Table of Contents...Welcome to Working Well: A Global Survey of Health Promotion, Workplace Wellness and Productivity Strategies sixth edition, July 2014 , which investigates emerging

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Table of Contents

Page Executive Summary ................................................................................................................................................................ 2 Methodology ............................................................................................................................................................................. 5 Buck Consultants Consumerism 360 .............................................................................................................................. 6 Global Prevalence .................................................................................................................................................................... 8 Strategies and Objectives ................................................................................................................................................... 9 Organizational Ownership .................................................................................................................................................. 18 Program Design ........................................................................................................................................................................ 21 Program Features .................................................................................................................................................................... 31 Incentives .................................................................................................................................................................................... 32 Participation and Satisfaction .......................................................................................................................................... 37 Measurements and Outcomes .......................................................................................................................................... 43 Communication and Culture .............................................................................................................................................. 54 Successes and Vision ............................................................................................................................................................. 59 Respondent Profile ................................................................................................................................................................. 60 Participant List.......................................................................................................................................................................... 61 About the Survey Sponsors................................................................................................................................................. 74 About Us ...................................................................................................................................................................................... 75

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Executive Summary

Welcome to Working Well: A Global Survey of Health Promotion, Workplace Wellness and Productivity Strategies sixth edition, July 2014 , which investigates emerging trends in employer-sponsored health promotion and wellness programs. This year we have expanded the title of our study, to include the term “productivity.” This recognizes the importance that employers are increasingly placing on the connection between employee well-being and performance — both individual and organizational. We believe that healthy, high performing employees drive a high-performing organization. You will see aspects of this reflected throughout this report in many areas, such as metrics related to productivity, absenteeism, presenteeism, and employee engagement. Employee health and well-being continues to be a significant concern for employers worldwide. Organizations cite their commitment to promoting health and wellness as a business strategy and show continued desire to expand initiatives in hopes of boosting individual engagement and organizational performance. In practice, however, the challenges and inconsistencies identified in previous studies persist. Typical participation and engagement rates indicate that employers are still struggling to find effective approaches to motivate workers. There is a significant gap between employers’ stated desire to create a “culture of health” and their assessment of the current status. And the design and measurement of health and well-being initiatives often is not consistently aligned with employers’ stated goals and objectives for their programs. Join us as we explore the latest trends, practices and results from over 1,000 employers from around the world. Why wellness? Leading reasons for implementing wellness programs are reducing sick leave and presenteeism, with improving workforce morale and engagement becoming increasingly important (especially in Europe and Australia). Managing health care costs remains the top objective in the United States (see page 12). Top health drivers. The main health issues and risks driving wellness strategies globally are stress and physical activity, with nutrition/healthy eating close behind. There are some significant outliers, however, such as workplace safety – a primary focus in Asia, Latin America and Africa/Middle East (see page 17). New strategies emerging. 29% of responding organizations have a fully implemented wellness strategy. This number continues to increase every year. However, 62% of organizations have had their wellness strategies in place for only five years or less, showing that they are still relatively new for many employers (see page 9).

Organizations going global. The trend toward globalizing wellness initiatives continues. Among participating multinational employers, 56% have a global health promotion strategy, up from 34% in 2008. The main reasons for not having a global strategy are differing cultures, laws and practices as well as no global oversight for health care (see page 11). HR driving the wellness wagon. Responsibility for wellness and health promotion lies with HR (Human Resources) by a wide margin in most regions. Other owners include HSE (Health, Safety and Environment), occupational health, and dedicated wellness professionals (see page 19). Wellness design — productivity and engagement focus increasing. HR polices related to flexible work schedules and PTO (Paid time off) ranked as the number 1 component of health promotion/wellness programs globally. Employee Assistance Programs (EAPs) rank second globally driven by top prevalence in US, Canada, Africa, and Australia. Regular wellness communication and immunization/flu shots follow (see pages 21, 23-30).

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Executive Summary

Influence of incentives. The data shows that incentive amount has a direct correlation to program participation levels, but initiatives that require long-term lifestyle changes (such as tracking exercise and working with a health coach) are not as greatly influenced by incentives as are more immediate programs (such as health assessments and biometric screenings) (see pages 37-38). Companies successful in driving participation without large incentives. Same employers achieve participation levels without incentives that are comparable to the participation rates achieved with incentives. However, in most cases participation rates do increase significantly above the 75th percentile. These findings indicate that factors other than incentives—communications, culture, programs—are also influential in increasing participation (see pages 37-38). Focused on participation not satisfaction. The measurement of participation in wellness programs is very high while the measurement of employee satisfaction with those programs is much lower. For example, 96% measure biometric participation while only 69% measure employee satisfaction for the same program. If we can reasonably assume that participation levels increase with employee satisfaction, measuring employee satisfaction is an additional opportunity for employers to better understand and positively influence program participation rates.

Fastest growing wellness program elements. “Telemedicine” (telephonic physician support services) is ranked as the fastest growing wellness program globally driven by a top position in Canada, Latin America and US, followed by “cycling to work” (first in Africa/Middle East), “on-site child care” (first in Asia), and “on-site healthy lifestyle programs and coaching” and “personal health records” (the top two in Europe) (see page 22). Top five programs to specifically address worker productivity globally. Globally time-off policies are most prevalent (69%) followed by flexible work schedules (66%), tobacco-free work-site (59%), ergonomic work stations (55%), and work from home (telecommuting) (51%) (see page 31). Wellness is a family affair. Increasingly, companies see the value in making spouses, domestic partners and children eligible for health promotion and wellness programs and associated incentives. Broadly, 62% of programs include spouses, 52% include domestic partners, and 43% include children(see page 31). Top incentive rewards and penalties used by employers. Top rewards include free or low cost preventive services (62%) followed by gifts and merchandise (58%), and raffles/drawings (57%). Health insurance premium increases (surcharges) were the most widely reported penalties (33%), followed by health insurance eligibility tied to wellness program participation (8%), and benefit reduction (7%). (See page 34)

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Executive Summary

Culture of Health. The pursuit of a “culture of health” continues to be a strong priority for at least 78% of respondents. However, significantly fewer (33%) indicate they have yet achieved a culture of health. Employers increasingly recognize the importance of more holistic leadership and environmental and infrastructure support for healthy lifestyles. Employers also are increasing their emphasis on branding—the use of a distinct identity (vs. one tied to a vendor or other health brand) rose to 43% (see page 56 and 58). Communication Channels. Investment in almost all communication channels increased, following a decline over the prior three years. The fastest rising tactics include a mix of traditional (posters/flyers as number 1) and technology (portals and personalized emails as number 2 and number 3, respectively). Use of home mailings also rose, suggesting a desire to include family members who influence lifestyle and health behaviors (see page 55). Utilizing social or peer influence also rose significantly, including the use of workplace challenges that leverage positive peer pressure. While lower in percentages, use is rising for social media and mobile technology, and a new question on gamification indicated considerable interest. Finally, organizations achieving higher levels of health care cost trend reduction (in the US) were those who focused their top messages on driving program participation and encouraging health risk assessments (know your numbers)—action and knowledge.

Measurement and Outcomes. A growing number of respondents, (52%) report measuring outcomes (up from 36% in 2012).Yet the majority of US respondents (59%) indicate that they don’t know if their strategies are reducing health care cost trend. 28% of the respondents indicate that wellness is reducing trend, up from 23% in the previous survey (see pages 43 and 50). Measuring outcomes is most commonly the responsibility of internal program managers at 57%. Interestingly, the reliance on carriers and insurers increased this year from 31% to 37%. This may be due to a shift to integrated wellness services offered by carriers/insurers and the growth of analytic support by these parties. Finally there was a slight increase in reliance on other third parties for outcomes measurement (see page 47). Two new questions related to outcomes were added this year, focusing on what respondents value in terms of outcomes and their awareness of the impact on their organization. 62 to 74% of respondents are aware of the potential impact in a variety of areas, indicating a growing opportunity for continued investment in wellness. Respondents ranked the following outcomes the most valuable (very high or highly valuable): Per employee per year health care costs (68%), safety (63%), employee satisfaction with their employer (66%), participation (69%) and satisfaction with the programs (66%). The outcome measures ranked as only slightly valuable or not at all valuable included: retention and recruitment (15%), disability days (11%), productivity (10%), prevalence of conditions (10%) and biometric values (10%). A notable percentage of respondents indicated “don’t know” on various outcomes, suggesting an opportunity to develop outcome measures of value to each employer to align health with improved business metrics (see page 49). For those US respondents who indicated a reduction in health care cost trend, 57% indicated a two to five point trend reduction, up from 50% in 2012.

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Methodology

General approach. The 1041organizations that responded to the survey are based in 37 countries. 46% of respondents employ workers in multiple countries. Participants ranged from small employers to large multinational corporations, representing all major industry sectors. Details are shown in the “Respondent Profile” section of this report. Survey questionnaire. The survey questionnaire was offered online in English (British and American), Chinese, French (Continental and Canadian), German, Japanese, Korean, Polish, Portuguese and Spanish (Castilian and Latin American). The questionnaire was designed so that respondents could complete it in 30 minutes or less. Target participants were senior or mid-level professionals with responsibility for corporate wellness strategy, execution and measurement. Global breadth. To draw out as much useful and credible information as possible, we have consolidated geographies into broader regions. US and Canadian results are typically presented separately, rather than combined as North America, because we have sufficient participation to demonstrate differences in the two countries’ approaches to wellness. Special country specific cuts of the report are available for countries whose respondents surpassed a designated minimum. How to reach us. Please direct any questions or requests for special analyses to the survey support team at [email protected] or 1.800.887.0509.

1041 respondents

37 countries

Workplace wellness. The term “wellness” is not defined or used consistently around the world. As defined for this report, wellness refers to programs designed to improve the health and well-being of employees (and their families) in order to enhance organizational performance and reduce costs. Wellness programs typically address specific behaviors and health risk factors, such as poor nutrition, physical inactivity, stress, obesity, and smoking. These factors commonly lead to serious and expensive health problems and have a negative impact on workforce productivity. Terminology. Health promotion, health improvement, health and well-being, and disease prevention are other terms used by employers to refer to workplace wellness initiatives. This report uses the terms wellness and health promotion interchangeably. Wellness or well-being is increasingly used to encompass a spectrum of personal issues beyond physical and mental health, such as financial security, community involvement and career success. Selection bias. Responses to the survey were provided by employers who chose to participate, not by a scientifically randomized sample of employers. As a result, responses likely are skewed to some extent by a “selection bias” toward organizations with an interest in wellness. Therefore, results should not be interpreted as indicative of all employers, but as relative markers of the prevalence of various program strategies and approaches, and as indicators of movement and trends among the organizations surveyed.

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Buck Consumerism 360

Wellness 1.0

A focus on general health promotion and prevention activities (such as fun runs, competitions, and health risk appraisals) and some interventions such as tobacco cessation. Little or no measurement of outcomes.

Wellness 2.0

Rapid adoption of health risk appraisals and biometric screening to assess population health. Wellness programs increasingly integrated with EAP and/or disease management programs, often leveraging portals and incentive tracking. Growth of external (often financial) incentives to motivate participation in various activities, sometimes for meeting defined clinical outcomes.

Wellness 3.0

A broader focus on overall well-being, including a more holistic view and integrated approach to supporting employees in their health, wealth and careers, with a shared responsibility and employer support for well-being as part of a compelling employee value proposition. Sophisticated measurement and metrics guide health and people strategy directly tied to the overall success of corporate objectives. Growth of intrinsic incentives/motivators and recognition of the value a supportive company culture and workplace environment can play in behavior change. Extending programs more fully to the family and sometimes to the community at large. Leveraging newer personal engagement methods such as social media, gamification, mobile technology, automated coaching, and personalized challenges.

