Health and wellness in the workplace: A UK perspective
1. Health and wellness
in the workplace
A UK perspective on the key health and wellness issues
Risk. Reinsurance. Human Resources.
Aon Employee Benefits
2. Health and wellness in the workplace
A UK perspective on the key health and wellness issues
Improving health and preventing disease is a key issue for policymakers
across Europe, whether this is at the UK Government level, driven by
European Union initiatives, by non-Government bodies, such as the World
Health Organisation or a combination of all of these. The burden of chronic
disease is rising at a significant rate globally and this combined with an
ageing population means healthcare expenditure is unsustainable.
The changing
workforce
Employee
health
Analytics
The future
of health
3. Employers will have an increasingly crucial role to play as chronic disease is
highly prevalent and is increasingly shifting to younger-age workers. With
this change, the economics of early onset of chronic disease increases not
only through healthcare costs but is further evidenced through illness-related
absence and productivity losses.
However, with challenges comes opportunity. Aon is investing millions of
dollars in developing health analytics that provide meaningful insights into an
employer’s people risks, insights that give a sound base from which to drive
future health strategy.
In addition to these insights, advances in digital technology means that the
opportunity for employers to engage with more individuals to try and influence
healthy behaviours has never been greater. Ensuring this engagement is lasting
and meaningful will be vital as the workplace should be a key environment to
focus on health promotion and disease prevention, taking advantage of the
access to employees and directing interventions at desired healthy behaviours to
change the long-term impact of poor health.
Furthermore, the role of the individual employee, or consumer of health,
is evolving as they have changing expectations regarding the role of a
‘progressive’ employer and requirements in terms of how they access treatment,
services and wellness tools.
Supported by Aon, using this combination of meaningful data analytics,
enhancements in digital health technology and changing individual needs and
expectations, many leading employers are increasingly integrating health into
their core business strategies. This is in recognition of the strong relationship
between employee wellbeing, a more fully engaged workforce, and improved
business results. For many other employers the time to properly embrace the
world of employee health and wellness is now.
The purpose of this paper is to provide an overview of the key issues we believe
employers across the UK will have to consider over the short and medium term.
November 2015
4. The changing workforce
The nature of the workforce is changing. If we accept that there could be up to
five generations of employee in the workplace then employers will need to give
some serious consideration to their employee health strategy.
Whilst there is a strong argument that age is just a number, and that in the
benefits space segmenting employee requirements by age could be viewed as
rather simplistic, this is not necessarily true with employee health strategy. There
is a correlation between an individual ageing and being a comparatively worse
health risk, a risk which is set to become an increasingly important factor if the
chart opposite projecting the future ageing trends across the EU28* proves to
be correct.
This evolving demographic will undoubtedly impact employers as ‘older’
employees will remain in the workplace for longer, particularly as in the UK the
concept of a normal retirement has all but disappeared. However, this challenge
is also an opportunity, an opportunity for employers to shift the emphasis from
potentially managing the consequences of poor health in the workplace to
focus more on health promotion and disease prevention that can prevent or at
least delay the onset of many chronic diseases. Understanding how an effective
health promotion and prevention strategy can be best implemented across a
diverse workforce will need some thought. Crucially the employer will need to
understand what their data is telling them about current health risks and how
best to engage effectively with their employees. The benefits of getting this
right, whether it is through higher productivity or reduced absence related
costs, should make this a valuable exercise.
Future population ageing trends in the EU
*EU28 – European Union 28 member states
Multi-generational workforce
5. Population health is a key focus for the European Union and reports like
offer a useful snapshot of health across the
region. Many of these insights are relevant to employers as they are reflective
of the employee health risk challenges they will face. Produced jointly by the
Organisation for Economic Co-operation & Development (OECD) and the
European Commission (EC) the report covers a number of different areas
including life expectancy, mortality causes, health expenditure and health
determinants. Some of the key headlines are:
In addition to looking at life expectancy in isolation the EU also measure Healthy
Life Years (or disability-free life expectancy). Whilst mortality rates might be
improving this trend is not the same when it comes to Healthy Life Years, and it
is noticeable that the gap between female and male healthy life years is minimal
unlike the gap in overall life expectancy – as detailed in the tables right.
