals and visions and adopt personal health goals in alignment

• Organization has its own wellness program manager who is an expert in the area and is responsible for developing and implementing the employee wellness program

• There is an established wellness team responsible for developing and implementing the program

• Actively engage employees in the design and implementation of the wellness program by holding monthly all-staff meetings that include a wellness team report on current wellness activities and resources, with the opportunity for employees to offer suggestions for improvement

• Wellness champions, or volunteer health ambassadors, offer local, on-the-ground encouragement, education, and mentoring, in addition to organizing and promoting local health events16

• Organization publishes annual report on CSR efforts, including programs that impact employee health

• Organization creates shared value by using one of the following three methods: reconceiving products and markets; redefining productivity in the value chain; enabling supportive industry clusters at the company’s locations17

• Organization excels in creating shared value using all three of the following methods: reconceiving products and markets; redefining productivity in the value chain; enabling supportive industry clusters at the company’s locations

• Organization asserts a stronger role in improving population health through a wellness and prevention lens, with efforts addressing not only their employees, but also their customers, suppliers, local communities, and the general public

• Organization develops its own system for estimating the ROI for certain interventions before the development of wellness program

• Organization leads the way in establishing a global benchmark standard for measuring ROI which can be replicated by peer organizations operating in one country or across several markets

• In addition to HRAs, organization measures employee participation and employee satisfaction in the wellness program (at least once a year)18

• In addition to HRAs and employee metrics, the organization measures the following organizational metrics: health care, safety, employee productivity (absenteeism and presenteeism), and organizational culture (trust in management, voluntary turnover, etc.)


Core Policy Category 2: Value Added Benefits

ISSUE OVERVIEW

As the complexities of everyday life increase, employees are looking to their employers as a trusted resource for information and tools about their health and welfare. At the core of every employee’s relationship with their employer is the question of benefits, and most specifically, health insurance. Value-based Insurance Design (VBID), also known as value added benefits, encourages the use of medical services when the benefits exceed the costs and discourages the use of services when the benefits do not justify the cost.19 In the VBID approach, copayment rates are set based on the value of the clinical services (benefits and costs)—not exclusively the costs. As a result, more efficient resource allocation can be achieved.20 The integration of value added benefits into a comprehensive well-being approach ensures that the provision and payment of care under insurance plans focuses on preventative measures to reduce long term care and expenses.


RELEVANT RESEARCH

The employment-based market provides coverage for approximately 177 million Americans.21 Still, approximately 39 million Americans are uninsured in any given year even though about 85% of the uninsured live in families headed by an individual who works at some time during the year.22 More than 50% of the uninsured are full-time, full-year workers or family members of these workers; the balance of the uninsured Americans are covered by Medicare, Medicaid,23 or another governmental program, and thus do not require employment-based coverage.

When faced with the option to receive employer-sponsored health insurance, employees consider such factors as price, service coverage, and level of choice among the packages offered.24 A significant number of individuals who have access to coverage through their employer decline it on the grounds that it is too expensive.25 By selecting particular insurance products to offer and excluding others, employers necessarily influence what services are covered and the circumstances under which those services can be delivered. Similarly, by selecting particular insurance products, employers effectively dictate the scope and nature of the cost-quality-access trade-offs their employees can make.26

Employers faced with the paradox of how to provide comprehensive benefits that can ensure a healthy workforce while simultaneously managing costs in an increasingly expensive healthcare market would benefit from answering the following questions:

• How can we incentivize the use of benefits that will improve health outcomes and discourage costly medical tests or treatments that are not proven to contribute to better health while still giving employees power over their health decisions?

• How can we best streamline benefits or at the very least ensure that we can remove inconsistencies between plans and vendors?

• Are we prepared and do we fully understand the implications of the Affordable Care Act on our immediate and longer term benefit design? Are there benefits relying on higher deductible plans (HDHPs) and perhaps making other concessions with healthcare savings accounts?

• Are there opportunities to look at whether bringing items traditionally included under health care savings accounts make more sense in covered benefits – like reimbursement for pregnancy supplements?

• Are we getting the most out of our benefit plans and, most importantly, do we have the numbers to tell us in a manner that we can all comprehend and translate into policy and practices?

The good news is that there are solutions and best practices to be shared, even on emerging topics like the Affordable Care Act, that can help organizations of every size and kind to create benefits packages that serve to improve employee health, reduce costs where appropriate, and lead to a business culture where employees and consumers flourish.

HEALTHIER GENERATIONS BENEFIT

Firms, organizations, and small business owners currently cover 48% of the United States population under employer-based insurance benefits.27 To this end, companies and organizations are looking for innovative ways to care for their employees and their families to increase employee well-being while decreasing costs. The topic of healthcare savings has expanded to include the health of employee dependents: approximately 40% of employer-based insurance rates were for dependent coverage28, and since 2010, through the Affordable Care Act, an estimated 485,000 dependent children have gained continual insurance coverage through their parents’ health insurance plans, which some have predicted would lead to an increase in national healthcare expenditures of 900 million dollars.29 Since dependent coverage now includes children up to age 26, employers have been considering the potential healthcare costs, and are seeking out methods to prevent expenditures from rising.

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CASE STUDY

In 2006, the University of Michigan (UM) implemented M-Healthy: Focus on Diabetes Program for its 2,200 employees and dependents with a diagnosis of diabetes mellitus. This program provides copayment reductions to targeted patients (diabetics) for targeted interventions deemed from the medical evidence as highly beneficial. The targeted services include several drugs that affect blood sugar, blood pressure, cholesterol, and depression, and that help prevent or reduce the long-term complications of diabetes. Only people with diabetes, identified by pharmaceutical claims, are eligible for copayment reductions. In order to maintain the tiered formulary incentives for use of less expensive medications (such as generics), the VBID intervention lowers copayments in a graded fashion. For the medications of interest, tier 1 copays decreased by 100% (from $7 to $0); tier 2 copays, by 50% (from $14 to $7); and tier 3 copays, by 25% (from $24 to $18). The program received overwhelming employee support through numerous e-mail testimonials and virtually no dissent, which suggests that human-resource concerns can be overcome.37

University of Michigan(UM)

One of the major epidemics that have been affecting the landscape of healthcare cost is domestic obesity. The figures on its effects are astounding - annual health care costs of obesity-related illnesses are $190.2 billion30, and obese adults spend 42% more annually on healthcare than normal-weight adults.31 Even with the amount of attention on treating obesity, 1 in 3 cancer deaths are still being linked to obesity or lack of physical activity.32 With an ever increasing impact, obesity stands out as the primary negative correlative factor on the health of future generations. According to the National Health and Nutrition Examination Survey (NHANES), close to 32% of children and adolescents are obese33, and with these current trends, obese adolescents are more likely to become obese adults.34 Obese male youths and females youths are more likely to become obese adults by as many as 18 times and 47 times, respectively.35 Although dependents might not be the ones contributing to the success of the organization, it’s important to start thinking about preventative measures for obesity in youth as they will become the leaders and workers of the next generation.

The Healthier Generation Benefit (Benefit), launched in 2009 by the Alliance for a Healthier Generation, is a collaborative effort between insurers, employers and medical associations to offer comprehensive health benefits to children and families for the prevention, assessment, and treatment of childhood obesity. Companies agree to provide insurance coverage for at least four follow-up visits with their primary care provider every year and at least four visits with a registered dietitian per year for eligible children. The reason for tackling childhood obesity is simple: this preventable health outcome is estimated to cost $14 billion annually in direct health expenses and has high correlation to school absenteeism for 4-6th grade students.36 As of 2014, 19 insurers and self-insured organizations are offering the Benefit, impacting over 2.8 million children.


ASSESSMENT CRITERIA

The beginning level represents organizations that offer basic benefits coverage to their employees. The performing level represents organizations that offer more advanced and non-traditional coverage with lower co-pays to their employees.

BEGINNING

BENEFITS COVERAGE

• Employers offer dependent coverage for employee’s spouse/domestic partner and children2

• Employers ensure that benefits are extended to same-sex and nontraditional couples in states that have same-sex marriages

BENEFITS DESIGN• Employers convene an ad-hoc group to assess efficacy of existing benefits or to

provide recommendations on revising benefits plan

BENEFITS COST

MENTAL HEALTH COVERAGE

• Management and/or HR officials communicate legal and health-related consequences of abuse and diversion of prescription/illicit drugs to employees through wellness assistance programs

• Employer places information on mental health and wellness resources available to employees in highly visible often crowded area in the workplace

COMPLEMENTARY AND ALTERNATIVE MEDICINE

• Employers connect staff to community resources including health advocates, wellness centers, etc.

REPRODUCTIVE COVERAGE

HEALTH SAVINGS ACCOUNTS & CASH INCENTIVES

• Employers offer HSAs as optional benefit

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Once an organization has reached the leading level, there are no ceilings on coverage for employees (both traditional and non-traditional services) and employers may offer a lump-sum benefit payment to use as employees see fit.

PERFORMING LEADING

• Employers offer enhanced coverage to traditional medical plans including consumer-driven health plans, disability income coverage, and critical illness coverage

• Key stakeholders from all levels of staff and management will create an active health and safety council that meets regularly to discuss and plan for overall mental health and wellness efforts in the office environment

• Low co-pays

• No cost to employee for any preventive or medically proscribed services, procedures, or medication

• No obligation to submit expense receipts

• Employers offer coverage that can go with employees if they leave their employer under certain circumstances

• Health insurance covers non-traditional methods (e.g.: acupuncture, herbal medicine, yoga, etc.) with the same co-pay as any other specialist

• There are no ceilings on complementary and alternative medicine (CAM) coverage with documented medical need

• Health insurance covers reproductive medicine up to 50% of costs incurred

• Health insurance covers all reproductive medicine costs incurred with no maximum ceiling

• Employers offer a lump-sum benefit payment to use as employees see fit


BEGINNING

HEALTHIER GENERATION BENEFIT

• Employers offer the Healthier Generation Benefit (Benefit), which includes 4 follow-up visits with their primary care physician per year, and 4 annual visits with a registered dietician to dependents between ages of 3-18 with a body mass index (BMI) in the 85th percentile or higher

• Employers promote the Benefit annually to their employees

• Employers upload a link about the Benefit on their employee web network

• Employers upload the Alliance Quarterly Campaign to company intranet site

ASSESSMENT CRITERIA

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PERFORMING LEADING

• Employers offer the Healthier Generation Benefit to dependents of ages 3-18 regardless of BMI and weight status

• Employers promote the Benefit twice annually

• Employers co-host a webinar or a lunch-and-learn session for employees on the Benefit

• Employers offer the Healthier Generation Benefit to all employees and dependents without restrictions

• Allocate a budget to promote the Benefit and obesity prevention to members

• Create customized promotional materials and send directly to employees

• Identify wellness champions for obesity prevention and wellness advocates within the organization


Core Policy Category 3: At-Risk Employee Populations

ISSUE OVERVIEW

This section focuses on employee populations with the highest risk of poor health outcomes with the goal of both highlighting the specific needs within these populations and identifying points of intervention to advance improvement. There are four at-risk populations that merit focus and attention:

• Employees working non-traditional work schedules (e.g. graveyard shifts, on-call shifts, or 24 hour rotations);• Hourly employees;• Manual labor employees; and• Healthcare industry employees.

