1. Health Promotion
in
The Work Place
Models of Workplace Wellness
Yvonne Lewis.
Director Health Education Division

2. OBJECTIVESOBJECTIVES
To:
•Explore the concept of Health Promotion
•Explore the rationale for health promotion
•Examine the relevance of the health
promotion approach in the workplace setting

3. WHAT IS HEALTH PROMOTION?WHAT IS HEALTH PROMOTION?
Health Promotion is based on a concept of health
as not merely the absence of disease, but complete
mental, physical, social and spiritual well-being
(WHO)
Health promotion is an approach that ‘enables
people, (individually and collectively), to take
increase control over and improve their health’
(WHO, 1986)

4. Health as:
A resource for living working,
learning, loving, etc
( A resource which gives people the ability to manage
and change their surroundings)
A positive concept
emphasizing social and personal
skills and resources as well as physical capacities. (Physical
capacities does not encompass key social and personal resources of people including
relational, learning, coping capabilities)

5. Health is created and lived by
people within the settings of their
everyday lives; where they live,
learn, work, play and love

6. Health Promotion is often
operationalised in different settings.
• School
• Community
• Workplace
• Health
• Institutions
Health Promotion in the workplace setting is
called Workplace Health Promotion (WHP)
WORKPLACE HEALTH PROMOTION (WHP)WORKPLACE HEALTH PROMOTION (WHP)

7. The Workplace Health Promotion approach will:
1. Target organisation culture and practices. These will
include changes in the organisational form as well as in
the quality of co-operation between executives and
employees (internal and external customers), and will
include health promoting processes (health beneficial
and health damaging processes)
“A healthy workplace is one in which workers and
managers collaborate to use a continual improvement
process to protect and promote the health, safety and
well-being of all workers and the sustainability of the
workplace by considering the following, based on identified needs:
- health and safety concerns in the physical work environment;
-health, safety and well-being concerns in the psychosocial work
environment including organization of work and workplace culture;
-personal health resources in the workplace; and ways of participating
in the community to improve the health of workers, their families and
other members of the community(PAHO/WHO).”

8. WHY Workplace Health Promotion?WHY Workplace Health Promotion?
Health is created and lived by people within the settings of
their everyday lives; where they live, learn, work, play and
love ….. This includes the workplace
Health of the workplace impacts the health of employees
Health of employees impacts the health of the workplace
Workplace health promotion creates the potential to
combine productivity and health in the workplace

9. Some Approaches to Workplace
Health Promotion
WHP as a component of Occupational Health
and Safety: Reduction and elimination of
physical risk factors in the workplace.
WHP as behavioural prevention in the
workplace: Widely practiced approach with a
focus on health education and behaviour
directed prevention programs in the work
place
Promotion & Education, Vol VI 1999/3

10. Some Approaches to Workplace
Health Promotion
WHP as a component of organisational
development strategy: Modern management
concepts eg. TQM approaches, emphasize the
function of human resources in order to realise
economic aims. WHP creates the necessary
pre-conditions for optimal creativity of
employees and production by employees
Promotion & Education, Vol VI 1999/3

11. Other Approaches to promoting healthOther Approaches to promoting health
in workplace settingsin workplace settings
• Employee Assistance Program (EAP)
• Occupational Safety and Health (OSH)
• Onsite Health Centre/Nurse
• Gym and Wellness Centre
• Health Insurance
• Health Education
• Work-life Balance Support
• Health Fairs

12. Workplace Health PromotionWorkplace Health Promotion
PolicyPolicy
December 13th
,
Presented by: Yvonne Lewis
Director Health Education
Division
Ministry of Health

13. Health is:
 A resource for living (working, learning, loving, etc)
 A positive concept emphasizing social and personal
skills and resources as well as physical capacities
 Not merely the absence of disease, but complete
mental, physical, social and spiritual well-being
(WHO)
What is Health Promotion?What is Health Promotion?
Health promotion is an approach that ‘enables people,
(individually and collectively), to take increased control
over and improve their health’ (WHO, 1986)
Health Promotion is a strategic objective of the
Ministry of Health , and an essential public health function

