Benefits Column

Embracing Diversity

There are many factors HR leaders should explore before creating a global health-and-wellness strategy, including the need to balance multiple cultures, regulatory environments and employee mobility.

Monday, August 29, 2011
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When the topic is multinational health and wellness initiatives, there could be no better place to put fingers to keyboard than Hawaii -- where I come for business every year.

Hawaiians embrace a diverse cultural mix, which includes the original Polynesians, who sailed here about 1,500 years ago, as well as Tahitians, English, Americans, Japanese, Chinese, Filipinos and Portuguese.

My friend, Malcolm Leong, tells me the Hawaiian Creole language -- Pidgin -- originated as a form of communication between English-speaking residents and non-English-speaking immigrants.

But most multinational companies are not like Hawaiians and they are sometimes challenged with balancing multiple cultures -- never mind employees located in sites around the world -- particularly when it comes to HR policies and employee benefits.

When I was asked to write a column on international health strategies, I turned to a group of friends who first introduced me to the topic's intricacies: Howard Gough, Peter Mills and Clive Pinder. When our paths first crossed, these three U.K.-based colleagues comprised the leadership of vielife -- a global health and well-being company that they, ultimately, sold to CIGNA.

I also consulted with Nicole Serfontein, a Washington-based senior international consultant at Towers Watson. Serfontein has South African roots and also has worked in Europe. She was involved in the recent release of a Towers Watson employer survey on multinational health and wellness.

As I thought through the information provided by these global wellness-and-productivity experts, a framework emerged for how multinational employers should consider worldwide employee-health benefits.

The first, and most practical step, is to have a global workplace-health strategy in place. The Towers Watson survey found that only 32 percent of international employers have a health-and-wellness policy, although nearly half intend to implement one within the next two years.

Pinder offers the second key piece of advice: "The rest of the world isn't the 51st state."

His words remind me of the advice I gained when writing about international employee assistance programs: "Think globally, act locally -- but in a culturally appropriate way."

All of the experts reinforce that, while it is important for a company to possess a global vision for health, wellness and productivity, it is essential to allow local leadership to achieve the program's objectives in a way that fits with the regional culture.

Serfontein points out that the U.S. approach of individual health coaching might not work in other parts of the world where family and community exert a bigger impact on the employee than they do in the United States.

It's also important, Gough says, for employers to understand the health status of their populations around the globe. Health data is not readily available outside the United States, so health-risk assessments become an important part of a multinational health-and-wellness strategy.

Mills believes "HRA data is a phenomenally valuable way to gain baseline information about employees, their health risks and how those risks might impact the employee population."

But, he says, "the ROI of HRAs is overhyped. And it's difficult to quantify the impact of health on productivity and performance."

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"However you can, shift the conversation from ROI to value -- the value of addressing health issues for an individual employee and the value for a company," he says.

Health issues across the globe may be similar, but the consequences can be different. For example, sickness, absence and the associated employee productivity losses may be bigger issues in countries with culturally shorter workdays than the United States, Mills says.

Employers should also consider turnover and retention rates before implementing wellness programs, which require multiple years before a ROI is seen.

Turnover, Serfontein says, is much higher in certain countries and industries, and in these geographic areas, employers may want to roll out initiatives that tend to produce faster results, such as onsite clinical resources and flu-shot programs.

Another factor to keep in mind, Gough says, is the trend for employers to improve the richness of benefits for local nationals. In the past, he notes, Western expats tended to have the richest benefits packages.

Thus, employers may want to consider a "global mobility strategy" and regionally consistent benefits packages due to the exponential growth in global regional expats. Being an expat is no longer limited to Western colleagues, he says.

"You might want to exclude the U.S. health plan, but allow full portability of your benefits package in Asia."

Finally, employers need to consider the complexity of "cross-border coverage" as well as the intricacies of the regulatory environment for immigration-visa issues.

"The regulatory framework of the Middle East, for example, won't allow for infertility treatments," Gough says, "And more and more countries require proof of health coverage as part of the visa-application process."

While it may be a small world, one size -- and one strategy -- will not fit all.

As the Towers Watson survey indicates, HR executives of multinational companies need to either establish or re-examine their global health-and-wellness strategies.


Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

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