A 2009 Gallup poll studying engagement across industries found that the least engaged employee populations are shift workers, including agriculture, food and beverage, hospitality, transportation, care, education, and heavy lift workers.38 This disconnect in engagement has a direct correlation to health outcomes, as employees with low levels of engagement have been shown to suffer higher incidences of chronic diseases and report higher levels of workplace stress. Employees within these higher risk populations typically work in industries that are highly competitive, rely on low-skilled labor, pay low wages, and provide only limited health insurance coverage.39


RELEVANT RESEARCH

Shift work is considered a risk factor for many health problems including cognitive disorders (e.g., learning and memory deficits, loss of attention and vigilance) and a higher probability of developing obesity, breast cancer, cluster headache, fatigue, stress, diabetes, and cardiovascular disease.40 Shift work can also exacerbate symptoms and progression of chronic diseases, such as sleep disorders, digestive diseases, heart disease, hypertension, epilepsy, mental disorders, substance abuse, diabetes mellitus type 1, asthma, and health conditions that require medications with circadian changes in effectiveness.41 Specific health risks by industry include:

• Farmers are at high risk for fatal and nonfatal injuries, work-related lung diseases, noise-induced hearing loss, skin diseases, and certain cancers associated with chemical use and prolonged sun exposure. Farming is one of the few industries in which families (who often share the work and live on the premises) are also at risk for injuries, illness, and death.42

• Nonfatal injuries and illnesses among food and beverage workers tend to result directly from their normal job duties and include sprains, bruises, cuts, lacerations, overexertion, and heat burns. The Bureau of Labor Statistics states that “the manufacturing industry sector accounted for over 30% of all private industry occupational illness cases, resulting in the highest illness incidence rate among all industry sectors.”43

• The hospitality industry employs the largest number of young workers. In 1996, hotels and restaurants accounted for about 6.3% of all time-loss claims accepted by the Workers’ Compensation Board (WCB). From 1992 to 1996 24,696 time-loss claims were accepted, 616,674 days were lost from work due to workplace accidents, and 10 claims were accepted for fatalities.44

• Highway transportation incidents are the leading cause of occupational fatalities in the United States.45 According to the Bureau of Labor Statistics, transit and intercity bus drivers had the highest rate of injuries and illnesses of all occupations measured in 2010, with light and delivery truck drivers close behind.46 Bus, truck, and taxi drivers face long hours behind the wheel, often breathing in exhaust fumes or eating unhealthy fast food. Sleep problems and on-the-job sleepiness are common among transportation professionals (which can include pilots and train operators). Their largest risk, motor-vehicle accidents are consistently the leading cause of workplace fatalities in the United States.47

• Citing scheduling and lack of wellness, as much as 65% of caregivers leave their jobs annually.48 In one study, care workers reported the frequency of medication errors declined by 50% after prevention activities were implemented in a 700-bed hospital.49 In a second study, there was a 70% reduction in malpractice claims in 22 hospitals that implemented stress prevention activities. In contrast, there was no reduction in claims in a matched group of 22 hospitals that did not implement stress prevention activities.50

• Educators and heavy lifters are among the highest groups for musculoskeletal injuries. In particular, this population as well as heavy lifters need trainings on proper body mechanics to understand the importance of posture in preventing strain on the lower back, education in proper lifting and carrying techniques, provision of furniture and fixtures at appropriate adult heights, regular exercise and stretching for increased strength and flexibility, and maintenance of proper body weight to prevent straining back muscles.51

24

HOURLY EMPLOYEES

Among industries with high proportions of hourly employees, workers in the hospitality and retail sectors suffer from a variety of institutional barriers to better health. Workers in both industries perform repetitive tasks for long periods of time, are not covered by employer provided health insurance, and often work in low moral environments due to high turnover and low levels of job security.52 Both industries also employ large numbers of populations that are sensitive to shifts in economic activities that leave them financially and professionally vulnerable; in the hospitality industry, a majority of employees are women, while in the retail industry a large majority of the employees are younger adults with low skill levels.53

HEALTHCARE EMPLOYEES

One of the most at-risk employee populations that work in unique environments are healthcare workers. Employees in the healthcare field, as described by the Occupational Safety and Health Administration (OSHA), include workers that provide direct or indirect health services to individuals.54 Regardless of the worksite or the type of health specialization, healthcare workers face some of the most serious and complex health hazards. According to OSHA, healthcare professionals are at risk of contact with blood borne pathogens, biological/chemical exposures, laboratory hazards, x-ray/radioactive hazards, mental health hazards from stress and violence, and much more.55 The Center for Disease Control and Prevention (CDC) lists additional hazards for healthcare workers, including back injuries, latex allergy, and needle stick injuries.56 Specific information about the current landscape of healthcare professionals is listed below:

• In 2010, the healthcare and social assistance industry reported 653,000 injury cases, more than any other industry that year (152,000 more cases than the manufacturing industry)57

• The incidence rate for the healthcare and social assistance industry for nonfatal injuries and illnesses was 139.9; the average incidence rate for all private industries in this category was 107.7.58

• The incidence rate of nursing aides, orderlies, and attendants for musculoskeletal disorders was 249 per 10,000 workers; the average rate for all workers was 34 per 10,000 workers.59

• Turnover rate of newly hired nurse graduates falls between 13-70%; a majority of the reasons for leaving work included psychosocial factors such as work overload, time pressures, necessary non-nurse duties, and low value placed on their contributions.60

There are many preventative techniques for healthcare workers to hone in on, but does not seem to be enforced by organizations. Companies, hospitals, and clinics will have to provide assistance and support in order to enhance workplace and worker wellness.

There is an increasing realization that hours-of-service guidelines alone may not achieve the objective of maximizing wellness, alertness, fitness for duty or employee engagement for the aforementioned populations. Studies show that employee alertness depends not only on how many hours are worked, but also on a variety of other factors including, among others, what one does at work; when one is at work; whether the work environment promotes alertness or fatigue; and whether there are mechanisms in place to detect excess fatigue.61


ADDITIONAL INSIGHT

POOR HEALTH OF HOURLY EMPLOYEES 38

• Compared to salaried employees, hourly employees miss work more often and the dominant cause is health-related.

Unscheduled absence rates vary from 6-11% in hourly workplaces compared to 2.1% for all US workplaces.

The biggest reason for such absences is personal illness and stress (at least 47%).

• As hourly employees are only paid when they work, they are more likely to do so while sick, decreasing productivity.

More productivity is lost when employees attempt to work while sick (72%) compared to being absent (28%).

The major reasons for lower productivity at work are chronic conditions (58%) like diabetes, heart disease, chronic back pain.

• Hourly employees represent 59% of the total U.S. labor market.

• Only 35% of hourly employees have access to employer sponsored wellness programs compared to 45% of salaried employees.

IMPACT TO EMPLOYERS

• On average, the cost to U.S. employers due to higher absence rates is $950 per hourly employee which translates to almost $5 million annually for a company of 5000 employees.

• Unscheduled absences also forces employers to either operate short-staffed or find a replacement, which could require the employer to pay overtime.

• The average cost to U.S. employers due to lower productivity in the workplace is $180 billion annually.

From Booz Steering Committee Slides


ASSESSMENT CRITERIA

For at-risk populations, the beginning level represents organizations that offer basic educational materials, health measures, and sick leave policies to their employees. The performing level represents organizations that offer more advanced health measures and policies.

BEGINNING

INDUSTRY-SPECIFIC RESOURCES AND ENGAGEMENT TESTS

• Employers provide education materials for industry specific risk factors

• Employers in aligned fields notify employees and recruits about PPACA funded opportunities for education, loan reimbursement, and special recruitment for healthcare workers

• Employers enlist personnel or a third party to connect employees to occupation-specific resources such as community centers and other free community-based clinics

INDUSTRY-SPECIFIC EQUIPMENT

• Employers subsidize industry-specific equipment at 50% (e.g., ergonomic accessories for heavy lifters, masks, ear plugs, visors, gloves and sunscreen for outdoor employees)

GENERAL AND INDUSTRY-SPECIFIC HEALTH MEASURES

• Employers follow shift/rest guidelines for shift workers

• Employers provide industry specific and general health vaccinations in house for employees

• Employers subsidize industry-specific off-site preventative measures at 50% such as inoculations, physical therapy, and medicines

SICK LEAVE • Employers provide unpaid sick leave at no risk to job security

TIME OFF

SHIFT AND WORKPLACE FLEXIBILITY

FREQUENT BUSINESS TRAVEL

GENERAL • Employers adhere to ‘part-time’ and other relevant beginning level standards in framework

27

Once an organization has reached the leading level, employers offer engagement tests, advanced workplace flexibility, and generous business travel policies.

PERFORMING LEADING

• Employers offer engagement tests that place employees in the ‘best fit’ positions

• Employers subsidize industry-specific equipment at 75% • Employers provide industry-specific equipment for free

• Employers subsidize industry-specific off-site preventative measures at 75%

• Employers offer industry specific preventative measures for free

• Employers offer paid sick leave for staff

• Employers offer paid leave for full time staff and part time staff at their rate of employment (15 hrs./week = full reimbursement at 50% of time off (out 2 days, 1 is reimbursed)63

• Employers grant extended unpaid time off without penalty (e.g. for trips to home countries or to take care of family)

• Employers limit shifts to 12 hours 64

• Employers encourage culture of flexibility by: Allowing employees to trade entire shifts; Allowing employees to pick up shifts; Allowing episodic time off (last-minute time off without pay granted without penalty); Offering downtime leave (time off without pay when the operation/business is slow); Allowing employees to drop and split shifts; Giving employees advance notification of monthly work hours; Scheduling preference bidding (or PBS, is a computer program providing crew scheduling)

• Employers encourage flexibility by: Guaranteed scheduled time off; Offering floating holidays; Offering shift time off that can be made up during the pay period

• Management encourages a day of rest upon return from an assignment

• Management enforces a day of rest upon return from a mission

• On-site health professionals contribute training and guidance for stress management and maintaining a healthy life balance

• Employer implements a travel policy that allows business class for flights of more than 3 hours


Core Policy Category 4: Family Friendly Workplace – Promoting Family Forward Culture

ISSUE OVERVIEW

According to a 2008 report by the Heartland Alliance Mid-America Institute on Poverty, approximately 8.6% of the instances when households enter into poverty in the U.S. happen when a child is born, and one out of every five temporary poverty spells for children begin this way.65 The report also found that 12.9% of families with a new baby become poor in the birth month, increasing to 24.6% when a female heads the household.66 These statistics demonstrate the need for addressing employee well-being through policies that support the health of the families and dependents of employees.


RELEVANT RESEARCH

Family leave policies that are not aligned with the needs of employees with children or dependents are increasingly at odds with an aging population base and the increasing number of female employees who are also heads of households. In the U.S. more than 19 million families with children now have a mother as the primary or co-breadwinner, and 70% of children live in households in which both adults are in the labor force.67 An increase in the number of older Americans (aged 65 years or older) stands to create additional strains on employee capacity, as employers must both replace an aging workforce and accommodate younger workers who care for elder dependents. The number of older Americans, or individuals 65 and older, is expected to climb from 41.4 million in 2011 to 92.0 million in 2060, and employers should prepare themselves for the effects of this dramatic shift accordingly.68

In addition to establishing paid paternal and caregiving leave, flexible scheduling that enhances employees’ ability to decide when and where they accomplish their work is on the rise. Since 2005, there has been a significant increase in the proportion of employers allowing at least some employees access to flextime and place.69 Such policies help families to better manage work assignments and personal responsibilities. As flexible scheduling and workplaces become more common, organizations that fail to adopt these options where appropriate run the risk of being outperformed by competitors who benefit from lower operating costs and better adaptation to a global knowledge and service-based economy.

