Symposium Gets 'Steps to a Healthier US Workforce' Initiative Moving

President Bush announced the effort last July, with a focus on preventing work-related illness and living healthier lifestyles.

ON June 20, 2002, President George W. Bush signed an Executive Order to promote personal fitness in the general public. The president's concern was the numbers of Americans suffering from lack of physical activity and poor dietary habits, and the failure of current practices to motivate the general public to improve.

The order was issued to the secretaries of all federal departments to review and evaluate current policies, programs, and regulations as they relate to personal fitness of the general public. Beginning with the Department of Health and Human Services, the order was passed to the Centers for Disease Control as the "Steps to a Healthier US."

Under the National Institute for Occupational Safety and Health (NIOSH), the initiative was renamed "Steps to a Healthier US Workforce" and tasked to encourage workplace programs that focus on two areas:

* Preventing work-related illness, injury, and disability, and
* Promoting healthier living and lifestyles to reduce and prevent chronic disease.

John Howard, M.D., NIOSH Director, kicked off the three-day "Steps" event Oct. 26 with a Call to Action Keynote. "Our symposium is the first event in a multi-year initiative that NIOSH is launching in collaboration with its co-sponsors and supporters to bring a new, more coordinated approach to achieving the goal of healthier, safer American workers." Co-sponsors included participants from 22 industry and labor groups, corporations, and professional and government organizations.

"Our partnership," said Howard, "should be a synergy of prevention strategies whose objectives are more than achieving zero adverse work-related outcomes, but rather a holism where work is self-defining in the most enhancing way possible, where a worker can enjoy their retirement years with intact health, and where health-enhancing behaviors are valued and promoted in the workplace along with safety and health protection."

The symposium brought together leaders from the occupational safety and health community with leaders from the health promotion community to take a first look at the science, policy and practice, and the economics of integrating injury prevention and health promotion programs at the work site. In all three areas, researchers from the Harvard School of Public Health, Cornell University's Institute for Health and Productivity Studies, and the Rand Corporation presented white papers summarizing recent studies that strongly support the case for integration.

The Steps symposium cites the growing push toward greater productivity in the face of global competition; the prevalence of obesity in our society, which is the root cause of numerous chronic diseases; and the emerging aging workforce as factors driving a new, more urgent focus on integration.

While these papers are still in the draft form, one goal of the symposium was to draw on the expertise of participants from various fields to review, revise, and expand the ideas presented to help solidify the NIOSH position in this endeavor and begin to formulate research agendas for the future of the integrated approach.

The Science
The science paper cited a large body of existing literature on the subject, with researchers acknowledging work sites offer a great potential for support of long-term behavior change using peer and environmental support and multi-level intervention as a means of sustaining interest in behavior change. Work sites allow health promotion contacts with individuals who may not otherwise be accessible.

The draft paper also supported what many safety and occupational health practitioners have learned over years of practical application: Employees are more likely to respond to employer health promotion programs if they are coupled with comprehensive work site safety programs. For example, employees will be more likely to respond to a smoking cessation program if the employer has addressed inhalation hazards at the work site.

Policy and Practice
As health, safety, and productivity management programs emerge as a business imperative, employers will look to NIOSH for an integration model. The policy and practice paper supported the notion that employers need to understand that the overall health of their employees, whether influenced by work habits or personal lifestyles, has a major impact on safety and productivity.

The paper strongly supports the case to develop and institutionalize and integrated model for worker health, safety, and productivity as an overall business practice. The benefits will come from many areas:

* Share resources across departments and functions.
* Get worker protection, worker health promotion, and productivity managers speaking the same language.
* Reduce competition for senior management attention and resources.

The Economics
The third paper focused on the economics of integrating injury prevention and health promotion programs. Rising health care and worker's comp costs have motivated employers to look more closely at promoting a healthy workforce. Data from the Bureau of Labor Statistics show employer-provided health insurance, short and long-term disability programs, and worker's comp combine to make up 10 percent of all payroll costs in the United States.

The economics paper cited the relative lack of empirical data comparing the benefits of integration, but it offered some insights on integration in terms of costs rather than outcomes (fewer injuries and illnesses). Theirs will be the difficult task of looking for common factors that may not be apparent in other studies.

The Summary
Discussants responded to the papers with additional recommendations that eventually will need to become part of the NIOSH integration efforts. These include the following important aspects of integration:

* Provide a calendar to continue the focus
* Investigate the impact of cultural differences with regard to integration
* Explore methods to ensure early buy-in from labor organizations
* Ensure integration models provide opportunities for small business as well as large (80 percent of U.S. businesses are in this category)
* Provide research data on the benefits of reallocating funding to the prevention side of health care (a method proven effective in safety practice)
* Include a more balanced mix of health and safety participants.
There were a preponderance of presentations on health promotion, in terms of official speakers and presenters, and very few on the occupational safety side. Including more safety educators and practitioners will present a more balanced approach to integration.

The Next Steps
What does this mean for safety practitioners in the near and long terms?

National Chair of the Steps Symposium and Senior Science Advisor of NIOSH Dr. Gregory R. Wagner summarized the significance of this banner event at the end of the proceedings on Oct. 28. In the short term, he cited the benefits of creating partnerships at the government research level, such as NIOSH; the National Institutes of Health; and labor organizations and health care providers. NIOSH also will be looking for opportunities to partner in funding demonstration projects. And, finally, it will look to evaluate innovative practices in both large and small business communities.

In the long term, the government focus on integration of worker health and worker safety will provide safety practitioners and program developers an opportunity to increase their value to their organizations. Safety practitioners across the country have, year after year for more than 30 years, reduced the number and severity of job-related injuries and deaths; while health promoters have continually failed to reduce the number of deaths and chronic diseases due to unhealthy lifestyles and the soaring cost of health care delivery.

Safety professionals and practitioners should view this government focus on integration as a "call to action." They should look to professional organizations such as the American Society of Safety Engineers and educators at the university level to provide insights and training in effective integration models that they can apply on the job.

This article originally appeared in the November 2004 issue of Occupational Health & Safety.

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