Health and productivity in New Zealand: an exploratory study
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Health and productivity management (HPM) is a business strategy employed by organisations to manage employee health risk and improve productivity. The major determinants of health are chronic disease and the associated risk factors and, as adults spend more of their waking time at work, the workplace is gaining ground as a setting for health promotion. However, HPM is in its infancy in New Zealand; thus the aim of this thesis was to examine the individual and environmental determinants of health and their relationship to productivity in this novel contribution to the HPM field. This study explores associations between employee health, environmental and policy attributes of the organisation (workplace), and workplace productivity. Three separate but related studies were conducted using two New Zealand-specific workplace tools, developed to measure the health risk profile of employees and the physical workplace environment. The studies described in this thesis represent the first investigations of these relationships in New Zealand. The initial step was to develop a New Zealand-specific online health risk assessment (HRA) tool to collect employee health risk data, workplace productivity information, and to compare to known population health data. This enabled three sub-studies to be conducted in Study 1 of this thesis. First, three health behaviours of working adults (meeting fruit and vegetable recommendations, being sufficiently active and maintaining a healthy weight) and their relationships with health conditions known to affect employee work factors were examined. Second, the relationship between employee health and organisational health culture was explored using the LifeGain Health Culture Audit (LHCA) tool. Third, associations between health risk factors and productivity in the workplace were characterised. Study 2 tested the first New Zealand-specific environmental audit tool designed to measure physical environmental factors that facilitate or inhibit health behaviour in the workplace. A case study analysis of one organisation with 23 worksites across New Zealand was conducted. Finally, Study 3 consisted of focus groups that were conducted with employees and managers to understand the factors influencing their health and work performance. The novel finding of Study 1 was that few participants adhered to all three selected health behaviours: only 3.8% of participants ate five or more servings of fruit and vegetables, were sufficiently active, and maintained a healthy weight. In addition, employees with two sub-optimal health behaviours reported a significantly greater number of health conditions (odds ratio range: 1.40 - 1.55) when compared to employees meeting the recommendations. The second key finding found support for healthy behaviour in the workplace was negatively (although weakly) associated with psychological distress (range of r = 0.17 to -0.30), and positively associated with the sum of health behaviours (r = 0.13) and being a non-smoker (r = 0.12). The third important finding was that, compared to people reporting high psychological distress scores people with low to moderate psychological distress scores reported a work performances 6.5% and 3.5% higher respectively (p<0.001). Similarly, physically active people reported a work performance 3.5% greater than those not active (p<0.001). In addition, high psychological distress levels and smoking accounted for 16.8 and 11.6 (respectively) additional absentee hours over the previous four weeks. These novel findings suggest that poor employee health may be costly to the employer; the HRA tool is the first to enable associations between work performance and employee health risk factors these associations to be measured and quantified. Study 2 illustrated that the New Zealand-specific workplace audit tool, developed to be freely available to New Zealand businesses, could be used for identifying priority areas of the workplace environment to be targeted for improvement. A number of low cost initiatives around physical activity and nutrition that were not currently utilised by the organisation were recommended based on best-practice guidelines. Though the utility of the tool to examine associations between environmental attributes of the worksite and employee health behaviour revealed trivial associations, the homogeneity of the workplace sample may not have allowed the true effect of the worksite environment to be observed. The environmental audit tool is an important advancement in the field of health and productivity management in New Zealand to provide structure to the development and evaluation of workplace wellness programmes within New Zealand businesses. Physical activity was the most frequently cited behaviour identified for maintaining and improving health in the final qualitative component of this thesis (Study 3). The accessibility of a fitness facility and exercise classes onsite and the inclusion of physical activity into the work day helped some participants manage work-life balance. The opposite was true for others, however, who preferred clearer divisions between work and leisure time. While perceived work stress and high job demands affected their ability to maintain healthy behaviour, employees valued the support they received from their team leader to help them manage work commitments. The team leaders perceived they were not offered the same support from management structures above them. While this organisation had components of a workplace health programme in place, both employees and team leaders felt that inconsistent messages prevailed throughout the organisation regarding the support for health behaviour, which served to undermine the health promotion efforts of the company. These significant findings highlight that wellness programmes need to be supported by health policy and practices that are embedded within all levels of the workplace structures if they are to be effective. Taken together, the novel findings of this research illustrate that poor employee health is associated with business-related outcomes and provides evidence of a business case for HPM in the local context. This novel research significantly contributes to the HPM field with the development and the testing of a HRA and environmental audit tool specifically designed for the New Zealand workplace. Future research could build on these findings by utilising the HRA tool in a variety of worksite settings. Demonstration that employee health and subsequent productivity can be improved through HPM is necessary to advance HPM as a business strategy for New Zealand employers.