Stress and work-life balance

Stress and work-life balance

The number of stress-related disability claims by American employees has doubled according to the Employee Assistance Professionals Association in Arlington, Virginia. Seventy-five to ninety percent of physician visits are related to stress and, according to the American Institute of Stress, the cost to industry has been estimated at $200 billion-$300 billion a year.

Steven L. Sauter, chief of the Applied Psychology and Ergonomics Branch of the National Institute for Occupational Safety and Health in Cincinnati, Ohio, states that recent studies show that "the workplace has become the single greatest source of stress". Michael Feuerstein, professor of clinical psychology at the Uniformed Services University of the Health Sciences at Bethesda Naval Hospital states, "We're seeing a greater increase in work-related neuroskeletal disorders from a combination of stress and ergonomic stressors".

It is clear that problems caused by stress have become a major concern to both employers and employees. Symptoms of stress are manifested both physiologically and psychologically. Persistent stress can result in cardiovascular disease, sexual health problems, a weaker immune system and frequent headaches, stiff muscles, or backache. It can also result in poor coping skills, irritability, jumpiness, insecurity, exhaustion, and difficulty concentrating. Stress may also perpetuate or lead to binge eating, smoking, and alcohol consumption.

According to James Campbell Quick, a professor of organizational behavior at the University of Texas-Arlington, "The average tenure of presidents at land-grant universities in the past ten years has dropped from approximately seven to three-and-a-half years".

The feeling that simply working hard is not enough anymore is acknowledged by many other American workers. "To get ahead, a seventy-hour work week is the new standard. What little time is left is often divvied up among relationships, kids, and sleep."  This increase in work hours over the past two decades means that less time will be spent with family, friends, and community as well as pursuing activities that one enjoys and taking the time to grow personally and spiritually.

Texas Quick, an expert witness at trials of companies who were accused of overworking their employees, states that "when people get worked beyond their capacity, companies pay the price."  Although some employers believe that workers should reduce their own stress by simplifying their lives and making a better effort to care for their health, most experts feel that the chief responsibility for reducing stress should be management.

According to Esther M. Orioli, president of Essi Systems, a stress management consulting firm, "Traditional stress-management programs placed the responsibility of reducing stress on the individual rather than on the organization-where it belongs. No matter how healthy individual employees are when they start out, if they work in a dysfunctional system, they’ll burn out."  

Worksite Fitness Framework

Worksite Fitness Framework

Worksite wellness programs including nutrition and physical activity components may occur separately or as part of a comprehensive worksite health promotion program addressing a broader range of objectives such as smoking cessation, stress management, and weight loss. A conceptual model has been developed by the Task Force for Community Preventive Services and serves as an analytic framework for workplace wellness and depicts the components of such comprehensive programs.^[1] These components include worksite interventions including 1) environmental changes and policy, 2) informational messages, and 3) behavioral and social skills or approaches.

Worksite environmental change and policy strategies are designed to make healthy choices easier. They target the whole workforce rather than individuals by modifying physical or organizational structures. Examples of environmental changes may include enabling access to healthy foods (e.g., through modification of cafeteria offerings or vending machine content) or enhancing opportunities to engage in physical activity (e.g., by providing onsite facilities for exercise). Policy strategies may involve changing rules and procedures for employees, such as offering health insurance benefits, reimbursement for health club memberships, or allowing time for breaks or meals at the worksite.

Informational and educational strategies attempt to build the knowledge base necessary to inform optimal health practices. Information and learning experiences facilitate voluntary adaptations of behavior conducive to health. Examples include health-related information provided on the company intranet, posters or pamphlets, nutrition education software, and information about the benefits of healthy diet and exercise. Behavioral and social strategies attempt to influence behaviors indirectly by targeting individual cognition (awareness, self-efficacy, perceived support, intentions) believed to mediate behavior changes. These strategies can include structuring the social environment to provide support for people trying to initiate or maintain weight change. Such interventions may involve individual or group behavioral counseling, skill-building activities such as cue control, use of rewards or reinforcement, and inclusion of coworker or family members for support.^[2]

Workplace and Obesity

Workplace and Obesity

Obesity and related conditions have risen to epidemic levels in the US and around the globe. The causes for this are numerous and included among the list are increases in automation and labor-saving devices that have resulted in a change in the way we live and work. Many workplaces are now sedentary settings and often provide easy access to energy-dense food and beverages. As a result, workplaces are contributing to the obesity epidemic.

