Posted at 08.10.2018
In 1986, the World Health Organization introduced the Ottawa Charter for Health Promotion, which sparked the movement supporting health promotion at work and devising policies and programmes to frame this new dialogue (Whitehead, 2005). To build up such policies, it's important to define health promotion. While Seed house (1997) called the word muddled, poorly articulated and devoid of an obvious philosophy, the united kingdom government has confidently addressed issues of public health under the umbrella of 'health promotion' in papers such as 'Saving lives: Our healthier nation' (1999) and 'Our health, our care, our say' (2006). For the sake of clarity, this essay will adopt Tones' (2000) definition, specifically, that 'health promotion incorporates all measures deliberately made to promote health and handle disease'. Such promotion could be best put to use in Britain's workplaces, where concentrated groups of individuals might be influenced and supported to lead healthier lifestyles through their existing workplace structures so that, ultimately, employers will reap the benefits of more able staff and the numbers of those influenced by manageable health issues will be reduced. Although Warner et al. (1988) were sceptical of the ability of workplace health promotion programmes to yield financial dividends and generate cost savings for employers, they don't dismiss the probability that carefully designed policies could prove beneficial to both employees and businesses. A report by Bertera (1990) demonstrated that comprehensive workplace health promotion programmes successfully decrease the variety of sick leave absences among blue collar personnel of an professional company. Over 40, 000 employees were included in the study; sites where promotion programmes were offered experienced a 14% decrease in the amount of days of absence in comparison to a 5% reduction at non-programme sites. This represented a net difference of 11, 726 fewer absence days with an associated financial return of $2. 05 for each dollar invested in the scheme.
With studies promoting the huge benefits, both financial and health-related, of implementing health promotion programmes at work, the question follows how policy can best introduce and support such strategies. Undoubtedly, the introduction of any such policy must take into account numerous influential factors that will determine the success or failure of subsequent programmes. These factors include wide-ranging issues such as public view and funding, plus more specific factors such as the organisational structure and culture of businesses desperate to implement such strategies. Noblet and LaMontagne (2006) warned that, by not considering these factors when creating new policy, practitioners risk losing sight of functional solutions, stressing that great emphasis should be placed on identifying and addressing organisational resources of health issues, rather than on merely dealing cursorily with certain problems. This essay will critically examine the aforementioned factors that should be taken into account when developing policy for health promotion in the workplace and focus on previous policy suggestions and practices, the social and political context of occupational health insurance and, finally, organisational structure and workplace culture.
In the traditional model of workplace healthcare promotion, specific interventions for smoking, diet and exercise are directed at at-risk individuals by using counselling, lifestyle education and medical treatments. Yet LaMontagne (2004) criticised this process, stating that it generally does not consider the contribution of job conditions to such behaviours or the contributions that adverse working conditions can have on lifestyle-related diseases such as cancer and heart disease. According to Noblet and LaMontagne (2006, p. 347), this traditional individual-centred model should rightly be criticised. They cite as supporting evidence the truth of Opticom, a big operator-assisted service provider, where high rates of absenteeism at the business led managers to invite a health promotion business to provide individual health checks and counselling sessions focussed on diet, exercise and fitness. An analysis of the programme after half a year found little improvement in the number of absences, and anecdotal evidence revealed that the working environment was still demoralising and stressful. Ultimately, the initiative was aimed at identifying individuals who were vulnerable to developing lifestyle-related diseases and encouraging them to adopt healthier lifestyles, rather than looking at the working environment itself and how it was affecting social, organisational and physical conditions.
However, such criticisms shouldn't discourage all kinds of individual employee-centred policies. Worker-directed initiatives have been found to be particularly successful at enhancing health in the workplace through comprehensive programmes that both address the organisational roots of health problems at work and appearance to treat the symptoms of any issues exhibited by employees. Kompier et al. (2000) felt that just such a holistic approach contributes to favourable long-term outcomes in the workplace. On the other hand, Bond (2007) supported policies that balance organisational- and individual-directed interventions that, when combined, ensure the 'preventative benefits associated with the former can have a widespread impact across an organisation, whilst the curative strengths of the latter can target those who have already succumbed to occupational ill health'. Thus, we have established that policies that merely tackle individuals with existing health issues are considerably less successful than those that approach health promotion at work in a more holistic fashion, appreciating the influence that the working environment can have on employee health. Yet, what of a lot more specific factors that affect these policy decisions? Let us now address the social and political context of health promotion policy in the UK, as these factors and so many more will be instrumental in creating beneficial health promotion approaches for the workplace.
