Employee Wellness

Employee Wellness-India:Layout 1 09.09.09 17:24 Page 1

Employee Wellness as a COMMITTED TO
IMPROVING THE STATE

Strategic Priority in India
OF THE WORLD

Preventing the Burden of
Non-communicable Diseases through
Workplace Wellness Programmes

Report of a Joint Event of
the World Economic Forum and
the World Health Organization Country
Office for India

In cooperation with
Public Health Foundation of India
World Health Organization Country Office for India

World Economic Forum
September 2009


This report was written by Ambika Satija and Puja Thakker of the Public
Health Foundation of India, with support from Vanessa Candeias Teixeira
Rodrigues and Godfrey Carmel Xuereb of the World Health Organization,
J. S. Thakur and Kavita Venkataraman of the World Health Organization
Country Office for India, and Eva Jané-Llopis, Chronic Disease and
Wellness Initiative at the World Economic Forum.

The views expressed in this publication do not necessarily
reflect those of the World Economic Forum.

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REF: 150909


Contents

Executive Summary 2

Commitment from the Meeting 3

1. Introduction: The Burden and Causes of NCDs 4

2. Rationale: Why Invest in Workplace Wellness? 6

3. Evidence: Workplace Wellness Works 8

4. The WHO India/World Economic Forum Joint Event on Employee Wellness as a
Strategic Priority in India 10

5. Barriers and Opportunities 11

6. Strategy for a Successful Programme 15

Model for Setting up a Workplace Wellness Programme 18

Monitoring and Evaluation 21

Bringing It All Together: The Power of Comprehensive Interventions 22

7. Conclusions and the Way Forward 25

Outcomes of the WHO India/World Economic Forum Joint Event 25

References 27

Annex 1: Agenda of the Joint Meeting of the World Economic Forum and World Health Organization

Country Office for India 29

Annex 2: List of Participants 32


Executive Summary

Background: NCDs and Workplace Wellness coordinated manner: leadership, people, culture and
Non-communicable diseases (NCDs) are on the rise process. Only when all of these are addressed in a
globally, and the low and middle income countries comprehensive way can an employee wellness
(LMICs) are the worst hit – 80% of projected deaths programme be successful.
from NCDs in 2005 occurred in LMICs, according to
a World Health Organization (WHO) report. India is Model for Developing a Healthy Workplace
also on the brink of an NCD epidemic – the burden For workplace wellness programmes to accomplish
it faces is high in terms of mortality, morbidity and the above, they must be designed, implemented
economic productivity, and it stands to face and evaluated in a systematic manner. WHO India
significant loss if effective NCD prevention strategies has developed a schematic model to describe the
are not implemented. The good news, however, is process of developing, implementing and evaluating
that NCDs are to a great extent preventable, as their workplace wellness programmes. The process starts
main underlying causes are modifiable lifestyle- with the formation of a wellness committee that
related, behavioural and environmental factors. undertakes the baseline evaluations and situation
assessments, on the basis of which health policies
Focusing on the workplace for the prevention of are chosen, implemented and then evaluated.
NCDs has a double target: health and business
reasons. India’s growing working population and the Monitoring and Evaluation of Workplace
high NCD burden among its workforce make the Wellness Programmes
workplace ideal for NCD prevention. The economic One step in the above-mentioned model is the
benefits of NCD prevention at the workplace for monitoring and evaluation of wellness programmes.
employers are vast, including reduced absenteeism, It is essential that time and resources are invested in
reduced injuries and workers’ compensation costs, this, as it is only through constant monitoring at the
reduced healthcare costs, reduced employee baseline during the implementation process, as well
turnover, increased productivity and profits, greater as of the outcomes of the programme, that any
worker satisfaction, improved morale, and increased improvements can be made in the policies and
attraction of talent and potential employees to the processes of the programme and best practices
workplace. Thus, focusing on workplace wellness is documented. Also, it is only with the demonstration
supported by the ethics of corporate responsibility, of the success of the programme that the
as well as by the rationality of corporate profitability. investments made can be justified.

Barriers and Opportunities World Economic Forum and World Health
Various barriers and opportunities should be Organization Country Office for India Joint
considered and analysed while designing and Event
implementing employee wellness programmes. The World Economic Forum and the WHO Country
Barriers and opportunities are discussed in this Office for India jointly convened a meeting on
report with respect to attitudes, employers, “Employee Health as a Strategic Priority in India”.
employees and capacity development. While facing This joint event was held in New Delhi, India, on 14-
hurdles is disheartening, it must be remembered that 15 November 2008. Participants included key
barriers transform over time into facilitators, and that stakeholders from the commercial sector, academia,
every barrier has a hidden golden opportunity for non-governmental organizations (NGOs), the United
change and transformation – this is why every Nations and other international organizations.
perceived barrier has been presented with an Existing barriers and potential opportunities in
opportunity to overcome it. workplace wellness programmes in India were
discussed, as well as the rationale for workplace
Strategy for a Successful Programme wellness investment in India, strategies for
To overcome barriers and make optimal use of the successful programmes, how to implement these
available opportunities, an employee wellness programmes, their monitoring and evaluation, and
programme should follow a “strategy for success”. how to adapt these programmes to small and
This strategy has four key elements that must be medium enterprises.
incorporated into a wellness programme in a

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Conclusions and Way Forward talented individuals. Such an investment is in
Business leaders must join the fight to contain alignment with India’s economic and development
NCDs. It is not only altruism but also enlightened priorities as a nation and an essential step in the
self-interest. Investing in the health of employees fostering of a healthy workforce, nationally and
increases productivity, cuts down spending on globally.
healthcare costs, reduces turnover and attracts

Commitment from the Meeting

At the World Economic Forum and the WHO international organizations such as the World
meeting in New Delhi in November 2008, several Economic Forum and the World Health Organization
commitments were put forward to advance playing the foremost role of stewardship, was
employee health, which was unanimously recognized as the primary course of action. The
acknowledged as a strategic priority for India. Public Health Foundation of India was identified as a
Multistakeholder action was identified as the single key organization positioned to bring together
most effective vehicle for change. In line with this, multiple stakeholders on a platform for action.
the creation of a council inclusive of several Annexes 1 and 2 provide the agenda for the
ministries, corporate leaders and civil society, with meeting and a list of the participants.