PARENTAL LEAVE

The United States is the only high-income nation without mandatory paid maternity leave. Almost all middle- and low-income countries offer it with the exceptions of Swaziland, Papua New Guinea—and the U.S.70 Unsurprisingly, the U.S. has 50% more first-day infant deaths than all other industrialized countries combined, the highest first-day death rate in the industrialized world.71 This lack of support has dire effects on the child, family, and business. A study of 18 countries spanning more than three decades found that extending the number of weeks of job-protected paid leave was associated with a significant decrease in infant mortality.72 Another study of 16 European countries from 1969 to 1994 found that more generous paid parental leave reduced deaths of infants and young children: a 50-week entitlement to paid parental leave was associated with about a 20% decline in post-neonatal deaths and a 15% drop in fatalities between ages 1 and 5.73

CAREGIVING LEAVE

Additionally, employers that offer child and eldercare support see higher productivity from employees.74 Employers who do not offer dependent care supports may feel the drain on work productivity given that respondents who do not have access to dependent care supports are 62% more likely to experience sleep issues that have an impact on their jobs compared to respondents who use these supports.75 In organizations where there is little or no room for error, such as patient care, manufacturing, or transportation, sleeplessness can have dangerous consequences.76 Workers who care for elderly relatives cost U.S. businesses about $34 billion annually in absenteeism, replacement costs, and lost productivity, according to a survey by the National Alliance of Caregivers and the MetLife Foundation.77 Employees who do not have access to supportive dependent care policies reported losing 31% more productivity due to stress during the prior month than the group that had access to supports; employees with access to such supports spent nearly 20% less time dealing with dependent care issues at work than those who did not have access to supports.78

30

BREASTFEEDING

Similar to parental leave, there are aggregate benefits at the societal level to supportive breast feeding policies. Recent research shows that if 90% of families breastfed exclusively for 6 months, nearly 1,000 infant deaths could be prevented.79 Other studies have shown that the United States would save $13 billion per year from the institution of increased breast feeding of infants, as medical care costs are lower for fully breastfed infants than infants that have never been breastfeed or were breastfed only for a short period of time.80 Breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations and require mothers to miss less work to care for sick infants, promoting lower medical costs to employers.

ADOPTION

The equitable treatment of families that pursue adoption is an integral component to a holistic set of family leave policies. Employers that provide adoption benefits with visible support and encouragement can realize the following benefits:

• Equity: Adoptive parents should be treated the same as biological parents in benefits extended – reducing the potential of discrimination suits brought against the company.81

• Low cost: Since few workers actually utilize the benefits, the cost to the company is low, assuring compatibility with cost containment concerns. An informal survey of companies shows that fewer than 2% of all employees use the adoption benefit.82

• Good will: Organizations receive good will and positive publicity for sensitivity to their employees that pursue adoption. Additionally, such policies tend to inspire greater loyalty amongst employees when given this extra consideration. Although difficult to quantify directly, supportive adoption policies can lead to a lower company turnover rate.83

• Social benefit: Children and families are the beneficiaries of the company’s support of adoption. The benefits may make the difference in a decision to adopt, which can be particularly meaningful for the growing number of available children with special needs who live in foster care or institutions.84

• Competitiveness and Talent Retention: As more and more companies enact adoption benefits packages for their employees, their counterparts will want to keep pace with their colleagues in order to stay competitive and retain and attract talent.85


BENEFITS TO BUSINESS AND THE ECONOMY OF PAID LEAVE The benefits to business operations and employee productivity of family friendly leave policies have been demonstrated in multiple studies. A 2011 CEPR Leaves That Pay report found that an overwhelming majority of respondents found paid family leave to have no negative impact on productivity, performance, turnover, or morale, with approximately 90% of respondents indicating their agreement with this statement.86 The same study found that the average percentage of employees who took advantage of paid leave to be fairly low at 6%, again indicating that usage of paid leave does not negatively impact business operation and employee productivity. Other notable statistics on the benefits of paid leave are as follows:

• 94% of leave-takers who received full pay during family leave returned to the same employer, compared to 76% of employees who took unpaid leave.87

• Paid leave can avoid the cost of employee turnover, which can range from 20% of annual pay for younger workers to 40% for more senior employees.

• Instituting 15 weeks of paid maternity leave in countries (such as the U.S.) without paid leave could increase multifactor productivity by 1.1%.

• Another study of US women workers found that lengthier childbearing leave (combined paid and unpaid leave) had a strong deterrent effect against women quitting the labor force or changing jobs postpartum.88

• The costs of maternity, paternity, and parental leave relative to population and gross domestic product are modest, even in countries with generous leave policies. Public expenditures on maternity leave are estimated to amount to an average of 0.3% of GDP for leave payments in countries in the European Union and the OECD.89

RELEVANT RESEARCH

32

CASE STUDY

Accenture provides its employees with a flexible workplace – giving options for how and where employees do their work. The company offers programs and tools to help individuals and teams understand how encouraging flexibility and a balance between work and personal health enhances, rather than impedes, productivity. Additionally, Accenture’s LifeWorks Employee Assistance Program (EAP) provides employees confidential support for challenging issues such as parenting, end-of-life issues, caregiver, and community support. The company also offers Backup Dependent Care so that employees can easily locate caregivers for their children, spouse, or relative when regular arrangements don’t work, with subsidized rates. Finally, Accenture treats expecting parents to a new parents’ toolkit, a nursing mother’s program, and adoption assistance.90 91

Accenture


ASSESSMENT CRITERIA

The beginning level represents organizations that offer their employees basic parental leave, caregiving leave, breastfeeding, and adoption benefits and support. The performing level represents organizations that offer more advanced benefits, with a more flexible workplace and generous Paid Time Off (PTO) policies.

BEGINNING

FLEXIBLE SCHEDULING AND WORKPLACE

• Employers offer flextime to students pursuing relevant certifications/degrees at no risk of unemployment

PAID TIME OFF (PTO)

PARENTAL LEAVE

• Employers offer 12 weeks paid maternity leave for all exempt employees• Employers offer 12 weeks paid maternity leave for all nonexempt employees at

75% pay• Full employee benefits continue throughout leave at no additional cost

CAREGIVING LEAVE

• Employers make resources and referral services available• Employers offer subsidies/reimbursements up to 50% (after government subsidies

and tax breaks) for child/elder care services (including transportation)• Employers offer emergency flextime• Employers offer parental leave structure• Employers offer affinity groups for employees with children/elders who have special needs

BREASTFEEDING ECONOMICS

• Employers provide information hotline• Employers provide a reasonable break time for an employee to express breast milk for

her nursing child for up to one year after the child’s birth• Employers make the break time available each time an employee needs to express breast milk• Employers must provide a space for employees to express milk that is not a bathroom, is

shielded from view, and is free from intrusion from coworkers and the public• Employers provide managers with information on how to accommodate nursing mothers• Employers will not force mothers to ‘punch out’ during breast expression breaks unless

they exceed 30 minutes• Employers provide refrigeration for breast milk

ADOPTION

• Employers offer adoption resources to all employees (literature, contact info, etc.)• Employers offer maternity leave benefits to adopting parents (see Parental Leave)• Employers cover universal adoption-specific expenses at 80% of cost for public agency

adoption and up to 25% (up to $2,500) of cost per adoption excluding unlicensed and inter-country adoptions

• Employers provide reimbursements applicable to inter-country adoptions and are limited to one child per employee (not family)

• Adopted child’s insurance benefits match biological child benefits• Employers home study fees are covered

34

Once an organization has reached the leading level, employers offer a fully functioning culture of flexibility, on-site childcare, and a generous allowance for individuals hoping to adopt.

PERFORMING LEADING

• Employers offer flextime, telecommuting and the option of designing a compressed work week to all employees

• Employees offer choices in managing work time• Employers offer a flex career option• Employers offer part-time/full-time flexibility

• Employers offer the option to switch to part-time work• Employers offer fully functioning culture of flexibility

• Employers offers PTO averaging 30 days/year (in addition to sick days, maternity leave, and vacation days) PTO includes: personal health days, floating holidays, and elder care days

• Employers offer PTO averaging 40 days/year

• Employers offer 36 weeks paid maternity leave for all exempt employees at: First 6 months 100% pay; Last 3 months at 50% pay

• Employers offer 36 Weeks Paid Maternity Leave for all nonexempt employees at: First 3 months 75% pay; Next 3 months at 50% pay; Last 3 months at 25%

• Employers offer 52 weeks paid maternity leave for all exempt employees: First 6 months 100% pay; Next 3 months at 50% pay; Last 3 months at unpaid pay

• Employers offer 52 weeks paid maternity leave for all nonexempt employees at: First 3 months 75% pay: Next 3 months at 50% pay; Last 3 months at 25%; Last 3 months unpaid

• Employers offer college readiness programs and educational assistance for dependents

• Employers offer backup child/elder care • Employers offer school holiday care• Employers offer support groups for parents of teens and tweens

• Employers offer before and after hours care• Employers offer sick care• Employers offer business travel and overtime• Employers offer on-site childcare

• Employers provide locks for privacy in pumping rooms• Employers provide a calendar for scheduling access to

pumping rooms• Employers encourage breaks so nursing mothers may pump

• Employers provide comfortable furniture in pumping rooms

• Health insurance covers reproductive medicine up to 50% of costs incurred

• Health insurance covers all reproductive medicine costs incurred with no maximum ceiling


Core Policy Category 5: Employee Health

ISSUE OVERVIEW

When designed well, employee wellness programs can yield improvements in health outcomes and cost savings. However, it should be noted that the latter is not always the best initial indication of the most effective programs. A comprehensive study by the Center for Studying Health System Change (HSC), “Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely,” which included literature reviews and interviews with industry experts and employers sponsoring wellness programs, concluded that wellness programs need to be customized to the individual organization.



RELEVANT RESEARCH

The costs of termination, replacement, and loss in productivity equate to $1,000, $9,000, and $15,875 respectively per employee. This means that losing one employee due to dissatisfaction, illness, or poor work environment could cost the organization $25,875 on average.92 A critical meta-analysis of the literature on costs and savings associated with integrated health and wellness programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.93 However, the 2004 National Worksite Health Promotion Survey showed that only 7% of employers offered comprehensive programs 94 of the type specified in the recommendations of the influential Institute of Medicine report Healthy People 2010.95 These include health education, worksite screenings linked to appropriate medical care, and the integration of the program into corporate or organizational structure. Noted difficulties that restrict employees from engaging and participating in wellness initiatives include:96

• Lack of knowledge of services

• Insufficient space for wellness initiatives

• Limited time

• Program consistency

• Cost of formalized prevention

• Confidentiality concerns

• Lack of interest

• Being overwhelmed with messages and deleting them without reading them

Furthermore, companies struggle with effective ways to increase utilization of these programs and to disseminate information, but there are some solutions that companies should look to:97

• Long-term commitment is pivotal to engage employees in wellness initiatives.

• Employees need significant incentives, besides gift cards and health insurance modifications, in order to help them focus on behavioral change.

• Resources requested by employees include periodical newsletters and seminars.

• Resources requested by employers include analysis of best practices on program structure and implementation and connection to resources.

MENTAL HEALTH

One in four adults, approximately 61.5 million Americans, experience mental illness in a given year. One in 17, about 13.6 million, live with a serious mental illness such as schizophrenia, major depression, or bipolar disorder.98 Approximately 6.7% of American adults − about 14.8 million people − live with major depression.99 Approximately 18.1% of American adults − about 42 million people − live with anxiety disorders, such as panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder, and phobias. About 9.2 million adults have co-occurring and addiction disorders.76

Privately insured individuals pay out-of-pocket for 34% of the cost of their ambulatory care and 30% of the cost of prescription medications.101 102 The average privately insured individual treated for a mental illness spends 3% of his/her total household income on behavioral healthcare services. Additionally, 5.2% of privately insured individuals spend 20% of their total household income on behavioral healthcare services.103

37

Estimates of the total workplace costs of mental illness and substance abuse disorders range from a low estimate of $79 billion per year, to a high of $105 billion per year (both figures based on 1990 dollars).104 Serious mental illness costs America $193.2 billion in lost earnings per year.105 Behavioral health problems cause more than 200 million missed work days each year in the U.S. at an estimated cost of $105 billion (National Business Group on Health). Providing a minimum level of enhanced care for employees’ depression would result in a cumulative savings to employers of $2,898 per 1,000 workers over five years. Even though the intervention would initially increase use of mental health services, it leadingly would save employers money, by reducing absenteeism and employee turnover costs.106 In total, the 217 million days of work loss and work impairment due to behavioral health disorders cost employers $17 billion annually.107

There are a multitude of mental health programs that employers can institute beyond the standard employee assistance programs to create supportive internal environments that reduce incidences of mental health illnesses. By offering accessible, consistent, and high-quality mental health services to employees, employers can both prevent declines in mental health from occurring and provide employees already suffering from mental illness with the support they need to become healthier. These programs can include:

• Health professionals or designated, appropriately trained professional staff, contact employees with learning disabilities or mental health and/or substance abuse issues on an annual basis to recommend and connect them with appropriate resources.

