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Recently, several high-profile randomized clinical trials conducted with employees at the University of Illinois and BJ's Wholesale Club have questioned the value of workplace health and well-being programs. This commentary focuses on the latest research published in The Quarterly Journal of Economics by authors Jones, Molitor, and Reif who evaluated the iThrive wellness program. The commentary challenges the study's main finding that wellness programs (in general) do not work. Several perspectives are explored including whether the evaluated programs are well-designed, sufficiently potent, and appropriate candidates for randomized trials. The article also asks what role employers can or should play in improving the health and well-being of Americans given recent troubling statistics showing a decline in life expectancy and an increase in health risks.

Purpose. The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multi-component worksite health promotion programs. Search method. A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. Important findings. The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes. Major conclusions. The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.

The COVID-19 pandemic presents a unique opportunity to gain support from the business community for rebuilding a more effective and resilient public health infrastructure in the U.S. This commentary provides the rationale for more engaged business involvement in efforts to promote public health during the time of COVID-19. Drawing on the current pandemic, the commentary highlights the implications of a fragmented public health system for businesses and the nation at large, the shortcomings of which are apparent as never before.

Purpose: To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. Design: An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. Setting: United States. Participants: The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. Measures: Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. Analysis: After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. Results: Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. Conclusion: Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

Objective: To test the validity and reliability of the American Heart Association's (AHA) updated Workplace Health Achievement Index (WHAI). Methods: We piloted the updated WHAI with respondent pairs at 94 organizations, and examined the inter-rater reliability (percent agreement) for each item on the survey. To evaluate face and content validity, we conducted preliminary focus groups pre-survey, and follow-up cognitive interviews post-survey administration. Results: Respondents found the updated WHAI to be comprehensive and useful in identifying gaps and opportunities for improving their health and wellbeing programs. The mean percent agreement on all items was 73.1%. Only 9% (or 14 items out of 146) had poor inter-rater reliability (below 61 percent agreement), but through follow-up cognitive interviews we determined that most were due to artifacts of the study design or were resolved through minor revisions to the survey question, instructions, and/or adding examples for clarity. Only 1 question was deleted due to lack of relevance. Conclusion: The updated WHAI is a valid and reliable tool for employers to assess how well they promote the health and wellbeing of their employees.