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1. Introduction: The Burden and Causes of NCDs

As India pursues a pathway of accelerated India is no exception to this trend – the major NCDs,
economic development, growth in industrial and including CVDs, diabetes, cancer and chronic
service sectors offers more employment respiratory disease, accounted for 53% of all
opportunities. Promotion of employee health should projected deaths and 44% of DALYs in India in
be recognized as a prioritized need, as it represents 2005. Over the period 2005-2015, while deaths
a prudent investment for enhanced productivity and from infectious diseases, maternal and perinatal
also signs responsible corporate conduct. The conditions and nutritional deficiencies are expected
growing realization that health and economic growth to decrease by 15%, deaths from NCDs are
have a bi-directionally reinforcing relationship is now expected to increase by 18%, and, most
beginning to foster investment in workplace wellness significantly, deaths from diabetes are expected to
in many countries. Workplace health programmes increase by 35%3. The cost of this burden cannot be
provide protection against occupational health ignored.
hazards and first line treatment for medical
disorders. It is important that India adopts In 2005 alone, India lost US$ 9 billion of its national
“workplace wellness” as an important pillar of its income due to NCD deaths, and by 2015 is
growth strategy. projected to lose US$ 237 billion in national income
due to deaths from CVDs, stroke and diabetes4.
Burden of Non-communicable Box 1
Diseases
What is Health and Wellness?
In the preamble to the Constitution of the World
Globally, six out of 10 deaths are due to non-
Health Organization (1948), health is defined as
communicable diseases (NCDs – see box 1).
“a state of complete physical, mental and social
Cardiovascular diseases (CVDs) are the leading
well-being and not merely the absence of disease
cause of death in the world, particularly among
and infirmity”*. Health and wellness refer to a
women1. According to the World Health Organization
state of physical, mental, social and spiritual
(WHO) report Preventing Chronic Diseases, a vital
balance, and the ability to make choices that help
investment, 60% of the projected 58 million deaths
achieve or maintain such a state of balance.
in 2005 and almost 50% of the projected global
Workplace wellness in this sense refers to all
burden of disease for 2005, as measured by
those activities that are designed to help and
Disability Adjusted Life Years or DALYs*, in the world
support employees and their families follow
were due to NCDs, with the four major NCDs –
healthy lifestyles that are conducive to achieving
CVDs, cancer, diabetes and chronic respiratory
such a state of well-being.
disease – accounting for most of this burden. While
death from infectious diseases, maternal and
What is a Non-communicable Disease?
perinatal conditions and nutritional deficiencies are
A non-communicable disease is an illness that
expected to decline by 3% by 2015, deaths from
persists for a long duration. It usually progresses
NCDs are expected to increase by an alarming 17%
slowly, and unlike infectious diseases, cannot be
over the same duration2.
prevented by vaccinations, nor can it be
transmitted from person to person. The major
Although the rise in NCD burden is a global
NCDs include cardio-vascular diseases (CVDs)
phenomenon, it is the low and middle income
such as heart attack; stroke; diabetes; cancers
countries that face the biggest challenge. WHO
such as breast cancer and prostate cancer;
reports that a staggering 80% of deaths from NCDs
chronic respiratory disease (CRD) such as
occur in developing countries2.
asthma; bone and joint impairments such as
arthritis; vision and hearing impairments; oral
disorders, etc. Mental disorders, such as
* A measure of the years lost to disease, calculated by
combining the healthy years lost due to premature death depression, dementia, schizophrenia and anxiety
from the disease, and the number of years spent in ill disorders also fall in this category due to their
health due to the disease; one DALY can be taken to chronic nature.
mean one lost year of healthy life.

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Tremendous gains can be made with even the
smallest of reductions – according to WHO, an
additional 2% annual reduction in NCD death rates
between 2005 and 2015 would result in an
accumulated gain in income of around US$ 15
billion in India2.

The Causes

One characteristic feature of most NCDs is that they
are mainly caused by lifestyle, behavioural or
environmental factors, most of which are modifiable.
A small number of such modifiable lifestyle-related
determinants are accountable for most of the major
NCDs. The most important of these are an
unhealthy diet and excessive energy intake, physical
inactivity (all of which lead to overweight/obesity) and
tobacco consumption. Other important changeable
risk factors include excessive alcohol consumption,
psycho-social factors such as stress, and
environmental toxins. In conjunction with the non-
modifiable risk factors of age and genetic heredity,
these account for most of the NCD burden we see
today2.

India’s risk factor profile has been worsening over
the decades, and is now a cause for concern.
Around 17% of males and 15% of females above
the age of 15 years have a body mass index (BMI)**
above 254, and these figures are even higher in
urban areas, being 22.2% and 28.9% respectively5.
In fact, some risk factors such as physical inactivity,
inadequate fruit and vegetable consumption and
unhealthy alcohol consumption have been found to
be higher among Indians and South Asians relative
to individuals in other regions6.