14. What is Workplace Health Promotion?What is Workplace Health Promotion?
Health Promotion is often operationalised in
different settings;
 School
 Community
 Workplace
 Health
 Institutions
Health Promotion in the workplace setting is called
Workplace Health Promotion (WHP)

15. Why Workplace Health Promotion?Why Workplace Health Promotion?
 Health is created and lived by people within
the settings of their everyday lives; where they
live, learn, work, play and love ….. This
includes the workplace
 Health of the workplace impacts the health of
employees. Health of employees impacts the
health of the workplace – Is the workplace
supportive of workers achieving and
maintaining optimal well-being and

16. Why Workplace Health Promotion?Why Workplace Health Promotion?
 Workplace health promoton creates the potential
to combine productivity and health in the
workplace
• A healthy lifestyle reduces the risk of negative
effects on the body.
– It is a promotive factor which enables people to
achieve optimal well-being, a resource for life
– It is a protective factor against the development
of negative health effects like chronic diseases.

17. Why Workplace Health Promotion?Why Workplace Health Promotion?
– It can help persons with illnesses
manage their disease and achieve
optimal well-being
– Workplace health promotion is a
component of occupational health and
responds to the MOH OSH Policy
Part 1-B (m)
“Promote good health and be concerned
with the prevention of occupational and
non-occupational disorders and diseases
through health counseling and education”

18. Workplace Nutrition &Workplace Nutrition &
Physical Activity PolicyPhysical Activity Policy
ContextContext
ObjectivesObjectives
Policy GuidelinesPolicy Guidelines

19. Context cont.’Context cont.’
 Chronic Non-Communicable Diseases threaten both the
quality of life of individuals, the productivity of the
population and the economic viability of the nation.
 Over the last twenty years, chronic diseases (heart
disease, cerebro-vascular diseases, diabetes, cancer) have
been the top four leading causes of deaths in Trinidad
and Tobago. Together, they account for over 60% of all
deaths.

20. RankRank Cause of DeathCause of Death No.No. % of Total% of Total
DeathsDeaths
Rate perRate per
100,000100,000
1 Heart Diseases 2,425 23.8 189.1
2 Diabetes Mellitus 1,427 14.0 111.3
3 Malignant Neoplasms 1,324 13.0 103.2
4 Cerebrovascular Disease 1,022 10.0 79.7
5 Accidents & Injuries 835 8.2 65.1
6 Respiratory Diseases 587 5.8 45.8
7 AIDS / HIV Disease 410 4.0 32.0
8 Digestive System
Diseases
333 3.3 26.0
9 Perinatal Period
Conditions
286 2.8 22.3
10 Genitourinary
Diseases
243 2.4 18.9
Total All Causes 10,206 100
Fig 1: Deaths and Death Rates for the Ten Leading causes by Rank
and % of Total Deaths, T&T, 2003

21. • Actions on the modifiable risk
factors and determinants of
NCDs
– behavioral risk factors
– Biological determinants
– environmental determinants and
global influences.

22. RISK FACTORS AND DETERMINANTS OF
CNCDs
Modifiable
Behavioral Risk
Factors
Modifiable
Biological Risk
Factors
Environmental
Determinants
Global
Influences
Tobacco use
Unhealthy diet
Physical
inactivity
Alcohol abuse
Overweight &
obesity
High cholesterol
levels
High blood sugar
High blood
pressure
Political, Social,
Economic, and
conditions
Physical
Infrastructure
Education
Environment
Access to health
Services and
Essential medicines
Globalization
Urbanization
Technology
Migration

23. The Goal Of The Workplace Health PromotionThe Goal Of The Workplace Health Promotion
Policy IsPolicy Is
• To develop a comprehensive, integrated
set of actions which enhances the health
of public sector employees, by creating a
supportive social and physical
environment in the workplace which make
health promoting behaviours and choices
relating to healthy eating and physical
activity, easier choices and promote
primary prevention of chronic diseases by
impacting on these two risk factors.