1
Health at a Glance: Europe 2014 report http://ec.europa.eu/health/reports/european/health_glance_2014_en.htm F
The report outlines that the average life expectancy at birth in EU
member states has increased to 79.6 years (81.1 years in the UK), with
average female life expectancy being 82.3 years (82.9 years in the UK)
compared to 76.7 years for a male (79.2 years in the UK)
53% of the population are either overweight or obese
Of the mortality causes cardiovascular related diseases account for 40%
of the deaths and cancer 26%1
Healthy life years
‘Health at a Glance: Europe 2014’
Healthy life years at birth - men, from 2004 onwards, time series of 9 years
Health status indicators - males Health status indicators - females
6. People are living longer and as there is a move towards employees potentially
working longer, in 2014 10% of over 65s were in work compared to 5.5% in
19922
, then maximising the amount of time they are healthy and productive
becomes critical. Employers can play a key role in positively influencing some of
the key behavioural and lifestyle risks that are the root cause of long-term illness,
including poor diet, lack of exercise, a lack of screening, smoking and excessive
alcohol, which in turn result in many chronic illnesses, such as obesity, diabetes,
cancer, depression and coronary artery disease.
Spending that only targets benefits, services and treatments to manage
these medical conditions when they occur will not in itself address this issue.
Employers do not have unlimited budgets and Government spending on health
in the UK is unlikely to keep up with the costs of medical developments and new
technologies. There has to be a change in approach in order to achieve
a sustainable outcome, protecting health and not just treating ill health.
2
ONS labour market data
7. One of the main tactics used by employers as part of their employee wellbeing
approach is to offer flexible working. Indeed, based upon the Aon Employee
Benefits 2015 Benefits and Trends Survey more than 50% of employers adopt
this approach.
Whilst adopting a flexible working approach will be viewed by many in a positive
light, employers do need to be careful that such an approach does not have the
opposite effect to that intended. Employees need a break from the workplace,
to re-charge and enjoy non-work related activities. The inability to do this could
ultimately leave employees feeling less engaged and risk damaging either their
physical or mental health, or both. The rise of the employee who is in effect
always working, or at least is always available to be contacted about work,
needs to be monitored closely.
The 24/7 employee
8. Whilst mortality rates are on average improving, as we have seen in the
Healthy Life Yearssection this does not necessarily mean individuals are living
longer in good health. Preventable, long-term diseases represent a significant
risk to employers and this will remain the case unless lifestyle risks and behav-
iours, such as poor diet, smoking, physical inactivity and excessive alcohol con-
sumption are addressed.
Indeed, if we accept that there are 8 risks and behaviours that result in 15
chronic medical conditions, and that these account for 80% of the total costs
for all chronic illnesses worldwide3
, then the business case for improving this
position is clear. The UK Government will not be in the position to continue
to increase healthcare spending at the level required in order to deal with
these illnesses or provide the breadth of services required via the NHS. The
responsibility for this will fall increasingly to employers and in many cases onto
the individual.
From an employer perspective the challenges associated with employee health
are well documented, including:
Employee health
These challenges mean employers are faced with a choice, the first option would
be to maintain the status quo, accept their employee health risks for what they
are, and use traditional reactive methods to manage spend, such as broking or
rationalising benefit provision.
Alternatively, employers have never been more empowered to build on the
traditional approach. There is a real opportunity to use the data available to
understand what the health risk position is now, what the future might look like,
how data can be segmented to target ‘at risk’ employee demographics, adopt a
truly integrated approach with insurers and service providers and achieve better
terms from the markets because, by working with Aon, together we are able to
demonstrate a real understanding of the risks and outline the strategies in place
to mitigate them.
We are seeing an increase in employers moving into this proactive space.
Shifting the focus away from managing medical conditions, moving towards
a more sustainable and preventable approach, helping employees and their
families to engage better with their health and improve their lifestyle risks.
Health & behaviour risks
Increasing benefit spend
Reduced productivity
Increasing absence related costs
Providing benefits and health support that meets the needs of an
increasingly diverse employee population
Addressing the impact of chronic medical conditions
Getting recognition for the Employee Value Proposition
Having a real understanding of what the actual employee health risks are 3
World Economic Forum – The New Discipline of Workplace Wellness: Enhancing Corporate Performance By
Tackling Chronic Disease
Healthy life years
9. As part of Aon’s 2015 Global Medical Trend Survey we asked questions around
the types of health and wellness initiatives currently being implemented by
employers as they look to manage costs and improve their people risk
position. Completed on a regional basis the figures relating to Europe are
outlined in the table below.
Based on these results the opportunity for many employers across
Europe to do more is apparent. An opportunity that should be
taken as workplace wellness initiatives should result in improved
employee health, which in turn should lead to better employee
engagement, retention, productivity and reduce
health related costs4
.