° TM

Buck Consultants’ Perspective: An Evolution from Health to Human Performance. The results of this latest research confirm that employers throughout the world continue to invest in wellness, and attribute a clear connection between the health of employees and their families and the health of their business. Even as the debate continues regarding data proving the return on investment for investing in wellness,

respondents continue to step up their efforts—from the breadth and popularity of program offerings, to communication efforts promoting attitudinal and behavioral change. In the seven years since Buck initiated the first and largest ever global survey on wellness, we have seen an ongoing evolution of employer strategies and approaches:

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Buck Consumerism 360 Buck has advocated a total well-being approach since before our original global wellness survey launched in 2007. We recognized early on the power of behavioral economics, and the vital role that various “levers” for change can play in driving engagement and change – when optimally combined according to each organization’s readiness, culture, urgency and more. Further, the collective voice of global employers emphasizes the return on investment as more than improving health and reducing health care costs. The objective of enhanced workforce productivity is more important than ever. Today, Buck is extending the conversation to Wellness 3.0 and human capital management. This includes productivity that can be measured through industry-specific business performance metrics – tying health to employee performance measures and ultimately to corporate financial and related results. Regardless of geographical and cultural differences, employers will be well served by a flexible, strategic framework that extends consumerism beyond health care purchasing and lifestyle decisions to influence employee engagement in issues that impact their Career, Health, and Wealth® for a more productive workforce. We believe Consumerism 360° allows companies to more thoughtfully connect strategy to program design, implementation and communication, as well as to predefined metrics for success. The payoff from this integrated approach will be a workforce that is better engaged in using available resources, who make more informed decisions about their career, health, and wealth, and whose behavior is in alignment with the company’s business and financial goals. The Consumerism 360° Framework. Improved employee health can only occur within a construct of shared responsibility. Consumerism 360° proposes an employer-employee relationship built on the concept that employers can create a workforce of informed and engaged consumers who are empowered through four levers of incentives, information, infrastructure, and imperatives to take on increased responsibility for all elements of their career, health, and wealth.

Consumerism 360° is a philosophical “contract” that requires both employer and employee to meet specific commitments in order to achieve mutual goals. It represents the middle ground on a spectrum that ranges from paternalism, wherein the employer takes full responsibility for every aspect of employees’ security needs, to individualism, wherein the employee, as a free agent, independently purchases health care, funds his or her own retirement, and pursues career development opportunities. Under Consumerism 360°, the employer provides an array of programs and decision-making support, and employees are responsible for making choices that maximize their personal benefits. In addition, the employer clarifies key elements of the employment value proposition: why employees should join the organization, choose to stay, and be motivated to maximize their contributions. Shared responsibility and mutual accountability come “full circle” — or 360°.

° TM

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North America

Latin America

Europe

Australia/ New Zealand

Asia

Africa/ Middle East

Global Prevalence

Percentage of organizations offering health promotion to employees – by region

*Respondents were allowed to select more than one answer.

Among survey participants—both multinational and single-country employers—wellness programs are most common in North America, but have a strong and growing foothold in other regions. Programs have some variation in objectives by region.

79%

46%

38%

46% 46%

47%

Location of employees*

Africa/Middle East

Asia

Australia/NZ

Europe

Latin America

North America

22%

41%

23%

42%

28%

68%

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Strategy and Objectives

of organizations have a fully implemented wellness strategy.

of respondents have had a wellness program in place for five years or less.

Strategies continue to grow. The past seven years have shown a continuous progression of employers toward developing and implementing a health promotion strategy, which typically includes a multi-year business plan and definition of program goals, design, evaluation, ownership, vendors, tools, infrastructure, and technology.

Status of health promotion and wellness strategy

Strategy is fully implemented

Strategy is partially implemented

Have strategy, but not yet implemented

No current strategy, but intend to develop one in next two years

No current strategy, but numerous initiatives distributed throughout organization

No plans for health promotion and wellness strategy

29%

31%

5%

10%

17%

9%

26%

36%

7%

14%

14%

4%

22%

37%

7%

12%

17%

6%

21%

37%

6%

12%

20%

3%

21%

34%

5%

12%

25%

3%

15%

29%

5%

14%

31%

7%

2014

2012

2010

2009

2008

2007

29%

62%Number of years health promotion or wellness strategy

has been in place

0 - 1 year

2 - 5 years

6 - 10 years

More than 10 years

Do not know

11%

51%

22%

14%

2%

10


lack the business case to support a wellness strategy.**

believe that managing employee health is not the role of the organization.**

*Respondents were allowed to select more than one answer. **Among those responding organizations that cite no plans for a health promotion and wellbeing strategy

Employer philosophy. Shifting year to year employer perspectives on the role of an organization in employee health management and wellness show continued work is needed in gaining management support and developing the business case.

Reasons for having no plans for a wellness strategy*

Lack of budget

Do not know how to organize or get started

Insufficient management support

Lack of business case to support implementation of wellness strategy

Insufficient internal ownership

Belief that managing employee health is not the role of the organization

Company culture is incompatible with wellness messages

33%

21%

22%

26%

13%

20%

8%

55%

33%

30%

30%

18%

13%

13%

34%

28%

29%

23%

29%

25%

17%

66%

16%

50%

31%

41%

22%

25%

47%

29%

18%

24%

18%

12%

12%

2014

2012

2010

2009

2008

26%

20%

Budget constraints. Large shifts in prevalence of budget constraints indicate that commitment to wellness strategies and the value over the long term is subject to competing economic priorities.

11 *Respondents were allowed to select more than one answer. **Prior to 2010, option was "Lack of cultural readiness across our regions". ***Prior to 2010, option was "Not a priority at the enterprise level“.


cite differing cultures, laws, and practices across regions as a reason for not having a global wellness strategy.

multinational participating employers have a global strategy.

do not have global oversight for health care strategy.

Reasons for not having a global wellness strategy*

Differing cultures, laws, and practices across our regions**

No global oversight for health care strategy

Lack of vendors who can meet our global objectives

Not a priority in our organization***

Limited availability of language- and culturally-adapted tools and solutions

47%

46%

21%

17%

9%

58%

40%

26%

15%

16%

59%

44%

29%

16%

23%

30%

56%

29%

22%

22%

27%

54%

25%

27%

16%

2014

2012

2010

2009

2008

46%

56%

47%

Strategy is global (covers majorityof employees regardless of geography)

n = 334

Yes56%

No44%

12


1 = most important, 10 = least important

Global focus on productivity. Reducing employee absence (and the related objective of improving productivity) are among the top priorities globally. Other highly ranked objectives include improving morale and workplace safety. Top US objectives. The United States’ top objectives continue to be reducing health care costs (due to an employer-provided system of health care), improving productivity and reducing absence.

Geographical differences. Although the objectives below were forced into a ranking for the purpose of this exhibit, it is informative to review exhibits on the following pages, which demonstrate that most objectives were highly rated in each geography. Clearly, employers expect multifaceted benefits from wellness programs. The ability of wellness initiatives to support multiple objectives helps explain the broad global appeal of health promotion programs.

Ranked 1st Ranked 2nd Ranked 3rd

*The “All regions (average ranking)” represents the average response rank across regions.

Relative importance of wellness program objectives – by region

All regions*

Africa/ Middle East Asia

Australia/ NZ Canada Europe

Latin America

United States

Improving workforce morale/engagement

1 4 6 1 3 1 1 4

Reducing employee absences due to sickness or disability

2 1 2 7 1 3 4 3

Improving workplace safety 3 2 1 3 5 4 2 7

Improving worker productivity/reducing presenteeism

4 5 8 4 2 2 3 2

Maintaining work ability 5 3 3 5 6 5 6 5

Furthering organizational values/mission

6 9 4 2 7 6 5 6

Reducing health care or insurance premium costs

7 7 10 10 4 10 8 1

Promoting corporate image or brand 8 8 5 6 9 9 9 9

Fulfilling social/community responsibility

9 5 7 9 10 7 10 10

Attracting and retaining employees 9 10 9 8 8 8 7 8

13



Importance of wellness program objectives – African/Middle Eastern employers*


Improving workplace safety

Maintaining work ability





Promoting corporate image or brand


Attracting and retaining employees

60%

60%

50%

40%

40%

30%

30%

30%

22%

20%

40%

20%

30%

50%

40%

60%

60%

30%

44%

40%

20%

20%

10%

40%

22%

20%

10%

10%

10%

11%

20%

10%

0% 20% 40% 60% 80% 100%

Extremely important Very important Moderately important

Slightly important Not at all important

Importance of wellness program objectives – Asian employers*











50%

50%

40%

36%

37%

34%

33%

32%

30%

30%

36%

28%

40%

43%

40%

40%

47%

38%

44%

35%

9%

18%

15%

17%

20%

23%

15%

25%

22%

26%

4%

4%

5%

4%

3%

3%

5%

4%

4%

7%

1%

0% 20% 40% 60% 80% 100%



14

Strategy and Objectives Importance of wellness program objectives – Australian/NZ employers*











45%

39%

37%

37%

32%

29%

35%

32%

20%

15%

30%

39%

32%

29%

32%

34%

18%

24%

37%

22%

13%

10%

15%

17%

22%

20%

35%

27%

32%

24%

8%

7%

10%

10%

7%

12%

10%

10%

2%

15%

5%

5%

7%

7%

7%

5%

3%

7%

10%

24%

0% 20% 40% 60% 80% 100%



Importance of wellness program objectives – Canadian employers*











39%

31%

31%

35%

27%

18%

14%

8%

14%

6%

39%

39%

37%

47%

51%

49%

49%

53%

41%

45%

20%

29%

27%

14%

20%

29%

24%

22%

24%

33%

2%

2%

4%

2%

2%

8%

12%

14%

12%

2%

2%

2%

2%

4%

4%

6%

4%

0% 20% 40% 60% 80% 100%




15

Strategy and Objectives Importance of wellness program objectives – European employers*











32%

28%

30%

26%

25%

20%

23%

21%

20%

19%

44%

38%

42%

57%

41%

23%

43%

40%

43%

43%

17%

25%

19%

12%

23%

35%

23%

25%

26%

27%

4%

5%

7%

3%

7%

13%

7%

9%

7%

6%

4%

4%

3%

3%

4%

9%

5%

4%

4%

4%

0% 20% 40% 60% 80% 100%



Importance of wellness program objectives – Latin American employers*











37%

43%

45%

50%

33%

42%

28%

41%

33%

26%

36%

41%

43%

36%

35%

48%

55%

42%

51%

48%

18%

12%

9%

7%

22%

6%

10%

10%

10%

16%

5%

2%

2%

5%

8%

3%

3%

4%

5%

6%

5%

2%

2%

3%

3%

2%

4%

3%

2%

5%

0% 20% 40% 60% 80% 100%




16

Strategy and Objectives Importance of wellness program objectives – US employers*











59%

38%

35%

36%

27%

27%

23%

24%

17%

14%

29%

45%

44%

42%

35%

40%

48%

35%

37%

30%

8%

13%

16%

17%

25%

23%

21%

27%

30%

35%

2%

4%

4%

5%

9%

8%

6%

11%

13%

15%

1%

1%

1%

1%

4%

1%

2%

3%

3%

5%

0% 20% 40% 60% 80% 100%



Importance of wellness program objectives – All employers**











45%

38%

37%

36%

27%

35%

30%

24%

24%

19%

31%

41%

45%

44%

46%

36%

42%

41%

36%

37%

16%

16%

13%

14%

19%

19%

19%

23%

27%

29%

5%

4%

4%

4%

5%

7%

7%

8%

10%

10%

4%

1%

2%

1%

2%

3%

2%

3%

3%

5%

0% 20% 40% 60% 80% 100%




**The “all employers” data represents responses combined from all regions

17


1 = highest impact, 17 = lowest impact

Extent to which certain health risks and issues drive wellness strategy – by region

All regions*



Latin America

United States

Stress 1 2 4 2 1 1 2 3

Physical activity/exercise 2 5 2 1 2 2 4 1

Nutrition/healthy eating 3 8 6 3 3 3 5 2

Workplace safety 4 1 1 5 9 6 1 12

Work/life issues 5 2 13 4 6 4 8 9

Depression/anxiety 6 8 11 8 5 5 7 10

High blood pressure (hypertension) 6 5 4 12 6 12 9 6

Chronic disease (e.g., heart disease, diabetes)

8 12 8 8 3 10 11 4

Personal safety 9 5 3 10 10 11 6 15

Psychosocial work environment 10 10 7 11 12 7 3 14

Sleep/fatigue 11 12 10 6 11 9 12 11

High cholesterol (hyperlipidemia) 12 15 9 14 8 12 10 7

Obesity 13 12 15 6 12 14 13 5

Tobacco use/smoking 14 16 12 13 14 8 14 8

Infectious diseases/AIDS/HIV 15 2 16 16 17 17 17 17

Substance abuse 16 10 17 15 15 16 16 16

Maternity/newborn health 17 17 14 16 16 15 15 13


Health risks and strategy. Health issues and behaviors determine health promotion strategy. The below “modifiable” health risks (i.e., lifestyle factors that can be controlled or managed) are ranked by their relative importance to responding organizations.