• Regulary accessible, discreet space is available in which peer-based mental health and wellness support groups can meet.

• Referral service where employees may anonymously recommend colleagues for a consultation with a mental health professional.

• Employees have access to employer-hosted mobile applications and online support groups, giving them around-the-clock access to mental health support.

• Mental health and substance abuse education boosters are offered to all employees during periods of high stress.

SUBSTANCE AND PRESCRIPTION DRUG ABUSE

Approximately 2 million adults age 50 and older (2.1% of adults in that age range) used prescription-type drugs non-medically in the past year.108 Substance abuse treatment admissions for individuals age 50 or older nearly doubled from 1992 to 2008, climbing from 6.6% of all admissions to 12.2%.109 A study by Bailey and Covell revealed that experience with daily hassles, sexual and emotional abuse, and depression were significant predictors of prescription drug abuse.110 A 1999 study in the American Journal of Public Health found that sexual harassment in the workplace has significant relationships with drinking to intoxication, frequency of drinking, and prescription drug abuse, in both men and women.111

Botvin et al. reviewed the research about tobacco, alcohol, and drug abuse prevention strategies and found that all studies of “generic skills training approaches” found significant and large effects on behavior.112 Specifically, reductions were shown in tobacco, marijuana, and alcohol use. Some of the skills tested in the broad range of studies included ability to increase self-control and self-esteem, and coping strategies for relieving stress and anxiety.113 CDC’s policy recommendations for addressing the epidemic include: prescription drug monitoring programs (PDMPs); patient review and restriction programs; laws/regulations/policies; insurers and pharmacy benefit managers (PBM) mechanisms; clinical guidelines; and improved access to substance abuse treatment.114 ASTHO recommends employers facilitate better access to effective treatment services, address under-treatment of substance abuse, increase parity, reduce stigma and barriers to care, leverage resources to improve service delivery, and identify performance indicators and outcome targets for opioid treatment services.115


SMOKING CESSATION

The total economic burden attributed to tobacco use is $183 billion.116 In the United States from 2001 to 2004, the average annual smoking-attributable health-care expenditures were estimated at $96 billion per year.117 In that same timeframe, productivity losses were estimated at $97 billion per year.118 Compared to nonsmokers, smokers miss about 60% more days due to sickness.119 The effects of smoking are vast. The Organization for Economic Cooperation and Development calculates that construction and maintenance costs are 7% higher in buildings that allow smoking than in buildings that are smoke-free.120 Employers who provide a smoke-free workplace may save as much as 30% on fire insurance.121 Companies that have tobacco-free policies are more likely to be seen in a positive light by their nonsmoking customers, applicants, and employees. According to the CDC, the benefits of promoting a “culture of health” include engaged and empowered employees, lessened health care costs, and increased worker productivity.122

Smoking cessation programs are relatively low in cost when compared with other benefits. According to the CDC, comprehensive tobacco cessation benefits cost between $1.20 and $4.80 per member annually.123 According to a 2009 study, financial incentives can increase enrollment in tobacco cessation programs and increase completion and abstinence rates.124 Each employee or dependent who quits smoking reduces annual medical and life insurace costs by at least $192 almost immediately.125 Over time, tobacco cessation policies and benefits generate financial returns for employers in reduced absenteeism, health care and life insurance costs, and in higher worker productivity. Currently, 78% of the best companies have a tobacco free campus.126

SLEEP

A person working the night shift, which causes disruption to the circadian rhythm, is at greater risk of various disorders, accidents and misfortunes, including:

• Increased likelihood of obesity

• Increased risk of cardiovascular disease

• Higher risk of mood changes

• Increased risk of gastrointestinal problems, such as constipation and stomach discomfort

• Higher risk of motor vehicle accidents and work-related accidents

• Increased likelihood of family problems, including divorce

• Probable increased risk of cancer, especially breast cancer

• Sleep deprivation caused by shift work may increase the risk of epilepsy in predisposed people

• Shift workers with diabetes can experience difficulties in controlling their blood sugar levels 127

39

CASE STUDY

ADDITIONAL INSIGHTS: WORKPLACE TRENDS IN HEALTH & WELLNESS PROGRAMS129

Johnson & Johnson is particularly focused on implementing effective smoking cessation programs. The company joined forces with external, similarly-minded organizations such as the CEO Roundtable on Cancer and the WHO with the goal of “leading by example” and becoming a completely tobacco-free organization. Because programs are set at a corporate level but initiated and implemented at the local level, Johnson and Johnson pays special attention to cultural norms by utilizing staff members who fully understand the specific issues involved. Additionally, regional consultation and support is always available from a Wellness expert if needed.

In 2008, after the company successfully implemented its tobacco-free workplace policy, it turned its focus to employee smoking cessation efforts. A rigorous campaign was conducted in order to align with the worldwide No Tobacco Day, with part of this campaign including offering Nicorette at no cost to employees. To date, 560 employees have participated in the quit smoking campaign and the percentage of smokers has declined approximately 2% each year. To further increase participation, a comprehensive 3-year plan was developed that focused on healthy lifestyle, stress care, and non-smoking. Ongoing measures to support employees in smoking cessation efforts now include an e-learning tool to encourage non-smoking, counseling by Employee Assistance or internal healthcare staff, group seminars, and financial aid for Nicorette. Also under consideration is an in-house “non-smoking website” where, among other things, individuals can share success stories and be informed of a variety of activities that support non-smoking efforts.128

Johnson & Johnson

FROM TO

Segregated Health/ Wellness Programs

Integrated Health Management

Systems

Single Risk Focused

Interventions

Multi Risk Focused

Interventions

Employer-Centric

Employee-Centric

Treatment Focused Models

Prevention and Behavior Change Focused Models

FROM TO


ASSESSMENT CRITERIA

The beginning level represents organizations that offer basic nutrition support, critical illness and disability coverage, mental health coverage, substance and prescription abuse support, and resources on sleep. The performing level represents organizations that offer more advanced policies and benefits.

BEGINNING

WELLNESS PROGRAM FEATURES AND COMMUNICATION

• Employers conduct assessment of existing programs/policies (if applicable) and employee needs before establishing/revamping wellness plan

• Employers conduct annual wellness program evaluations• Employers notify employees of screening results and plan manager must follow up

with informing and connecting employee to care plan resources• Employers assign space, time, and staff to help manage the wellness plan• Program must remain consistently active for at least 5 years (independent of

evaluation reports)• Employers must develop confidentiality plan and notify all staff of it• Employers implement participant (not outcome) based recognition program

COMPENSATION AND EQUAL PAY

• Equal pay for men, women, LGBTQ, race, ethnicity, etc.• Minimum wage begins at $10.00/hour for non-exempt employees

NUTRITION SUPPORT• Employers (if they provide access to snacks) follow the Alliance for a Healthier

Generation (AHFG) food and beverage guidelines

CRITICAL ILLNESS AND DISABILITY

• Employers provide discounts for medical equipment• Employers provide counseling services• Chronic illness and disability covered in family insurance plans• Prescriptions drug mailing service

MENTAL HEALTH

• Employers cover mental health as regulated by PPACA• Employers allow mental health providers to be designated as a health home as

designated by PPACA• Employers include in annual health screenings: screening for depression and other

common behavioral health conditions among individuals with chronic medical illnesses and other comorbidities. (Information from screenings is used to guide employees and connect them to community resources and is not kept in employees’ files)

• Employers ensure that provider partners use the collaborative care model to address the needs of patients with mental illness and/or substance abuse disorders who are receiving treatment in primary care

• Employers ensure that all outside medical screenings are reimbursed and patient monitoring is billed as a lab test

• Employers review short-term and long-term disability management programs and instruct vendors to actively manage all behavioral health disability claims

• Employers ensure that redundancies between EAPs and health plans by re-structuring EAPs are reduced

• Employers ensure that EAPs do not duplicate services offered through the health plan (MCOs and MBHOs), but should be re-structured, if necessary, to provide the following functions: Conduct periodic organizational assessments to evaluate the effects of work organization on employee health status, productivity, and job satisfaction; Assist in the design and development of a structured program to deliver health promotion and healthcare education tools that significantly affect employee and beneficiary health and productivity and lead the effort to deliver behavioral healthcare education programs; Employers provide targeted case management, 24-hour crisis services, hotlines, assertive-community treatment (ACT) programs, and multi-systemic therapy

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Once an organization has reached the leading level, employers leverage social media in their wellness communication strategies, offer mental health education boosters during times of year associated with high stress, worksite napping, and other additional benefits.

PERFORMING LEADING

• Employers conduct follow up outreach and connect employees with community resources

• Employers utilize diverse communication strategies (including a link on company webpage)

• Employers include free counseling and drug therapy for tobacco cessation programs to all employees

• Employers offer flexible health spending accounts• Employers offer legal insurance• Employers offer strategic engagement in CSR• Employer includes outcomes in annual evaluation

• Employers wellness communication strategies include social media

• Employers share evaluation results with employees

• Minimum wage begins at $12.00/hour for non-exempt employees• Minimum wage begins at $13.00/hour

for non-exempt employees

• Subsidized or on-site benefits: Nutrition counseling; Health and lifestyle coaching; Health Fairs at job site; Stress management/stress reduction programs; Fitness center subsidy or on-site fitness center; Subsidized weight loss programs; Quarterly Health Screenings

• Subsidized or on-site benefits: Stipend of 1K/ year to spend on any wellness item; 24 hr access to nurse/doctor/professional

• Employers cover medical equipment• Employers strategically place disabled employees in company advertisements• Employers cover ongoing therapy for medically needy employees• Employers provide stipend for high-cost medically necessary medications

(medications above reasonable out-of-pocket cost)

• Employers provide prescription drug, and medical equipment vouchers

• Employers provide counseling resources for dependents (under 26)• Employers provide coverage for evidence-based treatment modalities for

seriously mentally ill children and adults, including: targeted clinical case management services; assertive community treatment (ACT) programs; therapeutic nursery services; and therapeutic group home services

• Employers involve a behavioral health specialist in certification of psychiatric disability and treatment planning

• Employers involve a behavioral health specialist in the review of the treatment plan

• Employers refer employees on disability for a psychiatric condition to EAP for return-to work assistance

• Employers support management in addressing issues of productivity and absenteeism that may be caused by psychosocial problems

• Employers functionally coordinate with other health services including health plan, disability management, and health promotion

• Employers provide stipend for the following care when past coverage period: Ongoing therapy; Counseling; Prescription drug abuse resources and counseling

• Employers offer mental health education boosters during times of year associated with high stress (such as end of year/holiday season)

• Employers provide no limitations on the following care: Ongoing therapy; Counseling; Prescription drug abuse resources and counseling


ASSESSMENT CRITERIA

BEGINNING

SUBSTANCE AND PRESCRIPTION DRUG ABUSE

• Employers provide a comprehensive employer substance abuse program including: A workplace substance abuse education component; Confidential screening by an EAP or health professional; Treatment referrals to an EAP or health professional; Confidential follow-up care to support individuals in recovery

