American Journal of Health Promotion

The purpose of this review is to summarize the literature on the ability of health promotion programs to reduce employee-related health care expenditures and absenteeism.

Using key words in a literature-searching program, a comprehensive search was conducted on the following databases: MEDLINE, Embase, HealthSTAR, SPORTDiscus, PsycINFO, SciSearch, ERIC, and ABI Inform.

All data-based studies that appeared in peer reviewed journals in the English language. Theses, dissertations, or presentation abstracts that were not published in peer reviewed journals were excluded. The initial search identified 196 studies, but only 72 met the inclusion criteria and were included in the review.

Summary tables were created that include design classification, subject size, results, and other key information for each study.

Both the nature of the findings and the overall quality of the literature were evaluated in an attempt to answer two questions: Do individuals or populations with high health risks have worse financial outcomes than individuals or populations with low health risks? Do health promotion programs improve financial outcomes?

There are good correlational data to suggest that high levels of stress, excessive body weight, and multiple risk factors are associated with increased health care costs and illness-related absenteeism. The associations between seat belt use, cholesterol, diet, hypertension, and alcohol abuse and absenteeism and health care expenditures are either mixed or unknown. Health promotion programs are associated with lower levels of absenteeism and health care costs, and fitness programs are associated with reduced health care costs.

To summarize our knowledge of the economic impact of smoking on health-related outcomes and to discuss the quality of this evidence. The potential effect of smoking-related health promotion programs on reducing costs is discussed.

Studies reviewed were cited in recently published reviews, identified through database searches of MEDLINE/HealthSTAR, PsychINFO, and ABI/Inform or obtained from reference lists of other studies.

Included are studies of the health care and other costs of smoking published in English in peer-reviewed journals during the last 20 years. Studies of annual and lifetime costs are included as are studies of employer costs. Forty-nine studies were reviewed.

Data extracted were total costs, medical care and other direct costs, lost productivity, and mortality costs. Underlying methodologies were described and compared.

The annual cost of smoking is between 6 and 14% of personal health expenditures. Estimates have increased over time, reflecting better and more comprehensive methodologies. Smoking appears to result in increased lifetime costs, although some studies have found contrary results. In the workplace, smokers incur greater medical costs and more lost productivity than nonsmokers. They also impose costs on their nonsmoking coworkers.

The overwhelming body of evidence in the literature asserts that smoking imposes costs on an annual basis, that it leads to increased medical costs over the life span, and that many of these costs are borne by employers. Although the methods for studying this issue have evolved over time and are presently quite comprehensive, future research is needed to further substantiate the findings and develop further refinements.

To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion.

A panel of experts was used to identify the top studies supporting the purpose of this article.

Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion.

Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article.

A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.