Top influencers. Physical activity and stress are the top priorities globally. Workplace safety is of highest importance in Asia, Africa/Middle East and Latin America.

*The “All regions” rank represents the average response rank across regions

18

Organizational Ownership

Ownership and control of wellness programs (multinational organizations)

Centralized ownership and control

Centralized coordination with localized autonomy

No Centralized coordination - health promotion and wellness initiatives are spread throughout the organization

Other

Ownership and control of wellness programs (single-country organizations)

Centralized ownership and control

Centralized coordination with localized autonomy

No Centralized coordination - health promotion and wellness initiatives are spread throughout the organization

Other

42%

40%

14%

4%

46%

34%

14%

5%

43%

41%

11%

5%

2014

2012

2010

55%

23%

17%

5%

52%

27%

17%

4%

54%

25%

15%

6%

2014

2012

2010

of multinational employers report centralized ownership of their organization’s wellness program.

42%

Multinational employers. Multinational employers that desire to set a globally consistent strategy and infrastructure have the greatest challenge. They may have to contend with a variety of regional business approaches, cultures, and attitudes toward the employer’s role in supporting health care and promoting wellness, as well as different country laws and regulations.

Centralized coordination. Multinational employers are moving toward a model of centralized coordination with localized autonomy (considered a best practice for global programs) whereas single-country organizations are increasingly adopting centralized ownership and control.

19

Organizational Ownership

Responsibility for executing health promotion and/or wellness programs – by region*

Allregions**

Africa/Middle East Asia


Latin America

United States

Corporate Human Resources 76% 67% 60% 31% 84% 72% 79% 82%

Dedicated staffed wellness coordinator(s)

21% 11% 12% 38% 18% 14% 6% 29%

Health, Safety & Environment (HSE)

20% 22% 47% 36% 31% 25% 21% 9%

Occupational health function 13% 11% 26% 23% 14% 15% 13% 9%

Vendor-provided wellness coordinator(s)

11% 11% 7% 3% 20% 5% 3% 17%

Shared staff position 10% 11% 10% 15% 4% 18% 10% 9%

Contracted wellness coordinator(s)

7% 11% 4% 13% 6% 5% 2% 10%

Outside consultant 7% 11% 4% 8% 8% 9% 7% 6%

Other (please specify): 10% 0% 6% 8% 6% 9% 15% 10%


*Respondents were allowed to select more than one answer. **The “all employers” data represents responses combined from all regions

Human Resources responsible for programs. In many industry sectors, Human Resources is most typically responsible for programs. However, in some cases HSE (Health, Safety and Environment) professionals may also be likely to take ownership of health promotion.

Dedicated wellness coordinators are becoming more prevalent in some geographies, most notably Australia/New Zealand and the US.

20

Organizational Ownership Credentials or formal education of employees responsible for health promotion – by region*

Allregions**



Latin America

United States

Employee Benefits/HR 69% 67% 52% 23% 86% 69% 61% 79%

Safety 31% 56% 62% 43% 24% 31% 41% 19%

Fitness/Exercise 30% 22% 27% 37% 19% 26% 20% 36%

Health Promotion 29% 56% 31% 31% 17% 23% 27% 31%

Nursing 27% 44% 20% 49% 24% 26% 31% 25%

Nutrition 26% 22% 18% 31% 12% 25% 28% 28%

Health/Lifestyle Coaching 23% 33% 22% 20% 10% 21% 26% 24%

Medicine 21% 44% 33% 11% 7% 29% 29% 16%

Education 15% 11% 16% 14% 10% 17% 15% 15%

Mental Health 14% 22% 24% 14% 5% 23% 17% 10%

Health Care Management 13% 56% 10% 17% 2% 11% 16% 13%

Work/Life Effectiveness 13% 11% 24% 6% 5% 20% 14% 9%

Pharmacy 5% 33% 9% 3% 2% 4% 9% 4%

Other 7% 0% 4% 14% 2% 8% 12% 7%

*Respondents were allowed to select more than one answer **The “all employers” data represents responses combined from all regions .


21

Program Design Overview

1 = most prevalent, 25 = least prevalent

Health promotion/wellness program components (top 10 by all regions)*

All regions**



Latin America

United States

HR policies 1 4 5 2 2 2 6 3

Employee Assistance Program (EAP) 2 1 10 1 1 5 9 1

Regular communications (e.g., online mailings, posters)

3 11 3 4 5 3 1 4

On-site immunizations/flu shots 4 7 14 3 6 6 2 2

Biometric health screenings (such as blood pressure, cholesterol, glucose, body fat)

5 1 1 9 17 4 8 7

Ergonomic adaptations and awareness 6 18 11 6 3 1 3 8

Health risk appraisal (health and lifestyle questionnaire)

7 7 4 8 7 14 10 5

On-site healthy lifestyle programs and coaching***

8 1 8 7 10 11 5 16

Workplace health challenges (e.g., walking, weight loss)

9 15 6 5 7 8 16 11

On-site occupational health programs 10 7 2 12 18 10 4 20



Program design. Employers utilize a wide variety of initiatives to create their health management programs. The popularity of certain elements varies widely by geography, indicating that cultural and geographic practices may dictate different means to achieve similar wellness objectives.

***E.g., nutrition, weight loss, stress reduction, smoking cessation **The “All regions” rank represents the average response rank across regions

22

Program Design Overview

Fastest growing wellness program elements – by region

All regionsAfrica/ Middle East Asia Australia/ NZ Canada Europe Latin America United States

Telephonic physician support (telemedicine services)

Cycle to work program

On-site child care On-site employee health fairs


Personal health record (electronic summary of personal health information)




Environmental support*


Telephonic lifestyle coaching

Other on-site services

On-site healthy lifestyle programs and coaching**



On-site child care On-site child care Other internet tools (provider quality and cost information)

Telephonic chronic disease management support or coaching



On-site child care On-site healthy lifestyle programs and coaching**

On-site healthy lifestyle programs and coaching**


Work/life balance support (e.g., legal, financial services, elder or child care support)







Ergonomic adaptations and awareness

On-site employee health fairs

Other internet tools (provider quality and cost information)

On-site occupational health programs

On-site child care Other internet tools (provider quality and cost information)

On-site medical facility

Telemedicine services. Driven by Canada, Latin America and the US, telemedicine services improve access and convenience while reducing cost by using information technology to provide clinical care at a distance. Telehealth is projected to grow worldwide by 18.5% annually through 2018, with the US projected to increase at an annual growth rate of 56%.

Fastest growing programs. Across regions, “Cycle to Work” programs moved up the most compared to the 2012 survey. In the US, Cycle to Work moved from the 5th to the 2nd position. In Asia, Cycle to work is also listed as the 2nd fastest growing program.

*E.g., tobacco-free campus, healthy vending machines, cafeteria that emphasizes healthy options, walking trails **E.g., nutrition, weight loss, stress reduction, smoking cessation

23

Program Design All Regions

*Respondents were allowed to select more than one answer. *The “All Regions” data represents responses combined from all regions

Health promotion/wellness program components*

Employee Assistance Program (EAP)

HR policies


On-site immunizations/flu shots





Nurse line or other health decision phone support


Environmental support (e.g., tobacco-free campus, healthy vending machines, cafeteria that emphasizes healthy options, walking trails)


On-site healthy lifestyle programs and coaching (e.g., nutrition, weight loss, stress reduction, smoking cessation)




On-site fitness center







On-site child care

Other (please specify):