** BMI is a statistical measure of a person’s weight relative to
height. A BMI of 25 kg/m2 is considered the global cut-off
for overweight, and that of 30 kg/m2 is considered the
global cut-off for obesity.

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2. Rationale: Why Invest in Workplace Wellness?

NCDs are costly to employers in a direct way.
Modifiable risk factors such as smoking, lack of
exercise, alcohol use, poor nutrition, obesity and
hypertension increase an employer’s healthcare
expenditures by 25% and are currently estimated to
account for 2.1% of gross domestic product in
India. In today’s market-driven, competitive world, a
capable and resilient employee is an important
resource and fundamental to productivity. NCDs are
the prime cause of lost work time in the working-age
population. An Indian industry survey identified that
lifestyle-related illnesses account for 27% of illnesses
among employees. A quarter of the respondent
firms lost approximately 14% of their annual working
days due to sickness7. In India, productive years of
life lost to cardiovascular disease alone will almost
double between 2000 and 20302.

Being lifestyle-related diseases, NCDs must be
tackled at all stages of an individual’s life and in all
spaces that an individual occupies – at home, at
school and in the workplace. Globally, 65% of the
population over the age of 15 is in the productive
years and spending one fourth of its time in the Interventions to improve nutrition, encourage regular
workplace. In absolute terms, this translates into physical activity and avoid the use of tobacco and
3.18 billion people, a figure that is projected to harmful alcohol use are cost-effective and can
increase to 3.68 billion by 20208. In India, 58.5% of reduce up to 80% ill health and premature deaths
the population aged 15 years and above is currently due to NCDs. Reducing just one health risk
economically active7. Thus, the working population in increases an employee’s on-the-job productivity by
India is a huge, concentrated population which is 9% and cuts absenteeism by 2%. In fact, preventive
easy to target and, by implication, one in which healthcare activities at the workplace have been
results can show quickly and be substantial. found to be related to increased profits of Indian
companies7,9.

Benefits of Workplace Wellness Programmes NCD prevention through workplace wellness
to Companies programmes is also important in the context of the
• Reduced absenteeism increasing sedentary nature of work. The service
• Reduced injuries and workers’ compensation sector is increasingly becoming the predominant
costs employment sector in the world – globally in 2006,
• Reduced healthcare costs for the first time the share of employment in the
• Reduced employee turnover service sector overtook that of agriculture, with 40%
• Increased productivity and profits of employees working in the former9. In India the
• Greater worker satisfaction employment share of services has also been steadily
• Improved morale increasing, from 18.1% in 1965 to 23.5% in 200010.
• Increased attraction of talent and potential The workplace is also full of the pressures and
employees to the workplace strains of deadlines and performance, and the high
levels of stress and burnout reported by Indian
employees confirms this. A recent survey by the
Associated Chambers of Commerce and Industry of
India (ASSOCHAM) found that work-related stress

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Why the Workplace is Ideal for NCD
Prevention
• An easy, concentrated population to target
• Multiple levels of influence can be used –
direct, such as the provision of healthy food,
and indirect, such as creating a supportive
environment
• Possible to link workplace health promotion to
other programmes at the workplace, such as
occupational safety programmes
• Concentration of lifestyle-related risk factors at
the workplace
• The workplace has been recognized
internationally as an important health
promotion setting

and mental fatigue are common problems reported
by Indian employees not only in the areas
traditionally associated with work stress such as the
IT and BPO sectors, but also in many other sectors,
including construction, shipping, banking, media,
small-scale industries, trading houses and
government hospitals11. The high concentration of
lifestyle-related NCD risk factors in the workplace
makes it imperative that preventive efforts be
focused there.

A healthy population is an economically productive
population, and it is in the benefit of companies to
safeguard public health. Given the heavy
contributions of the private sector to the economy,
employee wellness programmes are not only a
strategic priority for India, but also an economic
imperative for corporations.

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3. Evidence: Workplace Wellness Works

There is considerable evidence suggesting that
Behavioural Outcomes
workplace wellness programmes aimed at
preventing NCDs through lifestyle changes are
The three most important lifestyle-related
effective, although this evidence is by no means
determinants of NCDs are physical inactivity, diet
exhaustive. Employee wellness programmes have
and substance abuse, in particular tobacco
been seen to have various types of effects, with
consumption. Workplace wellness programmes have
improvements observed in anthropometric*,
been found to improve all these behavioural risk
behavioural, psychological and economic outcomes.
factors.

Anthropometric Outcomes Physical Activity
A number of techniques have been used to
A review of workplace intervention programmes encourage physical activity at the workplace. A
focusing on weight control found that these were systematic review of the effectiveness of workplace
able to produce a reasonable amount of short-term physical activity interventions found the use of
weight loss among the employees12. Similar results pedometers to increase daily step counts, walking to
were found by Petersen et al. (2008) for an Internet- work (active travel) and workplace counselling to
based employee weight-management programme – have a positive impact on physical activity
in fact, increased website use was associated with behaviour16. Counselling as a technique to increase
increased weight loss13. The effect of such wellness energy expenditure and cardio-respiratory fitness
programmes on other physiological risk factors such was found to be effective in a Randomized Control
as hypertension14 and endothelial function**,15 has Trial as well17. Another study found a
also been found to be positive. communications-based campaign to be effective in
increasing knowledge of physical activity and
encouraging walking18.
* Anthropometry refers to the measurement of the human
body; in this context, it implies all body dimension and Diet
physiological measurements such as BMI and blood
pressure. A diet high in fats and sugars and low in fruits and
** Endothelial function refers to the functioning of the vegetables has been identified by WHO19, WCRF20
endothelium, which is the layer of cells lining the interior of and many other international organizations as a risk
blood vessels and the heart.
factor for NCDs. Several interventions at the workplace

