The Long Term Costs of Lifestyle Risks. Pathways to Change: A Case Study in the UK



BT has launched a number of initiatives targeting areas such as: reducing heart disease, smoking cessation, mental health, cancer prevention, improving diet and exercise.

Its most recent initiative was the “Cancer and You” campaign, with support from the charity Cancer Backup, which “helped people to understand the lifestyle choices that increase the risk of cancer and how to identify the early signs of illness”.

BT also takes stress management seriously and tries to combat the issue by providing employees with advice on working practices which will avoid stress, identifying signs of stress early and providing support to people with problems to recover. It also has an Employee Assistance Programme which is a confidential service available online and via a 24-hour helpline. (BT CSR Website, 2008)

Since 2003-04 BT has reduced the number of days lost to illness from 2.8% to 2.4% against the national average 3.1% (Norwich Union, 2008) and has reduced the number of OHS illness referrals from 140,000 in 2003 to 60,000 in 2008.

EDF energy

EDF energy’s Occupational health (OH) programme includes physiotherapy, ergonomics, clinical psychology, health data analysis and the prevention and treatment of musculoskeletal ailments. OH criteria have been incorporated into the company’s Health and Safety Standards.

EDF energy’s OH strategy is based around three key objectives: Reduction in incidence of work related ill health, reduction in days lost through work related ill health and improved employee health and wellbeing.

These objectives EDF have pursued by following advice provided by the OH team about job design, risk assessment and ways to work to avoid work stressors. These have led to initiatives in equipment and software testing, ‘Back to shape’ courses and stress awareness sessions. In addition in 2007 EDF launched an OH intranet page and the Chief Medical Officer and Chief Health and Safety Officer came together to run health and safety sessions for their ‘top 300 managers’ at the EDF Energy Executive Roadshow.

Further since 2007 improved OH reporting systems at branch level, new processes for recording work related absences and reviewing Workplace Rehabilitation Policy have been implemented.

EDF’s branch health awareness groups, including members of OH, HR, Health and Safety, Unions and management, provided the impetus for a strategy of coordinated health promotion initiative. These included Fit Clubs, Fruity Fridays, quit smoking courses, blood pressure and stress awareness weeks. Further, Improved communication between OH, Human Resources (HR), management and employees, combined with ‘fast track’ access to OH services has improved EDF’s treatment of physical and psychological illness.

A survey at their Worthing site found that 63% of workers found their access to onsite physiotherapy helped them avoid sickness absence while the number of employees absent due to mental health reasons fell from 28% in 2003 to 11% in 2007. Further, the number of employees off work when they accessed the psychological services of EDF fell from 11.6% in 2006 to 10% in 2007.

EDF measures the success of the strategy using the “Work Causal Ill Health Rate” calculated as “number of incidence per 1000 employees” and the results illustrate that by managing musculoskeletal and mental health risks the OH initiative has been a success.

GlaxoSmithKline (GSK)

GSK found that employees with psychological problems were likely to be absent from work 7.5 times longer than those suffering from physical illnesses. Consequently, though the number of absences due to psychological problems might be fewer than those due to physical problems the overall cost to the business is potentially much more. Therefore in order to promote productivity and growth GSK has developed its mental resilience strategy.

GSK describes maintaining the health of its workforce as the building block to protecting the health of GSK as an organisation and has an Employee Health Management (EHM) dedicated to doing so. The EHM focuses on the needs of individuals in the business and the teams that those individuals make up.

GSK settled upon a company understanding of resilience: “The ability to be successful personally and professionally, in the midst of a high pressured, fast paced and continually changing environment.” Based upon this definition the company offers a series of interventions.

All employees are offered a health and work-life assessment through their local sites that assesses individual health risks and identifies areas where an individual has a desire to make needed changes, e.g. smoking cessation. Further, team assessments and action planning session led by line management with EHM consultation. This involves team members collectively reviewing the combined results of their team’s resilience assessments (which are anonymous). Then, using accountability measures, the team discusses changes and improvements that address any issues identified, e.g. team relationships, management, and career. To ensure action is being taken around the objectives identified team update sessions are scheduled. On-site health professionals are also employed to deal with health issues that arise and to run sessions where needed. EHM coaches work with line management to ensure buy-in and ownership. Confidential 24 hour telephone support is available with additional counselling if required. The team programme is continually reviewed and is improved and customised to suit local needs. (IBLF, 2006)

GSK’s work on psychological problems works in tandem with its work on physiological problems. In 2001 GSK identified the need for its first Ergonomic Improvement Team at its Barnard Castle site to look at the increasing time lost due to musculoskeletal problems such as repetitive strain injury. The Ergonomic Improvement Team (EIT) was formed at the site and includes 13 different members from different departments there.

In the design of new equipment GSK considers ergonomics, conducting risk assessments and discomfort surveys and consults trained local ergonomic experts. The EIT has produced two ergonomics manuals for employees, an awareness training package and completed 80 improvement packages in a three year period (2002-04). (

The GSK team resilience programme is available in 12 languages and has been used in 41 countries by 21,161 employees. Since 2002, the programme has reduced work-related mental illness by 60% and decreased absence relating to mental illness by 20%. This has generated savings of £2.4 million and workforce surveys have shown a 10-15% reduction in fatigue and frustration as well as a 15% increase in self-esteem and job satisfaction (BitC, 2007).