81%

77%

76%

74%

72%

69%

69%

63%

62%

61%

60%

55%

54%

53%

52%

50%

45%

44%

44%

43%

28%

26%

23%

11%

5%

8%

10%

3%

9%

12%

10%

14%

5%

8%

13%

6%

14%

10%

8%

7%

3%

7%

6%

6%

3%

10%

8%

1%

5%

6%

5%

3%

7%

8%

10%

8%

4%

9%

8%

7%

12%

11%

11%

8%

6%

11%

9%

8%

5%

14%

10%

4%

9%

9%

9%

20%

12%

11%

12%

15%

29%

21%

18%

32%

20%

26%

29%

36%

46%

38%

41%

43%

64%

50%

59%

83%

0% 20% 40% 60% 80% 100%

Offered today Plan to offer in next year

Plan to offer in next 2-3 years Do not currently offer and no plans to offer

24

Program Design Africa/Middle East








HR policies


















On-site child care


80%

80%

80%

70%

70%

70%

60%

60%

60%

56%

50%

50%

50%

50%

40%

40%

40%

33%

30%

30%

30%

20%

11%

10%

20%

10%

10%

11%

20%

20%

20%

10%

10%

10%

20%

11%

10%

10%

10%

30%

10%

20%

10%

20%

33%

20%

10%

22%

10%

20%

20%

10%

20%

20%

30%

10%

30%

33%

10%

20%

50%

50%

40%

40%

60%

33%

40%

60%

60%

50%

56%

80%

0% 20% 40% 60% 80% 100%



25

Program Design Asia







HR policies



















On-site child care


62%

60%

59%

55%

51%

50%

50%

47%

47%

44%

44%

43%

35%

32%

32%

29%

27%

27%

24%

24%

23%

21%

17%

6%

9%

8%

13%

20%

15%

17%

10%

14%

7%

17%

18%

17%

11%

5%

8%

7%

7%

12%

11%

5%

9%

15%

13%

3%

15%

14%

10%

11%

15%

12%

17%

19%

9%

16%

11%

14%

15%

9%

18%

9%

17%

26%

26%

14%

19%

20%

25%

16%

13%

18%

18%

14%

19%

20%

24%

21%

38%

22%

27%

27%

39%

54%

43%

55%

49%

35%

39%

57%

48%

45%

46%

75%

0% 20% 40% 60% 80% 100%



26

Program Design Australia/New Zealand




HR policies




















On-site child care




78%

78%

76%

75%

68%

68%

58%

54%

54%

50%

46%

45%

43%

33%

33%

31%

25%

20%

18%

17%

15%

15%

12%

10%

5%

10%

7%

15%

15%

20%

18%

21%

15%

23%

5%

13%

15%

10%

8%

10%

10%

15%

10%

5%

3%

7%

8%

8%

12%

8%

12%

10%

10%

13%

5%

3%

15%

5%

3%

2%

2%

17%

13%

17%

8%

10%

13%

18%

18%

20%

20%

37%

33%

43%

48%

48%

64%

63%

80%

56%

63%

73%

85%

85%

83%

0% 20% 40% 60% 80% 100%



27

Program Design Canada




HR policies





















On-site child care



96%

88%

85%

77%

67%

69%

56%

56%

50%

49%

55%

46%

48%

47%

47%

40%

38%

31%

30%

30%

21%

15%

8%

6%

2%

4%

2%

8%

6%

13%

6%

2%

4%

6%

8%

2%

6%

2%

9%

6%

2%

9%

2%

2%

8%

6%

2%

8%

13%

13%

13%

4%

6%

10%

10%

9%

9%

2%

10%

10%

5%

4%

6%

9%

2%

6%

4%

17%

31%

15%

25%

19%

31%

45%

34%

38%

33%

43%

45%

58%

46%

56%

57%

60%

70%

67%

92%

91%

0% 20% 40% 60% 80% 100%



28

Program Design Europe




HR policies






















On-site child care


81%

72%

60%

60%

59%

54%

53%

50%

46%

46%

44%

43%

41%

39%

37%

31%

30%

28%

28%

24%

23%

23%

21%

10%

6%

12%

10%

8%

6%

5%

7%

5%

7%

14%

16%

9%

11%

11%

5%

7%

4%

7%

3%

5%

5%

6%

5%

1%

6%

7%

11%

9%

17%

3%

12%

13%

13%

8%

19%

14%

14%

19%

5%

8%

5%

7%

4%

10%

3%

5%

12%

5%

6%

9%

19%

23%

18%

38%

28%

32%

34%

32%

21%

33%

35%

32%

53%

54%

60%

58%

66%

61%

69%

66%

62%

84%

0% 20% 40% 60% 80% 100%



29

Program Design Latin America








HR policies


















On-site child care


76%

72%

66%

64%

60%

59%

54%

54%

51%

51%

47%

40%

40%

39%

38%

37%

37%

30%

29%

22%

21%

16%

13%

9%

10%

7%

19%

13%

23%

12%

7%

22%

13%

26%

12%

8%

24%

18%

3%

26%

21%

21%

22%

9%

16%

19%

19%

5%

4%

4%

7%

9%

10%

16%

3%

13%

10%

13%

5%

17%

7%

14%

10%

14%

17%

18%

12%

18%

7%

15%

10%

12%

9%

16%

7%

14%

7%

13%

35%

12%

25%

10%

36%

35%

29%

29%

49%

23%

24%

31%

37%

51%

55%

49%

57%

74%

0% 20% 40% 60% 80% 100%



30

Program Design United States





HR policies





















On-site child care


95%

87%

85%

84%

83%

81%

78%

76%

76%

75%

73%

70%

69%

68%

64%

57%

55%

50%

48%

37%

31%

24%

19%

13%

1%

2%

5%

9%

8%

3%

9%

7%

7%

4%

14%

13%

7%

5%

8%

12%

1%

6%

4%

4%

10%

2%

6%

1%

1%

2%

4%

3%

4%

3%

8%

7%

5%

4%

5%

6%

9%

7%

8%

10%

4%

11%

6%

8%

18%

6%

7%

2%

3%

10%

7%

4%

5%

14%

5%

11%

13%

16%

8%

11%

15%

21%

20%

21%

40%

33%

41%

51%

41%

69%

68%

85%

0% 20% 40% 60% 80% 100%



31

Program Features


Wellness is a family affair. Increasingly companies see the value in making spouses, domestic partners and children eligible for health promotion and wellness programs and associated incentives. Research shows that the health of an individual’s family and friends greatly influence the health of the individual.

Eligible to participate in health promotion and wellness programs

Employees

Spouses

Domestic Partners

Children

86%

27%

22%

18%

10%

27%

23%

17%

2%

8%

7%

8%

2%

39%

48%

58%

0% 20% 40% 60% 80% 100%

All Only those who participate in the medical insurance program Other Not Eligible

Programs implemented to specifically address worker productivity*

Time off policies

Flexible work schedules

Tobacco-free work-site

Ergonomic work stations and resources

Work from home (telecommuting)

Productivity standards (goals, policies)

On-site gym or fitness center

Personal financial or legal support

On-site health services

On-site lactation support

Concierge services (dry cleaning, administrative support, transportation)

On-site child care

69%

66%

59%

55%

51%

46%

40%

38%

33%

33%

18%

8%

32

Incentives

Africa/Middle East

Asia

Australia/NZ

Canada

Europe

Latin America

United States

Organizations that offer incentives, including rewards, penalties, or both, to encourage participation in wellness initiatives – by region*

60%

69%

29%

55%

43%

51%

90%

65%

73%

64%

56%

47%

48%

88%

34%

41%

29%

41%

25%

16%

62%

2014

2012

2010

Incentive growth rate plateaued. After explosive growth in the use of incentives from 2010 to 2012, the growth rate plateaued and most regions experienced flat to decreasing rates of incentive use from 2012 to 2014.

*Question was asked differently in 2010 and 2012.

33

Incentives 2014 Employee incentive value for US employers (in USD)*

Completing a health risk appraisal (health and lifestyle questionnaire)

Completing a biometric health screening (such as blood pressure, cholesterol, glucose, body fat)

Achieving or maintaining measurable health status results (e.g., overall health index, body mass index, cholesterol)

Completing educational courses (live or online)

Participation in workplace health "challenges" (e.g., walking, weight loss)

Tracking regular healthy living activities (e.g., frequent exercise)

Working with a health coach or advisor

Adherence to a disease management program

Adherence to a therapeutic regimen (e.g., taking a medication)

Refraining from tobacco use

Obtaining regular preventive care examinations

Other

3%

3%

5%

12%

13%

8%

7%

6%

8%

6%

7%

29%

25%

25%

46%

46%

38%

39%

35%

31%

23%

37%

13%

21%

20%

19%

21%

18%

14%

27%

27%

8%

11%

24%

13%

28%

27%

16%

9%

11%

23%

16%

21%

31%

12%

13%

25%

10%

15%

10%

7%

8%

12%

4%

6%

8%

22%

15%

13%

9%

10%

26%

6%

4%

6%

7%

4%

15%

26%

3%

38%

0% 20% 40% 60% 80% 100%

$10 and less $11 to $50 $51 to $100 $101 to $250 $251 to $500 Over $500

*Calculations include only those employers that offer incentives. Only US data is shown due to prevalence of financial incentives. Program features sorted in order of prevalence.

34

offer gifts or merchandise as incentives.

offer cash incentives.

Incentives

45% 58%

Incentives positioned as a premium reduction. 85% of respondents offer health insurance premium incentives (reduction or increase), as compared to 62% in 2012. Companies have increasingly moved away from premium penalties and are positioning the incentives as a premium reduction.

52% of survey respondents offer premium reductions (up from 24% in 2012) and 33% use premium increases as incentives (down from 38% in 2012).

Types of incentive rewards offered

Free or low cost preventive health services

Gifts/ merchandise

Raffles/drawings

Health insurance premium reductions (discounts)

Cash

Employer-subsidized gym membership

Reimbursement for wellness classes (e.g. ,nutrition, smoking)

Contributions to Flexible Spending Accounts and/or Health Savings Accounts

Reduced or no cost maintenance medication

Vacation days/paid time off

62%

58%

57%

52%

45%

42%

37%

35%

28%

23%

3%

6%

5%

4%

2%

3%

3%

4%

4%

3%

3%

4%

4%

9%

2%

7%

11%

10%

7%

5%

32%

32%

33%

34%

52%

48%

49%

50%

62%

69%

0% 20% 40% 60% 80% 100%

Offered today Plan to offer in the next yearPlan to offer in the next 2-3 years Do not currently offer and no plans to offer

Types of deterrents or penalties the wellness program include

Health insurance premium increases (surcharges)

Benefit reduction

Increased health benefit copayments

Condition of employment (e.g., not hiring smokers)

Salary penalty

Mandatory participation (such as health risk appraisal) in order to receive health insurance

33%

8%

7%

7%

4%

3%

4%

3%

2%

3%

1%

1%

9%

9%

5%

5%

4%

1%

54%

80%

85%

85%

91%

95%

0% 20% 40% 60% 80% 100%

Offered today Plan to offer in the next yearPlan to offer in the next 2-3 years Do not currently offer and no plans to offer

35

Incentives

Activities for which incentive rewards or penalties are offered




Refraining from tobacco use

Obtaining regular preventive care examinations

Tracking regular healthy living activities (e.g., frequent exercise)


Completing educational courses (live or online)

Achieving or maintaining measurable health status results (e.g., overall health index, body mass index)


Adherence to a therapeutic regimen (e.g., taking a medication)

Other

76%

70%

60%

47%

45%

44%

42%

41%

33%

30%

14%

21%

7%

6%

11%

8%

7%

11%

8%

8%

9%

8%

7%

1%

3%

7%

8%

12%

12%

11%

14%

13%

23%

17%

17%

6%

15%

17%

21%

33%

37%

34%

36%

38%

35%

45%

62%

71%

0% 20% 40% 60% 80% 100%

Offered today Plan to offer in the next year

Plan to offer in the next 2-3 years Do not currently offer and no plans to offer

Eligiblility to receive incentives from health promotion and wellness programs

Employees

Spouses

Domestic Partners

Children

68%

15%

12%

6%

28%

31%

26%

10%

3%

4%

3%

3%

1%

50%

59%

81%

0% 20% 40% 60% 80% 100%

All Only those who participate in the medical insurance program Other Not Eligible

36

Incentives Value of incentive rewards or penalties (in US dollars)

25th percentile Average Median

75th percentile


$ 50 $ 222 $ 100 $ 240


$ 50 $ 239 $ 100 $ 250

Achieving or maintaining measurable health status results (e.g., overall health index, body mass index, cholesterol)

$ 33 $ 286 $ 100 $ 312

Completing educational courses (live or online) $ 15 $ 116 $ 50 $ 100


$ 15 $ 268 $ 50 $ 100

Tracking regular healthy living activities (e.g., frequent exercise) $ 25 $ 158 $ 50 $ 155

Working with a health coach or advisor $ 20 $ 137 $ 50 $ 100

Adherence to a disease management program $ 0 $ 130 $ 50 $ 100

Adherence to a therapeutic regimen (e.g., taking a medication) $ 0 $ 136 $ 40 $ 125

Refraining from tobacco use $ 30 $ 283 $ 125 $ 480

Obtaining regular preventive care examinations $ 25 $ 167 $ 60 $ 150

Other $ 109 $ 926 $ 258 $ 1238

37

Participation and Satisfaction

$251+

$151-$250

$76-$150

$26-$75

$5-$25

No incentives

Biometric health screenings (such as blood pressure, cholesterol, glucose, body fat) incentive levels by program participation rate (US)

67%

33%

40%

26%

32%

38%

16%

24%

23%

33%

25%

8%

18%

42%

37%

41%

43%

54%

0% 20% 40% 60% 80% 100%

High Participation (61%+) Medium Participation (41% - 60%) Low Participation (40% or less)

Workplace health "challenges" (e.g., walking, weight loss)

$251+

$151-$250

$76-$150

$26-$75

$5-$25

No incentives

25%

8%

28%

13%

11%

17%

38%

28%

10%

13%

12%

75%

54%

45%

78%

76%

71%

0% 20% 40% 60% 80% 100%


$251+

$151-$250

$76-$150

$26-$75

$5-$25

Health risk appraisal (health and lifestyle questionnaire) incentive levels by program participation rate (US)

65%

33%

54%

25%

52%

21%

39%

13%

22%

17%

13%

27%

34%

53%

30%

0% 20% 40% 60% 80% 100%


Greater impact on immediate actions. Incentives have a greater impact on participation for immediate actions, such as a biometric screening or health risk appraisals. Initiatives requiring long-term lifestyle changes, such as tracking exercise and working with a health coach are not as greatly influenced by incentives.

