Low participation plagues wellness

Companies investing more than ever – but ROI remains elusive
By Liz Bernier
|Canadian HR Reporter|Last Updated: 12/16/2013

It’s hard to find fault with the level of investment in employee wellness programs — employers are investing more than ever.

And their commitment is growing: Most organizations (76 per cent) are planning to increase support for workplace health initiatives, according to Towers Watson’s Staying@Work survey of 114 Canadian employers.

“Businesses are focused on being efficient,” said Keri Alletson, senior consultant, health and group benefits, at Towers Watson in Toronto.

“When you look at the impact of poor workforce health, you see companies that lose a lot of days every year to absence, lose a lot of days to disability, lose people because of things like stress and burnout, so when you start adding up the cost… it can be a very significant portion of the money a company spends on their labour budget.”

But despite the deepened commitment to wellness programs, many organizations struggle with low employee participation rates.

“What we’re seeing is participation rates that haven’t improved a lot in the last two years,” said Alletson. “If you’re getting anywhere from 20, 25 per cent participation to 50 per cent participation... you’re pretty much in line with the Canadian market.”

So why are employees often so reluctant to take advantage of wellness programs? In some cases, it may be because the programs don’t actually fit well with employees’ needs, said Alletson.

“Sometimes, people are rolling out programs that are sort of one-size-fits-all and they’re not stopping to take the time to understand their own population health data, and they’re not taking the time to seek employee input and feedback and participation in designing these things.”

Low participation due to complex factors

There are a number of complex issues and factors that can prevent employees from participating in wellness programs, according to Michael Leiter, organizational psychologist and professor at Acadia University in Wolfville, N.S.

“A lot of people who would readily participate already have health activities in their lives… it’s not really a benefit to switch to the workplace activities,” he said.

“People with notable health problems may feel shy about demonstrating their lack of fitness to their work colleagues. So those most in need, with the biggest potential to benefit, avoid showing up.”

Also, many are just too busy to fit anything non-essential into their workday, he said.

Factors such as these demonstrate the limits of a voluntary wellness program. But there’s an even more fundamental deterrent to consider, said Leiter.

“Workplace health programs are too often a superficial overlay for jobs that are excessively demanding and ultimately bad for employees’ health,” he said. “Employees know this contradiction and it reduces their motivation to participate.”

Another problem is measuring the program’s success.

“You cannot be sure if a given individual was actually susceptible to whatever health problem the program was designed to avert. A person with a sedentary lifestyle may be more vulnerable to a heart attack, but never actually experience one,” said Leiter.

“You cannot expect any program to have 100 per cent success. So the fact that an individual in a relatively small population has a heart attack does not mean the program failed. The fact that no one had a heart attack does not constitute proof of a program’s efficacy.”

Cost benefits largely overestimated

Canadian employers are not the only ones struggling with low participation rates — there are similarly low participation levels in the United States, according to a 2013 RAND Health Workplace Wellness Programs Study.

“That’s what we hear again and again: Many companies have some sort of an offering but they find it hard to convince employees to actually join,” said Soeren Mattke, senior scientist at RAND Health in Boston.

And even when employees do participate, the cost benefits and positive health impact of these programs are often not as impressive as employers might have hoped.

The average annual cost reduction to a U.S. employer was estimated at US$157 per employee, found the study. But that number is significantly lower than the ROI employers might have expected.

“That’s important because you may have read these articles that say wellness programs return like three to one in terms of health-care costs, which would mean you would have expected $450 in savings as opposed to just $150… so we can clearly say that these numbers tend to be too high,” said Mattke.

And because many of the health benefits of wellness programs are long-term, it’s difficult to really measure how much the organization is saving based on short-term data, he said.

“Look at the biology. If I today start eating like a pig, not moving off my couch and smoking, it will take me 10 years until I develop diabetes and maybe 15 years until I develop heart disease,” said Mattke.

“To expect that a program that goes at health risks with a relatively distant link to manifest disease and actual health-care costs... would save you tremendous amounts of money in the short run, I think that’s just biologically implausible.”

Even if wellness programs could wipe out all risk factors like smoking, obesity and stress, they still wouldn’t drive down health-related costs as dramatically as people imagine, he said.

“People always say chronic disease accounts for 70, 80 per cent of all health-care costs — which is true. But what they don’t say is most chronic disease isn’t really avoidable. Bad genes, environmental influences and all kinds of other things put you on a path to developing certain diseases, and you can lower your risk by healthy lifestyle, but you cannot eliminate that risk,” said Mattke.

“It just does not translate into these huge savings that some vendors have promoted.”

With that said, corporate wellness programs can offer valuable benefits — particularly in regards to exercise frequency, weight control and smoking cessation. But it’s important to carefully design the program according to the population’s needs.

“The first thing is that employers should assess the needs of their workforce and plan accordingly… we have seen a lot of programs that were well-intended but totally misread what is the real underlying problem in the workforce,” he said.

“It’s really important to make these programs attractive, accessible and known. That means getting the word out, using all kinds of marketing channels to your employees, but also getting your line managers and your senior managers behind the program because many people do not have good control over their workday, and if their direct supervisor thinks this is just a waste of time, then they will just not go.”

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