24. ObjectivesObjectives
 To assist in the development of supportive workplace
environments and services which promote and enhance
the health and productivity of staff
 To build personal health skills of employees and support
them to adopt health promoting behaviours with
emphasis on healthy eating, physical activity and
smoking cessation
 To standardize guidelines for healthy eating at worksites

25. Policy GuidelinesPolicy Guidelines
Healthy Eating
Monitoring &
Evaluation
Physical Activity
Mechanisms to support
Implementation

26. Healthy Eating in the WorkplaceHealthy Eating in the Workplace
Policy Guidelines:
 Certified food handlers and food premise licensed
 No food for meetings shorter than two (2) hours or
meetings held after lunch, or after supper hours.
 Minimal amount of added fats and oils, low sodium
entrees, sauces and condiments
 Safe, potable water made availabe to workers close to
their work stations
Nutritious and safe food and beverage choices should be provided
at all meetings, workshops, and other functions
sponsored by Government Ministries, Statutory bodies and agencie

27. Physical Activity in the WorkplacePhysical Activity in the Workplace
The ministry/agency shall create an
enabling environment that promotes and
encourages employee participation in regular,
moderate physical activity

28. Physical Activity in the Workplace con’t…Physical Activity in the Workplace con’t…
 One or more active breaks shall be included in
meetings greater than two hours in length.
 Each Ministry shall develop workplace based physical
activity programmes including, ‘Take the Stairs’
campaign, walking/hiking clubs, and recreational
sports.
 Each Ministry/agency shall develop a workplace
wellness centre management
 Health education material on nutrition, physical
activity and health shall be provided for all staff on an
ongoing basis, and health education seminars and
workshops shall be conducted at least once per quarter

29. Prepared by Yvonne Lewis. Director Health Education Division, Ministry of Health.
Trinidad and Tobago. May 2012
Healthy
Lifestyle
Passport
Check
Yourself
… Know
your
Numbers

30. Blood Glucose Summary Profile:
Approximately thirty percent
(30.3%), had blood glucose
levels within the range of
120-179mg/dL
which is within the
acceptable range for
postprandial screens (CHRC
2011).
However, just over thirteen
percent (13.4%) had levels
≥180 mg/dl indicating high
risk of being either pre-
diabetic or diabetic.
(Results detailed in Fig 2)

31. 5%
27.97% 30.51%
33.05%
3%
No.ofpeople
B.M.ILevels
Total PercentageBMI Levels of both Malesand
Females
BothMale andFemale
Body Mass Index Summary
Profile:
Approximately twenty-eight
percent (27.97%) of the
individuals screened had a
healthy weight which was a B.M.I
within the range of 18.5 to 24.9
Five percent (5%) of the
individuals screened had B.M.I
Levels which were in the
underweight range of less than
18.5.
Approximately two thirds of staff,
(66.6%) were overweight or
obese, with BMI levels
above 25, as detailed in Fig 3.

33. The Cost of Chronic DiseaseThe Cost of Chronic Disease
is Mountingis Mounting
• In 2004 the public expenditure on drugs for the
treatment of cardiovascular disease, diabetes, cancer,
hypertension was 34 million TTD (USD 5.4 million).
In 2009, that figure has more than tripled to 121.8
million TTD or 19.3 million USD.
• Over a six year period (2004-2009), public
expenditure on drugs for treatment of the following
CNCDs: cardiovascular disease, diabetes, cancer,
hypertension, increased by over 250%.

34. The Cost of Chronic Disease isThe Cost of Chronic Disease is
MountingMounting
• Graph 1: Shows the Total Public Expenditure on
drugs for CNCDs (US$)
TOTAL PUBLIC EXPENDITURE ON DRUGS FOR CNCDS (US$$)
$5.4
$8.3
$9.2
$13.0
$17.7
$19.3
$0.0
$5.0
$10.0
$15.0
$20.0
$25.0
2004 2005 2006 2007 2008 2009
Years
USDollars

35. THANK YOU…THANK YOU…
Q & A

36. Some Major HealthSome Major Health
Issues Impacting theIssues Impacting the
Health of theHealth of the
Population in TrinidadPopulation in Trinidad
and Tobagoand Tobago