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are aimed at improving the dietary habits of
Economic Outcomes
employees. For instance, the Heartbeat Award (HBA)
scheme, which is a nutrition labelling scheme in
Various types of programmes have been observed
England was found to be effective in increasing four
to enhance productivity and profitability. One study
healthy dietary behaviours – increased fruit
found work health promotion to decrease sickness
consumption, reduced fried food and sweets
absences and enhance work ability29, while another
consumption, and a switch to lower fat milk21. Another
study found an employer incentive/disincentive
comprehensive intervention programme designed to
approach to be effective in reducing illness-related
target multiple levels of influence22 was found to be
absenteeism30. Workplace physical activity
effective in increasing fruit and vegetable intake
programmes have also been seen to have positive
among employees. This increase was much more in
effects in this regard, and have been found to
the workplace-plus-family intervention relative to the
reduce health-related impairments in time
workplace-only intervention, highlighting the
management, physical work, output limitations,
importance of multi-component programmes.
overall work impairment and short-term disability
workdays lost31.
Substance Abuse
Programmes targeting substance use/abuse by
Another study found workday exercise to improve
employees have been found to be effective in
white-collar workers’ mood and self-reported
reducing tobacco consumption23 as well as alcohol
performance32. Overall workplace wellness
abuse24. These intervention programmes have also
programmes have been found to be economically
found to be economically profitable for companies25,
beneficial for organizations, brining about reductions
particularly since substance abuse can greatly
in sick leaves, health plan costs, workers’
hamper an employee’s productivity.
compensation and disability costs33.

Psychological Outcomes

Frequently, workplace wellness programmes have a
mental health component aimed at relieving stress
and enhancing the feeling of well-being. In a review
of workplace interventions to promote mental well-
being, it was found that psychosocial intervention
courses, stress management training, counselling
and therapy, physical exercise and health promotion
interventions have a positive impact on mental well-
being26. Physical activity programmes at work in
particular have been shown to enhance subjective
well-being and enthusiasm of the employees at
work27, 28.

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4. The WHO India/World Economic Forum Joint Event
on Employee Wellness as a Strategic Priority in India

Following several recent consultations in Davos and
Dalian, the World Economic Forum and the World
Health Organization jointly convened a meeting on
“Employee Health as a Strategic Priority in India” in
New Delhi, India, on 14-15 November 2008.
Employee wellness was unanimously acknowledged
as a strategic priority for India.

A clear need for dramatic change was reiterated,
through ideas such as creating a new code on
public health to be adopted by companies, with
interventions extending not only to the employee but
also to families and communities. Multistakeholder
action was identified as the single most effective
vehicle for change. The next sections of this report reflect the scientific
evidence presented during the Joint Event, and
The immediate course of action identified at this highlight the key aspects discussed by the
meeting was the creation of a council inclusive of participants. Annexes 1 and 2 provide the agenda
several ministries, corporate leaders and civil society, for the meeting and a list of the participants.
with international organizations such as the World
Economic Forum and the World Health Organization
playing the foremost role of stewardship. The Public
Health Foundation of India was identified as a key
organization positioned to play a convening role in
bringing together multiple stakeholders on a platform
for action, with support from organizations such as
the Confederation of Indian Industry, the Indian
Association of Occupational Health, and the
International Labour Organization.

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5. Barriers and Opportunities

The increasing prevalence of NCDs is a relatively unique avenues of initiating and sustaining change.
new phenomenon in India, and the concept of The following section details the discussions of the
having wellness programmes at the workplace to meeting about barriers and opportunities relevant to
prevent them is an even newer one. Barriers to the India context.
implementation of workplace health promotion
programmes exist. However, many barriers become There are four main types of barriers and
facilitators over time, and it is important that we look opportunities – related to attitudes, employers,
for opportunities within these barriers, as well as employees and capacity development – in addition
aspects of the Indian context that provide us with to some general, overarching ones (see figure 1).

Figure 1: Potential Barriers and Opportunities Related to Implementation of Employee
Wellness Programmes in India

Barriers Opportunities

General Barriers and Opportunities
1. High NCD burden Possibility of making dramatic change

2. Global financial crisis affecting Health as an investment
Indian companies – global economy
will pose a challenge

Attitudinal Barriers and Opportunities
3. Lack of awareness of the Growing global recognition of NCDs, their potential impact and the opportunity to
implications of the NCD epidemic use national and local media to get the message across to the public
a. Health is getting linked to productivity and profitability

4. Health is considered a philanthropic b. Great opportunity to redefine human agenda to talk about human happiness
issue and human well-being
c. Idea of creating a new code on public health to be adopted by companies and
countries

5. Preventive care lacks incentive – a. Scope for appropriate policies and programmes for preventive healthcare
the focus is on curative health b. High quality expertise in IT and medicine providing resources for state-of-the-art
work interventions

Barriers and Opportunities Related to Employers
6. Lack of visibility of leadership – Reach out to chief executives (CEOs):
need to reach decision-makers • Through industry employee organizations
• Engage CEOs from outset to be champions
• Make and show business case
• Capture CEOs emotions
• Use the right language (tailor messages)
• Non-cost, high return, simple interventions (e.g. information, environment)
• Use of the media
• Goal setting – 10 commandments to implement this year
• Incentives – awards systems to best workplaces
7. Concern of employers regarding the How can it be integrated so it does not detract from time?
employees time a. Make the case that it is cost effective by being an investment
b. Find efficient delivery channels and structural support (e.g. sport, gym)
c. Identify a menu of options to choose from (adaptable to workforce at any time)
d. Management support medium and high levels
e. Identify existing opportunities for health in existing structures rather than adding
(e.g. canteen, design)
f. Go beyond individual education (environmental change)
g. Health as a human right and not just business