Wellness and health promotion initiatives
4
Aon Hewitt 2015 Global Medical Trend Rate Survey Report
5
Journal of Occupational and Environmental Medicine, 2013 55:1
Progressive employers are defined as employers of choice in each territory
i.e. known in each country to be successful in attracting and retaining
top talent.5
4
Journal of Occupational and Environmental Medicine, 2013 55:1
5
Aon Hewitt 2015 Global Medical Trend Rate Survey Report
10. As outlined previously, employers who have a strong and meaningful focus
on employee health and wellbeing are still likely to stand out as employers of
choice. Indeed, based on Aon’s employee engagement research, we know that
employees with a strong wellbeing are six times more likely to be engaged at
work, with engaged employees generally being healthier, as evidenced below:
However, it is important that employers view health and wellbeing in the
broadest possible context. The link between financial, physical and mental
wellbeing is widely acknowledged and therefore the evolution for more forward
thinking employers is to join up their approach in this area. In the same way
we are seeing a shift towards more employers, and to an extent employees,
making an effort to understand their health risks, the move towards supporting
employees to understand their current and future financial health makes sense.
After all, employees who are distracted by money related issues are less likely to
be productive in the workplace and arguably also suffer poorer health as a result.
A truly effective wellbeing model will be one that engages employees
to understand ‘current me’ and help them plan for what ‘future me’
looks like and needs to do, in terms of financial, physical and mental
health. This should be the aspiration for all employers. Having
effective flexible working practices, making health information and
education (physical and financial) available, offering access to stress
reduction programmes, weight management programmes and
access to onsite or virtual GP services, are all examples of good
practices supporting a wide-ranging approach.
The link between financial, physical and mental health
46% fewer unhealthy days as a result of physical or mental illness
39% less likely to be diagnosed with new disease in the next year
43% less likely to be newly diagnosed with anxiety and depression6
6
Aon Hewitt Engagement Survey
11. Employers who are successful in motivating employees to engage in employee
health over the long term will be those that have a clear and effective
communication strategy. The key is to implement communications that reach
target audiences effectively and at the right time, that educate, motivate
and inspire without being overwhelming. There would appear to be a great
opportunity to move away from the current methods typically used by around
80% of employers to communicate with and educate employees around health
and wellness, namely printed and email communications7
.
To get employees to engage and potentially change behaviours will involve a
number of key steps:
By combining the fact based “what” approach with the behavioural insights
“why” approach Aon is able to work with employers to achieve the best possible
outcomes.
The improved communication strategy that results from our work in this area will
increase the likelihood that an employer’s workforce recognises the value of the
health and wellbeing programme they have access to, and also make them more
likely to actively participate.
Effective communication and influencing behaviour
7
Aon Employee Benefits: Benefits and Trends Survey 2015
Understanding the “what” – Understanding the current state of an
employer’s employee health ensures there is a baseline to work from. By
completing a full data analysis this allows us to start developing potential
options to target different demographics to begin the process of education
around the types of health risks they might be exposed to
Understanding the “why” – Building on the “what”, the “why” allows
us to leverage our insight and experience with employees’ attitudes,
perceptions, values and preferences to develop a more tailored approach
to securing true engagement in the employer’s benefits and health and
wellness offerings and help achieve mind-set shifts and behaviour
changes
13. Analytics
There are a number of employee health related challenges facing employers
today. However, based on our experience the key challenges include:
As a result, employers are demanding that Aon supports them using a data-
driven, analytical approach to advise on every key health and wellbeing decision
they make, often both at the employer and employee level.
To respond to this demand Aon has established the Aon Centre for Innovation
and Analytics in Singapore, which has a dedicated Research and Development
team primarily focused on developing new financial tools and models. This
means that the Innovation Centre, together with local country know how, have
been able to build best in class analytical insights and capabilities that can
be harnessed locally, regionally, and globally depending on each individual
employer’s requirements and in line with the evolution of their employee health
strategy.
Aon’s solution areas include but are not limited to: risk and health profiling,
claims analytics and benchmarking, absence, financial analysis and health
improvement.
Insights to support better understanding of people risks
Understanding – what can an employer do to better understand the
health risks of their employees? This includes health risks now but also
potentially the health risks of tomorrow, if such data is available
Cost – generally an employer’s health related costs are increasing,
whether this is the cost of claims under benefit programmes or the costs
associated with absence and strategies for managing this constructively.
