Question

It is widely accepted that spending money to promote healthy lifestyles and prevent health problems makes good economic sense.  Epidemiologists often measure if the money spent implementing a health promotion program is economically worth the outcomes – i.e. – is it cost-beneficial (does it save money)?  This analysis, called a CBA, is often reported as ROI – Return on Investment.

Create a hypothetical intervention program that you believe would result in a positive ROI in a workplace, school, community organization, or clinical setting.  Project your expected costs (investment) of the program (you may keep it brief – use 3-5 line items that you think might be reasonable and expected costs of implementing your program).  Then project the savings (benefits) of your investment (again hypothetically create a cost-saving using 2-3 line items).  Show your work using the ROI equation.  Do you think your program would result in a ROI greater than one?  Why did you select this particular health promotion program?

Answer 1

Organizations depend on their employees to deliver their mission, vision, products, and services to drive overall success. Creating a healthy and safe work-place, one that protects both the physical and mental health of employees, is essential to achieving business objectives and shareholder returns. Clearly, investment in a mentally healthy workforce is required.

THE BUSINESS COSTS of poor mental health
in the workplace are staggering, with 30 of every 1,000 Canadian employees missing work for mental health reasons each week. In total, the loss of productivity at work due to mental illness–related absenteeism and presenteeism (working while unwell) adds up to CA$6.3 billion annually across Canada. Costs associated with
poor mental health include not just the cost of treating mental illness (for example, therapy and medications) but also the costs incurred when—as often occurs—poor mental health exacerbates the negative impacts and health care costs of other chronic illnesses, such as cardiovascular disease and asthma.

Mental health issues lead to both direct and indirect economic costs
Direct costs
• Health care costs, including psychological care benefits
and drug costs
• Income support, including short- and long-term disability
claims

Indirect costs
• Absenteeism
• Presenteeism (i.e., attending work while unwell but
with reduced productivity)
• Employee turnover

Mental Health Commission of Canada, Making the case for investing in mental health in Canada, 2012.
The World Health Organization estimates that poor
mental health costs the global economy US$1 tril-
lion annually in lost productivity. In Canada, the
estimated economic cost is at least CA$50 billion
per year, with direct costs related to health care,
social services, and income support making up the
largest proportion (figure 2). An additional CA$6.3
billion of indirect costs stems from lost productiv-
ity, with 500,000 Canadians unable to work each
week due to mental health problems or illnesses.

Business investment in health in the twenty-first century has become increasingly common as the private sector seeks to improve the health of their employees as part of their corporate citizenship efforts, find new business opportunities, and ultimately improve their return on investment (ROI) both socially and financially. Health and wellness programs, run by businesses or offered through employee insurance plans, are now standard at large businesses and are gaining traction among small and medium-size enterprises (SMEs). As businesses acknowledge the importance of health in the workplace, they have also begun to recognize the relationship between their employees’ health and the communities where their employees (and their families) and customers live. At the end of the workday, employees and customers still return home to communities that may be food deserts, have poor infrastructure, or have limited access to good-quality health care. Improving community health—long considered solely the responsibility of the public sector—is gradually being embraced by the private sector [11].

To gain more insight into businesses’ relationship to community health, the US Chamber of Commerce Foundation Corporate Citizenship Center (USCCF) partnered with the Action Collaborative on Business Engagement in Building Healthy Communities (the Collaborative). The Collaborative is a convening activity of the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement composed of private, public, and nonprofit sector parties that endeavor to improve health in US communities. This paper is part of the Collaborative’s effort to promote business engagement in strategies for improving community health with a focus on the health and economic well-being of businesses, workers, and communities.

Typically, community-based public health-related programs have been tied to healthy behaviors and clinical care. In recent years, however, public health practitioners have taken a more expansive view of community health, its effect, and the stakeholders involved in improving it. As defined, community health refers to the health status of a specific group of people, or community, and the actions and conditions that protect and improve the health of the community. Those individuals who make up a community live in a somewhat localized area under the same general regulations, norms, values, and organizations [12].

A framework for understanding the different factors and potential opportunities for interventions that influence population health is offered by the Robert Wood Johnson Foundation’s County Health Rankings & Roadmap (CHRR) (see Figure 1). This framework provides a useful graphic representation of the factors that contribute to health outcomes.

Most workplace wellness programs are structured to address improvement in healthful behaviors and clinical care without including external socioeconomic and environmental interventions (e.g., access to green spaces, active transportation, healthy housing, and nutritious foods) that also influence employee health [13]. Given the sheer amount of time that people spend outside of the workplace, work-site-based wellness programs offer only a partial solution to a complex problem centered in a company’s home community. For example, some major industries, such as retail and manufacturing, are more likely to be in counties with poor health, emphasizing the need to confront health issues outside the workplace [14].

However, there are businesses investing in community health. Researchers with the Health Enhancement Research Organization (HERO) cited several reasons for doing so:

• Enhanced reputation in the community as good corporate citizens
• Cost savings that would increase over time
• Job satisfaction
• Healthier, happier, and more productive employees
• Healthy, vibrant communities that draw new talent and retain current staff
• Compliance with regulations
• Enhanced consumer health