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Barriers Opportunities

Barriers and Opportunities Related to Employers
8. Employers are worried about issues Promote trade union leadership – getting unions engaged from the start
related to unionism (changing food
menus, etc.)
9. Issues related to high attrition in Workplace wellness as an incentive for employees to join the company and stay in it
companies

Barriers and Opportunities Related to Employees
10.Engaging employees in health Bottom-up approach (increase awareness to create demand for health):
programmes is difficult (lack of • Educate employees about their rights
visibility and transient, if any); and • Scope for creating healthcare opinion-makers among employees –
lack of interest of younger empowerment
employees in NCD prevention • Using other employees as vehicles for messages
• Employees as champions (incentives)
• Personal experience with diabetes and heart diseases
• Capitalizing on family ties

11.Issue with annual health check-up – Ensure employee trust in confidentiality
fear of losing job due to bad health
performance

Barriers and Opportunities Related to Capacity Development
12.Capacity gap a. Lack of a conceptual framework that explains why the change should happen
b. No Indian data showing that prevention is better than cure
c. Lack of more real-life data on the effect of NCDs on companies in India
d. Lack of HP material specific to industries
e. Create best practices in healthcare
f. Network of people for sharing what is being done, barriers faced and how they
are being overcome
g. Use existing organizations (e.g. CII) to disseminate information
h. Create a common set of HP materials to be used by all workplaces

13.Various interventions – what are the Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu
different options available and their of programmes:
costs? • Screening and medical check-up (tobacco, hypertension, diabetes, alcohol)
• Support provision of treatment (as ethical practice)
• Information and awareness raising
• Health styles change guidelines – health promoting environments (canteen, low
salt/sugar food, tobacco, alcohol); include stress and posture as key
• Structural and functional changes to workplace
• Informal sector: self-help groups sensitization
• Reimbursement for prevention/promotion
14.Management barriers – nobody to Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu
manage workplace wellness of proNeed to create a cadre of management personnel
programmes
15.Environmental barriers: availability Structural and environmental changes are needed – do not only put the
and affordability to be physically responsibility on the individual to make this change
active and eat healthy

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The main overarching barrier to implementing programme might introduce (for instance, changing
wellness programmes at the workplace is the global food menus to substitute high fat and sugar options
financial crisis, which is bound to compromise the with healthier ones might create resentment at the
extent to which Indian companies and organizations withdrawal of acquired rights). Most of these
can spend on workplace wellness. However, if problems stem from a lack of awareness and
workplace wellness is seen as an investment as involvement. It is thus essential that all key payers –
opposed to an expenditure, the global economic the top leadership, the employees, the union, etc. –
downturn can become an opportunity to enhance are involved from the beginning in the planning,
and augment human resources and better secure execution and evaluation of the programme. Lastly,
the future of an economy that is increasingly service employers are worried about investing in wellness
sector dominated. programmes when turnover rates are high; however,
it might be that the high stress and unhealthy
The second set of barriers is attitudinal. Being new working conditions are parts of the reason for
to NCDs and having faced a disproportionately high attrition. There is an opportunity for companies to
burden of infectious diseases, pregnancy-related promote wellness programmes as an incentive to
conditions and under-nutrition for a considerable attract new talent as well as retaining it – a powerful
period of time, LMICs are only beginning to means for management to show it cares.
comprehend the seriousness of the potential
negative impact of a high NCD burden. Moreover, On the employee side, the main barrier is the
health has traditionally been perceived as a matter of difficulty of encouraging participation in wellness
social welfare that lies within the domain of the programmes. Again, the problem is mainly due to a
government, and not something in which the private, lack of awareness of the importance of maintaining a
corporate sector should be involved. Even where healthy lifestyle; this is particularly true of younger
health has been recognized as a priority, almost employees who feel invulnerable to disease and
complete focus has been on curative services, with disability. This barrier creates the opportunity to
not enough emphasis given to preventive care – high enhance awareness in the workforce regarding
health-care costs incurred by corporations attest to NCDs and their risk factors – the employees must
that. be educated about their rights and a bottom-up
approach must be adopted to create a true sense of
However, as more and more evidence highlights the ownership among the employees. The other barrier
economic gains to be made by corporations if they faced by employees is a fear of losing one’s job due
work towards enhancing the health of workers, the to bad health performance on annual health check-
global perception is rapidly changing from health as ups. It is crucial to maintain complete confidentiality
social welfare to health as business and an asset to of results, and ensure the employees that the results
productivity and profitability. India must align itself of health check-ups are completely separate from
with this global thinking, and look at its workforce as their performance appraisals on the job.
a vital human resource to be invested in for future
productivity. It must create and impart a new code Lastly, there are certain barriers and opportunities
on public health, specifically to be adopted by related to capacity development. In the area of
business firms and corporations, so that health public health, there is a huge capacity gap – the
becomes a part of the value system of all firms in requisite data, studies, personnel and body of
the country. knowledge to make the appropriate policy changes
are not available. This lack of knowledge creates an
There are also several barriers and opportunities ideal opportunity to start gathering data from
related to employers, the most important ones being existing sources and disseminating it for others to
lack of visibility of leadership in workplace wellness, use. It is no longer sufficient to follow best practices;
the perception that health interventions take up a India has the ability to create the next best practices.
considerable amount of time of employees, and A key point will be to create a network of
concerns about the reaction of union members to organizations, industries and stakeholders so that
the drastic changes a workplace wellness there is transparent sharing of experiences and the

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lessons to be learned. Certain key organizations,
such as the Confederation of Indian Industries (CII),
the Public Health Foundation of India (PHFI), can act
as nodal agencies for collecting, synthesizing and
disseminating information in the form of best
practices.

