1. The Health Promotion Approach at the Workplace: Uses and Abuses Tage S. Kristensen Psychosocial Department National Institute of Occupational Health Copenhagen, Denmark 27th International Congress on Occupational Health Iguassu Falls, Brazil L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

2. Health promotion Definition Health promotion is the process of enabling people to increase control over, and to improve, their health. Ottawa Charter for Health Promotion, 1986

3. Why workplace health promotion? The workplace is one of the obvious stages on which to act out health promotion programmes. Cox. Work & Stress 1997;11:1-5. The most appropriate place to implement a health promotion programme may well be the worksite because of the proportionately large amount of time an individual spends working during his/her lifetime. Malzon & Lindsay. Health Promotion at the Worksite. WHO Europe: Copenhagen, 1992. The worksite is an arena that is especially amenable to the development and delivery of more integrated approaches to health care. Sokols et al. JAMA 1995;273:1136-1142.

4. Health promotion for working populations Targets of intervention: Report of a WHO expert committee. Geneva: WHO, 1988. Tobacco Physical activity Nutrition Alcohol Drug abuse Psychosocial factors Ergonomic factors

5. Workplace health promotion programmes Most common targets: Tobacco cessation Diet changes Control of cholesterol Physical activity Weight loss Exposure to ultraviolet light Stress Alcohol Drug abuse 27 16 14 8 1 3 N N = number of high quality studies included in review of studies on risk factors for cancer Janer et al. Scand J Work Environ Health 2002;28:141-157.

6. Workplace health promotion programmes Quality of research: It has frequently been assumed that worksite health promotion must have a positive effect, and many of these studies were not adequately designed to evaluate whether such an effect was present. Many studies did not have a reference group, they were based on a small number of subjects, and they did not give quantitative estimates of the changes achieved by the interventions. Janer et al. Scand J Work Environ Health 2002;28:141-157.

7. Work site health health promotion Work site health promotion programmes should be more widely adopted only if they can be demonstrated to be effective and cost-effective in reducing the risk of disease and in promoting health. Oldenburg et al. Health Education Quarterly 1995;22:9-19.

8. Review of 35 health promotion intervention studies Results Design evaluation: EncouragingMixedDiscouraging No comparison group 100% (11) 0% (0) 0% (0) Non-randomized comparison group 56% (9) 31% (5) 13% (2) Randomized comparison group 22% (2) 56% (5) 22% (2) Heany & Goetzel. Am J Health Promot 1997;11:290-307

9. Workplace health promotion programmes Country of research for 45 high quality studies: Thus, research has been performed in rich countries with low mortality. Janer et al. Scand J Work Environ Health 2002;28:141-157. USA Europe Australia Other Total 29 7 5 4 45

10. Workplace health promotion programmes Smoking cessation: Overall effect: 6% quit rate. Continuous abstinence:1-6% Higher effect among: Managers Moderate smokers Smokers of light tobacco Smokers who had smoked for less time Conclusion: Lasting effect is small. Largest effect among those who have the smallest need for smoking cessation from a health point of view. Janer et al. Scand J Work Environ Health 2002;28:141-157.

11. The basic problems of Workplace Health Promotion A healthy selection? WHP programmes take place in rich industrialized countries with low morbidity and mortality. WHP targets working individuals, who are healthier than non- working individuals. WHP is limited to the formal and urban sector of the economy. WHP is limited to larger companies. Companies with WHP tend to have better working conditions than workplaces without WHP. Participation rates are generally low (average approx. 50%). The participants tend to be the more healthy managers and white collar workers.

12. WHP for the healthy few: The healthiest employees Large companies with good working conditions Formal, industrial sector Working population Rich countries

13. Workplace Health Promotion and equity WHP tends to reach: – The healthy workers. – At the best companies. – In the formal sector of the economy. – Employing the healthier individuals. – In the rich industrial countries. If anything, WHP will: – Increase the inequality of health in the world.

14. This presentation can be found at: www.ami.dk/presentations