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Cited by 46Workplace Health and Well-beingPhysical Activity and HealthOccupational Health and Safety in Workplaces

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Decades of workplace health promotion research: marginal gains or a bright future ahead?

Open access
Robroek, Suzan JW, Coenen, Pieter, Oude Hengel, Karen M·2021·Scandinavian Journal of Work, Environment & Health
DOI 10.5271/sjweh.3995PMC PMC9058620
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Abstract

The potential of workplace health promotion Unhealthy behaviors (eg, insufficient physical activity, an unhealthy diet, high alcohol intake and smoking) and obesity are risk factors for adverse health outcomes (1, 2), productivity loss due to presenteeism or sickness absence (3–6), and early exit from paid employment (7, 8). Poor health and unhealthy behaviors are more prevalent among workers from low socioeconomic positions (1, 2, 9), as are unemployment and work disability (10, 11). With a growing challenge in our societies to work longer, reflected in the increasing statutory retirement age in many European countries, an urgent need exists to enhance workers’ health to remain in paid employment. Given the profound socioeconomic inequalities in health behaviors, health, and participation in paid employment, this is particularly pressing among workers in lower socioeconomic positions. The workplace is a promising setting for health promotion as workers spend a lot of time at work, and existing social networks for social support could be used to change behavior and enhance health. In the past decades, numerous workplace health promotion programs have been offered and evaluated regarding their (cost-)effectiveness. Workplace health promotion programs could be a way to improve workers’ health and can for example include elements of support, policies, or environmental changes to encourage healthy behavior. Traditionally, programs have focused on providing workers with advice on how to change their behavior. Such programs have been criticized because they do not take a broader perspective such as the environment (eg, workplace structures and conditions) into account (12). However, still many of these traditional programs are offered to employees and evaluated. The effects of such programs remain disappointing thus far. A recent review of reviews reported only small favorable long-term effects of workplace health promotion programs targeting physical activity and diet to reduce workers’ body weight (13). This is in line with findings from recent individual participant data meta-analyses of Dutch workplace health promotion programs that showed small and statistically non-significant decreases in unhealthy behaviors and body mass index (14, 15). In this editorial, we reflect on the body of research regarding workplace health promotion. Gaps in the literature will be described, most notably regarding (i) the need for more targeted workplace health promotion, (ii) a systems approach for workplace health promotion, and (iii) the delivery of workplace health promotion. We will conclude this editorial with future directions for workplace health promotion research. Gaps in the workplace health promotion literature Targeted workplace health promotion A recent individual participant data meta-analysis showed that the effectiveness of workplace health promotion programs differed across target populations. Those programs focusing on indicated prevention (ie, on workers who are already at risk for unhealthy behavior, obesity or other health problems) were found to be more effective than universal prevention where a program is delivered to all workers within an organization (15). This is in contrast with the Geoffrey Rose paradigm, which implies that universal prevention, aimed at reducing the risk of an entire population, would be more effective from a public health perspective than interventions only targeting high-risk groups (16). However, as unhealthy behaviors and obesity are highly prevalent in the general population, the high-risk group consists of a large share of this population. It could therefore be argued that a targeted approach for workplace health promotion would be effective from a public health perspective as well. In line with this and in an attempt to reduce socioeconomic health inequalities, effective interventions targeting workers in low socioeconomic position are needed. There are no indications that workplace health promotion programs differ in their effectiveness when delivered to different socioeconomic groups (14–16). However, a recent review on workplace health promotion showed that researchers substantially more often conduct studies on workplace health promotion among workers from higher compared to lower socioeconomic groups (17). This is striking because, as mentioned above, there is a particular need among workers in low socioeconomic groups to improve their health and reduce sickness absence and presenteeism. Researchers need to be encouraged to reach out to this group, even though it might be challenging. A systems approach to workplace health promotion As universal behavioral prevention strategies on health behaviors or weight reduction in health promotion programs show little-to-no effect (13–15), it could be questioned whether and – if so – how workplace health promotion programs are justified. As unhealthy behaviors and obesity often coincide with pressing life struggles, including rela

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  • Work culture and systems fall outside the impact area of the WHP method.

    “Of course, these aspects fall outside the impact area of the WHP method [7].”

    From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [7]

    In “The potential of workplace health promotion” (page unavailable), the paper says traditional programs often overlook workplace structures and conditions. But it also says workplace health promotion can include policies and environmental changes, and “A systems approach to workplace health promotion” calls for addressing structural determinants. It therefore supports a limitation of traditional programs, not the categorical claim that work culture and systems fall outside the method’s impact area. (LLM, conf=0.86)

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  • General WHP programmes mostly do not meet expected outcomes, so new approaches are necessary.

    “Robroek et al. (2021) found that general WHP programmes mostly do not meet expected outcomes; thus, new approaches are necessary.”

    From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [7]

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Research works printed but not linked: 1

  1. [26]Nordic Association of Occupational Safety and Health. Scandinavian Journal of Work, Environment and Health Key terms. [Internet] Accessed 30 Sept 2021 Available from: https://www.sjweh.fi/index.php?page=show-keyterms&key=80&start=600

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Metadata

Authors
Robroek, S. J., Coenen, P., & Oude Hengel, K. M.
Affiliations
  • Erasmus MC (NL)
  • Amsterdam Public Health (NL)
ORCID
Venue
Scandinavian Journal of Work, Environment & Health
Publisher
Scandinavian Journal of Work, Environment and Health
Published
2021-10-16
Volume
47
Issue
8
Pages
561-564
ISSN
  • 0355-3140 (ISSN-L)
  • 1795-990X
DOI
10.5271/sjweh.3995
PMC
PMC9058620
OpenAlex
W3207281050
Cited by
46
References
26
Citations by year
2026: 2 · 2025: 9 · 2024: 13 · 2023: 14 · 2022: 8
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Scandinavian Journal of Work Environment & Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • TNO Repository (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Safety in Workplaces
Keywords
workplace health promotion, cost-effectiveness, socioeconomic inequalities in health, physical activity, diet, body mass index, smoking, alcohol consumption, work environment, systems approach, targeted interventions, program delivery, work disability, sick leave, presenteeism, retirement age, social support, work-life balance
MeSH terms
Health Promotion, Humans, Occupational Health, Workplace, Qualitative Research

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