There are still many questions that need to be
answered – how can interventions be translated into
other industry sectors? How can India tackle health
promotion in its large, unorganized sector? How can
we address issues of sustainability? These and other
questions cannot be dealt with by companies alone
– there is an urgent need for multistakeholder
discussions and collaborations. It is only when the
various government departments, civil society, the
corporate sector and academia come together that
we can begin to find solutions.

14 |


6. Strategy for a Successful Programme

To overcome the above-mentioned barriers and
make optimal use of the available opportunities, an
employee wellness programme should follow a
strategy for success – it should appropriately take
into account and influence the leadership, people,
culture and processes deployed in the making of a
programme34 (see figure 2). The lack of leadership,
participation of employees, a health-promoting culture
and environment or effective processes can threaten
and weaken the effectiveness of a programme.
Thus, it is important to adequately address each of Health Education
the four elements to infuse commitment, efficacy Small lifestyle changes such as regular exercise and
and sustainability – essential ingredients required for healthy eating can prevent diabetes and
the success of a wellness programme. cardiovascular disease, yet awareness of them is
poor. Health education, through the dissemination of
Leadership health-related materials, seminars and talks delivered
Leaders are essential for the success of any by experts can help raise the profile of these
endeavour. Leadership lends visibility and sustainability avoidable conditions and motivate employees to
to workplace wellness programmes, and can entirely adopt healthy behaviours (see box 2).
determine the extent to which such programmes
operate within an organization. The lack of awareness Box 2
of workplace wellness among senior leadership is
Through Knowledge Comes Power: Health
often a barrier to committed action towards the health
Education at Reliance
of employees. Getting top leadership involved and
Health awareness and education forms a key
engaged to advocate change and be committed to
component of the health and wellness initiatives at
employee wellness is an essential component of a
Reliance. Reliance has medical teams that regularly
successful workplace wellness programme.
conduct awareness campaigns, educating
employees about lifestyle-related diseases and
People
stress management through exhibitions, lectures
In general, people want to be healthier, provided
and camps. These medical teams regularly
there is an environment that allows it. High rates of
conduct health promotion activities for advocating
participation are key to success and easier to
and bringing about improvement in the
achieve if the right strategies are deployed to reach
environment of the workplace. The Project CASHe,
out to employees.
Change Agents for Safety and Health, is an
endeavour to bring about a change in the attitudes
Figure 2: Key Elements of a Strategy to and behaviour of employees, to pave the way for a
Implement Workplace Wellness Programmes healthier life. The project aims to bring about
improvement in occupational health practices and
Leadership has been found to reduce work-related diseases
and injuries, decreased the rate of absenteeism
and improved productivity. The main result of this
project has been to bring about a change in
organizational culture – today, health and wellness
are priorities in themselves at Reliance.

References:
People Process 1. http://www.ril.com/html/aboutus/health_safety_environment.
html#policy (Last accessed January 2009)
Culture 2. Health, Safety and Environment, Reliance Industries Ltd 2004-05
3. Health, Safety and Environment, Reliance Industries Ltd 2005-06

| 15


advisory groups in which employees are
represented, such as employee-led walking clubs
and peer coaching, are some examples35.

Counselling
Private counselling of high-risk individuals has proven
to be an effective method of prevention (see box 4).

Culture
Culture plays an important role in conditioning the
way individuals think about their health. As
demonstrated in the previous section, several
barriers and opportunities are attitudinal due to the
prevailing socio-cultural perceptions. Inculcating a
Tailored Programmes
positive attitude towards prevention and wellness
In corporations, the pool of employees is often
among employees and creating an environment
diverse, including people of different ages, sex and
conducive to health-promoting activities are
health profiles. Thus, wellness programmes cannot
challenging yet desirable for an organization. Below
be one-size-fits-all; they need to be tailored to target
are some examples.
different audiences.

Age-specific programmes are such an example. In
Box 3
general, younger people (low-risk) assume a state of
good health, whereas the elderly (high-risk) are more Prevention is the Key: Medical Diagnostic
serious about prevention. Interest in different Screening and Targeted Interventions at
activities also differs by age group. Adventure sports Reliance
and team sports, for example, can be used to The Occupational Health Centres (OHCs) at the
attract the participation of younger employees. manufacturing divisions of Reliance are equipped
Programmes may also be disease-specific, or be with state-of-the-art facilities and apparatus, as
designed to protect employees from potential well as competent health professionals who
occupational health hazards (see box 3). conduct medical examinations of their prospective
employees and of their workers post-employment
Incentives on a regular basis. The results are used to create
Provision of incentives to employees who participate and implement targeted interventions among
can be extremely useful in increasing enrolment individuals and groups of individuals with similar
rates. Some corporations offer, for example, risk factor profiles. These OHCs are equipped to
wellness allowances which employees can use perform certain specialized tests, such as
towards the purchase of fitness equipment. biological monitoring, health risk assessment
However, incentives need not be financial – reward studies and audits for exposure to various
and recognition are also powerful tools. materials. The investment in the infrastructure and
manpower required to maintain such OHCs has
Engaging Employees paid off, as it has translated into at-risk-employees
A workplace wellness programme is most effective taking necessary preventive measures long before
when it caters to the precise needs of the employee. crippling lifestyle-related diseases are able to rob
Engaging the employee at each stage from them of their efficiency and productivity.
development to delivery not only provides the
constructive feedback needed in the eventuality of References:
applying mid-course corrections, but also hands 1. http://www.ril.com/html/aboutus/health_safety_environment.
html#policy (Last accessed January 2009)
over ownership of the programme to the employee,
2. Health, Safety and Environment, Reliance Industries Ltd 2004-05
thus ensuring greater responsibility towards 3. Health, Safety and Environment, Reliance Industries Ltd 2005-06
individual health. The creation of managerial or