The very foundations of workplace health promotion policy are bound up with current government strategies, healthcare targets and public opinion. Discussing these factors alone would provide ample material to address the question set; however, such an approach would exclude an analysis of other, more specific, influences on policy, such as organisational structures at work and corporate culture; these factors will be looked at later in this paper. First, we address the comments that McGillivray (2002) made regarding current government policy; he found inherent tensions between government policy rhetoric and the organisational and cultural reality of Britain's workplaces. For example, the government's aims to improve occupational health have been 'misguided', and policy has tended to bolster existing inequalities with regard to those people who have usage of health promotion programmes. McGillivray (2002) figured this indirect discrimination in the workplace due to non-participation in healthcare programmes has meant that reducing absenteeism and reaching the goals outlined in policies of improving the fitness of the nation's workforce will stay a distant pipedream. This policy document specifically addresses the necessity to reduce inequalities in usage of occupational health insurance and promotes working environments that present healthier employment settings. However, other recommendations such as forming links with bicycle providers to encourage people to cycle to and from work still look set to favour employees of large businesses capable of supporting such schemes through existing organisational structures (2004). It seems that factors affecting the ability of nearly all businesses in the united kingdom to implement healthcare promotion programmes continue being ignored by policymakers.
The positive benefits associated with instances where public thoughts and opinions and government policy merge forcefully can be seen in the recent prohibition of smoking in public areas. Whilst unpopular with a little minority, widespread support for the ban, encouraged by statistics released by Action on Smoking and Health demonstrating that 1, 200 people die per year from passive smoke inhalation at the job, has drastically improved occupational health (ASH, 2003). Presently, a variety of workplace health promotion programmes exist as a result of government targets aimed at reducing the number of smokers in the united kingdom; overall, the objectives outlined in 'Choosing Health' (2004) had successfully come to fruition. Despite the success of policy at influencing healthcare promotion initiatives regarding smoking, obstacles remain that must be taken into account when forming future policies in this area. For example, the issue of funding or a lack thereof is cited by many commentators who feel this factor alone is negatively influencing the government's ability to create meaningful policies that can adequately address health promotion at work. Speaking in 1992, but in conditions that resonate with the current economic climate in the united kingdom, Hill (1992) suggested there is a need to make a comprehensive database of most health promotion activities so that, through collaboration and coordination, today's meagre resources available for such workplace strategies can be best utilized by allowing policymakers to see current activities and examine how best to improve them. Having addressed some factors that look like considered when forming wide-ranging health promotion policy, such as public opinion, as well as those that seem to build barriers to forming an improved system such as the lack of funding, why don't we now decide on examine the finer information on what influences act on the introduction of policy in this field.
No policy regarding health promotion in the workplace will succeed unless it requires into account the organisational structure of the firms that the policy aims to target. DeJoy and Wilson (2003) felt particularly strongly that any efforts to improve the health of the UK's workforce must get started with an assessment of the targeted organisation. They even coined the phrase 'organisational health promotion' (DeJoy and Wilson, 2003) to spell it out this particular make of policymaking, that they believe takes account of the most influential factor as it pertains to making successful strategies. Ultimately, the basic organisational and structural fabric of the workplace will determine whether healthcare promotion will succeed or fail. Such a view is supported by Sparks et al. (2001) who suggest that the managerial style and structure of any business is one of the most important factors that affect health promotion at work and that, as a result, managerial organisation should be deemed a essential component to be looked at in the introduction of any related policy. Similarly, Danna and Griffin (1999) highlighted the value of appreciating existing organisational structures in the workplace when addressing health and well-being in this arena. Thus, given the above-mentioned strong beliefs that to-be-incorporated health promotion strategies must consider the organisational structure of the relevant working environment, this factor should be deemed of great importance by policymakers seeking to design functional programmes.
As far as workplace culture, this factor has previously been downplayed and overlooked as a phenomenon with the capacity of affecting healthcare policy. However, Airhihenbuwa (1994) was adament that appreciating the influence culture can have on policy decisions deepens and extends the possibilities of progressive approaches to policymaking that will finally be more beneficial to individuals. McPartland (1991) found the corporate culture of the business implementing a health promotion programme to be influential in its success. In comparison, the potency of such programmes is minimised if the work atmosphere was highly stressful and dehumanising for the workers. On a similar vein, Allegrante and Sloan (1985) recommend that health promotion policies shouldn't only cover behaviour change strategies, but also encompass the entire working environment and management practices. Therefore, taking into consideration the managerial and organisational structure of the business enterprise setting is essential to make policy decisions, as is considering the broader culture of the setting, especially corporate cultures that induce stressful settings or those that encourage unhealthy competition among staff and cause them to work in a 'dehumanising' environment (McPartland, 1991).
