Keri K. Stephens and Millie A. Harrison
Attention to population health issues is growing, and considering that people spend more time at work than in any other organization outside their home, worksites may offer a solution. For more than 30 years, many worksites have included programs to address employee health, safety, and risk. While some of these initiatives are mandated through legislation, other programs (e.g., workplace health programs (WHPs) or wellness initiatives) are often voluntary in the United States. Programs vary around the globe because some countries merge health, risk, and safety into one overarching regulated category, and there is a growing trend toward expanding these focus areas to include mental health and workplace stress. These programs can be quite innovative. Some interventions use technologies as prompts, such as mobile apps reminding employees to take medication. Other programs incorporate concepts from behavioral psychology and economics such as providing sleep pods at work and pricing healthy food in the cafeteria lower than high fat foods. Governmental incentives are offered in some countries that encourage employers to have WHPs. Yet despite the surface-level advantages of using the reach and access found in employing organizations to impact health, employees do not necessarily participate, and these programs are rarely or poorly evaluated. Furthermore, it is difficult to know how to make WHPs inclusive and how to communicate the availability of these programs. With the dual goals of directly impacting workers’ health and saving employers money, understanding how work can be a site for intervention is a worthwhile challenge to explore.
WHPs struggle to achieve documentable objectives for several reasons; theory-driven research is suggesting new ways to understand what might improve the outcomes of WHPs. Privacy and surveillance concerns have dominated the WHP conversation in countries like the United States due to fears that health data might be used to fire employees. Another concern is the need to tailor workplace health messages for diverse cultures, ethnicities, and gender identities. Two other concerns relate the power differentials inherent in workplace hierarchies to overt and covert pressure employees feel to participate and meet what is defined as an ideal level of health. While these major concerns could be difficult to overcome, several theories provide guidance for improving participation and producing positive behavioral outcomes. Employees who feel a part of their organization, or are identified with their group, are more likely to positively view health information originating from their organization. Growing evidence indicates that certain technologies might also tap into feelings of identification and help promote the uptake of workplace health information. In addition, workplaces recognized as having norms for safety and health cultures might be more influential in improving health, safety, and risk behaviors. Recognizing boundaries between employee and workplace can also be fruitful in elucidating the ethics and legality of WHPs. Finally, program evaluation must become an integrated part of these programs to effectively evaluate their impact.