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Employee Health and Business SuccessMaking the Connections and Taking Action

Global Research Summary

More and more, organizations worldwide look to a healthy, engaged workforce as a key to improved organizational productivity and financial performance. And every year, more of these organizations take steps to develop and implement health and productivity programs that promote employee well-being.

1 Employee Health and Business Success

Employee Health and Business SuccessMaking the Connections and Taking Action: Summary of the Global Findings of the 2015/2016 Staying@Work Survey

Table of ContentsExecutive Summary.........................................................................................................................................2

Improving Health and Productivity: A Top Priority Around the Globe .......................................................................................................................................................................5

Health and Productivity: A Multidimensional Issue ..................................................6

Using the Health and Productivity Strategy to Enhance the Employee Value Proposition .................................................................................................................7

Shared Concerns Driving Employers ........................................................................................9

The Challenges: Inadequate Budgets and Weak Employee Health Engagement ......................................................................................................................................12

Disconnect Between Employers and Employees ...................................................14

What Are Employers Doing to Strengthen Global Health and Productivity? ......................................................................................................................................................... 17

Are Employers’ Efforts Paying Off? .........................................................................................26

What Are the Best Doing Right?..................................................................................................27

Summary: Good Intentions, Formidable Obstacles, Notable Successes ..................................................................................................................................... 30

2 willistowerswatson.com

Top priorities of employer’s health and productivity programs are improving and maintaining workplace performance (74%), improving and maintaining workplace safety (73%), raising employee awareness of health and risks (69%) and developing a workplace culture of health (67%).

Interest in health and productivity is nearly universal. In our 2015/2016 Global Staying@Work Survey, nearly 90% of respondents say that improving workforce health and productivity is a core component of their organization’s overall health strategy, and nearly all (98%) said they’re committed to health and productivity improvement in the years ahead.* They believe these programs will reduce their employees’ health risks and improve their overall health and well-being, which in turn will lead to better business outcomes.

But commitment to a concept and the implementation of a successful strategy are very different things, and our 2015/2016 survey results point to a wide gap between the two. Globally, 56% of employers have no health and productivity strategy and instead simply offer various health and well-being programs. This percentage has remained nearly the same since our last survey two years ago, despite the fact that 49% of respondents to our 2013/2014 survey expected to develop an articulated health and productivity strategy that differentiated them from competitors. In fact, in our latest survey, only 11% of respondents said they have an articulated health and productivity strategy in place, and only 26% have effectively communicated the value proposition behind their health and productivity strategy and delivered on its promises.

What’s more, there’s greater opportunity for employers to boost employee participation in health and well-being programs. Half of employees participate in health risk assessments and use an onsite or near-site health clinic, and 62% participate in biometric screenings at work. Just 44% make use of onsite vaccination programs. When it comes to programs to support lifestyle changes (including coaching programs, weight management, tobacco cessation and stress management), participation numbers among at-risk employees drop off sharply, hovering between 10% and 20%.

Executive Summary

The Employee Health Risk Problem

Respondents say employee health risks — especially lifestyle risks, such as stress, lack of physical exercise, obesity, poor nutrition and lack of sleep — are among the foremost workplace issues they face. As in our survey of two years ago, stress remains the biggest employee health risk everywhere except Asia Pacific, where it ranks second.

Lifestyle health risks, many of which are interconnected, can have profound and lasting negative effects on both individual and organizational performance. Employers that understand the health risks of their own employee population, and the underlying causes, are likely to have greater success forging a holistic health and productivity strategy with interconnected programs than are employers who take a scattershot approach by offering individual, disconnected programs.

What Employers Want to Achieve

Respondents are very clear about the goals they’ve set for their health and well-being programs. Their top priorities are improving and maintaining workplace performance (74%), improving and maintaining workplace safety (73%), raising employee awareness of health and risks (69%) and developing a workplace culture of health (67%). Organizations that have well-defined, measurable goals for their health and productivity strategy, combined with a deep understanding of their employees’ health risks, are best positioned to develop targeted, coordinated strategies and programs.

* Health and productivity includes the strategy, tactics and programs to improve both employee/family health and well-being, and the organization’s workforce effectiveness; it’s an all-encompassing term that moves beyond basic health insurance.

Employers believe these programs will reduce their employees’ health risks and improve their overall health and well-being, which in turn will lead to better business outcomes.


What’s Keeping Health and Productivity Strategies From Being Successful?

A number of factors are keeping employers’ health and well-being programs from being as successful as they could be. Primary among them are the lack of several necessary elements: adequate resources (budgets and staff) to support their programs, measurable return on investment, adequate employee engagement and data to support targeted outreach. Also on the list is a lack of senior leadership support. Interestingly, only 23% of respondents cited the lack of an overall strategy as an issue, yet in our experience, this is often a core reason for the lack of success. Without a strategy that defines health and well-being program goals, uses data for decision making and program development, sets out a budget and takes employee preferences into account, it can be difficult for employers to get the necessary resources, obtain leadership support and engage employees.

Disconnect Between Employers and Employees

Ultimately, the success of the health and well-being program depends on the ability of employers to connect with employees around issues that have long been personal to workers and their families. The good news is that Willis Towers Watson’s most recent Global Benefits Attitudes Survey found that two-thirds of employees around the world generally believe their employer has an active role to play in this area. However, despite significant investments, less than one-third credit their employer with helping them lead healthier lives.

What’s behind this disparity? In part, more than one-third of employees have sensitivities about their employer having access to their personal health information, and just as many don’t trust their employer to be involved in their health and well-being. Instead, most employees (71%) prefer to manage their health on their own.

The gap between employer and employee views on health is most apparent when it comes to identifying the sources of stress. Employers highlight work/life balance issues, but employees are focused on four far different areas: adequate pay, the right resources to do their work, a clear understanding of priorities and a work environment that allows them to be effective. When employers don’t recognize the stressors employees face, employees are more likely to tune out, and the risk of turnover and low performance increases. Clearly, in order to convince employees that they have their health and well-being interests at heart, employers must build trust.

Do Financial Incentives Boost Employee Engagement?

Interestingly, employers that offer financial incentives to participate in programs (primarily those in the U.S.) are meeting with mixed success. In exchange for incentives, employees are willing to complete fairly simple, one-time activities such as a health assessment, but they’re far less willing to complete more difficult, longer-term activities such as a weight-reduction program. The bottom line on incentives: More than two-thirds of companies globally and nine in 10 U.S. companies that offer them plan to reassess their incentive designs in the next three years.

Without a strategy that defines health and well-being program goals, uses data for decision making and program development, sets out a budget and takes employee preferences into account, it can be difficult for employers to get the necessary resources, obtain leadership support and engage employees.

Defining Health and Well-BeingWhile definitions and measures of health and well-being vary, throughout this report, well-being is defined as a concept that includes physical, financial and psychological health, as well as personal connection and belonging. It isn’t merely the absence of disease or infirmity. Well-being is a broad, encompassing concept that takes into consideration the whole person. In simple terms, it describes someone who not only is in good physical health (body) but also judges life positively and feels good (mind).


How High-Performing Companies Succeed

A subset of respondents fall into a group we’ve identified as high performers with regard to their health and productivity strategy and results. Based on respondents’ self-evaluations of their programs’ effectiveness, we ranked their performance according to our Overall Health and Productivity Effectiveness (OHPE) metric. Using respondents’ scores, we divided them into three equal-sized groups. We found that the group with the highest OHPE scores (high performers) take a different approach and more effectively execute on their health and productivity strategy than the other groups do, and their programs are more successful.

Our research shows that high performers:

�� Offer prevention programs aimed at keeping employees healthy

�� Provide personal support to employees with specific health needs

�� Build and sustain a culture of health at the workplace

�� Align their health and productivity strategy with their employee value proposition (EVP)

�� Provide a range of program choices informed by regular evaluation of the programs’ effectiveness

�� Use the latest technology (including wearables and apps)

�� Target communication to reach employees in ways they prefer

In short, offering disconnected programs based on cost or longevity is not a path to success. Instead, employers need to take a coordinated approach based on a clearly communicated strategy that helps employees understand the benefits of participation to both themselves and the company, and uses a variety of approaches to encourage engagement.

For nearly two decades, Willis Towers Watson has conducted Staying@Work research in North America. Our 2013 Staying@Work Survey was our first that included employers in Asia, Europe and Latin America. The 2015/2016 survey, our second global study of employers’

health and productivity strategies, involved 34 markets, including the Middle East.

�� Conducted between May and July 2015 in 34 markets around the world

�� 1,669 employers surveyed

�� Respondents:

�� Asia Pacific: 582 respondents in 13 countries

�� Europe: 247 respondents in 14 countries, including 24 respondents from the Gulf Cooperation Countries

�� Latin America: 242 respondents in five countries

�� North America: 598 respondents in Canada and the U.S.