Obesity has been linked to numerous chronic diseases including cardiovascular disease, hypertension, dyslipidemia, type 2 diabetes, stroke, osteoarthritis and some cancers.^[1]

Concern about the economic burden associated with obesity is growing. Obesity drives up costs for employers and is associated with increased absenteeism, disability, injury and healthcare claims. Furthermore, when compared to other industrialized countries, the US has the highest per capita costs for health care and also as a percentage of Gross domestic product, yet ranks in the bottom quartile for life expectancy and infant mortality.^[6]

While the stated goal of workplace wellness programs is to improve employee health, many US employers have turned to them to help alleviate the impact of enormous increases inhealth insurance premiums^[3] experienced over the last decade. Some employers have also begun varying the amount paid by their employees for health insurance based on participation in these programs.^[4] Cost-shifting strategies alone, through high copayments or coinsurance may create barriers to participation in preventive health screenings or lower medication adherence.hypertension.^[5]

One of the reasons for the growth of healthcare costs to employers is the rise in obesity-related illnesses brought about by lack of physical activity, another is the effect of an aging workforce and the associated increase in chronic health conditions driving higher health care utilization. In 2000 the health costs of overweight and obesity in the US were estimated at $117 billion.^[6] Each year obesity contributes to an estimated 112,000 preventable deaths.^[7] An East Carolina University study of individuals aged 15 and older without physical limitations found that the average annual direct medical costs were $1,019 for those who are regularly physically active and $1,349 for those who reported being inactive. Being overweight increases yearly per person health care costs by $125, while obesity increases costs by $395.^[6] A survey of North Carolina Department of Health and Human Services employees found that approximately 70 cents of every healthcare dollar was spent to treat employees who had one or more chronic conditions, two thirds of which can be attributed to three major lifestyle risk factors: physical inactivity, poor diet, and tobacco use.^[8] Obese employees spend 77 percent more on medications than non-obese employees and 72 percent of those medical claims are for conditions that are preventable.^[2]

According to Healthy Workforce 2010 and Beyond, a joint effort of the US Partnership for Prevention and the US Chamber of Commerce, organizations need to view employee health in terms of productivity rather than as an exercise in health care cost management. The emerging discipline of Health and Productivity Management (HPM) has shown that health and productivity are “inextricably linked” and that a healthy workforce leads to a healthy bottom line. There is now strong evidence that health status can impair day-to-day work performance (e.g., presenteeism) and have a negative effect on job output and quality.^[2] Current recommendations for employers are not only to help its unhealthy population become healthy but also to keep its healthy population from becoming sick. Employers are encouraged to implement population-based programs including health risk appraisals and health screenings in conjunction with targeted interventions.^[5]

Worksite Wellness Barriers

Worksite Wellness Barriers

Most employers have yet to embrace the worksite wellness strategy according to the findings of the 2004 National Worksite Health Promotion Survey.^[1] Only 6.9 percent of surveyed organizations met the criteria for a comprehensive health promotion program. This is far short of the 75 percent target included in the Healthy People 2010 goal which shows that there are still significant barriers to the large-scale adoption of worksite health promotion practices by organizations, both large and small.

The encouraging news is that since the 2004 report was published, there appears to be more momentum toward implementation of comprehensive worksite health promotion. This is evident by pending federal legislation and the growth of employer-based health coalitions such as the National Business Group on Health, Institute for Health and Productivity Management, Center for Health Value Innovation, and the National Business Coalition on Health. Peer-based executive advocacy through the Leading by Example initiative of Partnership for Prevention is another example of this trend towards comprehensive workplace health promotion.

Low participation rates by employees significantly limit the potential benefits. Little is known or reported about the determinants of participation, but some clues are emerging. Ongoing management support and accountability are critical to successful worksite health promotion programs. Men and women participate in different types of activities, and white-collar employees engage in activities at a greater rate than blue-color employees.^[2] There are legal and ethical issues to consider as well including obtaining participant release forms, and maintaining employee confidentiality, especially concerning health risk appraisals and other information protected under federal law. One reason for low participation rates may have to do with the messaging associated with the policy or program. In order to motivate or persuade employees to participate and change behavior, messages should be individually targeted which results in more significant positive attitude change.^[3]

Workplace wellness programs should also be culturally sensitive and appropriate to economically challenged minority and other underserved populations. One of the strongest predictors of health status is socioeconomic status (SES), and the gap between SES groups is widening (Thompson). Research is being conducted to better understand the challenges and come up with solutions. One idea involves soliciting the assistance of member of the community and giving ownership of the program to the employees. This approach is based on Bracht’s 5-stage community organizational model for health promotion with adaptations for the worksite.^[4] Restrictive participation policies (e.g., off-the-clock scheduling) for onsite health promotion activities such as health screenings, health risk appraisals, and workshops may act as a barrier to participation and therefore have a negative impact on health outcomes and effectiveness.