Research reports

Workplace health promotion is a statutory duty of the statutory health insurance companies in Germany. The results are reported annually (In German).

In the 2021 reporting year, the health insurance companies invested a total of 247 Mio euros in workplace health promotion; this corresponds to EUR 3.37 per insured person. This includes EUR 0.76 per insured person for BGF in care. Hospitals and inpatient care facilities benefit from this, as they use a health promotion process to make work processes more health-promoting and want to offer their employees WHP offers.

In 2021, 18,437 companies could be reached directly. Companies/locations with ten to 49 employees were most frequently reached (22%). Companies with 50 to 99 employees and companies with 100 to 249 employees are reached in equal proportions by health insurance funded measures (19% each). Small businesses with up to nine employees are represented much less frequently (up to 5%). Larger companies with 500 to 1,499 employees and companies with more than 1,500 employees were involved in the measures of the health insurance companies more often in 2021 with a total of around 21% than in the previous year (2020: 15%).

In 2021, 1,768,604 employees were reached through health insurance companies’ WHP activities directly; this is 9% less than in 2020. In 2021, 41% of the projects were aimed at specific target groups and 59% of the activities were aimed at all employees equally. The proportion of target group-related activities has increased significantly compared to the previous year (2020: 23%).

Most frequently, target group-specific activities were aimed at middle and upper management levels. The management style at management level can strengthen employees' resources in terms of health promotion, but it can also have a negative impact on their health, for example through inadequate conflict management or a lack of appreciation for the work of employees. Corresponding activities therefore have great health-promoting potential.

Commercial providers/companies (34%), company doctors (34%) and accident insurance providers (29%) were most frequently involved as cooperation partners in the activities of the health insurance companies and contributed resources. Other health, social and educational institutions made up 19% of the cooperation partners. The integration of accident insurance as an important partner of the health insurance companies in the field of WHP is presented in the following in a differentiated manner.

Authors: Gert Lang & Kathrin Hofer-Fischanger

To support companies the Austrian Health Promotion Fund and the FH JOANNEUM - University of Applied Sciences have recently published a practice-oriented guide on the health-promoting organisation of the home office.

The COVID-19 pandemic triggered an accelerated upheaval in the world of work in spring 2020, which meant a rapid transition for many companies towards "working from home". While the home office was often an exception before COVID-19, it now became the new normal of everyday working life in many companies.

In order to contain the spread of the Corona virus in spring 2020, maintain workers' employment and limit the negative economic impact of the pandemic, many companies or units had to switch to home office wherever possible. Some were better prepared for this than others, but many entered completely new territory with the changeover.

Workplace health promotion (WHP) can play a decisive role in preparing employees and companies for the new challenges in the work environment, supporting them in taking appropriate measures. This is especially true in phases of profound change (e.g. digitalisation, flexibilisation and most recently COVID-19) in the "new work", in which the central framework conditions for health and work are constantly changing.

Research studies report both positive and negative effects of home office work on physical, mental and social health and wellbeing. The conditions for working in a home office are not exclusively beneficial to health, as they often require a close look at important factors that influence health, such as the design of the workspace, the organisation of work or the individual and social competences of the individual employees. Despite this, little attention has been paid to the possibilities of the health-promoting home office to date. However, the available findings suggest that decision-makers in the field of health promotion need to build up their competence and knowledge with regard to the home office.

The brochure "Health-promoting home office. A guide for companies and employees", now freely available in German, is intended to contribute to sustainable capacity building in companies, so that on the one hand the necessary strategic decisions can be made and on the other hand suitable offers and measures can be taken with the aim of promoting the health of employees in a holistic sense when working at home. Furthermore, the guideline can help provide responsible persons and actors within companies (e.g. OHS, HR, management, works council) with knowledge and skills as well as the necessary know-how to act themselves or bring about the necessary decisions in the company. The information and materials can also be put to good use in daily work with companies in the sense of high-quality occupational health promotion.

The Health-promoting home office is addressed using a holistic definition of health promotion and includes several determining factors and levels of action (ENWHP 1997; ÖNBGF 2021; WHO 1986). These are communicated in the guide in a low-threshold and practical manner. Topic-specific questions, examples as well as tips and tricks for practice, but also useful links underline this practical approach. A quick and easy-to-use self-reflection tool for companies completes the compendium.

The guideline is not only intended to provide concrete support for implementing the holistic guiding principles of modern WHP, but also for its continuous quality development.