The £20,000 cost of EIT was dwarfed by savings of £1.5 million over three years (European Agency for Safety and Health at Work).

GSK is targeting a reduction of musculoskeletal injuries by 5% per year through 2010 and their ergonomic improvement tool has been used by 25,000 employees at 172 sites worldwide since 2005.

Legal and General

Legal and General is the UK’s largest insurer. It covers 5.8 million people and is responsible for £304 billion in investments worldwide. Through its insurance products it has developed an effective system for preventing long-term unemployment from mental health problems.

The strategy consists of three key aspects: Early identification of problems, quick access to treatment and gradual reintegration into the workforce.

The company has brought in early notifications to ensure that employers become aware of the problems before they get too serious. Its clients send Legal and General an absence notification form as soon as they become aware of an absence related to psychological problems, within 48 hours they review it and if necessary request an independent nurse assessment and a member’s statement.

Once a problem is indentified employees are fast-tracked into cognitive behavioural therapies or other appropriate treatments, to ensure that they receive the help that they need quickly and to prevent further deterioration of their condition. These are privately sourced services as the treatment on the NHS generally results in too much of a delay.

In order to ensure optimal reintegration into the workplace if at all possible efforts are made to keep employees up to date while they are away. Efforts will also be made to reintegrate them quickly when they are fit to work, by ensuring flexibility on the employer’s part to tailor a position to their capabilities. This could involve them working reduced hours or in a different role for a period of time.

This scheme has resulted in 74% of people suffering from stress related problems getting back into the workforce in less than a year, allowing companies to minimise absence costs and private medical insurance (PMI) claims.

Nestlé UK

Nestlé UK has an employee wellness scheme that covers all of its 6,000 employees in the UK. These employees are predominantly involved in manufacturing across 11 UK sites. The company benefits from a very low turnover rate although this leads to problems with an ageing workforce, with 50% of employees over 45.

Employee wellness has been incorporated as a key part of the company’s human resources and occupational health strategy, and it benefits from the oversight of a committee including external leading experts in nutrition, chronic disease management, exercise and national union representation. There are also monthly briefings at Board level to report on achievements and next steps to ensure continuous alignment with business objectives. However, the real strength of the programme is the way it is delivered through volunteers at the local level, the site champions. These volunteers are well known within the factory environment and are responsible for tailoring the programme to individual work environments. These volunteers are supported by a network of occupational health professionals, nutritionists and rehabilitation experts.

The programme has four key strands: Nutrition, Exercise, Health screening, and Mental Resilience

A key part of the nutrition programme has been that of providing employees with training on the basics of nutrition to ensure that they are able to make healthy choices. Nutritional Quotient Training is a comprehensive nutrition training programme to equip their teams with key skills and knowledge on nutrition, and how to use this through their brands and communications. Nutrition training is not just a UK initiative but one that Nestlé is committed to globally. This has also been partly delivered through a series of road shows that have taken place around the company’s sites. It has been backed up by ensuring that healthy choices are available to all employees in staff canteens and vending machines. This has been achieved through working closely with caterers to provide healthy food as well as information on the nutritional merits of different food choices.

All employees are motivated to participate in exercise through the endorsement of the Global Corporate Challenge (GCC). The GCC runs annually. Participants take part in the challenge in teams of seven and input their daily step counts into the GCC website ( The website then converts these steps to distance and plots each team’s progress along their virtual journey around the world. The more active a team, the further they will progress along the journey and the more communities and countries they explore (using the power of Google Earth). Teams compete against others from other corporations at a global level, which increases the incentive to get involved and perform well.

Health screening is one of the newest elements to the programme. This has seen Nestlé working in collaboration with Nuffield Health to provide subsidised health assessments to its employees with Nestle paying half the costs every 2 years. These health assessments provide a thorough analysis of current wellbeing to give a comprehensive evaluation of the individual’s health. The cost is taken out of an employee’s salary over a period of 12 months.

Mental resilience is the final facet of this programme. Nestlé has effective systems for preventing and managing mental health difficulties. In order to prevent these it ensures that line managers are well trained to ensure effective communications and good working relationships with staff, which also ensures early identification of potential problems. If problems are identified employees have quick access to in-house rehabilitation. They are then supported back into the workforce.

The measurable benefits of the GCC have been: An estimated 90,000 employees worldwide will use a GCC pedometer and count their daily steps annually (with an aim of reaching 10,000 steps each a day). 13,438 average daily steps per employee (a 380% increase from step count pre-event) equates to 8.5km per day and burns 535 calories per day. 1.9 billion steps walked in total, which covers 1,249,234 km and great team performances with leading Nestlé team finishing third in the world and 22 Nestlé teams in the top 100. In 2008 22% of the workforce joined up, and the aim is for this figure to increase to 33% in 2009.

These measures led to a 50% reported weight loss, 67% of the workforce reporting increased energy, 71% reporting increased fitness, 39% reporting improved sleep as well as a 50% decrease in lift usage, a 66% increase in cycling and a 25% decrease in car usage.

By the end of 2009, they aim to have given over 600 Nestlé employees Nutritional Quotient training.

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