WORKPLACE HEALTH PROMOTION - OPPORTUNITIES, STRATEGIES AND SUPPORTIVE STRUCTURES

In the leading industrialized countries workplace health promotion and prevention appear to be one of the most rapidly growing fields of health-related intervention outside medical care. the vast majority of previous workplace health programmes were per son-directed interventions aiming at the reduction of risk behaviour and biomedical risk factors of cardiovascular disease (e.g. smoking cessation, stress reduction, weight reduction, blood pressure reduction). However, during the last decade there has been a continuous shift from single-factor to multiple-factor programmes as well as from person-centered to comprehensive programmes aiming at changes in the work environment that were assumed to improve health behaviour and well-being. The main reason of this shift seems to lie in the relatively low effectiveness and efficiency of person-directed and behaviour-centered interventions. From a methodological perspective in most workplace health programmes several stages can be distinguished: assessment or screening, programme development and decision making, programme implementation and health-related action, and - relatively infrequent - evaluation of process and outcomes. Despite the vast number of workplace health programmes in North America (e.g. in almost 90% of enterprises with more than 750 employees), Japan and rapidly growing efforts in Western Europe there is a serious lack of research, in particular of sound evaluation studies. For this reason reported outcomes of workplace health promotion efforts are difficult to compare and to interpret. Nevertheless, the available evidence seems to suggest that the positive changes in health behaviour and risk factors observed in person-directed interventions tend to level off and disappear relatively soon, and that comprehensive programmes have a higher chance of producing stable improvements in health behaviour, health status and hence of reducting cost due to ill-health and chronic disease. Whereas in the U.S. most workplace health programmes are initiated and organized by management, a somwhat stronger involvement of labour unions can be observed in certain European countries. In all countries, however, only very few efforts of small enterprises and almost no programmes directed towards the specific health needs of women have been reported. Based on a review of selected research in the field and drawing from results and experiences of our own work (Berne Workplace Health project, Phase I) the paper outlines a comprehensive approach to workplace health promotion. Tt combines both organization-directed or structural strategies as well as person-directed strategies. Important elements of these strategies are workplace and personal health reports, organizational and individual counselling, health circles and organization development. The key principles are those of the,,new public health'' to enable and support enterprises and employees to increase control over, and to improve, their health.