37. THE CHRONIC DISEASETHE CHRONIC DISEASE
CHALLENGE:CHALLENGE:
The five (5) leading causes of death in Trinidad andThe five (5) leading causes of death in Trinidad and
Tobagopercentage distribution, 2000 – 2006 (CentralTobagopercentage distribution, 2000 – 2006 (Central
Statistical Office)Statistical Office)
Rank 1980 1990 2000 2005
1 Heart disease Heart disease Heart disease Heart disease
2 Cerebrovascular
disease
Malignant
neoplasm
Malignant
neoplasm
Malignant
neoplasm
3 Malignant
neoplasm
Diabetes mellitus Diabetes
mellitus
Diabetes
mellitus
4 Respiratory
diseases
Cerebrovascular
disease
Cerebrovascular
disease
Accidents &
Injuries
5 Accidents/Injuri
es
Accidents&
Injuries
Accidents &
Injuries
Cerebrovascular
disease

38. THE CHRONIC DISEASETHE CHRONIC DISEASE
CHALLENGE:CHALLENGE:
The five (5) leading causes of death in Trinidad andThe five (5) leading causes of death in Trinidad and
Tobago percentage distribution, 2000 – 2006 (CentralTobago percentage distribution, 2000 – 2006 (Central
Statistical Office)Statistical Office)
Causes of Death 2000 2001 2002 2003 2004 2005 2006
Heart Disease 25.3 23.6 25.1 23.8 24.8 24.2 24.6
Malignant Neoplasms
(Cancers)
12.7 12.4 13.0 13.0 13.8 13.8 13.8
Diabetes 13.6 13.7 13.0 14.0 13.9 14.1 13.6
Cerebrovascular Disease
(Stroke)
10.1 10.0 10.4 10.0 9.6 9.1 9.0
Injuries and Accident 7.1 8.2 7.4 8.2 9.2 10.0 10.6

39. Trinidad and Tobago has one on the highestTrinidad and Tobago has one on the highest
mortality rates for Diabetes in the Caribbeanmortality rates for Diabetes in the Caribbean
PAHO Basic Health Indicators 2009
DM - diabetes; IHD – Heart disease; CVA - stroke
Adjusted Mortality Rates /100,000, Selected CARICOM countries
vs. Canada 2003 - 2005
0
20
40
60
80
100
120
140
160
Trinidad & Tobago Guyana Suriname Bahamas Canada
DM IHD CVA

40. From the Office of Yvonne Lewis.
Director Health Education Division
0
10
20
30
40
50
60Prevalence(%)
1970s 1980s 1990s
YEARS
Trends in Adult Overweight/Obesity
in the Caribbean
Male
Female

41. From the Office of Yvonne Lewis.
Director Health Education Division
Leading Causes of Death in CARICOM
Countries by Sex, 2004
1. Heart Disease
2. Cancers
3. Injuries and violence
4. Stroke
5. Diabetes
6. HIV/AIDS
7. Hypertension
8. Influenza/pneumonia
1. Heart Disease
2. Cancers
3. Diabetes
4. Stroke
5. Hypertension
6. HIV/AIDS
7. Influenza/pneumonia
8. Injuries and violence
MALES FEMALES
(Source: CAREC, based on country mortality reports)

42. The Top five Causes ofThe Top five Causes of
Mortality in Trinidad andMortality in Trinidad and
Tobago (2009)Tobago (2009)
• Cardiovascular disease (CVD)
• Cancer
• Diabetes
• Accidents and Injuries
• Cerbrovascular disease

43. The Chronic DiseaseThe Chronic Disease
ChallengeChallenge
• Heart disease is the #1 cause of death in Trinidad and
Tobago accounting for a quarter (25%) of all deaths.
• The diabetes prevalence rate is approximately 12%-13%
• Taken together, heart disease, cancer, diabetes and
cerebrovascular disease, account for over 60% of all
deaths

44. THE DECLARATION OF PORT OF SPAINTHE DECLARATION OF PORT OF SPAIN
CALLED FOR CRITICAL ACTIONS ON THECALLED FOR CRITICAL ACTIONS ON THE
RISK FACTORS OF CNCDsRISK FACTORS OF CNCDs
• Actions on the modifiable risk factors
and determinants of NCDs
– behavioral risk factors
– Biological determinants
– environmental determinants and global
influences.

45. Adoption of healthy lifestyles is not only dependent
on an individual’s choice… but on the capacity of
that person to make and implement that choice.
Behaviour and lifestyle are embedded in the social
and economic context in which people live.
Health promotion recognizes that the determinants
of health are varied. They go beyond lifestyles and
disease prevention and include peace, shelter,
education,food, income, equity, sustainable
resources.