�� Respondents are responsible for the health and well-being programs in their respective countries (i.e., local market survey)

�� All major industry segments represented

�� 34% of participating employers have more than 10,000 full-time workers

�� 73% of participating employers have workforces dispersed across multiple countries

�� 42 multinational companies provided additional details from a headquarters perspective about the global management of their health and productivity strategy

Concurrent with our Staying@Work Survey, we conducted our second Global Benefits Attitudes Survey, through which we collected responses from nearly 30,000 employees in 19 countries. The biennial Global Benefits

Attitudes Survey explores employees’ attitudes on a broad range of factors concerning their benefits, health-related behaviors, current and prospective financial situations, and work experience.

To a great extent, the success of health and well-being programs depends on employers’ ability to engage employees in these initiatives. That’s why employee attitudes hold important clues for getting the best return on health and productivity investments. Throughout this report, we complement the emerging trends in employer activities by presenting the voice of the employee to help employers understand the critical success factors as they develop and build upon their health and productivity strategy.

About the Survey

Employer

Employee


Over the last decade, the global economy has experienced one of the longest productivity slowdowns on record. Weak productivity growth — measured as output per worker — is a problem everywhere, affecting both developed and emerging economies alike and increasingly identified as a global crisis.* At the organizational level, reversing this problem to deliver productivity growth is the key to boosting the bottom line; in its absence, cost cutting is the only way for companies to remain profitable.

At the same time, an increase in preventable chronic disease is posing a significant problem for employers. In many countries, this translates into rising health care costs. And while the scale of the issue may be greatest in the U.S., the challenges are growing across the globe.** In addition, as rising health benefit costs squeeze merit bonus pools, it’s becoming more difficult for employers in markets where health care costs are highest to appropriately reward top-performing and critical-skill workers, which makes boosting productivity even more challenging.

Against this backdrop, it’s not surprising that addressing health-related issues and their effects on the workforce has become a global priority for employers, and that many organizations are making significant investments in health and well-being programs. As in 2013, almost 90% of the 2015/2016 survey respondents said improving workforce health and productivity is a core component of their organization’s overall health strategy (Figure 1). And nearly all (98%) of the 2015/2016 survey respondents revealed an unwavering commitment to health and productivity improvement in the years ahead.

The success of any organization’s health and well-being program hinges on the employer’s ability to engage employees in attaining and maintaining good health. The good news: Employees share employers’ enthusiasm about health improvement. Our 2015/2016 Global Benefits Attitudes Survey found that for 65% of employees, their health is a top priority. These results are remarkably consistent worldwide (Figure 2).

Improving Health and Productivity: A Top Priority Around the Globe

** For more discussion, see “The Future of Benefits: Disruptors, Talent Shifts and a Coming Transformation,” Willis Towers Watson, 2015.

** See Willis Towers Watson’s 2014 Global Medical Trends Survey.

0% 20% 40% 60% 80% 100%

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

48 36 48 36

46 36 46 36

48 41 48 41

47 34 47 34

53 37 53 37

Figure 1. Health and productivity is a top priority for organizations globally

It is essential to our organizational health strategy

It plays a moderate role in our organizational health strategy

50 37 50 37

0% 20% 40% 60% 80% 100%

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

71 71

67 67

66 66

64 64

60 60

Figure 2. A majority of employees report managing their health as a top priority

Source: 2015/2016 Global Benefits Attitudes Survey

Note: Percentage of respondents indicating “agree” or “strongly agree” on a five-point agreement scale.

Sample: U.S., Canada — full-time employees with employer-based health care; other countries – all respondents

65 65

Employee Perspective

Many employers see their health and well-being programs as vital tools for addressing a broad set of health and productivity challenges (Figure 3).* When asked about the top priorities of their health and productivity strategy, respondents didn’t coalesce around any single theme. Instead, they identified multiple priorities as being important to health and productivity success.

The top three priorities of employers worldwide are boosting productivity, improving employee safety, and increasing employees’ awareness of both their health status (physical and emotional) and their health-related risks. For many employers, simply educating workers about the near- and long-term consequences of their lifestyle can help the organization tackle the problem of insufficient employee engagement. Also, in every world region, organizations are using their health and productivity strategy to create a work environment that addresses the wide range of employee needs and preferences, hence building a workplace culture that encourages healthy behaviors.

Health and Productivity: A Multidimensional Issue

* Willis Towers Watson research has found strong links among employee health improvement, reductions in absenteeism, drops in benefit costs, and improvement in employee engagement and workforce effectiveness. See “Health and Well-Being in the Workplace: The Engagement Challenge,” Jonathan Gardner and Steve Nyce, Willis Towers Watson, December 2015.

0% 20% 40% 60% 80%

Incorporate emerging technologies as a way to deliverkey messages and information to employees abouthealth and well-being

Manage the rising cost of the health care program

Better understand the cost drivers linking health to absence and productivity

Incorporate workforce well-being as a key attraction and retention strategy

Make manager awareness and behavior a part of the workplace health strategy

Improve employee engagement in the health andwell-being program

Improve the physical health of employees

Improve the emotional/mental health of employees

Develop a workplace culture where employees areresponsible for their health and understand its importance

Improve employee awareness of health and risks

Improve/Maintain workplace safety

Improve/Maintain workplace performance

Figure 3. Workplace performance and safety are top priorities of health and productivity programs

65

65

64

55

51

45

43

41

74

73

69

67

Note: Percentages reflect 4/5 on a five-point extent scale.


For many employers, simply educating workers about the near- and long-term consequences of their lifestyle can help the organization tackle the problem of insufficient employee engagement.


Most organizations don’t have an articulated health and productivity strategy. With surprising consistency, over half of the survey respondents in all regions offer various health and well-being programs but don’t have a formal strategy that they’ve aligned with business priorities and explained to the workforce. Even so, there are signs of progress in this area: Roughly 10% to 15% have an articulated strategy; another 15% to 20% have communicated and delivered on their strategy’s goals, and 10% or less use their health and productivity strategy to differentiate their organization in the competition for talent.

Just as employers are at varied points along the health and productivity strategy path, their next steps on the journey will likely differ. But there’s widespread agreement among organizations about the need to step up their efforts and adopt a strategy that will deliver crucial organizational benefits, link to the EVP and motivate employees to join and stay with the organization. Across all markets, an impressive 88% of employers are planning to have a strategy in place in the next three years — up from 37% today (Figure 4). And roughly two in five plan to customize their health and well-being programs for critical workforce segments to help them

attract and retain key talent. That will be an increase of 30 to 40 percentage points by 2018.

The findings of our 2013 survey were similar: Most employers didn’t have a strategy in 2013 but did have very strong intentions about adopting, communicating and delivering on a formal health and productivity strategy in the near future. Does the failure of many organizations to do so by 2015 suggest a lack of commitment to health and productivity improvement?

No. Rather, it reflects the fact that building a health and productivity strategy takes considerable effort and organizational resolve. Setting objectives that resonate with employees and then delivering on the strategy’s promises is a journey, not a race. While employers may not have progressed as quickly as they’d intended, our 2015/2016 survey results show that organizations worldwide are consistent in their determination to use their health and productivity strategy as a key differentiator.

Using the Health and Productivity Strategy to Enhance the Employee Value Proposition

Figure 4. Employers are taking the next step in making health and employee effectiveness a key competitive advantage

No strategy Adopt strategyCommunicate and deliver

Differentiate health and productivity strategy Reduce emphasis

Offered various programs but have not articulated a health and productivity strategy

Articulated a health and productivity strategy with stated objectives and goals for each program

Effectively communicated the value proposition behind the health and well-being program and delivered on its promises

Customized the strategy for critical workforce segments and used organizational analytics to test program effectiveness

Reducing our focus on health and productivity

Today In 2018 Today In 2018 Today In 2018 Today In 2018 Today In 2018

Global 56% 8% 11% 16% 16% 29% 10% 43% 7% 4%

U.S. 51% 4% 10% 7% 22% 29% 12% 54% 5% 5%

Canada 60% 8% 16% 18% 17% 23% 4% 48% 3% 3%

Europe 60% 6% 9% 19% 17% 30% 10% 42% 4% 2%

Latin America 51% 5% 10% 19% 14% 25% 13% 46% 13% 6%

Asia Pacific 57% 13% 14% 20% 12% 28% 7% 35% 10% 4%


While workforce health is a growing priority for companies worldwide, results show that many organizations are still in the process of developing a formal health and productivity strategy. Multinational organizations have the additional challenge of considering how to connect the health and well-being programs in each of the markets in which they operate. This is increasingly important, as many organizations have linked or are planning to link their health and well-being strategy to their broader corporate objectives and goals, and to use their program to differentiate the EVP they’re trying to create.

