Effecting Heathcare Change

Online tools are available to help improve health and productivity in the workplace, but HR leaders first need to understand where improvements can be made.

Thursday, May 1, 2008
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Behavioral risk factors including tobacco use, obesity and lack of physical activity have been repeatedly linked by researchers to the onset of chronic illness, decreased productivity, poorer quality of life and early death of millions of Americans.

The direct and indirect costs of chronic illness are immense, and often borne by employers, as this white paper points out.

Health-empowerment tools offer a series of resources to assist individuals and organizations in their quest to improve wellness and control costs. Such tools include print materials, online interactive resources, health-risk assessments and lifestyle coaching.

While these tools are not a panacea, they represent a powerful and customizable resource for promoting change.

To help employers determine how online health-empowerment tools can help employees prevent health issues or improve their current health, it is important to develop a framework for understanding where improvements can be made.

There are opportunities to improve health before an illness or injury occurs (primary prevention), when an illness or injury has occurred but before it has caused harm (secondary prevention) and after harm has been caused, where the goal is to mitigate further harm (tertiary prevention).

At each of these points, employers can influence four different domains: the individual at risk, the agent causing risk, the physical environment and the social environment.

When employers think about empowering employees to take charge of their health and support them so they can make better lifestyle choices, they often employ health-promotion interventions aimed at the individual and their behavior.

It?s apparent, however, that the most effective strategy includes efforts in all domains.

For example, interventions in the workplace related to obesity could include information and support for the individual, but also offer healthier choices in the cafeteria; incentives for employees to take the stairs or walk to work; investment in community wellness efforts such as parks and walking trails; and efforts to improve the culture of the organization to be supportive of people at all levels of risk.

The good news is that employers can influence all of these domains and they all contribute to decreasing morbidity and mortality.

Many tools have effects in more than one domain. An online health-risk assessment is a tool that helps individuals determine their health risks and potential strategies to reduce those risks; thus, this tool helps in the individual?s domain.

But the fact that the tool is being offered in the workplace or as a benefit of employment begins to establish that the organization values health -- starting a process of culture change within the organization.

The implementation of these resources also can be part of a wellness strategy that motivates people to begin accepting that personal action can change outcomes. The information available from the tool can be used in aggregate to plan population-based health-promotion programs and to reward the organization for progress. 

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Because individuals learn differently, have preferences for the source of their health information and are motivated in different ways, no single intervention is going to be the solution for all employees.

The challenge, therefore, is to create a combination of tools that can be customized for each individual or organization. The tools must be culturally sensitive, meet individuals where they are in their readiness to change and begin to support and guide them along the path of change.

To build credibility, it is essential that the tools are firmly grounded in science and supported by evidence.

Someone who is being asked to change a long-held belief needs confidence that the change being advocated is based on a reliable source of health information. Each health-empowerment tool needs to function both as a stand-alone and as part of a larger whole.

For example, in a comprehensive program, an online health-risk appraisal should connect people with more in-depth information or health behavior interventions. And because consumers get a multitude of health messages every day, empowerment tools need to provide a unified, consistent message.

Success in diminishing the excess death and disability attributed to behavioral risk factors will not come easily. It will take persistence, patience, and effective interventions that empower individuals, organizations, and communities to change. 

Dr. Robin G. Molella, MPH, serves as a medical editor for Mayo Clinic EmbodyHealth personal health management portal, providing medical guidance on content including condition management and behavior change programs. She is a primary care physician in the Department of Internal Medicine and the Division of Preventive and Occupational Medicine at Mayo Clinic in Rochester, Minn. For more information, visit

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