Contact details:

Gert Lang, Austrian Health Promotion Fund, Vienna, gert.lang@goeg.at

Kathrin Hofer-Fischanger, FH JOANNEUM – University of Applied Sciences, Bad Gleichenberg, kathrin.hofer-fischanger@fh-joanneum.at

Bibliography

ENWHP (1997) Luxembourg Declaration on Workplace Health Promotion in the European Union. European Network for Workplace Health Promotion. www.enwhp.org. Accessed 18.09.2021

ÖNBGF (2021) 15 quality criteria of the Austrian Network for Workplace Health Promotion. http://www.netzwerk-bgf.at/. Accessed 10.11.2021

WHO (1986) Ottawa Charter for health promotion. World Health Organization, Ottawa

The living and working conditions of people with disabilities are often excluded from the activities and methods of WHP. An innovative project from Austria provides a remedy.

People with impairments represent a vulnerable target group because they are generally less healthy, more frequently chronically ill and suffer more often from comorbidities as well as having a more complicated progression of illness with an overall lower life expectancy. In addition, staff working in facilities for people with disabilities tend to be subject to high levels of psychosocial stress.

Comprehensive health promotion for staff takes place in many companies in Austria, including some institutions for people with disabilities. However, the usual approaches to and potential for WHP can cannot be utilised for people with special needs. The Health Inclusive Project developed and tested new methods of WHP for a participatory, inclusive setting, so that both employees with cognitive and/or physical impairments and employees without impairments can work together in the process of WHP on an equal basis.

Based on established principles of WHP (ENWHP, 1997) and quality criteria (ÖNBGF, 2021), the typical WHP methods and instruments were adapted to the needs of the target group of people with disabilities. Particular emphasis was placed on participatory processes and the inclusion of the views of all those affected, and also on the communication needs of people with cognitive impairments. For example, consideration was given to using accessible language and an appropriate choice of methods - an accessible questionnaire in easy language and an observation sheet were developed. In addition, the Health Circles approach was adapted to the needs of the target groups.

The testing of the methods and instruments took place between 2018 and 2020 at the competence network KI-I and in three workshops of Diakoniewerk Gallneukirchen in Upper Austria. In total, these companies employed almost 120 people, the majority of whom have disabilities. The project was evaluated by an external cooperation partner and by an advisory board of experts.

Key learning experiences from the project include:

·        the awareness-raising phase of the process was very conducive to inclusive WHP processes and should be maintained in future applications.

·        For a truly participatory way of working, it is necessary to adapt all documents, presentations, and media as best as possible to the needs of people with impairments.

·        Intensive cooperation, consultation and reflection with the target group is essential. This results in an increased need for time resources, e.g. for the preparation of documents, media, and materials for the target group as well as for the organisation of meetings and presentations or for the preparation of moderations.

The results were collected and summarised in a guide (Lattner, Peböck, & Bäck, 2021). This guideline is now freely available, published by the Austrian Health Promotion Fund and was written in "easy reading, comprehensibility level B1" language. On the project website, additional materials (e.g. checklists for staff with high support needs, video on health, game materials such as the adapted health determinant model and stages of participation) can be obtained in German for further use. Both the guide and the website have been designed to be accessible.

The results of the innovative project are ground-breaking for the further development of quality WHP and represent a promising contribution to more health equity for employees with disabilities. The companies involved in the project were awarded the WHP quality certificate (Gütesiegel für Betriebliche Gesundheitsförderung) in 2021 by Austrian Network for WHP, in which approaches are assessed according to 15 WHP quality criteria.

The project was supported by Austrian Health Promotion Fund (Fonds Gesundes Österreich, FGÖ), Austrian Network for WHP (Österreichisches Netzwerk Betriebliche Gesundheitsförderung), Austrian Health Insurance Fund (Österreichische Gesundheitskasse), Health Province Upper Austria (Gesundheitsland Oberösterreich), Social Province Upper Austria (Sozialland Oberösterreich) and Chamber for Workers and Employees Upper Austria (Arbeiterkammer Oberösterreich).

Links

Project homepage: https://www.ki-i.at/projekte/projekt-detail/gesundheit-inklusiv

FGÖ knowledge booklet: https://fgoe.org/sites/fgoe.org/files/2021-10/WB_20_gesundheit_inklusiv_bfrei.pdf

Authors

Gert Lang, Austrian Health Promotion Fund, Austrian National Public Health Institute, https://fgoe.org

Karina Lattner, Competence Network Information Technology to Support the Integration of People with Disabilities, https://www.ki-i.at/

Bibliography

ENWHP. (1997). Luxembourg Declaration on Workplace Health Promotion in the European Union.   Retrieved 18.09.2021 from www.enwhp.org

Lattner, K., Peböck, B., & Bäck, M. (2021). Leitfaden für inklusive Betriebliche Gesundheits-Förderung. Linz: Fonds Gesundes Österreich, Gesundheit Österreich.