For many multinational organizations, the process starts with the goal of creating global consistency in their health and well-being programs, regardless of where the headquarters are located. Yet today, just one-third of organizations with operations in multiple countries have a global health and productivity strategy, and most rely on regional or local strategies (Figure 5). Even so, large multinational organizations are out in front: Today, more than half of these companies have a global strategy.

To help ensure global consistency in their programs, global or regional headquarters for many companies have established specific health and well-being site-certification requirements that local markets must meet.

These can include requirements to offer programs that address specific health risks or chronic conditions, switch to healthier food options onsite, measure employee satisfaction, track specific metrics for safety or health-related absences, or have local health champions. Today, 25% of multinational companies have specific site-certification requirements in place, and another 35% plan to adopt them by 2018.

Once a global strategy is in place, success hinges on whether the overall health and productivity strategy allows for local flexibility, and fosters local management and employee engagement. Organizations that account for unique distinctions in local cultures, languages and health care systems have the best chance to both increase program appeal and build employee trust around the very personal issue of health — both of which are key to boosting engagement rates.

As Figure 6 shows, most employers rely on local resources for vendor selection, communication, program evaluation, and other elements of the administration and operation of their health and well-being programs, and 87% set their global strategy at headquarters.

Health and Well-Being — Global Strategy, Local Execution

Figure 5. One-third of organizations with operations in multiple countries have a global health and productivity strategy

Organizations with operations in multiple countries

No global, regional or local strategies are in place

Only local strategies (no global or regional strategies) are in place

A regional strategy (no global strategy) is in place

A global strategy has been in place for fewer than five years

A global strategy has been in place for five or more years

Less than 25,000 employees globally 18% 36% 11% 19% 16%

More than 25,000 employees globally 10% 23% 11% 24% 32%

Figure 6. Most organizations set their strategy centrally but rely on local execution

Establishing country priorities

Selecting the well-being programs to implement

Continually managing well-being programs, vendors and communication

Funding well-being programs

Selecting well-being vendors

Managing data and evaluating programs

Selecting brokers/consultants

Setting overall strategy

Centrally 28% 33% 23% 34% 27% 33% 34% 87%

Regionally 38% 30% 22% 18% 26% 28% 25% 17%

Locally 54% 64% 77% 70% 69% 65% 58% 16%

Note: Based on organizations operating in multiple countries


To design an effective health and productivity strategy and create a suite of health and well-being programs that will reduce absence rates, boost engagement and improve productivity, employers must first understand underlying workforce issues. Though these vary from one organization to the next depending on employee populations, many employers see similar causes of their biggest workforce challenges. The common elements are stress, insufficient physical activity, obesity and poor nutrition (Figure 7).

Employers worldwide see stress as the foremost workplace issue, with the exception of those in Asia Pacific, who rank it second. Insufficient physical activity and obesity are ranked the next highest in almost every market, with sedentary lifestyles the top concern in Asia Pacific. This is likely tied to the fact that employers understand the connections among obesity, lack of exercise and the rates of diabetes in countries like China, where the disease has reached epidemic levels.* **

Employers in all regions identify poor nutrition as an issue, except in Asia Pacific (which is surprising given the rate of hyperglycemia in the region). Employers in Europe and Latin America identify presenteeism*** as a prominent issue,

reflecting concerns about workforce productivity in those markets.

Many of these risk factors, including the foremost issue of stress, were identified by employers as significant issues in our 2013 study, which shows why employers must remain committed to addressing them. It’s also important for employers to recognize that many of these issues are interconnected. For example, research shows that insufficient physical activity, poor nutrition and inadequate sleep are strongly linked with obesity and stress, both of which negatively affect employee performance. This linkage is why employers’ efforts to address issues singularly could fail to improve employee’s health and well-being, and why tackling one issue at a time can create difficulties.

To alleviate employee stress, for example, employers must first understand its primary sources and the ways in which employees prefer to cope with it. There’s considerable misalignment between employers’ views on the leading causes of workplace stress and the views of employees themselves (see Sources of Employee Stress, page 10).

Shared Concerns Driving Employers

Figure 7. Stress and sedentary lifestyles are the top workforce risk factors globally

Rank Global U.S. Canada Europe Latin America Asia Pacific

1 Stress 64%

Stress 75%

Stress 85%

Stress 74%

Stress 72%

Lack of physical activity 52%

2Lack of physical activity 53%

Overweight/ Obesity 70%




Stress 44%

3Overweight/ Obesity 45%


Unplanned absences 45%

Presenteeism 33%



4 Poor nutrition 31%

Poor nutrition 50%



Presenteeism 40%

Lack of sleep 30%

5 Lack of sleep 30%

Lack of sleep 31%

Poor nutrition 41%

Poor nutrition 31%

Poor nutrition 36%

Presenteeism 23%

Note: Percentages reflect “to a great extent” — a 5, 6 or 7 on a seven-point extent scale.

* Yu Xu, Limin Wang, Jiang He, et al., “Prevalence and Control of Diabetes in Chinese Adults,” JAMA, 2013; 310(9): 948 – 59 ** Chan J.C., Malik V., Jia W., et al., “Diabetes in Asia: Epidemiology, Risk Factors and Pathophysiology,” JAMA, 2009; 301(20): 2129 – 2140 *** Presenteeism is when an employee is physically at work but not fully productive due to physical or mental health conditions, or to stress due to job-related,

personal or financial matters.


By comparing employers’ responses to our Staying@Work Survey with employees’ responses to our Global Benefits Attitudes Survey, we find marked differences of opinion on the primary causes of work-related stress (Figure 8).

For example, employees’ top cause of stress — low pay — is mis-ranked by employers as only number 11 on the list of stressors for workers. Clearly, a number of employees are dealing with financial challenges that their employers might be able to help them address with means that go beyond increases in pay (see Employees’ Financial Well-Being, page 20).

Sources of Employee Stress: Closing the Understanding Gap


Figure 8. Employers and employees not aligned on causes of stress

Employer View Employee View*

Lack of work/life balance (excessive workloads and/or long hours) 1 5

Inadequate staffing (lack of support, uneven workload or performance in group) 2 2

Technologies that expand availability during nonworking hours (e.g., mobiles, notebooks) 3 13

Unclear or conflicting job expectations 4 3

Excessive amount of change at my employer 5 6

Lack of manager support and feedback 6 7

Low level of control over my job 7 10

Concerns about my personal financial situation 8 8

Concerns about job loss 9 11

Company culture 10 4

Low pay or low increases in pay 11 1

Lack of technology, equipment and tools to do the job 12 12

Concerns about benefit reduction/loss 13 9

Unfriendly or unsafe work environment 14 14

* Source: 2015/2016 Global Benefits Attitudes Survey Note: Percentage of respondents indicating “agree” or “strongly agree” on a five-point agreement scale. Sample: U.S., Canada — full-time employees with employer-based health care; other countries – all respondents

A number of employees are dealing with financial challenges that their employers might be able to help them address with means that go beyond increases in pay.

Employee ViewSupport me Pay me Guide me


Conversely, employers incorrectly rank a lack of work/life balance as the leading source of workplace stress; employees say it’s actually fifth on the list of stressors. Also, employers underappreciate the stress caused by a poor company culture that lacks teamwork and accountability, and they overestimate the impact of technologies that expand employees’ availability during nonworking hours.

Such disparities hamper employers’ ability to mitigate the causes of workplace stress and to educate employees on the best ways to manage stress and improve resilience. Employers must make efforts to understand the primary causes of employees’ stress — whether they’re elements of the workplace or personal factors such as financial problems — and to develop a strategy for addressing the specific, employee-identified issues.

It’s important for employers to:

�� Ensure leaders at all levels know how to recognize employee stress.

�� Help managers understand what’s causing their team members’ stress.

�� Listen to employees to learn how they’re coping with stress and how management can help.

�� Adjust the organization’s workforce programs in light of those findings.

�� Ensure the employment deal includes elements that support effective stress management.

An employee assistance program (EAP) can be a valuable tool for alleviating stress, but it’s offered by fewer than half of companies outside North America (Figure 14, page 17). However, reducing stressors and helping employees manage stress is about much more than offering an EAP. By understanding employees’ challenges, employers can build trust with employees on personal health issues. When they understand employees’ needs, they can create the programs that will engage employees and improve their health and well-being.

This involves looking at the entire employee experience and finding opportunities to make changes likely to have a positive impact. Such efforts can pay off in the form of stronger employee engagement as well as less stress-related illness, absenteeism and presenteeism.

It can also improve retention. Employers that participated in our 2014 Global Talent Management and Rewards Study said helping employees manage stress is one of the top five ways they can strengthen their retention program.

When employers understand employees’ needs, they can create the programs that will engage employees and improve their health and well-being.


Unfortunately, a number of obstacles stand in the way of health and well-being program success (Figure 9). Globally, the most significant are:

�� Inadequate budgets

�� Insufficient evidence to build a case for health and productivity investment

�� A lack of employee engagement in well-being programs

Respondents to our 2013 survey identified both inadequate budgets and the lack of employee engagement as top challenges then, too.

