Small-business owners unable to afford full-service medical coverage for their employees may be unfamiliar with a lower-cost alternative: employee health promotion.
Unlike health insurance, which provides physician care and hospitalization for employees, health promotion provides education and screening in such areas as diet, smoking, stress, cholesterol, diabetes, cancer, parenting and workplace safety. The idea is to prevent health problems, rather than wait for illness to strike.
A recent survey of more than 46,000 workers by the Health Enhancement Research Organization in Birmingham, Ala., found that employee depression increased health costs by 70%. Stress boosted that tab by 46% and high blood sugar levels added 35%.
Overall, health expenses tripled for workers with several risk factors such as smoking, high cholesterol, elevated blood pressure and poor exercise habits. Other studies have shown that for every dollar spent on health promotion, businesses save from $1.80 to $6 through reductions in absenteeism or health-care costs.
Yet, small businesses largely have been absent from this health-care movement.
"A lot of small businesses haven't had the time or the resources to think about what it would be like to take a proactive approach to the health of their employees," said James S. Carman, a researcher in this field with the California Department of Health Services in Sacramento. "One of the major barriers is that it takes a certain critical mass of employees to support a person that could provide educational material."
But two fledgling attempts are underway in Southern California to provide small businesses with health programs that big companies have been using for nearly three decades.
The Worksite Wellness Project in downtown Los Angeles is working with nine small companies in the garment, food-processing and furniture manufacturing industries. And researchers at UC Irvine are training 80 companies to create their own employee health-promotion programs.
Meanwhile, Carman, other California health department officials and researchers at UC San Francisco are analyzing a statewide survey of 1,000 businesses to determine, among other things, what hampers small business' ability to provide health-promotion programs for their workers.
These efforts signal a growing recognition by health professionals that small business needs to get involved. All three programs seek a cost-effective method of delivery for these services to small firms.
"In a sense, we're all working at the test tube level as far as small business is concerned," Carman said.
For larger companies, employee health promotion is a familiar program. Also called work-site wellness or employee health education, it sprang from the fitness movement in the 1970s as another perk or benefit. Along with employee fitness centers, corporations used the programs to attract and retain workers, said Stephanie Pronk, a Minneapolis health consultant and head of the Assn. of Worksite Health Promotion.
During the 1980s, health promotion expanded into comprehensive programs given by corporate human resource departments, HR consultants, HMOs, hospitals and nonprofit organizations such as the heart and lung associations. As corporate cutbacks took hold in the '90s, employee health promotion has been restructured as less of a perk and more of a cost-saving measure. Annual costs range from $5 to $200 per employee.
Despite the growth of the programs, however, small businesses typically have not participated. Often small firms lack the money, staff and expertise to design their own programs, while the professionals that could help them tend to focus on larger workplaces.
Enter Worksite Wellness. With grants from the California Wellness Foundation, the Robert Wood Johnson Foundation and the California Endowment amounting to about $180,000 yearly, the pilot project began two years ago to assist businesses with between 20 to 100 workers whose pay averages $7.50 per hour or less. Executive director Liz A. Torres works with companies such as J.B.'s Private Label, a 15-year-old knitwear company in downtown Los Angeles.
"It's just a godsend," said J.B.'s co-owner Reenie Bender.
Bender and her mother Jackie previously had sought medical insurance to cover their 28 employees, but with quotes no lower than $20,000, the Benders couldn't afford it. Also, the estimates usually excluded coverage for their employees' children, a big drawback for a company whose labor force consists mainly of Spanish-speaking immigrant moms. The Benders could have provided lower-cost medical insurance with employee co-payments, but their workers preferred higher take-home pay instead.
So the Benders eagerly signed up with the free Worksite Wellness program. Now every other month their employees step away from their looms to get flu shots, eye exams, lectures on gynecological health issues or breast-cancer information.
"We found that three of our folks needed glasses," Bender said. "Ninety-five percent of our women had never had a Pap smear."
One woman who had never heard about breast tests found a lump later diagnosed as benign. Another woman who had been told she needed a mastectomy was simply working and waiting to die, knowing she couldn't afford an operation. Through Worksite Wellness, she discovered she needed only a lumpectomy. Now recovered, she's in good health, Bender said.
The lectures and tests have given the workers basic health information and prompted them to take better care of themselves, resulting in a decline in absenteeism, Bender said.
The fledgling program is probably the only one of its kind in the country, said director Torres, who plans to expand the pilot model into a fee-for-service program.
Meanwhile, another tack is being taken in Orange County by the Small Business Workplace Wellness Project. About 80 companies culled from a 1996 survey of 2,000 small businesses are receiving free training in how to create employee health-promotion programs, said Kimari Phillips, project coordinator. The businesses include manufacturing companies, small restaurants, stores, law offices and preschools.
"We're training the trainers," Phillips said. "We're encouraging the managers to take time out of their week or get interested employees to be program coordinators or get a group of employees to be a volunteer committee."
The project offers information on lifestyle, workplace relations and safety programs. It also provides a resource kit with listings of health organizations that give workplace lectures or services. None of the companies has established programs yet, Phillips said. The project is funded by the California Wellness Foundation for another year, during which she expects to see some get up and running.
At the state level, the approach is more analytical. From a random, statewide phone survey earlier this year, researchers hope to find how businesses can be encouraged to start employee health-promotion programs. It could involve forming coalitions or using existing community resources, Carman said.
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Where to Call
For more information on employee health promotion, contact:
* Assn. for Worksite Health Promotion, (847) 480-9574 or http://www.awhp.org
* Los Angeles County Wellness Council, (310) 967-4523 or http://www.lacwc.org
* Valley Wellness Assn., (310) 271-4190**
* Orange County Wellness Coalition, (714) 429-3113* or http://www.ocwellness.org
* Worksite Wellness Project, (213) 532-8850 or email@example.com
* Small Business Workplace Wellness Project, UC Irvine, (949) 824-5047 or http://www.seweb.uci.edu/users/dstokols/hpc_research.html
* Also check with local offices of organizations such as the American Cancer Society, American Heart Assn. and March of Dimes, which often provide free work-site speakers and literature.
** Phone number of group president