16 |


Promoting Work-Life Balance the clock, even when at home. Such a high-stress
Today, the hours an employee spends at work are lifestyle is a major risk factor for NCDs, and can lead
getting longer, as fixed working hours are fading to productivity losses due to mental exhaustion.
away. With recent technological advances and Corporations can thus promote a healthy lifestyle
gadgets such as laptops, cell phones and handheld through defined working hours and offerings such as
devices, employees are essentially working round social gatherings and on-site exercise and
recreational facilities.
Box 4
Healthy Cafeteria
Offering a Helping Hand: Wipro’s “Mitr” Unhealthy food choices and a sedentary lifestyle,
Wipro, one of the leading global corporations often exacerbated by job profiles, are risk factors for
based in India, has a number of wellness NCDs. Offering healthy options at workplace
programmes running in both its IT and BPO cafeterias is an effective and immediate approach to
sectors. Essential components of the programmes reducing risk factors among employees.
are, for example, nutrition counselling, cafés
offering low-calorie foods, health centres, medical Reaching the Family
camps, regular medical lectures and employee Inclusion of the family in adopting healthy behaviour
well-being events. One of its most successful influences the employees’ broader social context.
initiatives has been the in-house counselling Family support and participation in making healthy
programme called “Mitr”, launched in 2003. changes increase the reach of such programmes
Literally meaning “friend”, the programme trains and enhance sustainability due to greater adherence
employees to provide counselling services to (see box 5).
colleagues that are facing stress at work or in their
personal lives. The employees trained for this Extending Outreach to the Community/Unorganized
purpose are volunteers, thereby ensuring high Sector
motivation and a desire to help. The selection of It is not enough to invest in the health of one’s
counsellors from among the employee volunteers employees and their families – it is essential that
is stringent, ensuring that adequate motivation and companies go into the community in which they
commitment are accompanied by the necessary reside and which sustains them. Such a holistic
skills required to be a counsellor. As a programme approach allows wellness initiatives to grow beyond
“for Wipro employees, by Wipro employees”, it is the boundaries of the corporation and impact
highly sustainable and provides employees with a surrounding areas. Some companies also offer
sense of ownership. The programme is highly subsidized healthcare to contractual workers and
publicized within the company, to ensure that as clients, in addition to their own workers, as part of
many employees as possible are aware of an corporate social responsibility.
available helpline, not only for work-related issues
but also for personal problems. Certain key Effective Messaging
elements of the programme have made it highly Communicating the goals of the programme and
successful – the use of technology such as the messaging effectively so that it cascades throughout
intranet, the involvement of key people and in the organization is essential. Effective and frequent
particular of top management, which gives it the messaging lends visibility to the programme and
necessary support and backing needed for gradually gets absorbed and accepted as an integral
sustainability and further scalability, and interaction part of organizational culture.
with external public health agencies and
companies dealing with specific diseases, as well
as with individual consultants.

References:
1. Working towards wellness: An Indian perspective. 2007,
PricewaterhouseCoopers

| 17


Box 5 Process
Reaching Out to the Family: The TCS Maitree
While engagement of leadership, involvement of
Initiative
people and promotion of a culture conducive to
Under the leadership of Mala Ramadorai, wife of S.
health are necessary for the success of an employee
Ramadorai, Chief Executive Officer of Tata
wellness programme, they alone cannot guarantee
Consultancy Services (TCS), Maitree was initiated
results – it is essential that adequate attention is
in February 2003 to “weld TCSers and their
given to ensure that the processes to implement and
families” together. The main objective of Maitree
evaluate the programme are appropriate, efficient
has been to reduce alienation and stress at work
and cost-effective, and are put in place in a timely
and increase a sense of empowerment and
and systematic manner. The following sections deal
belonging among employees and their families.
with the process of setting up a workplace wellness
This is done by holding regular social gatherings to
programme in detail.
promote common interests and have a relaxed,
healthy atmosphere at work. Events include clubs
and workshops on diverse hobbies such as music,
Model for Setting up a Workplace
dance, yoga, trekking, origami, flower arrangement
Wellness Programme
and theatre. The events are open not only to TCS
employees but to their families as well – in
It has been clearly established that workplace
particular, the focus is to encourage the spouses
wellness programmes have great potential to benefit
of TCS employees to become a part of the TCS
not only the employees that are or potentially could
family. The company has open days during which
be suffering from debilitating NCDs, but also the
an employee’s family can visit the office to get a
organizations they work for in terms of increased
feel for the work environment. An effort is made to
productivity and profitability. However, the question
involve the children of employees as well, for
that remains is how such a wellness programme
whom special workshops and camps are
may be designed, implemented and sustained, and
organized. In addition, TCS Maitree provides
its benefits measured over time. Although there are
counselling services to the 30,000 employees and
numerous types of such workplace programmes,
their families, and there are several self-help
each targeting different aspects of health and
groups within the organization that anyone can
wellness, there are certain basic steps in launching
join. The idea is to build bridges between the
such a programme, as developed by WHO India,
company and its employees and their families, to
which must be followed in order to have a programme
encourage healthier, more meaningful lives.
that is successful, sustainable and scalable. These
steps have been illustrated in figure 3.
References:
1. “Saying tata to tedium”, The Hindu, Monday, July 23, 2003
2. http://www.careers.tcs.com/CareersDesign/Jsps/ Once the concept of having a workplace wellness
WorkingatTCSMaitree.jsp (last accessed January 2009) programme has been endorsed by industry and
3. Navare, S. Counselling at work place: A proactive human health departments, and the decision to implement
resource initiative. Indian Journal of Occupational and
Environmental Medicine, April 2008, 12(1), 1-2
one has been taken by the management of the
organization, a workplace wellness committee
should be established, with representatives from all
levels – employees that are potential participants,
individuals that might be involved in the
implementation and evaluation of the programme,
and top management36. In addition, a wellness
coordinator can be appointed to take charge of all
programme activities. This step is essential to a
successful programme, as research has shown that
programmes that have such committees and/or
coordinators in place to oversee them have more

