University Workplace Health Promotion Programmes: Getting the Balance Right

By Dr Hayden McDonald

Workplaces have a role to play in their employees’ health and mental wellbeing. Health promotion programmes are supposedly designed with this in mind, admittedly with other priorities. But how effective are they, and do they measure up to accepted guidelines? Dr Hayden McDonald of Australia’s Torrens University and colleagues examined workplace health promotion programmes at leading Australian universities – diverse workplace settings. What they discovered raises concerns.

Gone are the days when employers would simply pay employees to get on with their work. Nowadays, there is a growing expectation that employers consider the overall wellbeing of their employees. Indeed, when advertising job vacancies, organisations promote their workplace health promotion programmes, touted as caring for their employees’ physical and mental wellbeing. But are there designs behind such programmes that adequately align them with the expectations and preferred outcomes of organisations and employees? How can highly diverse organisations get the balance right and allocate resources for such programmes effectively? And what if budget restrictions threaten to throw a spanner in the works? These are some of the questions behind research from Australia that examined health promotion programmes. What the research discovered has highlighted the challenges organisations face in addressing multiple expectations around employee health. The outcomes also raised some eyebrows.

Dr Hayden McDonald is the Director of Business Analytics programmes at Australia’s Torrens University. His research focuses on optimising business value by accounting for social justice issues, and examines the craggy interface where issues of business and social importance intersect. His research, therefore, has significant relevance for organisations looking to develop and implement business models that also address critical social challenges such as improving the financial literacy, sustainability, and health of communities. Against this backdrop, the growing importance of workplace health promotion programmes is an area that demands careful and rigorous scrutiny. When McDonald and a team of researchers from Griffith University and the University of Tasmania decided to examine health promotion programmes, they turned their attention to the country’s universities, but their choice was not partisan.

Ripe for conflict

In many ways, universities are the consummate subject for such a study. They are usually highly diverse workplaces with a range of employees – including academic and professional staff – often drawn from all over the world. This environment presents specific challenges and opportunities for promoting employee health and wellbeing. Universities are not dangerous places to work in the traditional sense of having workplace hazards that can kill or cause serious harm to employees. Yet, given that academic and professional staff often experience high workloads and stress, health promotion activities have a significant potential impact on their wellbeing, job satisfaction, and performance. Universities are also competitive environments with a strategic interest in promoting a positive image and being an employer of choice. Implementing health promotion programmes can contribute to this strategic objective. However, without the deep pockets of, especially large corporate organisations, universities are more likely to feel the pressures of budget restraints in designing and managing such programmes. This nexus between university and employee interests is an area ripe for conflict.

McDonald and colleagues point out that whereas comprehensive frameworks are in place in Australia to encourage the rollout of workplace health promotion programmes, there’s little research into whether, in practice, organisations are hitting the correct targets. So, what organisations think is best may not be what employees are looking for. Like other organisations, universities design and implement health promotion programmes to improve physical and mental wellbeing among employees, but do so to generate a return on their investment into the programmes. If effective, health promotion programmes should increase productivity and performance, reduce absenteeism and presenteeism, enhance organisational culture, attract talent, and importantly, comply with legal and ethical responsibilities.

 What organisations think is best may not be what employees are looking for. 

For universities, the last point is especially significant. Hence, the researchers decided to examine universities within Australia that probably swing the most lead – those known collectively as the Group of Eight. McDonald and colleagues don’t refer to the universities by name in the published findings; they randomly assigned pseudonyms, U1 through U8. The researchers analysed content from 497 university website documents, including strategic and operational planning documents, policies, procedures, manuals, minutes of meetings, and information contained within advertising materials, all of which were contained within the ‘health, safety, and wellbeing’ sections of the universities’ websites. The analysis used a range of search strings to identify additional information based on synonyms of health and important terms such as ‘employee’ and ‘staff’. By doing this, the researchers captured comprehensive data about employee health-promoting practices and programmes.

A potential lack of trust

The study found that Australian universities emphasised programmes targeting health issues associated with lifestyles and behaviours, mainly mental health, cancer, cardiovascular disease, and diabetes. They also earmarked health risk factors such as alcohol and other addictions, discrimination and harassment, and physical activity.

The analysis also revealed no single or coordinated workplace health promotion programme for Australian universities. Instead, the different universities implemented varied programmes targeting the various health concerns and risk factors among their employees. In a way, this contrariety could be seen as a good thing. No two universities are the same, and whereas national health priorities may show prominence across all programmes, ideally, each should be tailored to its staff.

The study suggested little embracing of holistic views of health as outlined in accepted guidelines in health promotion, notably the Ottawa Charter — the fundamental principles and approaches for promoting health developed at the First International Conference on Health Promotion in Ottawa, Canada, in 1986. The Charter emphasises creating supportive environments and addressing the social and environmental preconditions necessary for healthy choices. It was the foundation for another set of guidelines specific to universities. The Health Promoting University (HPU) framework aims to transform university organisational systems according to health promotion principles prescribed in the Charter. It also promotes a holistic approach, recognising the need to consider connections and interactions between programmes and systems at individual, community, and business levels. Universities that adopt the HPU are encouraged to pursue health-promoting policies, laws, health services, and supportive environments through open and transparent consultative processes. Getting the balance right in a workplace health promotion programme is a big ask. Plus, as McDonald points out, ‘Paradoxically, as a complex and systemic product, health is a deeply personal and social experience.’

