Introduction

The CDC Worksite Health ScoreCard (HSC) is a tool designed to help employers assess whether they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as high blood pressure, diabetes, and obesity.

This tool was developed in 2008 by CDC’s Division for Heart Disease and Stroke Prevention in collaboration with the Emory University Institute for Health and Productivity Studies (IHPS); the Research Triangle Institute; CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Workplace Workgroup; and an expert panel of representatives from the federal, state, academic, and private sector. It was updated in 2013 to include four additional topics related to worksite health (lactation supports, occupational health and safety, vaccine preventable diseases and community resources) which were tested through CDC’s National Healthy Worksite Program (NHWP).

To develop the HSC, CDC and its partners conducted the following activities:

• • Examined existing worksite programs, tools, and resources^1–12 that address heart disease and stroke prevention.
  • Identified reliable and valid questions from the Heart Check^5,6 and Heart Check Lite assessment tools for use in the HSC.
  • Identified new topics and questions for the HSC from the worksite literature and from surveys that state heart disease and stroke prevention programs had previously used in worksites.
  • Pretested the original tool (which had 12 topics) with nine employers in 2008, nine employers in 2010, and more than 70 worksite health promotion practitioners across the country. This pretesting was done to make sure that the tool was easy to understand and simple to complete. (These employers were not the same as those included in the main study of 93 employers below.)
  • Revised the HSC on the basis of feedback from these groups.
  • Weighted the questions used for each topic on the basis of expert ratings of the level of scientific evidence and the health impact of each topic on intended health behavior.
  • Field-tested the HSC with a new sample of 93 very small, small, medium-sized, and large worksites for validity and reliability and the feasibility of adopting the strategies highlighted in the HSC.
  • Revised the HSC again on the basis of feedback from the 93 employers.
  • Edited and submitted the final HSC and this manual for public release.
  • In 2013, tested an additional four topics (lactation supports, occupational health and safety, vaccine preventable diseases, and community resources) with 102 employers nationwide that participate in the NHWP. The same validation protocols as the original modules of the HSC were used.

The United States is facing an unparalleled health epidemic, driven largely by chronic diseases that are threatening American businesses’ competitiveness because of lost productivity and unsustainable health care costs. The medical care costs of people with chronic diseases accounted for more than 75% of the nation’s $2.2 trillion in medical care costs in 2009.^13,14 For example,

• • Heart disease and stroke, which are the primary components of cardiovascular disease (CVD), are the first and fourth leading causes of death in the United States. They are responsible for one of every three (more than 800,000) reported deaths each year.¹⁵ CVD is responsible for 17% of national health expenditures, and as the US population ages, these costs are expected to increase substantially.¹⁶In 2010, annual direct and overall costs resulting from CVD in the United States were estimated at $273 billion and $444 billion, respectively.¹⁶
  • In 2008 dollars, the medical costs of obesity were estimated at $147 billion.¹⁷
  • In 2007, the economic costs related to diabetes were estimated at $174 billion. This figure includes $116 billion in direct medical expenses and $58 billion in indirect costs from disability, work loss, and premature mortality.¹⁸
  • During 2000–2004, the economic costs related to tobacco use were estimated at $192.8 billion a year. This figure includes $96 billion a year in direct medical costs and $96.8 billion a year in lost productivity.¹⁹

Although chronic diseases are among the most common and costly of all health problems, adopting healthy lifestyles can help prevent them. A wellness program that seeks to keep employees healthy is a key long-term strategy that employers can use to manage their workforce. To curb rising health care costs, many employers are turning to workplace health programs to make changes in the worksite environment, help employees adopt healthier lifestyles and, in the process, lower employees’ risk of developing costly chronic diseases.

The approach that has proven most effective is to implement an evidence-based, comprehensive health promotion program that includes individual risk reduction programs that are coupled with environmental supports for healthy behaviors and coordinated and integrated with other wellness activities.^20–22However, only 6.9% of US employers offer a comprehensive worksite health promotion program, according to a 2004 national survey.²³

Several studies have concluded that well-designed worksite health promotion programs can improve the health of employees and save money for employers. For example,

• • In 2005, the results of an analysis of 56 financial impact studies conducted over the past 2 decades showed that medical or absenteeism expenditures were 25%–30% lower for employees who participated in worksite health promotion programs than for those who did not participate.¹
  • In 2010, a literature review that focused on cost savings garnered by worksite wellness programs found that the return on investment (ROI) for medical costs was $3.27 for every dollar spent. The ROI for absenteeism was $2.73 for every dollar spent.²⁴

Studies have also found that worksite health promotion programs can take 2 to 5 years to see positive ROIs.^2–4

Although employers have a responsibility to provide a safe and hazard-free workplace, they also have many opportunities to promote individual health and foster a healthy work environment. CDC encourages employers to provide their employees with preventive services, training and tools, and an environment that supports healthy behaviors.

The HSC includes questions on many of the key evidence-based and best practice strategies and interventions that are part of a comprehensive worksite health approach to addressing the leading health conditions that drive health care and productivity costs.

Anyone who is responsible for promoting health in the workplace can use the HSC to set benchmarks and track improvements in their organization. Examples include employers, human resource managers, health benefit managers, health education staff, occupational nurses, medical directors, and wellness directors.

State or local health departments can help employers and business coalitions use this tool to find ways to create healthier workplaces. They can also use this tool to monitor worksite practices, create best practice benchmarks, and track improvements in health promotion programs in the workplace over time. This information can help health departments direct their resources and support employers more effectively.

The HSC has 122 questions that assess how evidence-based health promotion strategies are implemented at a worksite. These strategies include lifestyle counseling services, environmental supports, policies, health plan benefits, and other worksite programs shown to be effective in preventing heart disease, stroke, and related health conditions. Employers can use the HSC to assess how a comprehensive health promotion and disease prevention program is offered to their employees, to help identify program gaps, and to set priorities for the following health topics:

• • Worksite Demographics (6 required questions; 7 optional questions).
  • Organizational Supports (18 questions).
  • Tobacco Control (10 questions).
  • Nutrition (13 questions).
  • Lactation Support (6 questions).
  • Physical Activity (9 questions).
  • Weight Management (5 questions).
  • Stress Management (6 questions).
  • Depression (7 questions).
  • High Blood Pressure (7 questions).
  • High Cholesterol (6 questions).
  • Diabetes (6 questions).
  • Signs and Symptoms of Heart Attack and Stroke (4 questions).
  • Emergency Response to Heart Attack and Stroke (9 questions).
  • Occupational Health and Safety (10 questions).
  • Vaccine-Preventable Diseases (6 questions).
  • Community Resources (3 questions; not scored).