Editorial: A New Definition for Occupational Health

A leading physician says occupational health can be a more effective partner in the battle against rising health care costs.

Many Americans will agree that we have the best health care in the world, but we are paying dearly for it. Last year, the United States spent $1.7 trillion on health care, or $5,805 per person, according to the Centers for Medicare and Medicaid Services. As employers are squeezed by double-digit increases in health insurance premiums, they are passing along the costs to employees through increased premiums and higher out-of-pocket fees, or dropping health insurance coverage entirely.

In the workplace, occupational health traditionally has been viewed as dealing strictly with injuries and illnesses arising from the job carpal tunnel syndrome caused by word processing or fractured wrists from falling on slippery floors. Yet, a much larger portion of employers' health care costs stem in some way from employees' lifestyles and heredity.

That is why Dr. William Wanago, corporate medical director for Comprehensive Health Services Inc., a national provider of occupational health services, advocates a new definition of occupational health that encompasses any medical condition or health problem that affects a workers' ability to perform their job, even if it is not caused by the work itself. Wanago wants companies to continue investing in good safety programs in order to prevent on-the-job injuries and illnesses, but he wants them to increase their health promotion efforts. They should establish a way, he said, to "keep healthy people healthy, reduce the risk factors in those who may be at high risk for developing significant illness or disease in the foreseeable future and assist those who have already developed illnesses to manage them more effectively."

Baseline and Beyond

In Wanago's view, this effort starts with a preplacement examination that determines an individual's functional capacity to perform a given job and establishes a baseline against which to measure future changes in health status. Periodic health risk appraisals provide continuing monitoring of health, while medical surveillance programs monitor employees who may be exposed to certain on-the-job risks. Wellness and health promotion programs seek to educate employees about good health practices and to help them deal with common health risks such as smoking, obesity or high blood pressure.

This broader approach to occupational health is not just for Fortune 500 companies, Wanago noted. After all, the 5.8 million companies with 200 or less employees employ half of the nation's work force. In fact, said Wanago, employee health problems can have a greater impact on these smaller employers precisely because they have a smaller work force. He said they need to emphasize a "very proactive and preventive approach to safety in the worksite." To stretch their budget, they can enlist organizations such as the American Cancer Society or the American Health Association for help with employee education and screening programs. Making this effort, he said, will send a message to the employees that "the organization cares about their health."

Using screening programs to assess health risks in your employee population is an important start, but providing a one-shot screening is not the answer to controlling health care costs, Wanago warned. "You have to look at the results sequentially over time and determine whether you are making a significant impact on those risks. Then, you can decide whether the program is cost-effective or if the dollars and manhours should be spent elsewhere." Moreover, his company urges employers to combine screening with some on-site intervention by a health care provider. That way, the participants who volunteer for a program, such as for high cholesterol or high blood pressure, can be monitored over the course of a year to determine if they are receiving adequate medical treatment.

Some critics charge that these types of health promotion efforts at the workplace are paternalistic and intrude into workers' personal lives. "I encounter that attitude with some frequency, but it is far less so than it was even 5 years ago," said Wanago. "There is more open-mindedness and an acknowledgement by organizations that their least healthy employees are responsible for more costly medical claims and a higher absenteeism rate." He said it is important to provide health programs that are voluntary and optional. If a company has some early successes and managers lead by example, he noted, "then often the peer pressure of joining the healthy movement is enough to get some recalcitrant employees to change their minds."

Wanago's company cites studies by companies such as Johnson & Johnson, which saw a 30 percent return on its Health & Wellness program, and Bank of America, which saved $4, 298 per employee per year through reduced healthcare claims stemming from its health promotion efforts. "The strong message here is that good health is good business," said Wanago. "If organizations control risks involving both work and non-work related conditions, the cost savings will follow."

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