 Getting the balance right in a workplace health promotion programme is a big ask. 

McDonald and his team found that instead of trusting employees to govern their health and giving them a say in the health promotion activities offered, universities appeared to provide programmes their management teams determined to be effective. Employees were expected to maintain responsibility for their own health by participating in programmes provided by the university. This narrow view of agency was evident from the overemphasis on marketing health promotion activities such as body-mass index measurements and weight watchers to employees. Such initiatives were included in programmes that typically focused on disease management and nutrition and weight-management, rather than equally promoting physical activity. Encouraging staff to make responsible dietary decisions seemed to be a safer option than providing them with time and resources to participate in sporting activities. University employees are typically highly educated and self-driven workers. Yet, the findings suggest a potential lack of trust in employees to balance health and work commitments. Universities appeared to be preoccupied with the utilisation of programmes as opposed to their utility value for employees.

A consonance of care

So, did the universities achieve any measure of balance? This was a question McDonald and colleagues asked themselves. In essence, the study found that universities had not developed clearly established policies and practices to guide and support the implementation of health promotion programmes. The conditions required to implement successful programmes were overlooked, suggesting a need for more structured approaches to health promotion within university settings.

While universities are committed to education and research, they are not immune to the bottom-line pressures. Higher education is also a highly competitive business sector. As such, universities showed the influence of business concerns in adopting health promotion programmes, which seemed influenced more by risk and performance management objectives, focusing on business-related outcomes rather than solely on employee health.

There also seemed to be an over-reliance on commercially purchasable activities, such as counselling through employee assistance programmes, which suggested a focus on readily available solutions rather than comprehensive, tailored approaches to health promotion. It was also evident that university management teams made financially motivated health promotion decisions or allowed business objectives such as risk management to steer programme designs.

A holistic approach

However, McDonald and colleagues are pragmatic. Targeting diverse health concerns is highly complex, and satisfying multiple expectations, including business priorities and the realities of budgetary constraints, is an almost impossible task for universities. However, if they are serious about the health and mental wellbeing of their staff, universities need a comprehensive, holistic, health promotion policy based on evidence-based practices that is transparent and communicated to all employees. Any emerging programme should be steered by a needs assessment and tailored accordingly, have employee input, and include a mix of individual-level and organisational-level activities. Finally, universities should continually evaluate their health promotion programmes and make constant adjustments where necessary.

Health issues, risks, and activities (HIRA) framework

In a recent publication McDonald demonstrates the efficacy of the health issues, risks, and activities (HIRA) framework. Notably, the HIRA framework is effective in supporting organisations to target several United Nations Sustainability Goals, including good health (SDG 3), inclusive work outcomes (SDG 8), and equality (SDG 10). The framework can also be used to reinforce the importance of a collaborative approach to implementation that involves diverse stakeholders (SDG 17). McDonald adds, ‘The HIRA framework also provides employees, practitioners, researchers, and organisations, with a useful tool to analyse the extent and nature of wellbeing programmes.’

Employing a holistic approach to health through the HIRA framework, a university will show that it is effectively promoting the health and wellbeing of its employees, and – concerning the university’s staff and the health of its business – that it is getting the right balance.

Personal Response

What prompted you to investigate the health promoting practices of organisations?

My mother lost a battle with breast cancer in 2011 while in her early fifties. The loss prompted me to leave my career as a chartered accountant to research how organisations can improve employee health. Initially, my research focused on accounting for the cost of cancer to workplaces such as absenteeism and presenteeism costs attributable to patients and their informal carers (eg, employees). However, I quickly determined that organisations, particularly accountants, were sceptical about investing in any initiative to improve employee health without clear evidence of a return (eg, a benefit to the organisation). This observation changed my research scope in two ways: (1) broadened the focus from cancer to include all health concerns facing employees; and (2) challenged my hypothesis that people’s need for care was a universal value.Targeting diverse health concerns in the workplace is highly complex, but what component in health promotion programmes is unequivocal, and why?

Evidence-based activities have been scientifically proven to promote health and prevent illness. The use of evidence-based activities will help to ensure that workplace health promotion programmes are credible and likely to generate positive health outcomes for employees. However, as one of many programme components, it is important that evidence-based activites are not implemented at the neglect of other novel approaches to health promotion.

What advice would you give to organisations looking to implement the health issues, risks, and activities (HIRA) framework?

The HIRA framework is a tool that organisations can use to stocktake the health concerns that matter to employees and determine what activities to implement for health promotion programmes to succeed. The framework is also useful for conducting continuous, ex post, reviews of the health promotion activites implemented within an organisation.

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This post was previously published on RESEARCHOUTREACH.ORG under a Creative Commons License.

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