ÖNBGF. (2021). Die 15 Qualitätskriterien des Österreichischen Netzwerk Betriebliche Gesundheitsförderung.   Retrieved 10.11.2021 from http://www.netzwerk-bgf.at/

The Institute for Employment studies in Germany has produced an important study on the impacts of the Covid 19 pandemic on workers mental health. 

"Using individual monthly panel data from December 2018 to December 2020, we estimate the impact of the Covid-19 pandemic and two lockdowns on the mental health and subjective well-being of German workers. Employing an event-study design using individual-specific fixed effects, we find that the first and the second wave of the pandemic reduced workers' mental health substantially. Momentary happiness and life satisfaction also decline in response to Covid-19, but to a smaller extent. We observe adaptation in our study outcomes between waves of the pandemic. This applies to a lesser extent to indicators of well-being in certain areas of life, such as satisfaction with the job and with leisure, which are negatively affected, too. Women do not seem to suffer greater well-being losses than men. However, workers in the German short-time work scheme are particularly negatively affected. Our results imply that increased anxiety about the future and restricted personal freedoms are among the drivers of the well-being impact of the pandemic." (Author's abstract, IAB-Doku) ((en))

Schmidtke, Julia; Hetschko, Clemens; Schöb, Ronnie; Stephan, Gesine; Eid, Michael; Lawes, Mario (2021): The Effects of the Covid-19 Pandemic on the Mental Health and Subjective Wellbeing of Workers: An Event Study Based on High-Frequency Panel Data. (IAB-Discussion Paper, 13/2021), Nürnberg, 81 p.

It has almost been an article of faith for some that intervening to reduce stress at the group level is as important, if not more important than seeking to improve the coping capacity of the individual.  A strong recent study from Germany sheds interesting light on the issue.

Fischer and colleagues from the University of Heidelberg undertook a prospective study in multiple workplaces to estimate the potential reduction in sickness absence attributable to optimising group level psychosocial characteristics in the German automobile industry.  The tested a model of 7 work characteristics (cognitive stress perception, meaning of work, commitment to the workplace, quality of leadership, predictability, possibilities for development and work life conflict) and their relationship to future levels of sickness absence and found that interventions to improve these characteristics were as effectives as interventions to target individual behaviour or medical problems. 

Though this finding is provocative in that psychosocial, work characteristics are perhaps not targeted as often as other, more traditional factors.  More research in other sectors may be needed to generalise these findings, but they do open a line of intervention that has hitherto been neglected.

Fischer, J.E., Genser, B., Nauroth, P. et al. Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings. J Occup Med Toxicol 15, 33 (2020). https://doi.org/10.1186/s12995-020-00284-x 

The evidence that workplace psychosocial factors affect health continues to accumulate.  A recent review study provides a meta-analysis of the relationships with both physical and mental health outcomes.  The authors (Niedhammer et al, 2021) review 72 review studies published over the past 20 years and conclude that there is consistent evidence of relationships that vary in strength with the type of workplace factor and the type of health condition under study. 

The psychosocial risk factors examined included job strain, high strain, low decision latitude, psychological demands, long working hours, effort reward imbalance, job insecurity and organisational injustice.  In addition, some studies looked at the impact of bullying and workplace violence or threats in relation to mental health outcomes.  The health outcomes studied included coronary heart disease, stroke, diabetes, obesity, health related behaviours, depression and other mental health outcomes. 

Niedhammer and her co-authors provide a wealth of detail on these studies and report that they show multiple statistically significant relationships between these factors, with especially strong relationships being seen with various mental health related outcomes.

Though the study did not look at the kinds of interventions that can be made or their effectiveness, it nonetheless points to the need to devise ways to intervene effectively if both the requirements of health and safety legislation and the opportunity to promote health and wellbeing n the workplace are to be grasped. 

Niedhammer, I. Bertrais, S. and Witt, K. (2021).  Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis.  Scand J Work Environ Health 2021;47(7):489-508 

The model of WHP promoted by ENWHP lays great emphasis on the need to target interventions at both the individual and the work environment in its broadest sense.  All too often, WHP interventions are targeted solely at changing the behaviour of the individual.  So, it is refreshing to see a review study that has systematically examined more than 290 studies since 2000 that have looked at a broad range of outcomes.

Undertaken in Poland, the study found that interventions were most often conducted in SMEs.  The types of intervention that were most common were aimed at changing organisational strategy and culture as well as targeting employee behaviour.  Such integrated interventions commonly yielded positive impacts in terms of changed health behaviours, organisational change and less often in terms of savings or reductions in costs as measured by absenteeism, presenteeism, labour turnover and Return on Investment.