But today, the dearth of resources (budget and staff) is an even bigger issue; approximately two out of five employers see inadequate resources as the leading obstacle to health and productivity improvement, with the exception of those in North America. And only about two in five employers have sufficient budget to add new health and well-being programs that are critical for targeted populations or to adopt new technologies. Conversely, one-third have insufficient budget to even deliver on their existing programs.

Low program participation rates are troubling for employers, particularly those in the U.S., who’ve seen poor participation as the top barrier to health and productivity improvement for more than a decade. Conversely, participation rates in Latin America and Asia Pacific are quite a bit higher than in

The Challenges: Inadequate Budgets and Weak Employee Health Engagement

Figure 9. Lack of budget, ROI and employee engagement are top obstacles to changing employee behavior related to health and well-being

Global U.S. Canada EuropeLatin

America Asia Pacific

Lack of adequate budget/staff to support effective health management programs 39% 33% 34% 41% 45% 41%

Lack of evidence of appreciable financial returns and which practices work best 36% 34% 32% 33% 42% 37%

Lack of employee engagement (e.g., low participation or interest in programs) 34% 43% 28% 26% 33% 31%

Lack of actionable data to support targeted outreach (e.g., geographical) 28% 21% 27% 34% 24% 32%

Lack of organizational structure to support programs 28% 25% 25% 35% 30% 24%

Lack of senior leadership or manager support (e.g., lack of communication or flexibility for employees) 28% 23% 25% 32% 33% 28%

Insufficient financial incentives to encourage participation in programs 27% 23% 30% 24% 36% 30%

Fragmented or disjointed delivery of health and well-being programs 27% 25% 33% 37% 33% 20%

Lack of overarching strategy for investing in employee well-being 23% 19% 29% 28% 27% 21%

Regulatory limitations and uncertainty about employer-sponsored activities 14% 13% 5% 15% 16% 14%

Overly complex health and well-being programs 12% 13% 3% 9% 11% 13%

Note: Percentages reflect “to a great extent” — a 4 or 5 on a five-point extent scale.


measurement strategy. Few markets report heavy use of data and metrics for other purposes, such as evaluating employee awareness and engagement, identifying individuals for outreach and assessing the overall performance of health and well-being programs.

For example, only one in 10 employers measures the impact of health and well-being programs on costs, employees’ health risks or employee productivity (Figure 10). One exception is the U.S., where employers rely on data and metrics to evaluate the impact of their health and well-being programs. In addition, quite a lot of measurement activity takes place in Latin America, where medical claim data are available in many markets.

But without an assessment strategy, employers are ambiguous about what to measure and tend to have fragmented programs that might not complement each other. Also, senior leaders are reluctant to allocate more funds. In all, it’s difficult to make a case for expanding health and well-being initiatives or launching new ones, and this difficulty reduces organizations’ chances of creating effective programs.

the U.S., especially for worksite programs. Yet, no market has done more to boost employee health engagement than the U.S., where employers use personalized communication, technology-enabled tools, and a combination of financial rewards for participation and penalties for nonparticipation. Despite these initiatives, weak employee interest in health and well-being programs continues to hamper U.S. employers’ efforts to help workers adopt healthier lifestyles.

Another significant roadblock cited by 36% of employers: a lack of quantitative evidence of whether health and well-being programs are actually improving employee health and productivity. In the U.S., where employers have access to considerable amounts of data, the use of metrics and data to assess health and well-being programs is only now beginning to take hold. After decades of effort to provide programs enabled by new technologies, the emergence of sophisticated databases is helping U.S. employers build and strengthen the evidence about what’s having the biggest impact.

Above all, employers in all world regions struggle to provide such evidence in the absence of multiyear assessment plans. Only one in five surveyed employers has an articulated

Figure 10. One in five organizations globally has a strategy that supports multiyear evaluation of their health and well-being programs



Have a strategy that supports multiyear evaluation of our health and well-being program 22% 39% 17% 13% 21% 13%

Use clinical-level medical claim data/benchmarking information to inform decisions or changes to our health and well-being programs

31% 55% 38% 15% 39% 16%

Measure active participation or active engagement by employees/spouses in our health and well-being programs

28% 51% 28% 19% 30% 13%

Share health and well-being program performance metrics with C-suite or regional management on a regular basis

26% 48% 22% 16% 24% 14%

Use data to identify specific individuals or subgroups for targeted outreach on relevant health and well-being program(s)

23% 43% 21% 16% 31% 10%

Use a variety of financial and nonfinancial metrics to measure the impact of our health and well-being programs (i.e., value-on-investment approach)

13% 25% 8% 8% 16% 5%

Measure demonstrated impact of our health and well-being programs on health risks 12% 35% 15% 14% 27% 7%

Use ROI measures to measure the impact of our health and well-being programs 11% 24% 7% 6% 11% 4%

Measure the demonstrated impact of our health and well-being programs on health care costs 11% 35% 15% 10% 29% 9%

Measure the demonstrated impact of our health and well-being programs on employee productivity (e.g., lost time, employee work engagement)

11% 14% 13% 9% 18% 8%

Note: Percentages reflect 4/5 on a five-point extent scale.

Clearly, organizations have made employee health and well-being a priority, and many have made significant investments in their programs. As previously described, budgets are certainly tight. And for many employers, the resource issue limits their ability to enhance their well-being initiatives. But an effective health and productivity strategy is about more than offering programs. Ultimately, success hinges on whether employers can motivate their employees to live healthier lifestyles by actively participating in the company’s health and well-being initiatives or taking steps on their own.

The good news is that employees generally agree that their employers have a role to play in encouraging them to live healthier lifestyles. Two-thirds of employees think their employer should take an active role, and fewer than one in five believe their employer shouldn’t be involved in their health (Figure 11). The positive attitude is strongest in Latin America, where three in four employees are comfortable with employer involvement in their health-related behavior. The strongest opposition to such involvement is in Europe, where nearly one in four employees is resistant. Yet, the positive attitudes about employers taking an active role are higher today than in 2013 in every region, including Europe.


Ultimately, success hinges on whether employers can motivate their employees to live healthier lifestyles by actively participating in the company’s health and well-being initiatives or taking steps on their own.

Disconnect Between Employers and Employees

While many employers have drawn a clear path for engaging their employees in building and maintaining good health, many others have yet to sufficiently motivate employees. Many employees don’t yet recognize their employer’s efforts, and relatively few credit their employer with helping them lead healthier lifestyles (Figure 12). In the U.S. and Latin America, only one-third (33%) of surveyed workers give their employers that credit, and it’s only one-quarter (25%) in Canada. The percentage is a bit higher in Asia Pacific (36%), though it’s less than one in five (19%) in Europe.


Asia Pacific

Latin America

Europe

Canada

U.S.

Global

Figure 11. Most employees say their employer has a role in encouraging healthy lifestyles

65 19 16 65 19 16

65 19 16 65 19 16

54 22 23 54 22 23

74 13 13 74 13 13

70 16 14 70 16 14

Option A: Employers should take an active role in encouraging their employees to live healthy lifestyles

Option B: It is not the role of an employer to encourage their employees to live healthy lifestyles

Source: 2015/2016 Global Benefits Attitudes SurveySample: U.S., Canada — full-time employees with employer-based health care; other countries – all respondents

Strongly prefer Prefer Slightly prefer Neutral Slightly prefer Prefer Strongly prefer

66 18 17 66 18 17


Asia Pacific36%

Europe19%

LatinAmerica33%

Canada25%

U.S.33%

2013 2015 ChangeGlobal 32% 31% –1U.S. 34% 33% –1Canada 27% 25% –2Europe 16% 19% +3Latin America 39% 33% –6Asia Pacific 35% 36% +1


Figure 12. Few employees say that the well-being initiatives offered by their employer have encouraged them to live a healthier lifestyle

Source: 2015/2016 Global Benefits Attitudes Survey Sample: U.S., Canada — full-time employees with employer-based health care; other countries – all respondentsNote: Percentage of employees indicating “agree” or “strongly agree” on a five-point agreement scale.

Furthermore, Figure 13, page 16, shows that when it comes to managing their health and well-being, roughly three-quarters of employees prefer to do it on their own. Only in Latin America is that feeling slightly less prevalent: 59% of employees in Latin America prefer to be self-reliant concerning their health — still a majority of surveyed employees in the region. This suggests that either employers have yet to make a convincing enough case for employees to participate in company-sponsored initiatives or that there are other barriers that employers need to recognize and overcome.

This is leading many managers with global responsibility for health and well-being programs to ask themselves why employees aren’t responding. While there are many possible explanations, one is that many employees are highly sensitive to their employer having access to their personal, health-related information. This is particularly true in North America and Europe, where roughly half of employees don’t want their employer to have access to such information. Workers in Latin America and Asia Pacific are generally more comfortable sharing this information with their employer. And while the majority accept their employer’s involvement in their health, there are pockets of mistrust that could be disruptive if not addressed. Nearly one-third of employees worldwide say they don’t trust their employer getting involved in their health and well-being.


