Obesity is costing the National health Service over £9 billion per year. Long range forecasts suggest that by 2050 a staggering 50 per cent of the nation could be obese, placing an unsustainable burden on the NHS. Speaking to the Public Health England annual conference in Coventry recently, Simon Stevens, Chief Executive of NHS England proposed a new system for England, in which (as in the USA) employers would be financially rewarded for introducing schemes to help workers shed the pounds. But would the American model work in the UK? Dr Sally Wilson, senior research fellow at The Institute of Employment Studies is not so sure.
In common with much of the developed world the UK is facing an obesity crisis as well as increased prevalence of ‘lifestyle diseases’ such as diabetes, heart disease and some forms of cancer. It is evident that the situation would improve if adults of working age took more responsibility for their own health and, in an era of public spending austerity, the government are increasingly looking to employers to support public health initiatives.
In recent weeks there has been considerable press coverage of Simon Stevens’ (NHS chief for England) suggestion that companies in the UK should follow the USA lead in instituting financial incentives to encourage employees to adopt healthy lifestyles.
The recently implemented Affordable Care Act in the United States enables U.S. employers to increase the rewards they offer to employees who participate in workplace wellness programmes which support and encourage (for example) smoking cessation, weight loss, physical fitness and improved dietary habits. Specifically the Act allows employees to be eligible for significantly lower premiums on the health insurance they buy through their employers if they participate in workplace wellness programmes.
The ultimate goals of these programmes are to help people control blood pressure, fight obesity and manage diabetes and other chronic conditions and over the long term cut overall U.S spend on healthcare.
Investing in the workforce
The UK context is somewhat different not least because of the extent of ‘free at the point of use’ health care provided by the NHS and the relatively low number of employers offering private health insurance to their employees. Nevertheless the current coalition government are recognising the role that employers can play in promoting healthy lifestyles and supporting employee wellbeing in a more general sense.
The arguments for this have centred on the cost of sickness absence to the employer and state. For example research by PwC has shown that in UK companies, illness costs businesses around £29 billion per annum, which compares unfavorably to some of our global competitors. The state also takes a significant hit through sick pay and benefits associated with people leaving the workforce as a result of ill health.
A clear case for investing in the health of employees was set out in a 2010 public health strategy document which emphasises an approach that ‘empowers individuals to make healthy choices’. The Public Health Responsibility Deal, a Department of Health initiative which was launched in the following year invites organisations to commit themselves to public health improvement.
This includes core commitments such as ‘we will actively support our workforce to lead healthier lives’ and there are a range of pledges for specific health areas such as smoking and healthy eating. The impact of the Deal, which relies purely on voluntary participation, is currently being evaluated (although the benefits of workplace health interventions are notoriously difficult to measure).
Other UK policy initiatives have arguably centred on cure rather than prevention, such as the Department of Work and Pension’s new ‘Fit for Work’ service which will provide free occupational health assessments to employees referred to the service with the aim of to helping people return to or stay in work after an illness. This is due to be launched at the end of 2014 and is targeted at absences of four weeks or more.
A tax exemption will be introduced for amounts up to £500 paid by employers for employees’ medical treatment to incentivise provision of occupational health interventions.
While the measures described above clearly signal employers to take more action to improve on employee health and wellbeing, the adoption of the US-style approach described by Simon Stevens appears unlikely.
The complexities surrounding the design of a fair effective and appealing incentive driven system are vast. In the US, under the new rules employers must structure wellness programmes so every individual participating can “receive the full amount of any reward or incentive, regardless of any health factor” and this requirement potentially represents a major barrier.
In the UK designing a scheme that applies fairly to all employees regardless of their health status or disability would necessitate careful consideration of equality and diversity issues and well as confidentiality issues (an employee may feel forced to declare a health condition or other personal circumstance to their employer that might not otherwise be relevant to their working life).
Another potential hurdle centres on take up. A RAND review of the Workplace Wellness Market cites a 2010 survey suggests that it is typical for less than 20 per cent of eligible employees participate in wellness interventions. It could prove an expensive waste of time for employers to champion initiatives that those who might be helped the most choose to ignore.
Also at a more basic level, penalising non-participating employees, regardless of their reasons, could negative impact on their relationship with their employer resulting in disengagement and potentially increased staff turnover.
No simple solution
There are also important questions surrounding the efficacy of group-based health promotion interventions, particularly for individuals who may be ‘stuck’ in their habits and most in need of change. Increasingly health professionals are recognising that reasons people making unhealthy lifestyle choices can be complex, based on attitudes and beliefs specific to the individual.
This underlines the difficulty of offering ‘a one size fits all’ approach to health promotion that is acceptable to, and effective for, all workers. On a positive note, there is more free information and support available than ever before for employers who do want to help their employees make healthy choices at work.
However it is important to take an approach that strikes the right balance so that workers feel supported and encouraged to improve their own wellbeing rather than bribed or possibly coerced into activities not of their choosing.
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