By constructively this means without worsening terms wherever possible
Engagement – employers spend lots of money on health related benefits
and services, the nature of their workforce is changing and therefore
engaging them effectively around the Employee Value Proposition is a
requirement
Data – there is lots of talk around the power of data and employers are
aware that they have access to lots of different data sets. Consequently
they are looking to use this information better to build a business case for
future activity
14. Joining together all of the facets of healthcare, such as; absence, productivity,
health benefits, health management and wellbeing, delivers tangible advantages
for both employers and employees. Understanding the root causes of poor
employee health, making improvements to this, and having a truly integrated
approach should be an employer’s objective. Experience suggests that taking a
piecemeal approach often delivers less benefit for the business than might be
expected.
Rather than looking at any single element of an employer’s health management
approach, our methodology is flexible enough to complete a comprehensive
health risk profile.
By auditing the available information from an employer’s entire suite of benefits
we are able to:
Whether an organisation’s focus is on the cost of absence and lost productivity,
the increasing cost of benefit programmes, or both, working with us ensures
employers are well equipped to tackle the challenges ahead.
Data driven strategies
Analyse and quantify absence data and health data, monitor trends in
pricing and benchmark performance
Calculate the total cost of health and project future premium spend
Implement integrated strategies and provide access to key activities, tools
and services that will help drive down the employer’s total cost of health
and future premium spend
Segment the data and implement a targeted employee communication
strategy to raise awareness, increase the likelihood of better employee
engagement and improve productivity
Demonstrate best practice protocols to the insurance markets and use
this information to achieve the best possible pricing terms
Implement a framework for strong governance reporting
15. A recent Aon survey found that just over 60% of employers want to understand
the health risks impacting their business and that nearly 75% of employers
believe it is their responsibility to support employees change their negative
lifestyle behaviours and positively influence their health8
. We believe that our
data analytics approach enables us to inform the employer about the overall
health of their employee population. Having this employer level understanding
means that informed and targeted decisions can be made around the provision
of benefits and health related services going forward.
In addition to any benefit or wellbeing programme developments, a tailored
programme should also include the development of an effective communication
strategy, which should ideally have wide-ranging objectives. These include, but
are not necessarily limited to the following examples:
Tailored programmes based on need
Linked with achieving better recognition for the Employee Value
Proposition any communications should serve to raise awareness as
to the value and importance of any health and wellbeing strategies or
programmes in place.
Effective segmentation of employee demographic, whether this be age,
gender, business division or location, will mean employers have the
facility to educate different groups of employees on the types of health
risks and lifestyle issues they are likely to be faced with and point them
towards the valuable benefits, services and awareness resources available
in order to try and mitigate these risks.
Engage employees to the extent that rather than be a top down
communications approach it is clearly understood what they need to do
in order to change their behaviours, and if possible change their current
mind set.
Reaching the widest possible audience and therefore tailoring the
approach based on how the employee engages or interacts with the
employer in relation to health and wellness services or benefits.
8
Aon Employee Benefits: Benefits and Trends Survey 2015
16. Managing cost
For the first time in a number of years the UK health and risk market is witnessing
a hardening of pricing across all key insurance lines9
. Challenging economic and
market conditions mean that in order to effectively manage cost employers need
to be able to better demonstrate an understanding of their people risks and that
they have robust strategies in place to improve these risks.
Effective broking will help mitigate the impact of price pressures to some
degree. However, in order to achieve longer-term sustainable and competitive
pricing getting to the root cause of poor employee health is fundamental.
Once employers are in the ‘understanding and action’ phase not only would it
be reasonable to expect that the health risk situation will improve steadily over
time but crucially it means that the whole dynamic around broking interaction
with insurers shifts significantly. Underwriters are much more willing to price
a risk more competitively when they have a better understanding and more
certainty. Presenting risks in this format will ensure employers will be able to
procure their benefits and achieve the best possible price.
9
Aon Broking Report 2015
17. The future of health
In the future it is not unreasonable to assert that employees will be expecting
their employer to provide support in the following areas:
This Avoid Care, Need Care, Support Care ‘Health Experience Cycle’ illustrated
below is the approach advocated by Aon when discussing the future of health
with employers.
We expect to see a continued interest in wellness programmes as employers look
to address the problems caused by many employees’ sedentary lifestyles and the
shift in demographics. Many of these programmes will be supported by better
and more precise measurement, with greater use of effective communication
strategies to increase participation. Technology enabled connectivity for the
masses will become the norm.