• Employers implement a drug-free workplace initiative with written substance abuse policies, including: Under what circumstances will drug or alcohol testing be conducted; Employee and supervisor training in identifying impaired behavior and other signs of substance abuse; Outline of how to deal with impaired workers; Provisions for assisting chronic substance abusers; Possible disciplinary actions

• Employers must maintain an emergency first aid kit, which will contain but not be limited to an emergency Naloxone administration kit

SLEEP

• Employers train top executives, managers and/or HR on the effects of insufficient sleep, ensuring that corporate top management and fiduciary officers are on record in recruitment materials, new employee materials, and annual reports as supporting sleep health for all corporate employees and their families. Ideally, this is consistently presented to reinforce that sleep is the third pillar of health along with diet and exercise

• Employers provide resources on sleep• Employers provide sleep health education to employees• Employers provide in house medical health screenings that include sleep disorders

and connect employees to clinical services to ensure compliance with prescribed treatment (Co-morbidities are inquired about and noted at during the screening)

• Employers cover sleep screenings in health plan (insurance)• Employees receive 15 minute breaks per 2 hour work duration• Employees receive two full day’s off per week• Employers offer ongoing evaluation of sleep policies and investigations into accidents

as they relate to sleep• Employers adhere to shift duration recommendations• Employers provide explicit approval of down time from digital connectivity outside of

normal working hours

ADDITIONAL BENEFITS

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PERFORMING LEADING

• Employers offer comprehensive health plan benefits that support a broad range of services, including: brief intervention; outpatient and inpatient treatment; medication; peer support groups; illness self-management programs; treatment and recovery is an alternative or parallel to disciplinary action if an employee violates the company’s drug and alcohol policy or has job performance problems related to substance abuse

• In the event of a prescription drug overdose or death of an employee, employers will arrange for the following resources to be made available to all employees:

• Educational and psychological debriefings• Individual and group counseling for affected peers and family of employee• Promote healthy recovery within the community and hold town hall style

meetings to discuss employee needs and concerns• Employers develop Return to Work Agreement Employers offer affinity group

if desired

• Employers offer substance abuse education boosters during times of year associated with high stress (such as end of year/holiday season)

• Employers coordinate annual drug take-back day with local law enforcement, and other area employers

• Employers identify and mitigate corporate policies and operations that negatively impinge on sleep health for employees and their families, i.e., “sleep stealers.”

• Employers normalize online availability free-time from 10pm-6am [no emails sent/expected]

• Employers mandate a minimum of 30 minute breaks daily (logged off) per four hour shift

• Employers provide employees with Jawbone-type personal monitor to track sleep and other wellness aspects at a discounted price in accordance with income

• Employers adhere to NIOSH workload and shift length restrictions (five 8-hour shifts or four 10-hour shifts per week)

• Employers offer discounts on digital devices with apps (like flux.com) which mitigate the light exposure from devices in the later evening hours (9pm-7am)

• When negotiating contracts, employers ensure that there are provisions in contracts for services from health providers, requiring that: The annual physical examination protocols include provisions for asking employees and their dependents about their sleep health and practices; Employees who screen positively for sleep disorders are referred to clinical services to ensure compliance with prescribed treatment

• Health providers diagnose sleep disorders comorbidities, e.g. obesity, diabetes, cardiovascular disease, hypertension, depression and stroke (each can trigger sleep disorder)

• Employers offer worksite napping (up to 30 min)

• Welcome and provide incentives for employees to participate in scientific studies regarding sleep health in the workplace undertaken with academic research organizations or government health agencies

• Employers flag employers that are working consistent long hours and work to achieve balance

• Employer offers foreclosure and mortgage assistance counseling programs• Employers offer stipends for phone and home office materials• Employers offer free uniforms• Employers offer public transportation reimbursement

• Employers offer free employee parking• Employers offer free or subsidized meals• Employers offer sabbaticals


Core Policy Category 6: Talent Management

ISSUE OVERVIEW

Opportunities to improve health via strong talent management practices can seem unrelated at first glance, but recent research indicates a strong relationship between the two. In 2009, Gallup studied employee engagement in 152 organizations across 44 industries and found that employee engagement was positively associated with better customer loyalty, increased profitability and productivity, improved product quality (i.e., fewer product defects), and reduced employee turnover, absenteeism and safety incidents.130 Employee engagement continues to be a major concern for employers across all sectors. Developing employee skills via training and education is needed to drive innovation and productivity and to give workers the ability to access employment and advancement opportunities that can improve their health and “happiness.” Real-life experiences and mentoring opportunities also provide the learning that employees need to master a job. Similarly, when employees have the power to make decisions that are important to their performance and to the quality of their work life, they feel more accountable and connected to the organization. Power can involve giving employees relatively small opportunities for decision-making or allowing them to have final authority and accountability for decisions and their outcomes.



RELEVANT RESEARCH

The more transparent managers can make the organization’s operations, the more effectively employees can contribute to the firm’s success and understand the impact of their work. Managers should strive to provide information pertaining to output, revenues, and profitability – specifically as they relate to an employee’s particular area of work – so workers can influence these outcomes by adjusting levels of discretionary effort.

Talent management, although highly effective, can be difficult to implement due to the multiple points of intervention within an organization that need to be activated to improve the social and financial health of employees. In today’s current environment, employee engagement plays a crucial role in cultivating a supportive talent management infrastructure. There is sufficient evidence to demonstrate a clear financial return on investment from managing and developing talent within an organization. A study by Gallup Inc. reported that companies with engaged workers obtain higher earnings per share, and recovered from the recession of 2008 faster than other competitors.131 Research by the Kenexa Institute showed similar results, with organizations that had highly engaged employees achieving a total shareholder return seven times greater than organizations with disengaged employees.132 The same study also highlighted that the annual net income of the top 25% of engaged organizations nearly doubled that of the bottom 25% of engaged organizations.

On the other hand, a disengaged workforce can result in decreased productivity at the workplace. In Japan, an estimated $232 billion is lost every year as a result of low engagement levels that are pervasive throughout the country.133 An engagement database of 200 major organizations revealed that disengaged employees achieved average sales numbers that were 8% lower than highly engaged workers.134 Furthermore, the total number of quality errors (external and internal parts per million) in a Fortune 100 company for low-engagement workers was 5,658 errors, while highly-engaged workers had only 52 errors. A 2012 Gallup report found similar results, with organizations with high engagement levels reporting the following beneficial results:

• 37% lower absenteeism;

• 28% less shrinkage;

• 48% lower safety incidents;

• 10% higher customer metrics;

• 21% higher productivity;

• 22% higher profitibility; and

• 65% lower turnover.135

“The idea of corporate transparency goes hand-in-hand with offering rewards for those employees who do choose to expend extra effort.”

–SODEXO

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CASE STUDY

Facebook has a unique set of talent management practices that produce extraordinary business results. First, the company offers an extended six-week boot camp orientation or onboarding. During that time, new hires work on teams that spend their time working on multiple real projects, have full access to the complete computer code behind Facebook, and are assigned individual mentors. At the end of this process employees are asked which team and project within Facebook they wish to join – a powerful tool because when most employees apply to a job they have no way of knowing which team or project is the best fit for them. Additionally, Facebook’s Hackamonth process is a self-directed internal movement process that allows employees who have worked on a project for a year to select their own next project team and after working with them for a month, they can choose whether or not they want to remain.145

Facebook

So what can employees do to increase engagement? Accenture has identified several key drivers that can improve engagement and improve talent management processes – professional development and training, flexible recovery time periods, and empowering employees by increasing autonomy and influence.136 Employees who seem to be most engaged are those that feel their work is exerting some influence in their organization’s strategic operations. The report recommends that organizations create positions that provide opportunities for the employee to make a tangible impact and connect with the goal and mission of the company.137 According to Accenture, people with no career-growth opportunities are 13 times more likely to disengage at work.138 A survey reported that workers who feel they’re gaining skills and experiences for career advancement are seven times more likely to be engaged than those who don’t receive such developmental opportunities.139 Lastly, integrating time for recovery from long continuous periods of work is a great way to retain employees and engage them in a healthy manner. Accenture reports that employees who have adequate “recharge” times are three times more likely to be highly engaged, and experience decreases in absenteeism, insurance costs, and employee turnover.140

Talent management can take many shapes and forms, but no matter how it’s presented, engagement is important to organizational health if it is looking toward long-term success. Motivated employees are the driving force for a successful organization. Focusing on employee wellness in this way will provide a wealth of opportunities and new ideas to be created as employees become better and more productive workers and align their professional aspirations with the goals and visions of the organization.

COMPENSATION/EQUAL PAY

Women hold approximately 59% of low-wage jobs.141 Lower average earnings contribute to them being 32% more likely than men to be poor (based on 2009 data).142 According to the Working Mother’s annual Best Companies for Hourly Workers survey, women received 47% of the promotions to salaried exempt positions from hourly jobs and 38% of all promotions to non-exempt manager positions.143 Similarly, the proportion of non-exempt workers earning less than $12 per hour fell to 30% from 46% among employees at the 2012 Best Companies.144 All of this translates to the decreased ability of women to make the best possible decisions to manage their health and the health of their families.


ASSESSMENT CRITERIA

The beginning level represents organizations that provide basic skills training and interdepartmental engagement for employees. The performing level represents organizations that offer more advanced skills training and engagement programs.

BEGINNING

RESOURCES AND TRAINING

• Employers allow employees pursuing educational degrees, certifications, etc. flexible time

• Employers offer a minimum of paid entry and job skills training for current position (such as basic work skills, problem solving skills, etc.) during working hours if applicable

EMPLOYEE RECOMMENDATIONS

• Employers utilize employee recommendations to fill openings when applicable

JOB RELATED EQUIPMENT

INTERDEPARTMENTAL ENGAGEMENT

• Employers schedule activities that provide opportunities for new hires to engage with team members outside of their department

TRANSPORTATION SUBSIDIES

COMMUNITY SERVICE/CIVIC ENGAGEMENT

CULTURAL DIVERSITY

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Once an organization has reached the leading level, employers provide structured mentoring programs, social media training, and the opportunity to participate in civic engagement.

PERFORMING LEADING

• Employers have employee resource groups and affinity networks to support and strengthen diverse workforce

• Employers provide anti-bullying programs• Employers provide continual education coaching• Employers provide career advancement training including mentoring

opportunities• Employers provide life skills training• Employers offer basic technology training• Employers offer language skills training• Employers offer online self-directed training sessions• Employers offer information and training on financial literacy• Employers offer supervisor/team leader preparatory training• Employers offer peer learning/training groups• Employers offer career ladder and lattices (talent management trainings are

aligned with career mapping mobility goals)• Employers offer review courses (CPA, SHRM, when applicable)• Employers offer salary negotiation seminars

• Employers provide language programs• Employers provide translations for

critical information• Employers provide social media skills

training• Employers provide structured

mentoring program

• Employers offer subsidized uniforms and other job related equipment

• Employers offer public transportation subsidies

• Employers participate in community outreach/volunteerism; employees contribute to opportunity decision making

• Employers offer two days paid leave per year for employees to engage in civic engagement/CSR

• Employers offer one day paid leave per quarter for employees to engage in civic engagement/CSR

• Employers host culture days and celebrate heritage months• Employers offer ethnic dishes in employee cafeteria• Employers provide space/PTO for employees to celebrate international and

religious holidays


Core Policy Category 7: Veterans and Military

ISSUE OVERVIEW

The current decade-long war in the Middle East has created a vast pool of recent veterans, and coupled with the U.S.’s older generation of veterans from previous wars, there is an urgent need to address the growing health concerns of our current and former military men and women. Although the veteran and military population possesses unique skillsets that have demonstrated value to both private and public agencies, they face obstacles to well-being that merit specialized focus and resources to ensure optimal outcomes for the employer and the veteran employee.