Hill (1992) underlined the actual fact that, whilst health promotion should get worried with reducing inequalities in healthcare, a huge majority of British workplaces have little or no usage of appropriate occupational health services and health promotion services remain the concern of large corporations with suitable existing facilities. Given the opinions of Hill yet others, it would appear that any policy regarding health promotion in the workplace must consider matters of implementation. Specifically, policies that not look at the day-to-day functioning of the majority of Britain's smaller businesses or not-for-profit charities will be immediately obsolete, as any try to implement healthcare strategies must benefit the majority through thoughtful planning rather than by causing sweeping ideas that only tie in with the functioning systems of a handful of large corporations. Yet, McPartland (1991) was more positive, identifying that, although many small businesses lack the funds or manpower necessary to assign a staff member to health promotion, it is still possible to make effective and efficient use of the existing resources. In addition, allowing staff to become mixed up in decision-making and organisational processes often inspires them to create particularly successful health promotion programmes (McPartland, 1991). The Washington Business Group on Health (1985) also reported that, with power resting in the hands of employees, staff in many workplaces has acted with impressive organisation. For example, Employee Wellness Committees have built fitness centres, weight-loss programmes, smoking cessation organizations, and nutrition awareness classes (McGinnis, 1986). Similarly, a report by O'Donnell (2002) demonstrated a strong programme budget was only moderately important when determining whether policies for healthcare promotion strategies in the workplace would succeed; other factors such as strong management and enthusiastic participation from both employers and employees were more influential.
Whilst some commentators argue that financial capacity is no important factor in forming healthcare policy for the workplace, it could perhaps be foolish to totally disregard funding when creating a strategic plan. It's been demonstrated that, when staff have control over a budget, however small, for the look and direction of health promotion programmes, employee-centred initiatives can be highly successful (McGinnis, 1986). For this reason, O'Donnell (2002) suggested that policymakers should take into account the following questions when developing strategies for health promotion: How ready is the organisation to build up a health promotion programme?; Will be the programme outcomes realistic?; How participative an activity does the organisation desire? and exactly how intensive and holistic a programme will it desire to create? By answering these questions, healthcare promotion policy might become more likely to give a successful framework for future programmes, as policy makers will have sufficient information about the factors that are most significant and influential to a specific business. Despite the fact that such an approach might not exactly help out with forming wider national governmental policy, which would struggle to take into account the factors affecting every individual targeted workplace targeted, it would still guide the specific design and implementation of local policy and practices.
The concept of 'health promotion in the workplace' embraces two main streams of thought regarding the definition of health insurance and what factors influence it. The first ideology sees health as a product of individual behaviour and genetics. With this sense, the workplace can be regarded as a venue in which various programmes can be delivered such as smoking cessation groups and fitness courses. The second ideology sees health to be affected by a variety of factors, a few of which are outside the control of the average person. The role of the encompassing environment in influencing health is seen as particularly important; commentators such as Shain and Kramer (2004) who support this latter concept promote the need to address the organisational and cultural structures in the workplace as a means of positively impacting physical and psychological health. Bond (2000) certainly believed a blend of individual-centred approaches and strategies that enhance the overall working environment might be most successful because these consider factors that concern both individual staff members, such as their lifestyle choices, and the overall influence that a person's environment can have on his / her health. Alternatively, LaMontagne (2004) considered it essential that healthcare promotion policy for the workplace addresses changes that must be made to the working environment all together. In addition, the factors that define these environments, such as their organisational structure and culture, are vital components that tend to be more relevant than individual-centred problems. Whichever view is correct, this essay has demonstrated that, regardless of the existing disagreement about the entire approach that should be used regarding things to consider when forming healthcare policy, finer details like the organisational setup of businesses, available funding and the established corporate culture are widely considered to be pivotal in deciding appropriate and successful policy. Quick fixes in conditions of fabricating an agreed and constant healthcare policy for the workplace aren't realistic according to O'Donnell (2002), who believed that the look and implementation of any healthcare promotion programme often takes between six and eighteen months. Because of this, it's advocated that policy should take this timescale into account and incorporate short-term goal-oriented stages that eventually culminate in the creation of an effective healthcare strategy (O'Donnell, 2002). Overall, the factors that affect the development of successful healthcare promotion policies are widespread and contested. However, given the disparate nature of influences that affect our health and wellness, from personal medical histories to culture and environment, it is essential that policy take into account the varied nature of these influences and adapt strategies that are sympathetic to the wide range of needs around.