38

Participation and Satisfaction Tracking regular healthy living activities (e.g., frequent exercise)

$251+

$151-$250

$76-$150

$26-$75

$5-$25

No incentives

40%

20%

36%

13%

20%

39%

20%

40%

25%

20%

5%

40%

40%

64%

63%

60%

56%

0% 20% 40% 60% 80% 100%



$251+

$151-$250

$76-$150

$26-$75

$5-$25

No incentives

25%

11%

17%

23%

13%

11%

6%

14%

75%

100%

79%

78%

77%

73%

0% 20% 40% 60% 80% 100%



$251+

$151-$250

$76-$150

$26-$75

$5-$25

No incentives

6%

8% 8%

100%

100%

94%

85%

100%

100%

0% 20% 40% 60% 80% 100%


39

Participation and Satisfaction Respondents that measure employee participation

kBiometric health screenings (such as blood pressure, cholesterol, glucose, body fat)








On-site child care











HR policies (e.g., flexible work schedules, break policies, PTO policies)






96%

94%

94%

93%

92%

89%

88%

87%

86%

85%

85%

84%

82%

81%

81%

78%

76%

76%

75%

74%

74%

72%

70%

65%

4%

6%

6%

7%

8%

11%

12%

13%

14%

15%

15%

16%

18%

19%

19%

22%

24%

24%

25%

26%

26%

28%

30%

35%

0% 20% 40% 60% 80% 100%

Measured Not Measured

40

Participation and Satisfaction Respondents that measure employee satisfaction














Telephonic physician support / telemedicine services

On-site child care










0.375

72%

69%

68%

68%

67%

66%

66%

65%

63%

61%

55%

55%

54%

53%

52%

52%

51%

51%

51%

49%

49%

47%

46%

37%

28%

31%

32%

32%

33%

34%

34%

35%

37%

39%

45%

45%

46%

47%

48%

48%

49%

49%

49%

51%

51%

53%

54%

63%

0% 20% 40% 60% 80% 100%

Measured Not Measured

41



On-site child care
























47%

38%

36%

36%

34%

32%

29%

27%

25%

24%

23%

22%

21%

21%

20%

19%

18%

17%

16%

16%

16%

12%

11%

11%

15%

13%

25%

28%

25%

26%

29%

29%

25%

40%

31%

24%

23%

25%

24%

20%

21%

23%

27%

23%

19%

32%

17%

24%

3%

2%

5%

4%

5%

5%

6%

7%

9%

5%

8%

4%

8%

7%

5%

7%

8%

10%

7%

8%

11%

9%

6%

12%

1%

2%

1%

1%

3%

1%

1%

1%

2%

2%

1%

1%

2%

1%

1%

2%

2%

1%

2%

2%

2%

2%

3%

2%

1%

1%

2%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

32%

48%

33%

31%

34%

32%

34%

35%

39%

28%

37%

49%

46%

45%

49%

54%

49%

47%

48%

51%

53%

45%

63%

51%

0% 20% 40% 60% 80% 100%

Completely satisfied Somewhat satisfiedNeither dissatisfied or satisfied Somewhat dissatisfiedCompletely dissatisfied Not measured

*Respondents were allowed to select more than one answer. **The “All Regions” data represents responses combined from all regions

Participation and Satisfaction Satisfaction Rate (All regions**)

42

Participation and Satisfaction Participation Rate (All regions**) Health promotion/wellness program components*






















On-site child care




55%

47%

34%

31%

30%

29%

25%

23%

22%

14%

12%

11%

11%

9%

9%

8%

8%

6%

6%

6%

5%

3%

2%

2%

15%

10%

14%

15%

13%

12%

18%

12%

21%

13%

15%

9%

8%

3%

10%

3%

9%

3%

3%

3%

7%

3%

3%

11%

11%

16%

14%

11%

12%

18%

9%

17%

25%

24%

10%

15%

6%

14%

9%

14%

5%

5%

4%

14%

4%

3%

2%

7%

13%

15%

14%

16%

13%

21%

14%

19%

28%

26%

25%

16%

15%

26%

17%

18%

13%

5%

10%

25%

13%

12%

10%

11%

19%

20%

26%

30%

34%

17%

42%

22%

20%

23%

45%

50%

67%

42%

63%

52%

73%

81%

77%

49%

79%

80%

83%

0% 20% 40% 60% 80% 100%

81% - 100% 61% - 80% 41% - 60% 21% - 40% 0% - 20%

*Respondents were allowed to select more than one answer. **The “All Regions” data represents responses combined from all regions

43

Measurement and Outcomes

Measuring results. Most organizations implement wellness strategies with certain objectives in mind and expect a return on their investment. 2014 has seen a significant increase in the percentage of organizations measuring outcomes from their wellness initiatives. However, almost half of all respondents globally still do not measure specific outcomes.

of respondents have measured specific outcomes from health promotion programs.

Have measured specific outcomes fromhealth promotion programs

Yes52%

No48%

Have measured specific outcomes fromhealth promotion programs – by region

All regions

Africa/ Middle East

Asia

Australia/NZ

Canada

Europe

Latin America

United States

52%

40%

68%

54%

22%

37%

61%

53%

36%

33%

53%

47%

13%

18%

31%

35%

37%

36%

40%

25%

30%

29%

42%

37%

201420122010

52%

Have measured specific outcomes from health promotion programs by number of employees

More than 20,000

10,001 to 20,000

5,001 to 10,000

1,001 to 5,000

501 to 1,000

500 and less

63%

49%

44%

49%

49%

49%

44

Improved worker productivity/reduced presenteeism

0 - 1 year

2 - 5 years

More than 5 years

41%

36%

48%

34%

36%

36%

24%

29%

16%

0% 20% 40% 60% 80% 100%

High impact Medium impact Low to no impact

Reduced employee absences due to sickness or disability

0 - 1 year

2 - 5 years

More than 5 years

39%

36%

47%

39%

38%

36%

21%

26%

17%

0% 20% 40% 60% 80% 100%


Reduced health care or insurance costs

0 - 1 year

2 - 5 years

More than 5 years

43%

39%

44%

30%

35%

36%

27%

26%

20%

0% 20% 40% 60% 80% 100%


Improved workplace safety

0 - 1 year

2 - 5 years

More than 5 years

55%

38%

53%

24%

27%

24%

21%

35%

23%

0% 20% 40% 60% 80% 100%


Measurement and Outcomes Impact of wellness initiatives by years program has existed

45

Improved workforce morale/engagement

0 - 1 year

2 - 5 years

More than 5 years

54%

48%

55%

33%

36%

35%

13%

16%

9%

0% 20% 40% 60% 80% 100%


Enhanced attraction and retention

0 - 1 year

2 - 5 years

More than 5 years

53%

38%

48%

24%

33%

33%

24%

29%

19%

0% 20% 40% 60% 80% 100%


Reduced population health risks

0 - 1 year

2 - 5 years

More than 5 years

48%

43%

52%

29%

33%

33%

23%

25%

15%

0% 20% 40% 60% 80% 100%


Improved organization image

0 - 1 year

2 - 5 years

More than 5 years

46%

46%

59%

32%

33%

28%

22%

20%

12%

0% 20% 40% 60% 80% 100%



46

Increased use of preventive exams or benefits

0 - 1 year

2 - 5 years

More than 5 years

49%

49%

55%

30%

35%

34%

22%

17%

10%

0% 20% 40% 60% 80% 100%


Improved overall employee health

0 - 1 year

2 - 5 years

More than 5 years

46%

51%

60%

34%

34%

30%

20%

15%

10%

0% 20% 40% 60% 80% 100%


External recognition (e.g., awards, “best places to work” lists)

0 - 1 year

2 - 5 years

More than 5 years

26%

43%

56%

34%

21%

21%

40%

37%

23%

0% 20% 40% 60% 80% 100%



47



Entity that measures outcomes of health promotion and wellness programs*

Internal program manager

Health promotion or wellness vendor

Health plan administrator or insurer

Other third party (e.g., academic, consultant)

Top reasons outcomes are not measured*

Insufficient resources to support measurement

No priority from leadership

Do not know how to measure

Do not believe there is a measurable return

Do not believe the cost of measurement is justified

n = 422

57%

56%

37%

24%

57%

56%

31%

22%

68%

52%

33%

23%

2014

2012

2010

70%

32%

32%

16%

14%

68%

29%

34%

10%

7%

59%

33%

34%

13%

9%

2014

2012

2010

48


Respondents awareness of wellness initiatives impact on organization

Improved worker productivity/reduced presenteeism

Reduced employee absences due to sickness or disability

Reduced health care or insurance costs

Improved workplace safety

Improved workforce morale/engagement

Enhanced attraction and retention

Reduced population health risks

Improved organization image

Increased use of preventive exams or benefits

Improved overall employee health

External recognition (e.g., awards, “best places to work” lists)

62%

63%

71%

67%

75%

69%

71%

74%

72%

72%

74%

38%

37%

29%

33%

25%

31%

29%

26%

28%

28%

26%

Aware of impact Unaware of impact

49

Measurement and Outcomes Value of outcomes toward organizational objectives

Per-member/per-employee medical and pharmacy costs per year overall or select populations

Adherence to safety and company policies

Employee satisfaction ratings of their employer

Participation rates

Employee satisfaction ratings of programs

Biometric/lab value improvements

Adherence to evidence-based medicine rates (preventive care and disease)

Retention and recruitment rates

Projected productivity savings

Overall prevalence of conditions compared to benchmarks

Disability cases and days missed

Use of high performance providers/quality and cost


36%

32%

31%

31%

30%

25%

22%

22%

21%

19%

19%

18%

32%

31%

35%

38%

36%

27%

34%

29%

29%

30%

30%

33%

12%

17%

15%

15%

16%

17%

16%

20%

20%

21%

24%

19%

4%

6%

4%

4%

5%

6%

6%

11%

8%

6%

8%

6%

1%

2%

2%

1%

2%

4%

1%

4%

2%

4%

3%

3%

14%

12%

13%

10%

12%

21%

20%

14%

19%

21%

17%

21%

0% 20% 40% 60% 80% 100%

Extremely valuable Very valuableModerately valuable Slightly valuableNot at all valuable Do not know

50


of US employers indicate that their wellness program had an impact on trend.

of US employers who indicated their wellness program had an impact on trend, reported reductions of 2 percentage points or more.

of US employers who indicated their wellness program had an impact on trend, reported reductions of 6 percentage points or more.

28%

68% 12%

Average annual reduction in health care trend rate(US employers)

Reduction of 0-1 trend percentage points per year



Reduction of more than 10 trend percentage points per year

32%

57%

9%

3%

Reduction in health care trend rate (US employers)

Yes28%

No13%

Do not know59%

51


have measured trend impact for five or more years.

is the median number of years organizations have measured impact on cost trend.


42%

Number of years health care cost impact has been measured (US employers)

7%

12%

31%

8%

12%

22%19%

11%

37%

12%

21%

33%

11%

24%

1 year 2 years 3 years 4 years 5+ years

2014

2012

2010

42%

3

Reasons that wellness initiatives have not reduced organization's health care trend rate (US)*

The programs are too new; it may take time to see reduced trend

The programs are not yet comprehensive

Participation is not yet high enough

Other

Don’t know

38%

33%

33%

27%

13%

52


Prevalence of program components for organizations experiencing trend reduction (Top 10 US)

All US organizations

Trend reduction of 0-1 percentage points


Trend reduction of 6+ percentage points

95% 89% 97% 93%

87% 84% 84% 100%

85% 74% 82% 86%

84% 87% 91% 93%

83% 92% 93% 100%

81% 84% 78% 79%

78% 89% 91% 86%

76% 76% 69% 100%

76% 92% 76% 79%

75% 84% 75% 79%







HR policies





53


Which of the following is true of your organization*

We interpret wellness as including overall well-being, that is, physical wellness and financial wellnessWe consider our program an important element of our employee value proposition

Our leadership demonstrates strong support for wellness

We regularly collect employee feedback on our wellness programs (surveys, focus groups)

None of the above

57%

57%

43%

30%

11%

Perception of greatest employee barriers to health and wellness engagement**

Not enough time to participate and change health habits

Difficulty in finding the personal motivation to change long-held lifestyle habits

Concern about the privacy of their personal health data

Skepticism regarding the programs ability to help improve health

Lack of programs that seem relevant to their unique individual needs

Mistrust of their employers' intentions for the wellness program

Difficulty accessing resources, websites and wellness tools

Other

66%

55%

36%

28%

25%

24%

17%

3%

*Respondents were allowed to select more than one answer. **Respondents were allowed to select up to three responses.