Photo: Barbara Kinney / Clinton Foundation


RELEVANT RESEARCH

A recent Military Medicine study of 809 military personnel living on McGuire Air Force Base in New Jersey found that more than one-quarter (27.4%) of this population reported suffering from significant job stress.146 The report found that work stress and depression were both significantly related to impaired work performance, more days of missed work, poorer physical health, and negative perceptions about the abilities of supervisors and commanders. This trend towards worse health outcomes is especially alarming when compared with the overall population of the nation. Although military members comprise less than 1% of the U.S. population, veterans represent 20% of suicides nationally. Each day, about 18 veterans die from suicide.147

Screening efforts to identify mental health concerns in the months following return from combat suggest that up to 42% of National Guard and Army Reserve troops require mental health treatment, but that less than 10% actually receive care. Many redeployed soldiers express concerns about interpersonal conflict (14-21%), highlighting the potential impact of war on the well-being of family members, as well as friends and employers.148

A survey of 245 Fortune 500 firms indicates that the need for targeted mental health services in the workplace has not gone unnoticed, with just under 25% of firms surveyed indicating that their EAPs included mental health programs tailored specifically to support veterans and military personnel short- and long-term needs.149 These tailored programs are significant in that they signal a commitment on the part of the employer to create a welcoming environment for veterans and assist in breaking down obstacles to care and access within an organization. Ultimately, organizations need to address the mental health needs of veterans without stigmatizing its presence; there exists a fine line between unnecessarily scaring colleagues, coworkers, and supervisors of veterans about the impacts of mental health ailments like PTSD and minimizing the effect of such disorders on employee health if untreated. Appropriate tone, messaging, and communication are paramount in the successful implementation of programs geared towards this audience.

As employers continue to develop appropriate mechanisms for supporting veterans in the workplace, there is a growing body of evidence that demonstrates the worth of their increased inclusion in private enterprise. According to the 2012 Society for Human Resource Management (SHRM) Poll, Military Employment, organizations continue to place a high value on the skills individuals with a military background bring to the workplace. Over 90% of respondents that hired military talent in the 36 months preceding the poll agreed that those employees demonstrated:150

• A strong sense of responsibility;

• Working as part of a team under pressure and with a high degree of professionalism;

• The ability to see a task through to completion;

• Strong leadership and problem solving skills;

• The ability to adapt.

Organizations that engage this talent pool benefit in key measurable ways that directly align to common business goals, such as:151

• A workforce with coveted core competencies that consistently fall within the top ten employer desired attributes, including leadership, teamwork, critical thinking, problem solving, and working under pressure;

• Enhanced brand recognition for the organization that translates into increased market share;

• Increased talent attraction and retention;

• Increased customer attraction and retention; and,

• Opportunities for tax credits.

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CASE STUDY

Starbucks recently announced its plan to hire 10,000 military veterans and active-duty spouses over the next five years as part of a global expansion that calls for 500,000 employees companywide, an increase from 200,000 today. According to Starbucks CEO Howard Schultz, this new hiring program is “good business” because these skilled, highly trained people have significant leadership capabilities and will add value to the company. Additionally, various Starbucks locations will donate a portion of each customer purchase to local nonprofits benefitting military veterans, such as a Goodwill program called Operation: GoodJobs, which helps veterans with their post-military job searches. While the company already employs thousands of veterans in its stores and corporate offices, the new program will enable Starbucks to identify post-military employees and track their numbers companywide. One additional component of their program includes specialized training for hiring managers so that veterans can more easily translate their experience to the workplace and find jobs.153

Starbucks

IMPLEMENTATION IN THE WORKPLACE

Federal agencies and many NGOs have prepared guidelines for supporting veterans in the workplace throughout their entire employment, from the initial transition back to civilian work to continual organizational advancement. Collectively, these programs can help employers address the entire spectrum of social determinants of health through purposeful interventions in the workplace.

Job Accommodation Network (JAN): The U.S. Department of Labor’s Office of Disability Employment Policy provides free services to employers via JAN’s digital platform and in-person technical assistance. Although JAN’s primary focus is on supporting inclusive workforces that accommodate individuals with a variety of disabilities, it has compiled a robust set of recommendations on addressing the needs of veterans, especially those that suffer from PTSD. The recommendations cover the entire spectrum of health, inclusive of mental deficits, stress, sleep, time management, and interpersonal relations. The criteria assessment in this section includes many of the JAN recommendations. (http://askjan.org/media/ptsdvets.html)

Continuing Education for Human Resource Professionals: An initiative of the Secretary of the Army, the OneSource initiative provides free continuing education to human resources and medical professionals on the topic of veteran health. As of April 2014, OneSource provides four free courses online that cover the impact of deployment on family health, military cultural competency, building resilience, and the effects of PTSD. The courses count towards continuing education requirements for a variety of accreditation boards domestically and are administered by an external Army vendor. Detailed course information and registration can be accessed at: http://www.restofthewayhome.com/page/crack-the-code/

Mentorship & Affinity Groups: The Burton Blatt Institute’s survey found that formal mentorship programs and structured affinity groups were two key practices that veterans found to be most effective in supporting their well-being in the workplace.152 Providing mentorship opportunities between junior veteran employees and more senior veteran employees can bridge the gap in services that often exist once formal onboarding of employees ends. This mentorship can also extend beyond the boundaries of the organization and into the community, as some Fortune 500 companies have created mentorship programs between their veteran employees and veterans outside of the organization that are looking for a job or coping with transition to civilian employment. Internal affinity groups can provide many of the same benefits as mentorship programs, especially for larger firms that can connect greater numbers of veterans across initiatives, departments, or functions. Military affinity groups can also provide feedback and recommendations on existing veterans programs and serve in an advisory capacity to organizations as they evaluate the effectiveness of their outreach to veterans.


ASSESSMENT CRITERIA

The beginning level represents organizations that offer basic resource groups and assistance programs to military and veteran families. The performing level represents organizations that offer more advanced benefits, such as succession plans and family and social support.

BEGINNING

GENERAL• Employers adopt policies that explicitly address the health and wellbeing of veteran

employees

RESOURCE GROUPS AND ASSISTANCE PROGRAMS

• Employers offer a military-focused affinity or resource group in place (determine who in the department will be assigned as the new hire’s buddy)

• Dependents of deployed employees have access to EAP and other benefits programs

PROFESSIONAL DEVELOPMENT AND SUCCESSION PLANS

• Employers provide dedicated internship programs for veterans or military personnel

FAMILY AND SOCIAL SUPPORT

PAYMENT

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Once an organization has reached the leading level, employers become branded as a military ready company and offer pull pay and bonuses to military employees during employment.

PERFORMING LEADING

• Employers set specific goals regarding the hiring, retention, and promotion of veteran employees

• Employers establish partnerships with military agencies and veteran groups to provide definitive paths of transition and continuous support to veteran employees.

• Employer offers stress reduction benefit stipends to employees

• Employers offer moving assistance upon arrival in new state

• Employer offers support care packages

• Employer creates a mentoring program linking the new military employee with existing veteran employees as well as military spouses and family members

• Employers take pictures of what’s happening at work and send them to the deployed service member

• Employers have succession plans for military that may be called for active duty

• Employers provide targeted training and education opportunities to veteran employees that address their specific professional development needs

• Employer offers relocation assistance for transitioning spouse

• Employers consider social events that include family members to fully engage with the organization

• Employers use video conferencing to keep deployed employees connected, not only with their families, but with their department or even the whole organization if feasible

• Employer offers full pay and bonuses during deployment


Core Policy Category 8: Built Environment

ISSUE OVERVIEW

There are many factors that influence and trigger stress, but the built environment can act as a stress reliever for outside stresses, as well as independently trigger positive physiological reactions. A built environment that provides opportunities to connect with others and engenders a feeling of connectedness, and one that integrates biophilic elements known to promote optimal health can counteract stress and ill health promoters in the worksite. Biophlic interventions include the presence of natural elements, such as water, plants, trees, and non-threatening animals. Even artistic depictions of nature in paintings and murals have been shown to reduce anxiety and discomfort. In a research study in Sweden, hospital patients who were recovering from open heart surgery experienced the least post-operative anxiety when looking at pictures of natural scenes that included water, compared with pictures of abstract art, a control picture, or no picture at all. 154


RELEVANT RESEARCH

If workers are faced with nowhere to relieve stress in the office, the premature onset of psychiatric, stress-induced, and anxiety-related illnesses can surface.155 Studies show that our ability to directly access nature can alleviate feelings of stress, thus bolstering the case for biophilia in the workplace.156 The advantages of biophilic experiences include improved stress recovery rates, lower blood pressure, improved cognitive functions, enhanced mental stamina and focus, decreased violence and criminal activity, elevated moods, increased learning rates, decreases in blood sugar secretion, and psychological and eye health improvements. The incorporation of these relationships into the interior and exterior design of worksites can reap demonstrated benefits to productivity and effectiveness including, but not limited to, the following indicators:

• Illness and absenteeism

• Staff retention

• Job performance (mental stress/fatigue)

• Healing rates

• Classroom learning rates

• Retail sales

• Violence statistic

When linked to the effects of a renewed connection with nature, these metrics show remarkable gains, upon which companies and institutions can capitalize.

It merits noting that these environmental elements have direct effects on employer operations – a 2012 study found that 10% of employee absences can be attributed to architectural elements that did not connect with nature and that a person’s view was the primary predictor of absenteeism (an average $41,000 in salary costs).157 Similarly, presenteeism costs employers in the private sector $938 and employers in the public sector $1,250, per employee per year.158

• Biophilic work environments increase office workers’ productivity. Creating biophilic work environments for many of New York City’s office workers would result in over $470 million in recouped productivity value.159

• The study reported 52% fewer felonies in the greener buildings, 7-8% of which could be linked to increased access to nature.160

• The Park Prescriptions report states that 10% of the nation’s medical costs, or $150 billion, is attributed directly to obesity, and that $2,200 per person per year can be reduced if sedentary individuals become more physically active three or more days per week.161

• In 2010, the direct costs of occupational injuries and safety incidents for U.S. companies were more than $53 billion, in addition to the indirect costs of absenteeism, the hiring of temporary staff, and diminished customer service.162

• In 2010, 62% of the Business Group’s Best Employers for Healthy Lifestyles® Leading winners offered flexible work time for physical activity.163

• Study participants wanted a place for exercise including walking trains and a coordinator for activities.164

GREEN BUILDINGS HOLISTIC WORKSITES

• Energy Efficient• High-Quality Indoor Air• Recycled/Renewable Building Materials• Low Water Usage

• Natural Lighting• Color Therapy• Ergonomic Furniture• Integration of Natural Elements• Acoustics

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IMPLEMENTATION IN THE WORKPLACE

Possible interventions in the physical environment of the worksite range from the comprehensive development of holistic worksite campuses to small-scale improvements to building interiors. This Framework recognizes the value in wholesale development of healthy buildings and worksites, but as a majority of organizations may face constraints in their ability to implement such large-scale change, the focus in this section is small to medium scale changes that are low cost but yield significant results.

• Color therapy: Research has shown that most individuals exhibit psychological responses to colors that are inherent in the biology of humans. The color red, for example, is known to trigger more regressive reactions than others in the color wheel. By contrast, the color green has a restorative effect on physical, mental, and emotional health.

• Lighting: Proximity to windows and natural lighting can increase employee satisfaction and has been shown to moderate stress levels.165 Where feasible and possible, employers should maximize the amount of natural light allowed into interior workspaces and position employee workspaces within close proximity to natural light sources. One qualifier to this recommendation is that the amount of control that employees possess over natural lighting (such as blinds and/or other forms of window shielding treatments) does influence the positive impact of natural lighting.