Employers clearly need to build employees’ trust in areas pertaining to health, especially the use of employees’ personal data, so that workers will begin to see their employer as a go-to resource for improving their health and well-being. For some employees, improving their health and well-being may always be strictly a personal pursuit. In these cases, employers can play a pivotal role by creating a workplace environment that supports these employees as they tackle health issues on their own.

Despite the sensitivities, many employers have raised employees’ awareness about their programs, and few employees say their manager is a barrier to their participation. Even so, employees may be suffering from information overload in some markets. For example, many U.S. employers have made significant investments and offer a vast portfolio of health and well-being programs through a variety of providers and vendors. In these cases, too much information competing for employees’ attention could be drowning out important messages.


Figure 13. Sensitivities around personal health data impede engagement in well-being activities



I prefer to manage my health on my own 71% 71% 76% 73% 59% 72%

I don’t want my employer to have access to my personal health information 39% 46% 52% 48% 28% 34%

The initiatives offered by my employer do not meet my needs 34% 32% 38% 38% 40% 32%

I don’t trust my employer to be involved in my health and well-being 31% 30% 36% 36% 29% 31%

I am not sure about the activities provided by my employer or how to sign up 26% 19% 24% 30% 29% 29%

My manager is not/would not be supportive of my participation 23% 14% 20% 28% 30% 26%



Note: Percentage of respondents indicating “agree” or “strongly agree” on a five-point agreement scale.


Program Offerings

Most organizations offer a range of health and well-being programs, with the most common focused on prevention, particularly screening activities and programs related to staying well at work. Not surprisingly, U.S. employers lead the way with such worksite programs. But biometric screenings are also widely available in other regions, particularly Asia Pacific. Many employers in Europe, Canada and Latin America offer vaccinations at worksites.

Worksite activities related to diet and exercise have become increasingly popular worldwide over the last few years, with between one-half and three-quarters of respondents offering these programs. Onsite clinics that include medical services with a doctor or nurse onsite are widespread in Europe and Latin America, partly because they’re compulsory in some countries (Figure 14). In general, the success of worksite programs depends on having a critical mass in a location; the more widespread an organization’s operations, the more difficult it is to implement onsite programs, especially in locations with few employees.

What Are Employers Doing to Strengthen Global Health and Productivity?

Figure 14. Employers offer an array of health and well-being programs


AmericaAsia

Pacific

Worksite well-being activities and screenings

Worksite biometric screening 68% 73% 39% 53% 68% 75%

Onsite vaccinations 66% 88% 76% 62% 78% 48%

Worksite diet/exercise activities 65% 77% 72% 61% 53% 59%

Health risk assessment/appraisal 60% 85% 54% 58% 57% 40%

Well-being fairs at some/all locations 55% 74% 53% 43% 35% 50%

Onsite or near-site health clinic 42% 32% 23% 51% 55% 44%

Onsite healthy lifestyle coaching in at least one location 41% 38% 23% 35% 45% 50%

Lifestyle change and health management activities

Stress or resilience management 47% 68% 64% 47% 27% 31%

Maternity support (pre- and post-delivery, child care resources) 46% 81% NA 35% 38% 25%

Tobacco-cessation programs 45% 89% 62% 27% 24% 22%

Weight management programs 44% 81% 57% 20% 37% 25%

Chronic condition (disease) management programs 39% 86% 25% 16% 32% 16%

Telephonic lifestyle behavior coaching programs 35% 72% 49% 18% 15% 16%

Web-based/Mobile lifestyle behavior coaching programs 31% 58% 44% 18% 16% 17%

Healthy sleep programs 19% 37% 35% 11% 9% 10%

Decision-support tools

EAP 61% 98% 98% 46% 35% 42%

Online information on demand 34% 59% 57% 24% 22% 20%

Telemedicine for professional consultations 28% 46% 19% 14% 9% 26%


For example, in the U.S., there’s an uptake in telemedicine by which employees can consult medical professionals via phone, online chat or video in lieu of or before seeking more expensive care at a medical facility. Telemedicine, which can increase the access to and efficiency of health service, is expected to expand even more over the next few years. Higher use in Asia Pacific is already evident. Lower uptake in Europe is likely attributable to tight privacy and security requirements.

Program Participation

Though the offering of health and well-being programs is broad and growing in all regions, employers are still challenged to motivate employees to participate. Our study found that only around half of employees who are eligible to participate in these programs are actually making use of them (Figure 15).

In North America and Europe, employee participation in most lifestyle change and health management programs ranges between 10% and 20%. And participation rates in the U.S., where programs have been in place for many years, have historically been low for some programs, including weight management and onsite fitness programs. Possibly due to the absence of financial incentives to encourage participation, rates have declined in the U.S. in recent years for programs such as health coaching and health assessments.

The emphasis that employers continue to place on prevention programs isn’t surprising given the rising rates of preventable chronic illnesses such as cardiovascular disease and diabetes. The prevalence of these conditions has expanded beyond Western economies to become a global issue — and in some countries, an urgent one. This is particularly problematic for employers whose health and well-being programs are evolving, a process that can take many years. It’s common for employers to begin by adding primary and secondary prevention interventions such as screenings, vaccinations and onsite services that focus on catching diseases in their earliest stages. Once employees become more aware of disease risks and understand the connection between lifestyle and disease, demand for these services rise.

The uptake in lifestyle management programs hasn’t been widespread outside of North America, where health and well-being programs have been established and evolving for several decades. It’s common for U.S. employers to directly address the full gamut of lifestyle-related risk factors that drive up health care costs by offering programs to help employees manage stress, maintain a healthy weight and cease using tobacco.

While lifestyle management programs aren’t widely offered in other regions, stress management and resilience management programs are the most prevalent, especially in European countries, which is consistent with stress being the top lifestyle-related risk globally. There are opportunities for greater employer uptake in programs like tobacco cessation in some areas of Asia, Europe and the Middle East, where smoking rates, especially among men, are quite high. And though a vast majority of U.S. employers offer programs for chronic condition management, these programs haven’t yet made their way into other markets, except for a few in Latin America.

In one of the more exciting areas, many new health-related online and mobile applications are becoming widely available. This development provides employers with more cost-effective opportunities for enhancing their health and well-being programs. These include online tracking and education tools that help employees understand their lifestyle-related health risks, as well as platforms for providing efficient delivery of acute health care services.

Figure 15. Companies struggle to boost participation in health and well-being programs

0% 10% 20% 30% 40% 50% 60%

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

57

57

50

38

31

49

Our study found that only around half of employees who are eligible to participate in these programs are actually making use of them.


The use of lifestyle and behavioral change programs is highest in Latin America and Asia Pacific — nearly two or three times rates in the other regions.

Figure 16. Employees make greater use of worksite screenings, but few participate in lifestyle management programs


AmericaAsia

Pacific

Worksite well-being activities and screenings

Worksite biometric screening 62% 48% 29% 45% 70% 78%

Health risk assessment/appraisal 52% 48% 26% 49% 61% 61%

Onsite or near-site health clinic 51% 35% 28% 52% 67% 53%

Onsite vaccinations 44% 43% 26% 27% 63% 52%

Well-being fairs at some/all locations 40% 34% 29% 30% 63% 47%

Onsite healthy lifestyle coaching in at least one location 32% 18% 16% 37% 40% 35%

Worksite diet/exercise activities 32% 22% 22% 25% 44% 43%

Lifestyle change and health management activities

Maternity support (pre- and post-delivery, child care resources) 24% 14% NA 26% 43% 38%

Stress or resilience management 22% 11% 18% 19% 46% 32%

Web-based/Mobile lifestyle behavior coaching programs 21% 17% 15% 10% 34% 40%

Chronic condition (disease) management programs 20% 14% 9% 16% 46% 38%

Healthy sleep programs 18% 9% 9% 10% 34% 33%

Weight management programs 18% 10% 10% 16% 38% 34%

Telephonic lifestyle behavior coaching programs 16% 12% 8% 17% 31% 30%

Tobacco-cessation programs 12% 8% 5% 10% 34% 22%

Decision-support tools

Online information on demand 25% 11% 16% 27% 47% 37%

EAP 19% 14% 17% 19% 39% 24%

Telemedicine for professional consultations 12% 8% 7% 19% 21% 18%

Note: Participation rates are based on employees who qualify for and/or are recommended to participate in these programs and based on companies offering the program; excludes “don’t know.”

Asia Pacific and Latin America, where health and well-being programs are a bit newer, have the highest participation rates. Once the novelty of these programs subsides, could participation rates in these markets trend downward? Or do these participation rates show that employees in these markets are more open to engaging with their employers regarding health and well-being?