54

Communications and Culture

use targeted email to communicate their wellness program.


71%

Tools and channels used to communicate wellness programs*

Web portal/ intranet

Posters/flyers

Targeted email

Newsletters/articles

Annual benefits enrollment materials

Employee meetings

Health fairs

Mailing to the home

Workplace challenges

Management/leadership briefings

Social media (Web-based)

Mobile technology

76%

76%

71%

65%

61%

57%

49%

42%

54%

34%

17%

19%

70%

68%

66%

59%

53%

50%

46%

37%

35%

31%

14%

7%

72%

70%

65%

66%

53%

54%

56%

40%

40%

31%

11%

4%

73%

77%

70%

69%

58%

55%

58%

44%

41%

37%

2014

2012

2010

2009

55


use a web portal to communicate their wellness program.

use posters and flyers to communicate their wellness program.

use workplace challenges for social engagement.

Tools and channels used to communicate wellnessprograms – by region*

Allregions**



Latin America

United States

Posters/flyers 76% 90% 53% 69% 71% 67% 77% 82%

Web portal/ intranet 76% 30% 50% 74% 77% 72% 65% 84%

Targeted email 71% 80% 59% 59% 50% 70% 77% 76%

Newsletters/articles 65% 50% 41% 62% 56% 57% 54% 74%

Annual benefits enrollment materials

61% 20% 15% 5% 63% 27% 17% 87%

Employee meetings 57% 60% 51% 69% 40% 50% 42% 62%

Workplace challenges 54% 20% 36% 59% 44% 41% 22% 66%

Health fairs 49% 60% 17% 18% 38% 32% 40% 63%

Mailing to the home 42% 10% 11% 10% 21% 22% 9% 62%

Management/leadership briefings 34% 40% 39% 51% 27% 27% 34% 34%

Mobile technology (apps for smartphones, tablets)

19% 10% 11% 8% 17% 14% 5% 25%

Social media (Web-based)*** 17% 0% 5% 26% 8% 11% 25% 20%

Games or game-like features 15% 10% 8% 0% 10% 8% 14% 20%

Mobile-enabled websites 13% 0% 3% 10% 2% 8% 8% 18%

Texting 8% 20% 20% 15% 0% 5% 9% 6%

Other (please specify): 1% 0% 3% 0% 4% 0% 0% 1%


*Respondents were allowed to select more than one answer. **The “All Regions” data represents responses combined from all regions ***e.g., Facebook, Yammer, Twitter, other blogs or employee discussion groups, testimonial postings)

76%

76%

54%

Communication channels. Employers are learning from experience that effective and engaging communications are critically important in order to get employees’ attention and motivate ongoing participation in wellness activities. Most employers use a variety of communication channels. Technology, including portals and targeted email, are top channels.

56


have created a distinct wellness theme, brand or identity to promote program participation.

use personalized or targeted messages when communicating wellness programs.

How personalized messages are used to communicate*

Their participation in certain programs

Their health risk appraisal scores

Their health benefit claims or health history

Their stated preferences or interests

Other

No personalized messages

32%

28%

22%

16%

3%

47%

Theme or identity created for wellness program*

Distinct health promotion/wellness theme, identity, or brand

Theme linked to organizational brand

Theme based on benefits communications

Theme inherited from health promotion/wellness vendor

Theme inherited from health plan or health insurance/sickness fund


Have not created theme or identity

43%

18%

15%

7%

3%

1%

35%


65%53%

Personalized communication. Personalized or targeted messages continue to rise, as used by 53%, in an ongoing trend likely reflecting both adoption of technology and the recognition of the need for relevance to drive engagement.

Branding. Employers increasingly also recognize the importance of marketing their wellness efforts through a branded identity. Use of a distinct theme, identity or brand rose from 41% in 2012 to 43% in 2014. Only 35% have no theme or identity, down from 37% in 2012.

57


Prevalence of communication message for organizations experiencing trend reduction (US)

All US respondents


Trend reduction of2-5 percentage points


No personalized messages 42% 34% 15% 8%

Their participation in certain programs 36% 45% 54% 69%

Their health risk appraisal scores 34% 50% 49% 69%

Their health benefit claims or health history 26% 0% 0% 0%

Their stated preferences or interests 19% 32% 33% 38%

Other criteria (please specify): 3% 0% 4% 8%

Prevalence of communication tools for organizations experiencing trend reduction (US)

All US respondents


Trend reduction of2-5 percentage points


Annual benefits enrollment materials 87% 92% 94% 93%

Web portal/ intranet 84% 97% 88% 93%

Posters/flyers 82% 97% 90% 93%

Targeted email 76% 92% 85% 100%

Newsletters/articles 74% 92% 90% 79%

Workplace challenges 66% 89% 79% 71%

Health fairs 63% 73% 78% 79%

Mailing to the home 62% 86% 71% 93%

Employee meetings 62% 68% 75% 71%

Management/leadership briefings 34% 43% 50% 57%

Mobile technology (apps for smartphones, tablets) 25% 38% 46% 29%

Social media (Web-based)*** 20% 24% 38% 43%

Games or game-like features 20% 35% 32% 29%

Mobile-enabled websites 18% 30% 31% 21%

Texting 6% 19% 9% 14%

Other (please specify): 1% 3% 0% 7%


***e.g., Facebook, Yammer, Twitter, other blogs or employee discussion groups, testimonial postings)

58


of respondents have a strong culture of health today but at least intend to pursue a culture of health for the future.

Culture of Health. An emerging concept in health promotion and wellness is that of a “culture of health,” defined as an organizational climate that promotes healthy lifestyle choices. Building blocks for an ideal culture of health include senior leaders that champion health promotion and act as role models, frequent communication with employees (including collecting feedback), support from all levels of the organization including middle management and line employees (with grassroots initiatives often taking shape), program elements that holistically address physical and psychosocial well-being, and a workplace environment and organizational policies that support healthy lifestyles.

78%

33%

Africa/Middle East

Asia

Australia/NZ

Canada

Europe

Latin America

United States

Extent that the organization plans to pursue a culture of health by region

30%

33%

47%

29%

23%

22%

40%

50%

44%

37%

44%

46%

45%

45%

20%

21%

13%

21%

29%

22%

12%

2%

3%

4%

2%

6%

3%

2%

4%

1%

0% 20% 40% 60% 80% 100%

Extremely so Very much so Moderately so Slightly so Not at all

n = 1033

Extent to which the organization currently has a culture of health

5%

19%

43%

26%

7%

Not at allSlightly soModeratelyso

Very muchso

Extremelyso

n = 1028

Extent to which the organization plans to pursue a culture of health for the future

1%3%

17%

44%34%

Not at allSlightly soModeratelyso

Very muchso

Extremelyso

Africa/Middle East

Asia

Australia/NZ

Canada

Europe

Latin America

United States

Extent that the organization currently has a culture of health by region

20%

9%

24%

4%

6%

5%

6%

40%

42%

8%

23%

27%

23%

25%

20%

41%

34%

44%

49%

36%

46%

20%

7%

26%

23%

15%

25%

19%

1%

8%

6%

3%

11%

4%

0% 20% 40% 60% 80% 100%

Extremely so Very much so Moderately so Slightly so Not at all

59

Successes and Vision

Greatest Successes and Long-Term Vision. At the conclusion of the survey questionnaire, we posed three open-ended questions: • What are the greatest successes you've achieved with

your health promotion and wellness programs? • What specific, measurable goals or metrics do you hope to

achieve in the next few years? • Describe your long-term vision for the future of your

health promotion and wellness programs. Representative examples are highlighted below, selected from the hundreds of responses to these questions Greatest Success. Below is a sample of what participants listed as their greatest successes. “Many individual success stories of employees learning of a health risk for the first time, taking control, and improving their health.” “Opening an onsite clinic at our headquarters and seeing the usage increase year over year.” “Support from leadership to establish a group of wellness champions.” “Implementing a global annual biometric screening program at our manufacturing plants.” “Over 90% of employees have had a blood pressure screening within the past year.” “We have had great success with our on-site yoga program.” “Our walking challenge gets bigger support/participation each year we hold it.” “Aligning program objectives to the business purpose and strategy.” “Better relationships among employees.” “Complete buy-in from senior management.” “Testimonials have indicated lives have been saved and changed. Who could ask for more?”

Measurable Goals. Below is a sample of what participants listed as measurable goals they hope to achieve in the next few years. “Continue to reduce turnover and absenteeism due to illness.” “Increase participation in health screenings, flu shots, mobile mammographies and financial wellbeing classes.” “Tobacco-free campuses in the US this year, and globally next year.” “Increase awareness and education of sound nutritional practices.” “Reduce metrics from employee health screening, such as high blood pressure and cholesterol level.” “Reduce the number of smokers by 5-10%.” “Address and reduce chronic conditions that seem to be affecting a large portion of our workforce.” Long-Term Vision. Below is a sample of what participants listed as the long term vision for their health and wellness programs. “We want to fill our company with healthier employees who take pride in themselves.” “Improve overall health of employees by providing access to tools that create an overall work life balance, which includes physical, emotional and financial wellness.” “To develop a culture of health that increases employee engagement, improves health, and manages healthcare costs.” “To develop a comprehensive program that actively monitors wellness indicators and adapts the programs offered each year to what employees value most.” “To provide employees with the opportunity to manage their own health, in their preferred way.” “To create a meaningful, integrated program with minimal barriers to participation that provides employees with tools and resources that improve health and wellness, leading to reduced healthcare costs and improved productivity and quality of life.” “To influence every single employee in a positive way through our wellness initiatives.”

60

Respondent Profile

Respondents by organization type

Not-for-profit10%

Governmental8%

Publicly traded33%

Subsidiary5%

Private43%

Workforce is in multiple countriesn = 1,160

Yes46%

No54%

Industry Number of employees

Percent of total Percent of totalAccommodations, Hospitality & Food Services 3% 32 More than 20,000 11%Aerospace & Defense 1% 13 10,001 to 20,000 7%Agriculture, Forestry, Fishing & Hunting 1% 16 5,001 to 10,000 9%Associations & Membership Organizations 1% 11 1,001 to 5,000 21%Construction 1% 17 501 to 1,000 10%Consulting & Professional Services 9% 99 500 and less 42%Educational Services 4% 42 n =

Energy/Utilities 4% 47 100.0% Financial Services 9% 106Government & Public Administration 4% 51Health Care Providers & Services 9% 100High Technology 6% 73 Annual revenue (USD)Life Sciences 2% 20Manufacturing, Materials & Mining 19% 219Media & Information 1% 14 Percent of totalReal Estate 1% 11 $10 billion and greater 17%Rental & Leasing 0% 4 $3 billion to $9.99 billion 19%Retail/Wholesale 7% 77 $1 billion to $2.9 billion 23%Telecommunications 2% 21 $100 million to $999.9 million 23%Transportation & Warehousing 2% 28 Less than $100 million 19%n = 1159 ###

61

Participant List

A Boa Vida Alfredo Cruz y Cia

AAA Northern California, Nevada, Utah All Nippon Airways Co.