• Ergonomic Furniture: Of the five implementation elements outlined in this section, investments in ergonomic furniture have shown to have the most direct and tangible increase in worker effectiveness. A study from 2000 found that employers that purchased ergonomic furniture recouped their costs within as little as five months and realized continued gains in effectiveness beyond that time horizon.166

• Integration of Natural Elements: Several studies within the behavioral psychology field have found a link between increased stress, anger, and aggression and non-pastoral settings.167 Humans inherently are wired to respond positively to green elements in their view shed such as forests, plants, flowers, or other naturally occurring settings. Exposure to green images has been shown to improve both mental health and physical health through increases in attention capacity and memory retention and decreases in resting heart rate, stress, and anxiety levels.168 Employers can easily translate these findings into their office environments and realize tangible benefits from small scale interventions such as incorporating potted plants, images of natural settings on walls, and even encouraging employees to install screensavers or computer desktops that feature green images.

• Acoustics: The U.S. Occupational Health and Safety Administration (OSHA) sets forth a series of recommended intervention strategies to reduce physical harm from noise exposure, including engineering controls (low noise machinery and adequate physical sound buffers), administrative controls (off-shift operation of noisy machinery and restrictions on amount of time exposed to noise), and hearing protection devices.169 OSHA’s recommendations have been designed to comply with the National Institute for Occupational Safety and Health’s (NIOSH) baseline noise exposure level of 85 dBA per eight hours, and OSHA mandates employers whose worksites exceed this baseline to implement a comprehensive Hearing Conservation Program that encompasses all appropriate intervention strategies.

• Office Worksites: While OSHA’s standards are applicable to all employment sites, they primarily address noise issues that arise at sites where heavy machinery and tools are used on a daily basis, such as manufacturing plants or construction sites. For workers employed in office or campus settings, noise typically impacts mental health more so than physical health, as collective noise arising from conversation, office equipment, and other common activities can increase stress levels and decrease attention span.170 As both of these outcomes can negatively impact an employee’s personal health and effectiveness in the workplace, employers would benefit from implementing solutions to mitigate office noise. Small-scale interventions include installing rubber mats underneath computers, printers, and other office equipment as well as making noise cancelling headphones available to employees, while large scale interventions include the provision of a variety of work spaces with differing noise levels and the usage of sound absorbing materials within the office interior.171


CASE STUDY

In 2007, Heifer International, a non-profit organization based in Little Rock, Arkansas, constructed a new office building to house their headquarters on the site of an abandoned brownfield. The new office complex, which has since been certified as LEED Platinum, was designed with the explicit goal of creating a worksite that minimized environmental impact and maximized efficiency. The building incorporates a wide array of sustainable best practices, including harnessing natural light for heating and lighting needs, recycling rain water for irrigation and air temperature control needs, and using locally sourced and/or renewable building materials throughout. Heifer extended this attention to sustainability to its office interior by providing open office interiors that provide employees with clear vistas to external greenery, installing white noise machines that help mitigate standard noise sources, and ensuring that all interior spaces receive a significant portion of natural light throughout the day.172

HeiferInternational


ASSESSMENT CRITERIA

The beginning level represents organizations that incorporate nature into space design, ensure that employees make better food and drink choices, and participate in community-wide wellness activities.

BEGINNING

HEALTHY DESIGN• Employer ensures that healthy built environment culture is reflected in the workplace

(i.e. bike factories have bikes visible)• Employer ensures that worksite is wheelchair, walker, cane, etc. accessible when possible

LIGHTING • 25% of interior square footage has access to natural lighting source

ERGONOMIC FURNITURE

• Standing desks, walking desks, and ergonomic furniture are available only for those employees that are prescribed such treatments by their physician

ACOUSTICS (MANUFACTURING & CONSTRUCTION)

• Employers utilize one of the following types of controls to mitigate noise: engineering, administrative, or personal

ACOUSTICS (OFFICE ENVIRONMENTS)

• Employers install rubber mats under common computer equipment and make mats available for personal equipment

INTEGRATION OF NATURAL ELEMENTS

• Employer purposefully integrates green elements (potted plants, images of greenery) into interior design

HEALTH BEHAVIORS• Employer ensures that vending machines adhere to AFHG HS guidelines• Employers offer hot and cold water dispensers on every floor

COMMUNITY INVOLVEMENT

• Employer wellness activities engage the greater community

MORE AMENITIES

59

The performing level represents organizations that have implemented more advanced elements such as behavioral economics into workplace design to encourage employees to adopt better health behaviors. Once an organization has reached the leading level, employers offer on-site health facilities and other amenities to employees.

PERFORMING LEADING

• Worksite offers open and closed office space, closed meeting space at a 5:1 ratio

• 50% of interior square footage has access to natural lighting source

• 75% of interior square footage has access to natural lighting source

• Standing desks, walking desks, and ergonomic furniture are available for all employees that request them

• Standing desks, walking desks, and ergonomic furniture are standard for all employees

• Employers utilize two of the following types of controls to mitigate noise: engineering, administrative, or personal

• Employers have adopted and implemented comprehensive Hearing Conservation Program that includes engineering, administrative, and personal interventions

• Employers make noise cancelling headphones available to all employees

• Employers provide both private and common working space to all employees, including those without personal offices

• Worksite uses biophilia (construction with nature in mind)• Company incorporates ‘Nature Analogues’ design

• Worksite uses Nature of the Space design (theatre, outdoor play, galleries) and integrates green environments (courtyards, terraces)

• Stairs are visible as an option (when accessible)• Employers place point-of-choice messages strategically in

front of stairwells, vending machines and in cafeterias, to encourage employees to make healthy food choices and be physically active

• Worksite offers on site health facilities (gyms, pools, etc.)

• Employers will seek out opportunities to positively influence the community landscape.

• Worksite offers meals, haircuts, chiropractic services, dry cleaning, etc.

• Worksite offers on site medical resources, childcare, café, etc.


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8 Berry, Leonard L., Ann M. Mirabito, and William B. Baun. “What’s the Hard

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9 World Health Organization. WHO Healthy Workplace Framework and Model. Rep. N.p.: World Health Organization, 2010. Print.

10 Booz & Company. Clinton Health Matters Initiative Steering Committee.

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11 SafeWell, Harvard School of Public Health Center for Work, Health and Well-

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17 Porter, Michael E., and Mark R. Kramer. “Creating Shared Value.” Harvard Business Review Jan.-Feb. 2011: 1-17. Print.



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21 Hyman, David, and Mark Hall. “Two Cheers For Employment-Based Health

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32 National Center for Health Statistics. Health, United States, 2012: With

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34 Ibid.

36 “Childhood Obesity in the United States.” National Collaborative on

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38 “Q12® Meta-Analysis.” Q12® Meta-Analysis. N.p., 2009. Web. 07 Jan. 2014.


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40 Scheer, F., M. Hilton, C. Mantzoros, and S. Shea. “From the Cover: Adverse

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41 Sood, A. “Medical Screening and Surveillance of Shift Workers for Health

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42 “Workplace Safety and Health Topics: Agriculture.” Centers for Disease Control and Prevention. National Institute for Occupational Safety and

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43 “Workplace Injuries and Illnesses – 2010.” The Bureau of Labor Statistics.

20 Oct. 2011. Web. 12 Aug. 2013.

44 Workers’ Compensation Board of British Columbia. Preventing Injuries to Hotel and Restaurant Workers, Focus Report. Rep. N.p.: n.p., 1998. Print.

45 Pratt, Stephanie G., PhD, and Rose L. Rodríguez-Acosta, PhD.

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46 U.S. Department of Labor Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work,

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47 Occupational Health and Safety Administration. Guidelines for Employers to Reduce Motor Vehicle Crashes. Rep. N.p.: n.p., 2005. Print.

48 Sturgeon, Jodi, and Ai-Jen Poo. “Fair pay for 2.5 million home care aides

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49 National Institute for Occupational Health and Safety. Stress... At Work.

Rep. Cincinatti: NIOSH, 1999. Print.

50 National Institute for Occupational Health and Safety. Stress... At Work.

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51 “Staff Health in Early Care and Education Programs.” California Childcare

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December 28, 2012.

53 Ibid.

54 “Healthcare.” Occupational Safety & Health Administration. United States

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55 Ibid.

56 “Healthcare Workers.” The National Institute for Occupational Safety and

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57 “Healthcare.” Occupational Safety & Health Administration. United States

Department of Labor. Web. 13 Mar 2014.

58 Ibid.

59 Ibid.

60 SafeWell, Harvard School of Public Health Center for Work, Health and Well-

being. SafeWell Practice Guidelines: An Integrated Approach to Worker Health. Rep. N.p.: SafeWell Inc, 2014. Print.

61 Lerman, Steven E. MD, MPH; Eskin, Evamaria MD, MPH; Flower, David J.

MBBS, MD; George, Eugenia C. MD; Gerson, Benjamin MD; Hartenbaum,

Natalie MD, MPH; Hursh, Steven R. PhD; Moore-Ede, Martin MD, PhD.

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62 Booz & Co. “Hourly Health and Wellness.” Steering Committee Meeting.

N.p.: Booz &, n.d. 13-25. Print.

63 “Staff Health in Early Care and Education Programs.” California Childcare

Health Program. 2006. Web. 12 Aug. 2013.

64 “Shiftwork- health effects.” Better Health Channel. State Government of

Victoria. 3 Apr. 2013. Web.12 Aug 2013.

65 Rynell, Amy. “Causes of Poverty: Findings from Recent Research.”

Heartland Alliance Mid-America Institute on Poverty. Oct. 2008. Web. 12

Aug. 2013.

66 Rynell, Amy. “Causes of Poverty: Findings from Recent Research.”

Heartland Alliance Mid-America Institute on Poverty. Oct. 2008. Web. 12

Aug. 2013.


67 Failing Its Families: Lack of Paid Leave and Work-Family Supports in the US. Rep. N.p.: Human Rights Watch, 2011. Print.

68 United States. U.S. Department of Commerce. U.S. Census Bureau News.

Washington, D.C.: U.S. Census Bureau, 2013. Print.

69 Matos, Kenneth, and Ellen Galinsky. 2012 National Study of Employers.

Rep. N.p.: Families and Work Institute, 2012. Print.

70 Finnegan, Annie. “Everyone but U.S.: The State of Maternity Leave Working

Mother.” Working Mother. Working Mother Media. N.d. Web 12 Aug. 2013.

71 Surviving the First Day: State of the World’s Mothers 2013. Rep. N.p.:

Save the Children, 2013. Print.

72 Tanaka, Sakiko. “Parental Leave and Child Health Across OECD Countries.”

Economic Journal. (2005): F7-F28.

73 Ruhm, Christopher. “Parental Leave and Child Health.” Journal of Health Economics. 19.6 (2000): 931-960.

74 “Enhanced Employee Health, Well-Being, and Engagement through

Dependent Care Supports.” The Consulting Practice: Bright Horizons Family Solutions. Bright Horizons Family Solutions LLC. 2010. Web. 12

Aug. 2013.



Aug. 2013.

76 Ibid.

77 McNamara, Melissa. “Elder Care Benefits.” CBS Evening News. CBS

Interactive Inc. 11 Feb. 2009. Web. 12 Aug. 2013.



Aug. 2013.

79 “Why Breastfeeding Is Important.” Womenshealth.gov. U.S. Department of

Health and Human Services, 04 Aug. 2011. Web. 12 Aug. 2013.

80 “Why Breastfeeding Is Important.” Womenshealth.gov. U.S. Department of

Health and Human Services, 04 Aug. 2011. Web. 12 Aug. 2013.

81 “Adoption Benefits.” Adopting.org. 1994. Web. 13 Aug. 2013.

82 “Adoption Benefits.” Adopting.org. 1994. Web. 13 Aug. 2013.

83 Ibid.

84 Ibid.

85 Ibid.

86 Appelbaum, Eileen, and Ruth Milkman. Leaves That Pay. Rep. N.p.: Center

for Economic and Policy Research, 2011. Print.

