An international employee health and wellbeing programme can face common issues in any country it covers, but there are local differences that employers must take into account.
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- Many health and wellbeing issues are common to all countries covered by a programme.
- The type and prevalence of medical treatments will vary from country to country.
- Interventions such as healthy eating and physical activity are relevant despite geographical location.
- Multinational employers should be aware of what is required by all employees and what is legislated in each country they are based.
Multinational organisations that roll out a health and wellbeing programme across a variety of countries should consider the different risk factors in different regions, and must imbed specific interventions to suit particular workforce needs.
Ann Dougan, marketing director, UK healthcare benefits, at Cigna, says: “We have more employer clients that are looking at their population internationally, and there does seem to be a lot of commonality in the challenges they are facing.
“That lends itself well to having a global programme, because there are some common needs around things like the ageing workforce, issues around chronic conditions and challenges around lifestyle. Some of those transcend geographical borders.”
But sub-Saharan Africa, for instance, has a disproportionate incidence of infectious and chronic diseases compared with other regions of the world, according to research published by the department of epidemiology at Harvard School of Public Health in 2011. It also found that in that region, cardiac disease and its risk factors were increasing, the incidence of diabetes was growing, and a lack of health resources was leading to late diagnosis.
Doctor Tracy Kolbe-Alexander, professor in the University of Cape Town’s exercise science and sports medicine research unit, is researching whether physical activity links with other risk factors of non-communicable diseases. “If we had physical activity-based interventions in the workplace, we will be able to improve other health profiles and reduce other risk factors,” she says. “We have found that employees who were physically active had significantly fewer additional risk factors than those who were inactive.”
An employee with a specific health issue, such as HIV/Aids or cancer, would still benefit from healthy eating and physical activity, says Kolbe-Alexander. “I think that creating a global health programme is possible because there are many unintended consequences for a lot of these types of healthy behaviours.”
However, there are health stigmas that employers might have to overcome in certain regions. Bart Jordens, general manager at Cigna Global Employer Segment, says: “If you were to look at chronic condition management programmes around HIV, one of the risks is that there is still a stigma around HIV. The employee might ask: ‘If I participate, is there a risk that my employer will find out about my HIV status?’
“There are stigmas that lead to people not entering into a chronic condition management programme. Everything related to confidentiality is of the utmost importance.”
Mental health stigmas also exist globally. Such health issues are often individualised, which is one of the main challenges, but many multinational employers have employee assistance programmes (EAPs) in place to help their global workforces.
Sarah Dennis, international healthcare director at Jelf Employee Benefits, says: “EAPs can have stigmas attached, but we think it’s really important to have international EAPs, purely on the basis that people are seeing more and more turmoil around the globe. There are lots of expatriate employees in high-risk destinations.”
The type and prevalence of medical treatment that is provided will differ from country to country, which is of particular concern for employers with staff in diverse locations. Beverly Cook, managing director of Expacare, says: “Depending on where the employees are located, employers need to take into consideration what their evacuation cover includes and where the employees are likely to be sent.”
Equalising global provision
Whether global employees are local nationals or expatriates, there are two main drivers for employers implementing a global health and wellbeing programme: commonality of needs and an interest in providing equal benefits across all international workplaces.
Cigna’s Dougan says: “While it may not be immediately practical to implement a fully comprehensive programme in every country, if an organisation identifies what the priorities are around building something that is international in nature and they take it step by step, they can effectively start the journey.”
It is also important for employers to tailor these programmes to local requirements. Jordens adds: “It is important that a global health and wellbeing strategy is being defined, but you still have some margin to adapt it to the local needs and culture.”
Employers should also be aware of what is required, and how health benefits are legislated, in each country where they are based. Cook says: “Employers need to go through a good data-gathering exercise to know exactly what the requirements are and where their employees are, and then it is important to speak to the insurers that have the detailed knowledge of the requirements in various territories so they can help employers come up with a suitable benefits package.”
Case study: American Express rolls out global health programme
American Express has rolled out its health and wellbeing programme, Healthy Living, across 16 of the 45 countries in which it is based.
The programme covers four areas: nutrition, exercise, healthcare and emotional wellbeing. Breckon Jones, director of health and benefits, Europe, Middle East and Africa (EMEA) at American Express, says: “Common health risks are mental wellbeing, obesity and sedentary lifestyle. This is fairly consistent around the world, although there are many cultural nuances in the way these countries approach health promotion and intervention to address the risks.”
In November 2012, American Express launched the programme in Italy, with the main focus on nutrition and its link with emotional wellbeing. The launch included a series of presentations for the organisation’s 500 employees in Rome, as well as a live stream of the presentations for 150 staff in Milan.
“One thing I love about Healthy Living Italy is the programme for nutrition and weight management,” says Jones. “Its approach was nutritional assessment, and, if at risk, nutrition counselling and programme design to achieve a healthier weight goal.
“But it is uniquely Italian. Because an intervention of this sort takes a long time to achieve the desired outcome, the interim support to the nutrition counselling included a fashion consultation, where employees are given advice on what to wear and how to wear it best, and therefore boost their self-confidence and, in turn, motivation to stick to the harder task of changing eating and exercise behaviour.”
Viewpoint: Dame Carol Black: A healthy workplace is a global issue
Globally, in developed and developing economies, there is a growing recognition of the importance of the health and wellbeing of employees to the success and reputation of businesses and their contribution to the wider economy.
It is self-evident that for each individual of working age, being sufficiently healthy is a condition for entering and maintaining work for as long as is necessary or possible. Indeed, maximising healthy working life is a desirable goal for individuals and society, everywhere.
There is compelling evidence that the conditions of work are themselves important and sometimes decisive factors in influencing both mental and physical health and wellbeing. Acknowledgement of these facts has brought challenges to employers and employees, opening new opportunities for their mutual benefit.
The World Health Organization (WHO) defines a healthy workplace as one in which employees and managers collaborate to use a continual improvement process to protect and promote the health, safety and wellbeing of staff and the sustainability of the workplace.
The challenges are to ensure good work and good organisational health; a workplace culture and practices that promote and support good physical and mental health; an emphasis on the responsibility of each individual for their personal health; enhanced personal resilience, recognised as one of the conditions that ultimately influences employee wellbeing and engagement; and managers who are trained in, and capable of, recognising and dealing with matters that affect employee health and wellbeing.
Dame Carol Black is expert adviser on health and work, Department of Health England, and chairperson of the Nuffield Trust