46. HEALTH
PROMOTION
ACTION
CARIBBEAN CHARTER FOR HEALTHCARIBBEAN CHARTER FOR HEALTH
PROMOTION STRATEGIESPROMOTION STRATEGIES
REORIENTING
HEALTH
SERVICES
FORMULATING HEALTHY
PUBLIC POLICY
CREATING
SUPPORTIVE
ENVIRONMENT
S
EMPOWERING
COMMUNITIES TO
ACHIEVE WELLBEING
DEVELOPING AND
INCREASING
PERSONAL HEALTH
SKILLS
BUILDING ALLIANCES
WITH SPECIAL
EMPHASIS ON THE
MEDIA

47. Examples of:Examples of: Primary preventionPrimary prevention,,
Secondary preventionSecondary prevention, and, and Tertiary careTertiary care activitiesactivities
in a worksite setting.in a worksite setting.
Physical
exams
Health fair
Health
education
Fitness
activities
Health
screenings
Immunization
Safety
Precautions
Health risk
appraisal
Environmental
interventions
Case
management
Rehabilitation
Emergency responses
Source: Evaluating Worksite Health Promotion 2002, by David Chenoweth

48. Taken from Planning Health Promotion at the Worksite by D. Chenoweth, 1991, Dubique, IA: Brown and
Human Resources
Health Services
Medical Center
External Services
Psychological
Services
External Services
Referral
s Referrals
ReferralsReferrals
Referral
s
“Alcohol:
Everybody’s
Business”
Stress management
Referrals
Physical Fitness
Wellness Center
Weight control
Smoking Cessation
Nutrition
Evaluation
Referral
s
The Integrated Health Management Framework used at
the Adolph Coors Company

49. HEALTHFUL
WORKPLACE/HEALTHFUL
CORPORATE POLICIES
Short-term benefits
Improved well-being
Improved risk profile
JOHNSON & JOHNSON
EMPLOYEES
Slower increase in corporate
health benefit costs
Decrease in
absenteeism
Improved motivation, attitudes, and behaviour
Moderate risk reduction
Small decrease in health care
utilization
Improved corporate commitment
Long-term benefits
Improved corporate commitment
HEALTH RISK
APPRAISAL AND
LIFESTYLE EDUCATION
OTHER HEALTH PROMOTION
PROGRAMMING
The LIVE FOR LIFE Conceptualization of Program Effects
Taken from Worksite Health Promotion by Dr. David Chenoweth, 1998

50. Note. From “Control Data’s Staywell Program: A Health Cost Management Strategy” by W.S. Jose and D.R. Anderson
Perspectives in Behavioural Medicine: Health at Work by S.M. Weiss, J.E. Fielding, and A. Baum (Eds.), 1991
HEALTH PROGRAM
COMPONENTS
SUPPORTIVE
ENVIRONMENT
•WORK
•HOME
PROGRAM
PROMOTION
LOWER
RISK
FACTOR
S
LOWER
MORBIDITY
AND
MORTALIT
Y
BEHAVIOUR
CHANGE
HEALTH
KNOWLEDGE
ACQUISITIO
N
EMPLOYEE
BENEFITS:
• Reduced personal
health costs
• Improved quality of
life
• More energy and
vitality
HEALTH
ATTITUDE
CHANGE
HEALTH
SKILLS
ACQUISITIO
N
EMPLOYER
BENEFITS:
• Reduced health care
costs
• Reduced disability
costs
• Reduced absenteeism
• Reduced turnover
• Increases productivity
The Staywell process model

51. RISK FACTORS ANDRISK FACTORS AND
DETERMINANTS OF CNCDsDETERMINANTS OF CNCDs
Modifiable
Behavioral Risk
Factors
Modifiable
Biological Risk
Factors
Environmental
Determinants
Global
Influences
Tobacco use
Unhealthy diet
Physical
inactivity
Alcohol abuse
Overweight &
obesity
High cholesterol
levels
High blood sugar
High blood
pressure
Political, Social,
Economic, and
conditions
Physical
Infrastructure
Education
Environment
Access to health
Services and
Essential medicines
Globalization
Urbanization
Technology
Migration