Furthermore, increasingly the impact of socio-economics will become a factor
as employers make the link between an employee’s financial wellbeing and their
physical and mental wellbeing.
Access to relevant health benefits and services will be driven by better
engagement with employee focus groups and the desire to give individual
employees more choice. A benefits programme will need to adapt and recognise
that an increasingly diverse workforce will have different health requirements
depending on where they are in their employee lifecycle.
With regards to the support around managing health conditions and providing
access to the best treatment, the future could be characterised by a more
fragmented delivery system. A system of working with benefits and service
providers based on their capability to deliver the most effective treatments for
specific medical conditions. The delivery of these services will increasingly shift
from the conventional face to face model to more remote methods. We are
starting to witness this already with tele-medicine and second opinion services.
The future state will see employers increasingly engage with these models as
they strive to help employees with often complex health conditions navigate
the health system better to get the right care from the right provider at the right
time.
For the employer
Helping them to be healthy and stay healthy
Giving them access to relevant health benefits and services
Helping them to manage health conditions when they arise and access the
best treatment quickly
Health Experience Cycle
18. If it is accepted that health and wellbeing is changing both in terms of provision
and delivery, for example, due to changes in the nature and needs of the
workforce, due to technological advances and due to the fact that employers
have never been a better place to get impactful insights into the health of their
employee population, then the role and expectations placed on the individual
employee will also change.
As a minimum, in the new era employees will expect to have access to the best
possible protection benefits, access to support to help them get and remain
healthy and structures in place to help them navigate the healthcare system as
effectively as possible when they are not healthy, accessing the best possible
treatment.
Increasingly, employees are becoming consumers of health and are front and
central to the developments continuing to happen. One clear example of this
being the number of employees using wearable technology and engaging with
various health and fitness related platforms, and whilst much of this is currently
focussed on recording physical activity or measuring things like sleep patterns
the whole landscape is shifting.
As the health and wellness related technology revolution continues many
employees will expect their employers to adapt their health and wellbeing
strategies accordingly. Accessing consultations, treatments, information or
second opinions remotely will become a core requirement for such individuals,
both from a personal health perspective or to support them in work, for example
with family friendly policies.
Some individuals will embrace technology or tests that support health
predictions, potentially to the extent of diagnosis prior to the medical event
actually happening. However, some, or all, of these developments will not
appeal to all employees, possibly due to concerns around data privacy or
general concerns around the role of the employer in this process. This could
be linked and reflect the nature of the workforce (as discussed in the multi-
generational workforce section). The needs and expectations of employees will
change either incrementally or more rapidly.
If the role of the employee is to engage more in health and wellness, then in
return the employer needs to recognise the needs of those employees and
support the broadest possible engagement. Success is very much dependant on
strong employer and employee interaction.
For the employee
19. Focus on preventing bad health wherever possible, on health information
and allowing more choice around how best to access health services when
required, all underpinned by advances in technology, will characterise the
future landscape. From the larger organisations, such as IBM, Apple and Google,
through to start-up ventures, significant investment in health appears set to
continue and overall this should generally be viewed in a positive light.
As we have already seen in this paper, employers are at the sharp end in terms
of trying to prevent and ultimately support a workforce where chronic medical
conditions, such as obesity, cancer, diabetes and heart disease, are prevalent.
Technological advances that help employees avoid the need for care but can
also assist them when they need medical treatment or support will result in
changes to the health and wellness delivery models employers utilise. The
provision of preventative services, diagnostics, treatments and support will
increasingly become fragmented; the one-stop shop approach to health and
wellness will be a thing of the past for many.
When one considers that developments in digital diagnostic tools, digital
platforms to connect all relevant stakeholders in the health chain i.e. patients,
carers and medical professionals, next generation wearables, concierge services
or online support networks for coaching individuals with different needs, the
opportunities to re-think the traditional model of health and wellness appears
limitless. Furthermore, the fact that technology is not restricted (generally) by
geographical boundaries will further appeal to many employers as they look to
implement a consistent health and wellbeing framework regionally or globally,
albeit tailored accordingly based on local needs. From an employee perspective,
the fact that much of this technology will be portable will also be viewed in a
positive light, a bespoke health and wellbeing approach that they can potentially
plug and play should they decide to change employer.
The challenge for employers is to ensure that they are not left as bystanders
in this whole process. Technology will continue to evolve, employers need to
ensure that if they are serious about employee health and wellness they give
themselves the best possible chance to take advantage of the opportunities they
have access to.
With technology