AASA Allen & Overy

Acez Instruments Pte Allergan Produtos farmacêuticos

ACH Group Alliance Data

ACI Specialty Benefits Alliant

Acquatron Comercial Allina Health Systems

Acument Global Technologies Allstream

AcxiomCorporation Alstom India Limited

Adecoagro vale do ivinhema AMB Group

Adimark Ambiel RH

Adirondack Financial Services Ambiente y Tecnologia

Adirya Sustainability Solutions Ambulance Victoria

Adobe AMC Networks

ADOC Amcor Flexibles

Adsensa AMD

ADT American Airlines

Advent Software American Cancer Society

AES Corporation American Capital

AES Gener American Commercial Lines

Affinity Medical Group American Red Cross

AFP Planvital Amica Mutual Insurance Company

AGECOMET AMP Inversion

Agencia de Aduana Pedro Serrano AMSEC

Agricola Rio Blanco Amway

Agrium Anagma

Agro Alimentos Aon Australia

Agroindustria Esmeralda Aon Hewitt

Agrosystems Apache Corporation

Aguas Pirque Applied Materials

AIA Benefits Resource Group Aramark

AIPM Arauco Distribucion

AirData Arfier

Akeso Care Management Argos Ready Mix

Akron General Health System Arlington County Government

Alameda Moveis ARPHS

Albatros Sp. z o.o. Sp.k. Arthur J. Gallagher

Alberta Energy Regulator Ascena Retail Group

Alcatel-Lucent Polska Ases y Ventas AQB

Alco Impresores Asesorias y Servicios Donoso y Rau y CiaAlejandra Espinoza ASML

62

Participant List

ASP Chile Bharat Heavy Electricals

Assa Ablay BICE Corredores de Seguros

AstraZeneca BIS Benefits

Athlon SCooo Biuro Styl Sp. z o.o.

Ativittà - Qualidade de Vida BI Worldwide

Atlantic BJC HealthCare

Atos IT Solution Service Bloomin' Brands

Auge BMO Financial Group

Aurizon Bodegas San Francisco

Autodesk Boehringer Ingelheim (Canada)

Automobile Insurance Plans Service Office Boehringer Ingelheim (Chile)

Automobile Parts Manufacturing Co. Changzhou Changrui Boehringer Ingelheim Pharmaceuticals

Autonomo Bombardier

Avantor Performance Materials Bombardier Produits Récréatifs

AXA Business Services Bombas de Pozo

AXA PPP healthcare Bonar

B&Q Plc Bońkowscy

B. Braun Medical Booz Allen Hamilton

Babcock & Wilcox Bordados Krefela

Bacardi Martini Chile Bormax

Bago Bosca Chile

Baker, Donelson, Bearman, Caldwell & Berkowitz, P.C. Bosch

Ball Packaging Boston Scientific

Banco Estado Corredores de Seguros Bourgeois Medical Clinic

Banco Internacional Bozzo

Banco Penta BP Zhuhai Chemical Co.

Banco Santander Bravo Energy Chile

Bank Millennium Bread House

Bank of Hawaii Bridgestone Chile

Barker Ross Group Bridgewater Associates

Barnard College Brightstar Chile

Barry-Wehmiller Companies Brisbane Tree Experts

BASF Bristol-Myers Squibb

BBM - Condicionamento Fisico Personalizado Brownells

Bebe Bruker Corporation

beBetter Health BSR

Beijing Chuangju Herun Technology Development Co. BT CWU

BenQ Materials Co. Buck Consultants

Benz Communicatons Buck Consultants (UK)

Bull HN Information Systems

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Participant List

Bupa (Australia) Central College

Bupa (UK) Central GA Technical College

Burnham Benefits Centrum PISOP

Business Software Centura Health

C3 collaborating for health Centurum

CA Technologies Cermag Poznań Sp. Z O. O.

CAA South Central Ontario Cesmec

CACI CGI

Cairns Regional Council CGI (Canada)

Caixa De Previdência Dos Funcionarios Do Banco Do Brasil CGP (Brasil)

California Department of Industrial Relations CH2M HILL

Calpine Corporation Changzhou Xingyu Automotive Co.

Calzados Guante & Gacel CHEC Australia Pty

CAM Gym Chedraui

Cameron Singapore Pte Chenega Corporation

Camilo Diban Chevron

Campanil Chi Heng Foundation

Canada Bread Chibukuproducts

Canada Life (UK) Limited Children's Medical Center

Canada Post Children's of Alabama

Canadian Cancer Society, BC & Yukon Division China BlueChemical Hainan Base

Capital BlueCross China Resources Cement (Changjiang) Limited

Capital Health Chongqing Acoustic-Optic-Electronic Co.

Captagua Chongqing Polycomp International Corp.

Care Plus Chongqing Tianyuan Chemical Co.

Cargill (US) Chongqing Tobacco Leaf (Fukao) Co. Pengshui Fukao

Cargill Agricola S/a CHS

Carl Zeiss Microscopy Cial Alimentos

Carlson Cielo

CarMax Cigna

Carter's Cigna (UK)

Cartograf CIRCOR

Casio Techno Cirque du Soleil

Catholic Diocese of Richmond Cisco

Catholic Health Initiatives Citizens Property Insurance Corporation

CBI Citti GV Partner Polska Sp. z o.o.

CBRE City of Beaumont

CD Internacional City of Casper

CEDA City of Columiba, MO

Cementation Sudamérica

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Participant List

City of Mountain View Corporacion Sofofa

City of San Jose Cosmetica Avon

City of St Petersburg Country Financial

Clariant Chemicals (Guangzhou) Co. Country Life

CLAUDI County of Los Angeles

CLIN Covidien

CME Group Covidien (Chile)

CNH Industril Polska CPP Investment Board

CNO Financial Group Cristaleria Toro

Coca-Cola Enterprises Cromadora Jota

Coca-Cola South Pacific Crown Castle International Corp.

Colgate-Palmolive Crown Castle USA

Collotype Labels Cruz Blanca

Colonial Pipeline Company CSAA Insurance Exchange

Colorado PERA CSR Korea

Comaco CTP - Serviços Médicos e Terapias

Comercial Habitat Culligan International

Comercial Rey Custom Design Benefits

Comercial y Distribuidora Grupo Activa CVS Pharmacy

Comercializadora ANF Cytec Aerospace Materials

Comércio Digital BF Dafiti Cytec Industries

Comporium Dafeng (Chongqing) Computer Co.

Con Edison Dallora

ConAgra Foods Dana

Conexion Danfoss

Confecciones Herr Daqo Group

Confrut Datang International Power Generation Co. Douhe

Consejo de Defensa del Estado Dataprev

Constructora de la Rivera Dawn Foods

Constructora Lahuen Dayco

Consumer Reports Daymon Worldwide

Convergys Dazhongli Properties Limited

Con-way DCS Corporation

Cookson Electronics Dealertrack Technologies

CooperVision Deere & Company

Cordero Del Monte Fresh Produce

Core Laboratories LP Dell

Cornes Tech Dell (Brazil)

Corning Deloitte

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Participant List

Department of Transport and Main Roads Electronics for Imaging

Department of Treasury and Finance Embraer

Dept Attorney General and Justice Embraer S.A.

Dharma treinamentos EMD Millipore

Diageo Emirates CMS Power Company

Dick's Sporting Goods Empik

Discovery Empresas Amdromaco

District School Board of Pasco County Empresas Lipigas

Diversey Energizer

Dixons Retail Energomix Sp.z.o.o.

Dollar Bank EnerNOC

Domino's Pizza Entropic Korea

Domtar EnviroWaste Services

Donaldson Company EOH Health

Dongguan Samsung Electro-Mechanics Co. Equifax

Dot Foods Equity Brands y Retail

Dover Corporation Erickson Air Crane

Dow Chemical Ericsson

Doylestown Hospital Ernst and Young

DPM Sp. z o.o. Ernst and Young (Chile)

Draeger Esmetal Metalurgica

DriveTime ESQV

DS Americas Estre Ambiental

DSM Ethan Allen Global

Duke Realty Etla

Earth Arts Euler Hermes

East Carolina University Euroamerica

Eastman Chemical Company Evolution1

Eat'n Park Hospitality Group Ex. Rio Blanco

Eaton Exelis Systems Corporation

EbenConcepts Export Development Canada

ECE Projektmanagement Polska sp. z o.o. EY

Eco Club Sp.zo.o. F. Hoffmann-La Roche

Eduardo Cisterna e Hijos F.E.Colegio SSCC Manquehue

Education Management Faenadora de Carnes Victoria

Edward Jones Federal Express Canada

Eisai Federal Reserve Bank of Atlanta

Ekoanalityka J.Sternal Fentress Architects

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Participant List

Feronia GetWellNetwork

FES Zaragoza UNAM GFA

Fifth Business Glen Raven

Firma x Global Foundries Singapore

First American Global Hand

First Health Care Goldman Sachs

Fisher and Paykel Finance Graco

Fitch Ratings and Fitch Risk Graebel Companies

Flextronics Great-West Healthcare

Flight Centre Travel Group Great-West Life

FLSmidth Green Shield Canada

Fluor Corporation Groupe Yves Rocher

FM Global Grupa Raben

FM Insurance Grupo Fleury S/A

FMC Technologies Grupo Genesis

Fonterra Cooperative GSESCL

Ford Motor Company Guangdong Hongda Blasting Co.

Forest City Enterprises Guangdong Polaroid Power Co.

Formosa Plastics Corp., U.S.A. Guangzhou Baiyun Shan Ming Xing Parmaceutical Co.

Fortress Investment Group Guangzhou Baiyun Shan Pharmaceutical Co.

Four Seasons Hotels Limited Guangzhou Guangri Elevator Industry Co.

FQM (Akubra) Guangzhou Xiaohu Petrochemical Wharf Co.

Franklin County Cooperative Health Benefits Gwinnett County Government

Franklin Templeton Investments GymPass

Frauenthal Hainan Provincial Disease Prevention and Control Center

Fuerza Aerea de Chile Halliburton Energy Services

Fuji Xerox Singapore PTE Hallmark Cards

FURP Hamilton Caster & Mfg. Co.

Gartner Harris Health System

Gate Gourmet Hartford HealthCare

GDF SUEZ Energy North America Hauraton

Gelateria Bravissimo Hawaii National Bank

General Dynamics Information Technology Hays Companies

General Mills HCA

General Motors Chile Industria Automotriz Health Management Systems HMS

Genesee County Health Plan Advocate

Geoassay HealthFitness

Georg Fischer AG HealthScape Advisors

George Mason University Heart Foundation

George Smith Hebei Guohua Candong Power Co.

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Participant List

Henan Pinggao Electric Co. Ingersoll Rand

Henkels & Mccoy INGRA Indústria Gráfica S. A.

Hewlett Packard Ingredion

HICA Institute of Bioengineering and Nanotechnology

Hillcrest Instituto Profesional AIEP

Hilton Worldwide Intel

HOKEN NO MADOGUCHI GROUP Intelsat

Hollard Insurance Company Inter-American Development Bank

Honda International Fibres Group

Honda Auto Parts Manufacturing Co. International Flavors & Fragrances

Hopland Sho-Ka-Wah Casino Internet Society

Horizon Media Intersystems

Hornbeck Offshore Intraco Limited

Hospital Alemão Oswaldo Cruz Intuit

Hotel Zdrojowy Pro-Vita ISO-LAB Sp. z o.o. Sp. k.

Hotelera Austral STGO Spa IUE-CWA Pension Fund

Huasheng Fujitec Elevator Co. J.R. Simplot Company

Hubei Province Cigarette Material Factory Japan Association of Corporate Executives

Hubei Qixing Group Co. JATO Dynamics

Hubei Sanling Special Purpose Vehicle Co. JCI

Hubei Yichang Jinsi Tobacco Co. Jewish Federation of Metropolitan Chicago

Hudson's Bay Co. JHI Property Services

Hunter Douglas Jiangshu Tiansheng Pharmaceutical Co.

Huntington Ingalls Jiangsu Liburui Garment Co.