18 |


Figure 3: Model for Developing a Healthy Workplace

Endorsement by Industry Healthy Workspace Committee
and Health Departments (All stakeholders)

Evaluation of NCD Risk Factor Profiling by
Current Status a Standard and Short
Performance e.g. IDRS + TA

Workplace Level Situation Employees’ Level Health
Analysis Policies, Infrastructure Behaviour Survey – on a sample

Assessment of Mental
Health Status
Plan of Action
Assessment of Occupational
Health Specific for
the Industry
Health Promotion Policies:
Commitment from Management (HR)

Physical Work Environment Psychosocial Work Environment Promoting Healthy Practices
• Healthy canteen • Counselling facilities • Tobacco and alcohol free workspace
• Facilities for recreational activity • Social club formation and • Promotion of healthy lifestyle
• Reduction of occupational hazards improving co-worker relations • Health education messages on stress
• Availability of basic sanitary • Defined working hours reduction techniques
facilities • Periodic seminars to update • Periodic screening
• Availability of child care facilities knowledge • Frequent follow up of high-risk individuals
• Waste management • Healthy employer-employee • Access of health services by family
• Safety of employees relationship members of the employee
• Supportive work environment

Developed by World Health Organization Country Office for India

policy support to bring about environmental and Assessment36, profiling the risk factors of the
behavioural changes promoting healthier lifestyles employees for NCDs, on the basis of which an
among the employees37. overall organizational profile can be created. Such
a profile will indicate priority areas, as well as help
The wellness committee is encouraged to: identify high-risk individuals for targeted
interventions. It should also include an
• Undertake a detailed analysis of the situation at assessment of the mental health status of each
the workplace, also called an organizational employee.
health survey36, 37, to assess the extent to which • Depending on the nature of work, perform an
the organization has the necessary prerequisites occupational health assessment specific to the
in terms of its physical and psychosocial industry and type of work involved.
environment, work policies, management • Conduct an Individual Interest Survey36 to get an
relations, etc., to pursue a healthy life. idea of employee preferences for how they want
• Assess the physiological, behavioural and to receive information (e.g. electronically or
psychological characteristics of the employees pamphlets), the kind of group activities they
themselves, to ascertain the kinds of problems would be most interested in joining (e.g. dance or
and behaviours the programme should focus on, yoga), etc. This would ensure greater participation
both in terms of prevalence and perceived need. and commitment from employees.
Such an exercise should include a Health Risk

| 19


This preliminary analysis will determine the type and extent of intervention chosen. The
forthcoming plan of action for the ensuing wellness organizational culture of the company and the
programme. The recommendations will be used by constitution of the workforce will also play a role in
the workplace wellness committee and/or top this decision. Small and medium enterprises, for
management to formulate the goals, strategies and example, may alter certain components of the
policies that will constitute the wellness process and still accomplish health goals (see box 6).
programme37. It must be ensured at this stage of
design that the formulated policies have the full Box 6
support of top management, human resources and
the decision-makers of the organization. This is one Workplace Wellness Programmes for Small
of the key components of any successful workplace and Medium-sized Organizations
wellness programme. Small and medium-sized organizations do not
have the same managerial and monetary
The plan of action will consist of the basic capabilities as large organizations to focus on
overarching goal or mission statement declaring employee wellness programmes. Nevertheless,
what the programme aims to achieve. Under this will there are several cost-effective interventions that
be the main goals or objectives through which the can be easy to implement:
programme will achieve the overarching goal – these • Outsource health check-ups and screenings to
objectives must be made measurable, with specific, save on full-time, on-site health facilities
realistic timelines so that it is possible to assess • Provide vouchers for use at local gyms rather
whether they have been achieved. Alongside this, a than on-site recreational facilities, or negotiate
budget should be developed so that the costs can be corporate rates at gyms
easily compared to the benefits of the programme • Distribute information on healthy eating and
and the feasibility of the programme determined. nutritional seminars in the absence of a canteen
offering healthy food choices
The mission statement and goals of the programme • Partner with community centres and local
will determine the kinds of health promotion policies events (e.g. marathons, exercise classes) open
that should be adopted to accomplish them. As the to employee enrolment
identified goals and objectives will come from the • Disseminate health information at the workplace
situation analysis, the policies selected on the basis
of these goals will be specifically designed to
address the particular needs of the workforce and
the organization, thereby allowing for tailor-made
interventions.

According to the specific needs of the organization,
a committee can pick and choose from a number of
available policy options listed in figure 3. These can
be classified into three broad categories:
1) Changing the physical work environment
2) Changing the psychosocial work environment
3) Promoting healthy behaviours and/or
discouraging unhealthy behaviours

These are not mutually exclusive and might be
chosen in combination to have a multilayered
intervention for maximum effect on the targeted
problem. The level of commitment by the company,
the resources available, and the seriousness of the
health issue targeted will in tandem determine the

20 |

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