When we look at participation in specific programs, we see wide disparities (Figure 16). Programs that focus on prevention — screenings, health risk assessments and vaccinations — have the highest participation rates. This is particularly true in Latin America and Asia Pacific, where in some organizations, more than 70% of eligible employees participate. Because some programs such as worksite screenings are compulsory in some countries, employees in those countries could be accustomed to employer

involvement in their health and therefore more open to participating in additional programs that aren’t required simply because their employer requested it.

When it comes to employees’ use of coaching (web-based and telephonic) and other lifestyle support programs, participation rates are only in single-digit figures, particularly in North America and Europe. Yet again, the use of lifestyle and behavioral change programs is highest in Latin America and Asia Pacific — nearly two or three times rates in the other regions.


Employers worldwide are starting to take a more holistic approach to employee well-being. For example, 30% have incorporated financial well-being in their organization’s health and productivity strategy. The U.S. has somewhat of a head start in this area, with nearly half of surveyed U.S. employers incorporating the personal financial aspect in their well-being strategy (Figure 17).

In other regions, there’s notable interest among employers to make financial well-being a more significant part of their health and productivity strategy in the coming years. We found increasing interest in educating employees about ways to improve their financial well-being and in providing tools to help them budget their spending and manage their debt.

This increased interest indicates that employers understand the connection between employees’ financial well-being and their ability to be at their best on the job. As we showed earlier, personal financial issues are a source of stress for employees, and many employers recognize those issues (Figure 8, page 10). Even more significant: Our recent Global Benefits Attitudes Survey found that workers with financial worries are more stressed, less engaged and less healthy than their more financially secure peers. The financial well-being factor clearly affects employees’ ability to be productive at work, which in turn affects the bottom line.

Still, when implementing financial well-being programs, employers in some markets face challenges different from those they face when they offer health management programs or other health-related activities in the workplace. To help avoid problems, the employer must first answer an important question: Have we secured, through our internal branding, the permission we need to take a more active role in employees’ financial well-being?

As shown in Figure 18, employees are generally less comfortable with their employer’s involvement in their personal financial matters than in their health. But there are significant differences by region. Employees in North America and Europe are the least comfortable, with more than half of employees in Europe saying it’s not the employer’s role. Conversely, employees in Latin America and Asia Pacific are much more tolerant of employer involvement in their financial lives than are workers in more developed countries. These are important differences, as they suggest that employers should consider regional and cultural factors in developing a strategy to engage employees on financial well-being issues.

Employees’ Financial Well-Being

Figure 17. Universally, organizations plan to adopt financial well-being programs over the next few years

0%

20%

40%

60%

80%80

61

41

56

3947

34

2029

22

Asia PacificLatin AmericaEuropeCanadaU.S.Global

2015 2018

54

30


Financial Incentives

As our earlier Staying@Work studies found, financial incentives are primarily a U.S. strategy to boost program participation and increase employees’ accountability for their health. U.S. employers use incentives to spur participation, with 86% offering some type of financial incentive — most often linked to employee health plan contributions (Figure 19 and Figure 20, page 22).

Outside the U.S., financial incentives are rare. When used, they tend to reward behavior and be distributed via such activities as raffles, lucky draws or gifts. This could be due to the design of health care programs in some markets or to regulatory restrictions on incentive designs. Sometimes these rewards come as part of the health benefit package.

Increasingly, companies in Asia Pacific are linking financial incentives to their health insurance premiums — a common practice in the U.S. For example, 18% of Asia Pacific employers are using health insurance premium reductions, and 14% are using reduced copay as part of their well-being incentive design, compared to 5% and 4% in 2013, respectively. Employers in Latin America and Europe use financial incentives the least: Less than half of organizations in those regions offer some type of financial incentive. This sparse usage outside of the U.S. could be due to cultural disapproval (especially in Europe) or to employers’ concerns that financial rewards might be considered part of the remuneration package. Still, if we look at how incentive usage has evolved over time, we see a marked increase in all regions.


Figure 19. Interest in financial incentives to boost program participation is on the rise

0% 20% 40% 60% 80% 100%

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

2013 2015

7886

5061

3045

3745

4360

4263

Figure 18. Employees are less comfortable with their employer’s involvement in personal financial matters

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

42 17 41 42 17 41

37 20 43 37 20 43

28 20 52 28 20 52

60 14 27 60 14 27

55 18 26 55 18 26

Option A: Employers should take an active role in encouraging their employees to better manage their finances

Option B: It is not the role of an employer to encourage its employees to better manage their household finances



46 18 36 46 18 36


The central question is whether financial incentives increase employees’ long-term commitment to health and well-being. In the U.S. and some other markets where employers have used incentives for a while, the relationship between incentives and participation is strong, particularly for activities that require the employee to take simple, defined actions with time-marked parameters, like complete a health risk assessment or participate in a screening. But for many programs that require the employee to do the hard work of changing long-developed habits — such as eat more wisely, quit smoking, manage stress or comply with medication regimens to treat chronic conditions — the evidence of incentives’ effectiveness is far less convincing.

The mixed success of incentives at changing behavior is leading many organizations and experts to rethink whether and how to use them.

The mixed success of incentives at changing behavior is leading many organizations and experts to rethink whether and how to use them. While many U.S. employers that offer financial incentives aren’t yet backing away from their use, nearly nine in 10 plan to reassess their incentive designs over the next three years.

Again, the employee perspective helps guide employers forward. Are financial incentives necessary for employees to participate in health and well-being programs? Our recent Global Benefits Attitudes Survey found that less than one-third of employees worldwide see financial incentives as absolutely necessary for their participation in employer-sponsored, health-related initiatives (Figure 21).


Figure 20. Employers use a wide variety of financial incentives to encourage participation in health and well-being programs



Health insurance premium reductions/increases 24% 40% — 18% 9% 18%

Raffles/Lucky draws 22% 39% 37% 12% 20% 15%

Gifts 19% 21% 22% 14% 16% 20%

Vacation days/Paid time off 15% 4% 5% 11% 12% 29%

Cash 14% 29% 6% 5% 4% 9%

Copayment reductions/increases 9% 4% — 8% 9% 14%

Deductible reductions/increases 8% 5% — 11% 3% 9%

Flexible spending account credits 6% — — 3% 2% 10%

Enhanced employer contributions to a retirement plan 4% 1% 4% 9% 3% 2%

Other (e.g., health savings account contributions) 11% 24% 27% 7% 4% 4%

None of the above 37% 14% 39% 55% 55% 40%

Figure 21. Many employees would participate in a health and well-being program without a financial incentive

Asia Pacific

Latin America

Europe

Canada

U.S.

Global

33 23 44 33 23 44

42 29 30 42 29 30

41 30 29 41 30 29

69 15 16 69 15 16

48 25 27 48 25 27

Option A: I would participate in a company health initiative without a financial incentive

Option B: I would participate in a company health initiative only if there were a financial incentive (prize or other financial reward)



44 24 32 44 24 32


provider community to influence their employees’ health-related behavior. Over the next few years, employers will continue to rely on their plan designs and local providers to effect behavior change (Figure 22).

As we explained in the previous section, incentives can raise awareness and influence simple, well-defined behaviors. Other than the U.S., most markets (notably Asia Pacific) would like to expand their incentive use over the next few years. But employers want to support and sustain the health and well-being of employees over the long term, and that requires them to understand and tap into employees’ intrinsic motivations, which are stronger drivers of behavior change than extrinsic factors such as rewards.

Above all, employers in all regions see the workplace environment as their most important asset in effecting employee behavior change. Creating a workplace where health and well-being are deeply rooted in all aspects of employees’ day-to-day experience is critical to gaining their trust around these personal issues and convincing employees that their employer is a go-to resource. By 2018, nearly two-thirds of employers will work at building a healthy workplace culture as an effective way — if not the primary way — to boost employees’ engagement in health.

But employee attitudes vary quite a bit by region. In Latin America, incentives don’t seem to be very influential; more than two-thirds of employees there would be willing to participate in health and well-being programs without a financial incentive. U.S. employees are the most reluctant to participate without an incentive. This suggests that many U.S. employees have come to expect financial rewards for their participation in any employer-provided health and well-being program. This is an important consideration for multinational employers considering various techniques to gain employee attention and participation.

Before adding or expanding incentives, what can employers with operations in other parts of the world learn from the recent U.S. experience? And aside from financial incentives, what else can organizations do to boost employee engagement in these programs?

Building a Healthy Workforce Culture

Employers around the world use varied strategies to encourage smart health-related behaviors among their workers. Around 40% emphasize their health benefit plan designs, particularly in North America. (In Europe, where state health benefit plans prevail, employer health plans may play a smaller role in influencing healthier lifestyles). And despite the broad differences among health care systems around the world, about one-third of all employers look to the health care

Employers in all regions see the workplace environment as their most important asset in effecting employee behavior change.

