By Randy Boss, CRA, CIC, LIC, SPHR, CWCA, CRM

There are 311 million Americans in the United States and 155 million of those are workers. On average they spend half their waking lives at work (8.7 hours/day). Work affects employees' health care options, emotional well-being and family life. In order to fully address health, we have to address what happens both at work and outside of work.

Historically, workplace wellness and safety programs have been managed in silos along with workers comp and benefits. Health protection programs (safety) have focused on reducing worker exposures to risks arising in the workplace itself. And workplace health promotion programs (wellness) have focused exclusively on lifestyle risk factors off the job.

While it can be argued that workers comp costs have been relatively stable, the cost for health care is a much bigger problem. In fact, the high cost of health care is listed as one of the top three concerns by business owners. Experts predict with the current growth rate we will be spending 27% to 30% of our gross domestic product in 2030 on health care. This becomes economically unsustainable.

Another challenge is that many workers are choosing to work longer. Fewer and fewer workers today retire early and the expectation is that this trend will continue. According to a recent Boston College report, many older workers rate their health status as good to excellent. Unfortunately, many also report having chronic conditions that affect their well-being, causing them to retire early due to health issues.

According to a 2007 Duke University study, workers compensation costs for obese employees were much higher than costs for non-obese employees. Researchers also found a clear linear relationship between BMI and the rate of claims. Employees with BMI greater than 40 had twice as many claims, seven times more lost workdays and 10 times more lost wages.

Another problem is how the insurance industry works with its clients, and how most employers are structured internally. It's been my experience that the CFO or controller and property/casualty agents focus on workers comp/safety, while human resources and benefits agents focus on employee benefits/wellness. In most cases employee benefits cost six to eight times more than workers comp but are overseen by HR and not Finance. The insurance industry may be aligning with the siloed structure in companies because it's convenient, they lack the expertise, or it's always been done this way. Whatever the reason, it just doesn't make any sense.

When it comes to managing risk, we find that workers compensation and safety seems to get the most attention, with a total lack of attention paid to managing health. This in turn raises the cost of health care and increases lost productivity though absenteeism and presenteeism. This not only raises the cost to the employer but also to the employee in the guise of higher premiums and lower pay.

There is growing evidence that a coordinated approach to health promotion (wellness) and health protection (safety) is more effective than if either is approached separately. In 2004, the National Institute for Occupational Safety and Health (NIOSH) launched an initiative based on a comprehensive view of worker safety and health that explored all avenues affecting the health of workers. This comprehensive view made sense, so in 2005 our agency began implementing a combined process with our customers to integrate safety and health promotion with the focus on keeping employees healthy and safe both at home and at work.

While employers have a responsibility to provide a safe and hazard-free workplace, they also have abundant opportunities to promote individual health and foster a healthy work environment. Maintaining a healthier workforce can lower direct costs such as insurance premiums and workers compensation claims. It will also positively impact many indirect costs such as absenteeism and worker productivity. To improve the health of their employees, businesses can create a wellness culture that is employee-centered; provides supportive environments where safety is ensured and health can emerge; and provides access and opportunities for their employees to engage in a variety of workplace health programs.

It's safe to say that everyone benefits from a healthy workforce. As a result, employers see lower workers comp premiums, higher productivity and higher morale. And when employees are healthier so are their families.

Here are examples of overlapping health hazards at home and at work.

• Stress from work can affect our family lives and vice versa.
  
• Eating nutritious foods makes for a healthier more productive workforce, yet healthful food is often difficult to find at work.
  
• Chemical exposures on the job can be brought home on work clothes and expose family members.

This means we have an excellent opportunity in the workplace to influence overall worker health by addressing general health issues and not just workplace hazards. But this is only if we put forth a strategic and operational coordination of policies, programs and practices designed to simultaneously prevent work-related injuries and illnesses, while enhancing overall workforce health and well-being. We also have to continue the traditional occupational safety and health protection we have implemented since the Occupational Safety and Health Act was passed, coupled with health promotion.

Integration
There are a number of key indicators that need to exist for integration to be possible:

Organizational leadership and commitment. Top management needs to set the vision and provide adequate resources for implementation. Like anything else, if top management isn't behind the plan, you might as well not bother to do it.

Coordination between health protection and health promotion. Finance and human resources, along with safety and wellness need to be at the table. A good start is to remake the current safety committee into the health and safety committee since the basic structure and budget is already there and it's much easier to add to an existing committee rather than start something new.

Supportive organizational policies and practices. This includes processes for accountability and training, coordinated management and employee engagement strategies, benefits and incentives to support workplace health promotion and protection, and integrated evaluation and surveillance.
Comprehensive program content. This should include classes, toolbox talks, health promotion topics, etc.

Implementation
Once these indicators are in place, it's time to design your program. There are a number of general principles to keep in mind when putting together a plan that integrates wellness and safety. Following are the 10 most important:

1. Actively engage workers.
   
2. Actively engage management.
   
3. Develop a clear path with adequate resources.
   
4. Integrate systems: Break down "silos."
   
5. Focus on organizational solutions.
   
6. Customize your design.
   
7. Provide appropriate incentives.
   
8. Protect confidentiality.
   
9. Stay flexible.
   
10. Evaluate your program.

Integration is not easy but it should be a priority for a variety of reasons. Workers are interested in health issues. It can slow the rising costs of workers comp medical claims. And it may increase program acceptance as wellness is folded into safety, which already has been accepted by workers.

The difficulty is exacerbated by the fact that, traditionally, workers comp is managed in the finance department while benefits belong to the human resources department. The insurance industry has aligned itself with its own siloed approach. There is a clear line of distinction between commercial and benefits producers and very little cross training between the two. But that is changing as agencies begin to bring training in-house and are using a team selling approach that allows for successful integration.

Most diseases, injuries, and other health conditions experienced by working people involve a number of factors or causes that the siloed approach fails to recognize or treat. This is especially true as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. We need to deal with the whole worker, doing what we can to keep him or her healthy and safe both at home and at work. Successful integration will result in lower costs for both workers comp and group health. It also will result in a healthier work force and improved morale.

Rising health costs have intensified the interest employers have in promoting a healthy workforce. While there is still a historical reluctance, I think workplace integration of health protection and health promotion activities is becoming a new standard for safeguarding the health and safety of the workforce.

The author
Randall S. Boss is partner/owner of Ottawa Kent Insurance, an independent agency with four locations in Michigan. He designs, builds and implements risk management and insurance plans for middle market companies in the areas of human resources, property, liability, workers comp and benefits. He has 35 years' experience and has been at Ottawa Kent for 32 years.