87 Bell, Lisa and Sandra Newman. “Paid Family & Medical Leave: Why

We Need It, How We Can Get It.” National Center on Caregiving. Family

Caregiver Alliance. Sep. 2003. Web. 12 Aug. 2013.

88 Glass, Jennifer and Lisa Riley, “Family Responsive Policies and Employee

Retention Following Childbirth,” Social Forces, vol. 76(4), June 1998, p.

1426.

89 Lohmann, Henning, Peter H. Frauke, Tine Rostgaard, and C. Katharina

Spiess. “Towards a Framework for assessing family policies in the EU: Final

Report.” DIW Berlin and SFI Copenhagen, Apr. 2009. Web. 12 Aug. 2013.

90 “The 46 Healthiest Companies to Work For in America.” Greatist. N.p., 21

Oct. 2013. Web. 08 Dec. 2013.

91 “Work/Life Balance and Time Off.” Accenture. Accenture, n.d. Web. 08

Dec. 2013.

92 Loftness, Vivian, Volker Hartkopt, Beran Gurtekin. “Building Investment

Decision Support (BIDSTM).” Carnegie Mellon University Center for Building

Performance and Diagnostics. Pittsburg, PA. 2007.

93 Baicker, Katherine, David Cutler, and Zirui Song. “Workplace Wellness

Programs Can Generate Savings.” Health Affairs. 29.2 (2010):304-311.

Web. 14 Aug. 2013.

94 Linnan, Laura, Mike Bowling, Jennifer Childress, Gary Lindsay, Carter

Blakey, Stephanie Pronk, Sharon Wieker, and Penelope Royall. “Results of

the 2004 National Worksite Health Promotion Survey.” American Journal of Public Health. 98.8 (2008): 1503–9. Web. 14 Aug. 2013.

95 U.S. Department of Health and Human Services. Office of Disease

Prevention and Health Promotion. Healthy People 2010. Washington, DC.

96 Shinogle, Judith, and Lina Martinez. “Healthiest Maryland Business

Evaluation Final Report.” Maryland Institute for Policy Analysis and

Research. University of Maryland: Baltimore County. Nov. 2012. Web. 13

Aug. 2013.




Aug. 2013.

98 “Any Disorder Among Adults.” National Institute of Mental Health. National Institutes of Health. N.d. Web. 14 Aug. 2013.

99 “USA [State & County QuickFacts].” United States Census Bureau. U.S.

Department of Commerce. 2011. Web. 14 Aug. 2013.

Endnotes

63

100 “The Numbers Count: Mental Disorders in America.” National Institute of Mental Health. National Institutes of Health. N.d. Web. 14 Aug. 2013.



102 “The Numbers Count: Mental Disorders in America.” National Institute of Mental Health. National Institutes of Health. N.d. Web. 14 Aug. 2013.



104 Kessler, Ronald C., et al. “The effects of chronic medical conditions on

work loss and work cutback.” Journal of Occupational and Environmental Medicine 43.3 (2001): 218-225. Web. 14 Aug. 2013.

105 Insel, Thomas. “Assessing the economic costs of serious mental

illness.”American Journal of Psychiatry 165.6 (2008): 663-665. Web. 14

Aug. 2013.

106 Wang, Philip S., et al. “The costs and benefits of enhanced depression care

to employers.” Archives of General Psychiatry 63.12 (2006): 1345. Web.

13 Aug. 2013.

107 Hertz Robin P., and Christine L. Baker. The impact of mental disorders on

work. Pfizer Outcomes Research. 2002. Web. 14 Aug. 2013.

108 Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA)

11-4658. Rockville, MD: Substance Abuse and Mental Health Services

Administration, 2011.

109 Office of National Drug Control Policy. A Response to the Epidemic of Prescription Drug Abuse. Rep. N.p.: White House Drug Policy, 2011. Print.

110 Bailey, S. Jeffrey, and Katherine Covell. “Pathways among abuse, daily

hassles, depression, and substance use in adolescents.” The New School Psychology Bulletin 8.2 (2011). Web. 14 Aug. 2013.

111 Richman, Judith A., et al. “Sexual harassment and generalized workplace

abuse among university employees: prevalence and mental health

correlates.” American Journal of Public Health 89.3 (1999): 358-363.

Web. 14 Aug. 2013.

112 Botvin, Gilbert J., et al. “Effectiveness of culturally focused and generic

skills training approaches to alcohol and drug abuse prevention among

minority adolescents: two-year follow-up results.” Psychology of Addictive Behaviors 9.3 (1995): 183. Web. 14 Aug 2013.

113 Botvin, Gilbert J., et al. “Effectiveness of culturally focused and generic

skills training approaches to alcohol and drug abuse prevention among

minority adolescents: two-year follow-up results.” Psychology of Addictive Behaviors 9.3 (1995): 183. Web. 14 Aug 2013.

114 “Preventing Prescription Drug Misuse, Abuse, and Diversion Across the

Continuum.” Association of State and Territorial Health Officials. Apr.

2012. Web. 14 Aug. 2013.

115 “Preventing Prescription Drug Misuse, Abuse, and Diversion Across the

Continuum.” Association of State and Territorial Health Officials. Apr.

2012. Web. 14 Aug. 2013.

116 “Tobacco Use.” Centers for Disease Control and Prevention. Centers for

Disease Control and Prevention, 16 Nov. 2012. Web. 08 Jan. 2014.

117 “Tobacco Use.” Centers for Disease Control and Prevention. Centers for

Disease Control and Prevention, 16 Nov. 2012. Web. 08 Jan. 2014.

118 Ibid.

119 Mid-America Coalition on Health Care. Promoting Tobacco Cessation in the Workplace: A Policy Resource Guide. Rep. N.p.: Mid-America

Coalition on Health Care, 2012. Print.

120 “NBGH – Tobacco: The Business of Quitting – The Business Case.” NBGH

– Tobacco: The Business of Quitting – The Business Case. National

Business Group on Health, 10 Nov. 2011. Web. 08 Dec. 2013.

121 Health Now!, “Health Now! And the business community.”



123 “Planning a Tobacco-Free Campus Initiative.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 06 Jan. 2010.

Web. 01 Dec. 2013.



125 Fitch, Kate, Kosuke Iwasaki, and Bruce Pyenson. Covering Smoking Cessation as a Health Benefit: A Case for Employers. Rep. New York:

Milliman, 2006. Print.




Aug. 2013.

127 “Shiftwork - Health Effects.” Better Health Channel. N.p., Sept. 2011.

Web. 08 Dec. 2013.



129 Booz & Co. “Hourly Health and Wellness.” Steering Committee Meeting.


N.p.: Booz &, n.d. 13-25. Print.

130 Gallup. (2009). Q12 Meta-Analysis. Retrieved from http://www.gallup.com/

consulting/126806/q12-meta-analysis.aspx

131 Gallup. (2013) How Employee Engagement Drives Growth. State of the

Global Workplace Report 2013, 20-22

132 “The Impact of Employee Engagement.” Kenexa Research Institute. Web.

28 Feb. 2014.

133 “Employee Engagement: The Key to Realizing Competitive Advantage.” DDI

World. Web. 28 Feb. 2014.

134 “Employee Engagement: The Key to Realizing Competitive Advantage.” DDI

World. Web. 28 Feb. 2014.

135 Gallup (2013). Engagement At Work: Its Effect on Performance Continues

in Tough Economic Times. Web. 28 Feb. 2014.

136 What Executives Really Need to Know about Employee Engagement,

Accenture, 2011. Print.

137 Ibid.

138 Ibid.

139 Ibid.

140 Ibid.

141 Kim, Marlene. “Women Paid Low Wages: Who They Are and Where They

Work.” Monthly Labor Review (2000): 26-30. Print.

142 “Reading Between the Lines: Women’s Poverty in the United States, 2009,”

The Women’s Legal Defense Fund. Legal Momentum. Sep. 2010.

143 2013 Working Mother Best Companies for Hourly Workers. Rep. N.p.:

Working Mother, 2013. Print.

144 2012 Working Mother Best Companies for Hourly Workers. Rep. N.p.:

Working Mother, 2012. Print.

145 Sullivan, John. “A Case Study of Facebook’s Simply Amazing Talent

Management Practices.” EREnet RSS. N.p., 09 Sept. 2013. Web. 08

Dec. 2013.

146 Pflanz, S. E., & Ogle, A. D. (2006). Job stress, depression, work

performance, and perceptions of supervisors in military personnel. Military

Medicine, 171(9), 861-865.

147 “Fact Sheet: VA Suicide Prevention Program- Facts about Veteran Suicide.”

Department of Veterans Affairs. 2011. Web. 14 Aug. 2013.

148 Milliken, Charles S., Jennifer L. Auchterlonie, and Charles W. Hoge.

“Longitudinal assessment of mental health problems among active and

reserve component soldiers returning from the Iraq war.” JAMA: the journal of the American Medical Association 298.18 (2007): 2141-2148.

149 Competitive Edge Services and Barton Blatt Institute (2013). Veterans in

the workplace: Recruitment and retention.

150 2012 SHRM Poll, Military Employment. Rep. N.p.: Society for Human

Resource Management, 2012. Print.

151 http://www.shrm.org/templatestools/toolkits/documents/12-0177%20

behind_the_lines_toolkit_fnl.pdf

152 Competitive Edge Services and Barton Blatt Institute (2013). Veterans in

the workplace: Recruitment and retention.

153 Martinez, Amy. “Starbucks Aims to Hire 10,000 Vets, Active-duty Spouses

over 5 Years.” The Seattle Times. N.p., 06 Nov. 2013. Web. 08 Jan. 2014.

154 Ulrich, R.S and Lunden, O. (1990). “Effects of Nature and Abstract

Pictures on Patients Recovering from Open Heart Surgery.” Paper

presented at the National Symposium on the Role of Horticulture in Human

Well-Being and Social Development. Washington, D.C.

155 “The Economics of Biophilia: Why designing with nature in mind makes

financial sense.” Terrapin Bright Green. 2012. Web. 14 Aug. 2014.

156 Grahn, P & Stigsdotter, AUK 2010, ‘The relation between perceived sensory

dimensions of urban green space and stress restoration’ Landscape and Urban Planning, vol 94, no. 3-4, pp. 264-275.







160 Kuo, Frances and Sullivan, William. (2001) “Environment and Crime in the

Inner City: Does Vegetation Reduce Crime?” Environment and Behavior, vol 33, no. 3, p. 343-367.



Endnotes

65

162 Zeemke, Ron, Claire Raines, and Bob Filipczak. Generations at work: Managing the clash of veterans, boomers, xers, and nexters in your workplace. AMACOM Div American Mgmt Assn, 2000.

163 Innovations 2 Solutions. 2013 Workplace Trends Report. Rep. N.p.:

Sodexo, 2013. Print.




Aug. 2013.

165 Vischer, Jacqueline C. “The effects of the physical environment on job

performance: towards a theoretical model of workplace stress”. Stress

and Health,

166 Vischer, Jacqueline C. “The effects of the physical environment on job

performance: towards a theoretical model of workplace stress”. Stress

and Health,

167 Fitzgerald, C. J., * Danner, K. M. (2012). Evolution in the office: How

evolutionary psychology can increase employee health, happiness, and

productivity. Evolutionary Psychology, 10(5), 770-781.

168 Ibid.

169 Office of Safety and Health Administration. OSHA Technical Manual. 2013.

170 Maxwell, L. E. (2001). Noise in the office workplace. Facility Planning and

Management, 1(11).

171 Ibid.

172 Personal Communication. Tracey Meyer Chesser. April 8, 2014.


Credits

The Clinton Health Matters Initiative would like to thank Willa Wolfson and Shammara Wright for their assistance and research for this Framework.

For questions and assistance on implementation of the Framework, please contact Alex Chan and Rain Henderson via [email protected]

clinton health matters initiative employee health … · 2014. 9. 18. · employee health...

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