Figure 22. By 2018, employers in all regions see changes to the workplace environment as their primary strategy to encourage healthy behaviors

0%

20%

40%

60%

80%

4

No strategy toencourage

healthy behaviors

Focus primarily onstrategies to build

the health andwell-being of the

workplace and culture

Rely primarily onproviders, medical

professionalsand emerging delivery

system models

Focus primarily ondirect financial

incentives

Focus primarilyon plan design

2015 2018

66

3742

27 313634 37

18


Figure 23. Key elements in building a healthy workplace culture


AmericaAsia

Pacific

Communication

Have local health champions and/or committees to promote a healthy workplace 44% 62% 49% 47% 29% 30%

Build health and well-being into the organization’s EVP 43% 49% 45% 45% 49% 34%

Use employee testimonials and/or personal stories 42% 61% 49% 38% 36% 27%

Use key influencers and viral messaging to communicate through the company’s social networks 32% 32% 26% 42% 44% 23%

Use consumer marketing techniques (e.g., segmentation based on health-related behaviors and spending patterns) to develop a customized/targeted communication strategy

17% 28% 9% 10% 23% 11%

Technology

Ensure all online tools are available for at-work and at-home access 45% 74% 62% 42% 29% 23%

Have a dedicated portal to deliver health-related information or introduce health challenges (individual or team) 34% 58% 38% 32% 25% 16%

Sponsor the use of wearable devices for tracking physical activity or nutrition 21% 36% 32% 15% 12% 12%

Leadership

Employee health and well-being is included in our organizational goals or value statement 46% 40% 38% 53% 48% 45%

Tools are provided to managers to support their efforts to promote employee health and well-being 32% 38% 39% 29% 28% 30%

Environment

Improve physical environment to encourage healthy employee behavior (e.g., healthy food in cafes, walking paths) 59% 70% 62% 73% 60% 40%

Offer work/life balance support (e.g., concierge service, caregiver support, commute-time reduction, flexible working arrangements)

59% 63% 62% 70% 45% 50%

Encourage employees to offer suggestions for changing the work environment to improve their well-being 56% 56% 52% 61% 56% 54%

Certify or audit the work environment, and health and well-being programs to align with the culture 32% 23% 17% 27% 37% 43%

Invite family members to participate in various programs and activities (e.g., nutrition and cooking classes, financial planning and budgeting, weekend health fairs)

26% 35% 16% 15% 23% 27%

What steps are employers taking to build a workplace that supports the health and well-being of their employees? As shown in Figure 23, employers in all regions are embracing activities that raise awareness and tap into the organization’s social networks. They’re using team participation, storytelling and other consumer marketing approaches to connect employees at all levels of the organization in health and well-being improvement. It’s also critical to solicit employee feedback and suggestions on how the program can be improved to better meet employees’ needs.

Many organizations recognize that managers and leaders can set the tone at the workplace by investing in changes to the physical environment, participating in various communication campaigns and providing employees with the flexibility to pursue personal health and well-being activities. Above all, senior leaders set the strategic vision of the organization. And many employers are developing comprehensive communication plans that tie employee health and well-being to the organization’s goals and make them an integral part of the organization’s EVP — a trend that’s consistent in all regions, with Asia Pacific lagging slightly behind.


Employees themselves say technology is quite important for the management of their health and well-being. Our recent Global Benefits Attitudes Survey found that approximately three in five employees say wearable devices and apps to monitor their health-related activities or manage conditions are important to them managing their health. Although employers in Asia Pacific and Latin America have lagged behind in adopting new technologies, employees indicate considerably more usage in these markets, likely in part because of the age profiles of workers in those regions (Figure 24).

While employees may not use these tools daily or even weekly, the high rate of importance to employees suggests there’s strong interest and awareness about online or app-based tools that support their health and well-being. This highlights a potential opportunity for employers in all regions as they strengthen their well-being programs.

The pursuit of a healthy workplace culture is gaining traction in all regions. For example, nearly half (46%) of employers include messages about employee health and well-being in their organizational goals or value statement — up from 23% in 2013. This organizational commitment is strong and consistent across all regions.

Other notable changes between 2013 and 2015 include:

�� Having local health champions: 44% (2015) versus 21% (2013)

�� Using key influencers: 32% (2015) versus 16% (2013)

�� Giving managers tools to support well-being efforts: 32% (2015) versus 13% (2013)

�� Encouraging employees to offer suggestions for changing the workplace environment: 56% (2015) versus 29% (2013)

More and more, employers are using technology to inform employees about their health and engage them in pursuing healthier lifestyles. Almost half of the surveyed organizations provide employees with online tools via remote and at-work access. Companies in North America have been early adopters of these technologies, while those in Asia Pacific and Latin America have progressed more slowly. This slower uptake could be linked to the budget challenges identified by employers in these regions.


Figure 24. Employees have already embraced emerging technologies to help manage their health and well-being


AmericaAsia

Pacific

Websites with ratings of doctors and hospitals 68% 67% 52% 53% 79% 76%

Apps to monitor a health condition 63% 48% 49% 47% 80% 80%

Online consultation with a medical professional (discuss medical issues via the Internet) 63% 53% 51% 49% 76% 75%

Price-comparison sites to check the price of health-related products or services 62% 56% 49% 47% 76% 71%

Apps to track diet 61% 53% 50% 46% 76% 72%

Wearable device to monitor fitness activity (steps taken, workout tracker) 60% 54% 51% 46% 71% 69%

Apps to monitor sleep/relaxation 56% 43% 43% 40% 71% 72%

Online forums that discuss health issues 56% 44% 43% 46% 66% 69%



Note: Percentage of respondents indicating “very important” or “moderately important” on a five-point importance scale.


Employers around the world face similar challenges in influencing the lifestyle-related decisions that play a role in employees’ chronic disease and disability. Organizations continue to make significant investments in health and well-being programs, and they recognize that a formal health and productivity strategy is necessary for success. They also recognize that building employees’ trust is crucial to boosting engagement in health and well-being programs.

As in previous years, our 2015/2016 Staying@Work Survey found strong links among highly effective health and productivity strategies, high-performing employees and strong financial results. To evaluate the effectiveness of the health and well-being programs, we asked employers to rate their performance in 20 health and productivity-related areas. The assessment covered both health program effectiveness and elements of the workplace experience. The employers assessed their own effectiveness in providing elements essential to developing a healthy, effective workforce. Taken together, the responses reveal the effectiveness of an organization’s health and well-being strategies and programs.

We call the effectiveness metric the Overall Health and Productivity Effectiveness (OHPE) score (see Effectiveness Methodology, page 27, for more details). Using respondents’ OHPE scores, we divided them into three groups of equal size. We found that employers in the group with the highest OHPE scores take a distinctive approach to health and productivity, and their programs are clearly more successful than those of employers with lower scores.

First, the employees of high-OHPE organizations are more engaged in their own health and well-being. This is evidenced by participation rates in health and well-being programs that are 15 percentage points higher than the participation rates at low-effectiveness companies (56% versus 41%).

Second, high-OHPE organizations have better health outcomes:

�� 25% fewer employees with hypertension

�� 24% fewer employees with high blood glucose levels

�� 30% fewer employees using tobacco

Third, companies with highly effective programs are twice as likely as low-effectiveness companies to report improving financial and human capital performance.

�� Twice as likely to significantly outperform their peers financially

�� 50% more likely than competitors to report lower turnover rates

�� 33% higher market premium (market value to replacement cost of assets [Tobin’s Q*])

�� 50% higher revenue per employee

Are Employers’ Efforts Paying Off?

*Tobin's Q is the ratio between a physical asset’s market value and its replacement value.


Our survey results show that high-effectiveness organizations take a holistic view of health and productivity, and focus primarily on four vital elements:

�� Prevention. They offer programs that aim to keep employees healthy and encourage them to adopt and maintain healthy lifestyles.

�� Personal support. They address the specific health needs of employees who have health-related risks and chronic conditions. And with disabled employees, they use best-in-class return-to-work approaches.

�� Organizational support. They work at building a healthy workplace culture and aligning their health and well-being programs with that culture.

�� Design and delivery. They align their health and well-being programs with the organization’s EVP, provide employees with an array of choices, leverage the latest technology and use targeted communication to reach employees where and how they prefer.

What Are the Best Doing Right?

Effectiveness Methodology (OHPE Score)

To evaluate the effectiveness of companies’ health and well-being programs, we asked participating employers to rate their organization’s performance in 20 health and productivity-related areas. Based on these employer-provided ratings, we created an overall score for each organization by adding equally weighted values to their responses. This approach allowed us to summarize all facets of an effective health and productivity framework in a single variable, which we call the organization’s OHPE score.

We then divided the respondent cohort into three equally sized groups based on their scores. Organizations with the highest scores are deemed to have the most effective health and well-being programs.

