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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.

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.

Purpose: We investigated the relationship between companies' efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance. Design: We administered 2 surveys, which measure companies' programs, policies, and supports for improving the health of their employees and communities. We then compared the companies' stock performance to the Standard and Poor's (S&P) 500 Index from January 2013 through August 2017. Setting: United States. Participants: Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT. Measures: Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources. Analysis: We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COH-EXT companies. We examined total returns for each portfolio compared to the S&P 500. Results: High COH-INT companies' stock price appreciated by 115% compared to the S&P benchmark (+69%), while low COH-INT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (+44%) when compared to the S&P 500 (+69%) and low COH-EXT companies (+89%). Conclusion: This study supports the view that employers' efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.

Purpose. This study tested a repeated-measures application of the Leading by Example (LBE) questionnaire, a self-report instrument measuring organizational leadership support for health promotion. Design. The efficacy of the LBE was tested in a quasi-experimental health promotion intervention trial. Twelve worksites were assigned to three intervention conditions (i.e., control, moderate, high intensity). Setting. The worksites were selected from a large U.S.-based chemical company. Subjects. Baseline data were collected from employees in various job roles in 2005 (N = 125). Follow-up data were collected in 2006 (N = 114) and 2007 (N = 106). Response rates ranged from 54% to nearly three-fourths of potential respondents. Intervention. Worksites assigned to both treatment conditions received changes in the built environment via supports for weight management. Worksites assigned to the intense condition received additional elements designed to impact leadership's support for a positive health promotion climate. Measures. Four LBE factors measuring management support for health were assessed over time. Analysis. The Kruskal-Wallis H-test and analyses of variance/covariance were used to compare LBE scores. Results. Significant changes from baseline to 2006 were identified for the four factors (p = .000) of the LBE. No significant changes were found from 2006 to 2007. Conclusions. The LBE effectively captured perceptions of management support for health. Researchers and practitioners alike should consider using the LBE to track and evaluate perceptions of management support for health promotion.