Are Corporate Health Programs a Good Idea?

On Monday, Post Office workers in Moseley, Birmingham, can board the Medibus – and find out how fit they are. The medical team on board will measure height and weight, take blood pressure readings, offer stress checks and health quizzes and encourage people to go on the exercise bike to monitor their overall fitness.

The Medibus is part of an occupational health program which the Post Office has been running for about five years. The corporation (which employs 15 doctors and 43 nurses to care of the health of its 210,000-strong workforce) also provides a travelling exhibition for the larger offices; it is currently examining the effectiveness of providing stress counselling in the work-place; and it has just announced that it is to begin work-based breast and cervical cancer screening for its female staff.

Dr. Richard Welch, head of the Occupational Health and Safety Executive, is convinced that all these measures are of benefit to both employer and employee. ‘We do pick up things that merit fairly quick intervention – undiagnosed hypertension, the odd case where someone doesn’t realize they have asthma,’ he says. ‘By offering work-based screening to women, for example, we think we’ll get a lot of women who have not yet been involved.’

Companies which run work-place health programs on this scale in Britain are few and far between. Yet in other parts of the world such as Scandinavia, the United States and Japan, company involvement and concern about employees’ health is widespread.

In the US, for example, health education comes in booklets, ‘brown bag’ lunchtime lectures, seminars, health fairs and so on. Some companies, such as American Express in New York, which has devoted some 15,000 square feet in its new building to a health and fitness center, put out a health newsletter. American Express’s health program was set up last year to ‘help employees live a healthy lifestyle’, and includes seminars, subsidized sports facilities and sporting weekends for its 21,000 employees throughout the city.

The fitness center in the American Express Tower, with treadmills, exercise bikes, rowing machines and two kinds of weight-training systems, had 15 full-time staff and was opened in April 1987. Currently it has 2,500 members, ranging from people in their twenties of their sixties, and a waiting list of 1,200. Employees are ‘absolutely not’ pressurized into joining, but those who do pay for a year’s membership can use the machines or take classes in aerobics. The peak hour is before work, from 7 to 8am.

So far American companies based in Britain have taken a less aggressive approach than their US counterparts. American Express workers here, for instance, simply have corporate membership at health clubs or belong to the sports and social club.

As for the Japanese, although Kosmatsu (makers of construction equipment at Birtley, Tyneside) have a daily exercise program, this is voluntary (unlike in Japan) and the exercises have been modified to suit the English workforce.

Every morning before work, some gentle warm-up routines accompanied by taped music are played over the PA system and workers from the shop floor to the MD can join in wherever they happen to be. According to the company, there is a 95 percent take-up, and the process helps foster team spirit as well as improving safety by giving everyone a chance to warm up before starting work.

In America, company health programs make economic sense. When employees are ill, it is at a cost to the company – not simply in terms of absenteeism but through the employer-sponsored private health insurance plans. Health education and promotion programs are seen as an indirect way to cutting costs.

However, even in Britain, where private health insurance is not nearly as universal, there are signs that company health programs are beginning to take off.

Last year MORI carried out interviews with personnel directors from the largest 500 of The Times 1,000 list of British manufacturing companies. Nearly all (98 percent) had medical insurance schemes and two-thirds said they use external medical practitioners. Two-thirds and no-smoking areas at work. A similar number provided regular health screening – although only a third of these do so for all employees, rather than concentrating on the senior echelons.

About half said they employ part-time medical practitioners, offer ‘health foods’ in the company’s dining areas, provide some kind of sports facilities such as a gym or squash court, subsidize subscriptions to sports club or employ a full-time occupational nurse.

David Inglejew, who specializes in health promotion for the Mersey Regional Health Authority, thinks wider measures are likely in the future. ‘It’s partly a cultural thing,’ he says. ‘When health and fitness become popular in society at large, it becomes a recruitment perk, especially if there is a shortage of skilled staff – the hi-tech industries, for instance, see it that way.’

Some companies are already calling in outside consultants to set up health screening programs for them – BUPA is already established in this field. Dr. Alan Bailey is medical director of the BUPA medical centers and has been developing new techniques for company health assessment.

The ‘company profile’, as BUPA calls it, measures overall company health and provides companies with a coronary risk factor as well as information on a number of health parameters such as blood pressure, cholesterol levels, smoking and indicators of stress. Once the problem areas are identified, advice can be given, behavior changed and the risks modified.
‘One company has introduced a gym after we showed them their employees were not getting much exercise,’ Bailey says. ‘We’ve advised some companies in catering where we found cholesterol levels to be above average. But Britain still lags behind.’

How far will employers go? Welch says the Post Office program is not so much about cost effectiveness as a question of employee care, ‘It does cost us a fair amount to run – setting up the screening program will take about Pounds 1 million over two years.

‘If we can prevent people from having to retire early or having long periods of absenteeism, then we will have helped the business, but it’s difficult to prove these kinds of reductions.’

Yet if the private health insurance market expands (as the Government has indicated it finds desirable) and companies find themselves increasingly involved in the costs of providing such insurance of their employees and their families, then self-interest may take over from paternalism.

At present employee involvement in health and fitness program is voluntary – but will it stay that way? What will happen to those who do not want to stop eating potato chips and downing double whiskies, or who cannot face the lunchtime aerobics? BUPA stresses that its company profiles are carried out in such a way that individuals cannot be identified and so confidentiality is maintained. But could there come a time when companies running their own programs decided they want access to medical records in order to make decisions about the future prospects of particular employees?

As Inglejew says: ‘There is a potentiality sinister side to this. If the ideology is becoming that employees should be fit, employers may become less sympathetic to those who are not. And does that mean that the man who is 40 and flabby is not a desirable employee?’