For an in-depth look at the characteristics of effective health and well-being programs, Willis Towers Watson also developed the health and productivity scorecard, which inventories the programs and policies of employers in each of the three effectiveness groups. In each world region, we’ve identified the programs and tactics of the organizations with the most effective health and well-being programs. These best practices provide a road map for employers to follow as they consider the next steps of their health and well-being strategy journey.


Improving Health and Productivity Means Going Beyond ProgramsTo reap the rewards that a strong health and productivity strategy can deliver — and to make good on their commitment to improving workforce health — employers can consider the lessons provided by high-OHPE organizations. As mentioned earlier, their strategies are based on four pillars: prevention, personal support, organizational support, and sound program design and delivery.

These pillars can form the basis of a formal, enterprise-wide health and productivity strategy. They can help employers forge disparate programs into a cohesive whole that has enormous potential to address vexing, persistent issues such as weak employee participation and insufficient resources.

Employers can build a strong foundation on which to launch these efforts by involving the workforce in an assessment of health-related needs and preferences, and then directing their limited health and productivity resources to address the identified needs of local offices, regions and various workforce segments and the most serious threats to workforce health. By delivering the right messages to employees via the appropriate channels, employers can educate them about health risks and proven methods of health improvement.

Employers can make their communication program more effective by segmenting the workforce according to employees’ communication preferences and health needs, and then delivering targeted, personalized messages. By using the full range of today's communication technologies, employers can reach workers how, when and where they prefer. Placing health-related messages within the context of the overall employment deal helps current and potential employees understand the value of both their health and well-being programs, and the employer/employee deal.


What about the most common barriers to health and productivity effectiveness? Employers can do several things to overcome them, the most significant of which are measurement and data analysis.

Measuring the effectiveness of health and well-being programs provides quantitative data. Employers can start by focusing on tracking absences and the effects of absenteeism on productivity. These data can be used to build a business case for additional investments in the staff, programs, activities and communication needed to make a high-OHPE organization. Employers can use the data to enlist the support of senior leaders in enlarging the budget for funding their health and productivity strategy. They can also use measurement to determine whether financial incentives actually increase employee participation in well-being programs and activities.

Designing an Effective Employee Health and Productivity Framework

Prevention: Keeping people healthy

�� Health promotion and safety

�� Prevention and screenings

�� Lifestyle

�� Emotional health

Personal support: Addressing health needs

�� Stay at work/Return to work

�� Care delivery and onsite services

�� Health advocacy

�� Financial support and education

Organizational support: Building a healthy workplace culture

�� Leadership and alignment

�� Measurement and accountability

�� Work environment and flexibility

�� Funding and resources

Design and delivery: Building high-performing programs

�� Engagement approaches

�� Technology

�� Communication and change management

�� Program management


Employers around the world understand the impact of workforce health on their business; as a result, health and productivity remains a core component of their organizational health strategies. But employers also recognize that their strategies and programs aren’t as effective as they could be. A lack of employee engagement in programs, inadequate budgets and a lack of metrics are hindering program effectiveness and, in some areas, rates of program adoption.

Market-leading employers approach these problems holistically. Here’s how you can follow their lead:

�� Build a strong foundation. Creating and implementing a realistic health and productivity strategy that aligns with your business priorities and EVP, and reflects your organization’s unique challenges — whether they be a lack of employee engagement, a limited budget or organizational health issues such as stress, lifestyle-related illness or changing demographics — will make it easier to identify high-impact programs and increase your effectiveness.

The commitment of leaders in senior and middle management, backed by resources and a sufficient budget, is also essential. Link your health-related programming to other corporate priorities — such as safety, corporate social responsibility, diversity and inclusion, and sustainability — where there’s clear alignment. This will help you leverage additional resources and create an integrated employee experience that aligns with clear business priorities.

�� Focus on the workplace environment. For nearly two-thirds of employers, building an organizational culture of health will be their primary strategy for promoting healthy employee behaviors by 2018. This means considering every aspect of the workplace, from safety, to the food offered in the cafeteria and snack machines, to workplace stress.

And the importance of managers and other influencers continually promoting a culture of health at work can’t be overemphasized. Managers can play a key role in promoting organizational health by modeling behaviors, encouraging employees to take advantage of onsite programs and helping them eliminate or reduce workplace stressors. To get messages across, use multiple communication channels such as posters, social networks, mobile apps and other technologies. Celebrate successes, use social rewards and publicize individuals’ workplace achievements.

�� Offer programs across the full health continuum. Focus on prevention by offering programs that encourage healthy lifestyles and teach employees how to access the right type of care at the right time. If low employee participation rates are an issue for your organization, consider offering a range of programs, such as opportunities for physical exercise, classes on stress reduction, guidance on living a healthy lifestyle and onsite immunizations.

Offering programs both onsite and off, and at various times of day can also encourage employees to take part. And as financial well-being programs evolve, careful consideration of employees’ attitudes about the employer’s role will be important in addressing this important aspect of well-being.

Summary: Good Intentions, Formidable Obstacles, Notable Successes

The importance of managers and other influencers continually promoting a culture of health at work can’t be overemphasized.

The commitment of leaders in senior and middle management, backed by resources and a sufficient budget, is also essential.


You can also use consumer marketing techniques, such as segmentation based on health-related behaviors, to design targeted communication campaigns. Offer specialized programs for employees with specific health-related risks, as well as best-in-class return-to-work programs for those recovering from long-term illness or disability. Make the connection personal and authentic so that the link between health and business success becomes part of the organizational culture.

�� Combine global consistency with local execution. Companies with operations in multiple countries can drive synergies and leverage global economies of scale in health and well-being programs while addressing specific local needs and cultural considerations. It’s important to clarify what’s driven globally and what’s managed locally. Organizations that spend time understanding local cultures, and unique employee needs and behaviors — as well as tracking successful and less successful approaches — have the best chance of increasing program appeal and forging a connection with employees around health and well-being.

�� Continually manage and communicate to promote best practices. A health and productivity strategy shouldn’t be static, but rather should adapt to changing organizational conditions, evolving best practices and the results of your ongoing measurement of program effectiveness. Ask employees to provide periodic feedback to ensure programs remain relevant and meet ever-changing workforce needs.

�� Leverage new technologies, and make them mobile. Technology can increase employees’ interest in their well-being, and employers’ use of new technologies for this purpose is gaining traction. Mobile applications help break down the barriers to access and provide employers with convenient ways to encourage employees to make smart health-related decisions and use health care services effectively. Websites that rate providers, wearable devices that monitor activity and calorie intake, apps that monitor health conditions, and price-comparison websites for health products and services can help employees to make wise decisions.

And telemedicine can help them address simple medical needs and reduce office visits. To build employees’ trust in the programs, assure them that their health-related data will remain private and secure, and explain the steps you’ve taken to secure it.

�� Personalize the experience. Personalization is another powerful tactic for boosting engagement. Make it easy for employees to participate in programs, and help them understand that you’ve designed programs with them in mind. Create individual or team health challenges, such as walks, stair climbs and weight-reduction activities, and offer prizes. Online tools should be available both at work and on employees’ personal devices. Create a dedicated portal to deliver health-related information and promote health challenges.

As financial well-being programs evolve, careful consideration of employees’ attitudes about the employer’s role will be important in addressing this important aspect of well-being.

Technology can increase employees’ interest in their well-being, and employers’ use of new technologies for this purpose is gaining traction.

Make it easy for employees to participate in programs, and help them understand that you’ve designed programs with them in mind.


�� Know your numbers — and use them. Establish a baseline, continually measure program effectiveness using a variety of financial and nonfinancial metrics, and make changes as needed. Collecting data on organizational health issues, absence trends, employee preferences, program usage and costs can help you make data-driven changes, confirm successes and promote cost-effective interventions.

An effective health and productivity strategy requires a strategic focus and employer commitment. And as the results from high performers demonstrate, it can deliver tangible payoffs that will set your organization apart from competitors by linking human capital results directly with business performance.

A health and well-being strategy shouldn’t be static, but rather should adapt to changing organizational conditions, evolving best practices and the results of your ongoing measurement of program effectiveness.

Collecting data on organizational health issues, absence trends, employee preferences, program usage and costs can help you make data-driven changes, confirm successes and promote cost-effective interventions.

Copyright © 2016 Willis Towers Watson. All rights reserved.WTW-GL-16-RES-1631a1

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About Willis Towers WatsonWillis Towers Watson (NASDAQ: WLTW) is a leading global advisory, broking and solutions company that helps clients around the world turn risk into a path for growth. With roots dating to 1828, Willis Towers Watson has 39,000 employees in more than 120 countries. We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand the power of capital to protect and strengthen institutions and individuals. Our unique perspective allows us to see the critical intersections between talent, assets and ideas — the dynamic formula that drives business performance. Together, we unlock potential. Learn more at willistowerswatson.com.

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