Hydro Tasmania JM Family Enterprises

hylant John Deere

HYPO NOE Gruppe Bank John Paul College

IBGEN John Wiley & Sons

IBM Corporation John Wiley & Sons (UK)

IBOPE Media Johnson & Johnson (Suzhou) Medical Equipment Co.

ICBC JOINTEX Incoming Services

ICF International JYSK Sp. z.o.o.

IDT Kaijou Bill Clinic

IFES Kaiser Permanente

IMA Kanlux S.A. (China)

Indalum Kanlux S.A. (Poland)

Indiana Regional Medical Center Katarzyna

INDISA KBR

Industrias Chloe Chile Keppel FELS

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Participant List

Kimberly-Clark Corporation Marketplanet

Kirchhoff Polska Sp. z o.o. Mars

KLA-Tencor Corporation Mars (Poland)

KLA-Tencor Singapore Pte Marsh & McLennan

Kobelco MARTA

Kraft Canada Marvell Semiconductor

K-Swiss Global Brands Materion Corporation

Kuakini Health System Mayo Clinic

Laboratório Biovet S/A McAfee International

Laboratorio Durandin McAfee International (UK)

Laboratorio Saval MEC Kołobrzeg

Lafarge North America Medtronic

Laird Technologies MemorialCare Health System

Lake County Government Mengniu Dairy (Dangyang) Co.

Lancaster General Mercer Marsh

Land O Lakes MetLife

Lansons MetLife Europe Limited

Lastar Metroland Media Group

Latham & Watkins LLP Miami Dade College

Legg Mason MicronLeidos Microsoft

Les Higiena sp. z o.o. Microsoft Sp. z o.o.

Lextar Mikroserwis

Lianzhong (Guangzhou) Stainless Steel Co. MindSolutions

Lifelabs Mine Safety Appliances Company

LighterLife Minera Antucoya

Lincoln Industries Mingledorff's

Livestock Improvement Association of Japan Minha Vida

LM Wind Power (Tianjin) Co. Miron Construction

Lockton Companies Mississippi Lime Company

Lonza Brasil Mitsubishi International Corporation

Loras College Montefiore Medical Center

Los Angeles Department of Water and Power Morrison Utility Services

LSI Logic Corporation Mosaic restaurant group

Lubrizol Corporation, The Motorists Insurance

Luoyang Ship Material Research Institute Move

Lureye Movilway Chile SpA

LyondellBasell Industries MPC

Mackays Stores MPS International Sp. z o.o.

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Participant List

MSA The Safety Company (Brazil) Onlife Health

MSD Singapore Oracle Corporation Singapore Pte

Municipalidad de Padre las Casas Orientando e Educando

Murphy Oil Corporation Orriant

Nashville MTA Owens-Illinois

National Express Pactiv Corporation

National School Boards Association Parexel International

Nektar Parque del Sendero

NetApp Patriot Coal

Netia S.A. Paul, Hastings, Janofsky & Walker

New York University Peel Regional Police

Newalta Corporation Pelion SA

Newmont Mining Corporation People In Aid

NGK Insulators TangShan Co. Pepperdine University

Nigerian Institute of Transport Technology Zaria Pernod Ricard Chile

Nike Pfizer China

Nike (Netherlands) Philhaven

Nintendo of America Philips Lighting Industry (China)

Nippon Paint Piedmont Group

NJ Hospital Association PKO Bank Polski

NJ Transit Places for People

Northern Offshore PMI Global Services

Northwest Community Healthcare Prefeitura Municipal de São Paulo Northwest Federal Credit Union Polska Organizacja Turystyczna

Novelis POT

NSD Co. Power Construction

NSWC Powernet Group

Nuffield Health PPC WorldwideNVFS PraxairNYISO Praxair (Canada)NYU Langone Medical Center Precision ResourceOfcom Precoat MetalsOffice of Group Benefits, State of LA PrecyseOfficeMax Pricewaterhouse CoopersOfficeTeam Primedia InstoreOknoplast Sp. z o.o. Principal Global Investors (Europe)Olgoonik Development PrintpackOM consultants ProcomOMERS Professional Engineers OntarioON Semiconductor Promondo

70

Participant List

Prosegur Holding SandvikPrudential Insurance Company of America SanofiPruHealth Sanofi Aventis ChilePrzedsiebiorstwo Produkcyjno Usługowo Handlowe Rasel SanondaPSECU SAS Institute Sp. z o.o.Puma Energy Savills plc PVH Corp. SBKS MIRCPwC SC JohnsonPwC Management Services Schwan Food Company, TheQk4 ScotiabankQueensland Urban Utilities SCS Polska Sp. z o. o.Rabobank SDIC Zhongmei Tongmei Jingtang Port Co.Radio PiN Seagate TechnologyRail Tec Arsenal Sebrae NARambus Semiconductor Manufacturing International Co.Ramsay Health Care SEPTARandstad Chile SequenomRASTROS DAGUA SeR PsicologiaRCF SercoRedBrick Health SernapescaRehabilitation Hospital of the Pacific SersanoRepsol Sinopec Brasil Servicio de Salud Metropolitano OrienteRespicardia Servicio Salud Bio BioRice University Servicios Gráficos y ComputacionalesRicoh Canada SESIRidgewood Savings Bank SESI Santa CatarinaRio Tinto SFFRockefeller Group International SGLRockland Trust Company Shanghai American SchoolRödl&Partner Shaw IndustriesRolls-Royce PLC SheetzRosa Maria do Prado Oliveira Shell Chemicals Seraya PteRosetta Stone Shell Polska Sp. z o.o.Rosewood Abu Dhabi Shenma PHP Airbag Yarn Manufacturing Co.Rowan Shennan Circuits Co.Royal Greenland Seafood sp. z o.o. Shoppers Drug MartRYC Servicios Computacionales SHT Haustechnik AGSAIC SiemensSalient Federal Solutions Simon Property Group

Simon Property Group (Canada)

71

Participant List

Sinacofi SynecpolSingapore Oriental Motor Pte Szczecińskie Kopalnie Surowców Mineralnych S.A.Sinochem Zhenjiang Coking Co. TAM AirlinesSinopec Guangzhou Petrochemical Tangshan Aisin Gear Co.Sinopec Sichuan Vinylon Works TCDSBSinosteel Luoyang Institute of Refractories Research Co. TD Bank Financial GroupSinosteel Refractory Co. TechnicaSK Comercial Telefônica Brasil S/ASmith Brothers Insurance TenarisSociete Generale Tennessee Farmers Mutual Insurance CompanySomerset Hospital TeradyneSonoco Territorial Savings BankSouth Australian Council of Social Service Tesla MotorsSouthco Texas Mutual Insurance CompanySpafinder Wellnesss TGS-NOPEC GeophysicalSpansion The Children's Place Retail StoresSpicers Paper (Singapore) The City of NewcastleSpinrite The David and Lucile Packard FoundationSpokane Regional Health District The Fit for Work TeamSport Thieme GmbH The Goodyear Tire & Rubber CompanySpringboard Health & Performance The Great Atlantic & Pacific Tea CompanySPX The HartfordSQM The Law Society of Upper CanadaSQS Group The Metropolitan Museum of ArtSRA International The National Restaurant AssociationST Medical Services The Pampered ChefSt. Johns River Water Management District The Samuels GroupSt. Louis County Government The Wellness ArchitectsStandard Bank The Wellness Program at WVU Healthcare Stantec Consulting Services The Woodbridge GroupStarwood Hotels & Resorts The World Bank GroupState Farm Insurance Tianjin FAW Toyota Engine Co.State library of Queensland Tianjin Liugong Machinery Co.Statoil Tiffany and CompanyStryker Corp Tim HortonsStumm Insurance TLC Management Co.Sunflower Education Center Tootsie Roll IndustriesSuominen Polska Sp. z o.o. Toplite (Guang Zhou) Technology Battery Co.Superintendencia de Bancos TopMed Assistência à SaúdeSymantec Total Malawi Limited

72

Participant List

Town of Longboat Key Vivero RancaguaTownsville City Council VMwareToyota Boshoku Volaris GroupToyota (Mexico) Volkswagen Group South AfricaTransamerica VWRTransport for London Vykin CorporationTroton Sp. Z O.O. W.E.T. Automotive Systems (China)TRW Automotive Components (Langfang) Co. Waitemata District Health BoardTufts University Wanhua Chemical GroupTuravion Wanxin Optics GroupTVN WawaTwitter (US) WebMDTyco Electronics Singapore Pte Well Connected AllianceUF Health Wells Fargo & CompanyUFRGS Werner EnterprisesUmweltverband WWF Österreich WESCO DistributionUnited States Olympic Committee West Pharmaceutical ServicesUniversal Innovations Western & Southern Financial GroupUniversidad de los Andes Western Downs Regional CouncilUniversität Heidelberg Western Electric Pa Weier Electric Co., ChangzhouUniversity of PEI Westinghouse Electric CompanyUniversity of Sydney Westlake ChemicalUniversity of Virginia WeyerhaeuserUnum WidgetUrząd Gminy Kołobrzeg Wilbur Curtis Co.Uzdrowisko Kołobrzeg SA Will CountyVaisala Willis Lease Finance CorporationVale Wilson Sonsini Goodrich & RosatiVanderbilt University WindstreamVapor Industrial Wipro TechnologiesVCE Company WISE CCIBVerisign Witkoppen Health and Welfare CentreViacom WK design groupVictory Consulting Wodociągi ZachodniopomorskieVidrieria Jorge Barrias Zamorano Work Health SystemsVinilit WorkbaseViscofan Workup Soluciones en Salud y Productividad S. C.Visteon Corporation Wydawnictwa Szkolne i PedagogiczneVita Wuxi Sunshine Power Co.Viva Planos de Saúde Wyndham Worldwide

73

Participant List

XeroxXerox (Canada)Xerox (UK)XylemYahooYale New Haven Health SystemYangxi Haibin Electric Power Development Co.Yankee AllianceYankee Candle CompanyYichang City Cement PlantYichang Dalong Industrial Co.Yichang Dongyangguang Thermal Power Generation Co.Yichang Jinbao Musical Instrument Manufacturing Co.Yidu Multi-State Chemical Co.Yingli SolarYKK AP (Suzhou) Co.Yum! BrandsZenrosai National Federation of Workers and Consumers InsuranceZM Unimięs Sp. z o.o.Zurich Insurance GroupZurich Insurance Group (UK)

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About the Survey Sponsors

Special thanks to the Cigna and Global Healthy Workplace, the key sponsors of this survey as well as Wolf Kirsten, a partner in the survey. For more information contact [email protected] and visit http://globalhealthyworkplace.org or visit http://www.cigna.com/business/. Additional promotion was provided by many organizations worldwide, including: AOK Institute Associação Brasileira de Qualidade de Vida Deutsche Demographie Netzwerk European Network for Workplace Health Promotion GRUPO LM&S Health Promotion Board of Singapore HERO Hidalgo & Asociados Hotel Provita Institute for HealthCare Consumerism International Association for Workplace Health Promotion Institute of Sports Medicine Austria International Organisation of Employers The Jacques Malan Group of Companies LorantMS/CAMSA Midwest Business Group on Health Nat. Institute of Occupational Health and Poison Control China National Wellness Institute of Australia Sanpo Society Japan SCIATH Insurance Brokers Vishwas

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About Us

Since the invention of Xerography more than 75 years ago, the people of Xerox have helped businesses simplify the way work gets done. Today, we are the global leader in business process and document management, helping organizations of any size be more efficient so they can focus on their real business. Headquartered in Norwalk, Conn., more than 140,000 Xerox employees serve clients in 180 countries, providing business services, printing equipment and software for commercial and government organizations. Learn more at www.xerox.com. Organizations succeed when their people succeed. At Buck, we love to find answers to tough challenges that impact your people. We work in the areas of employee benefits strategy, human resource operations, programs, performance, and talent strategy. Buck Consultants is now a part of the HR Solutions division of Xerox. Learn more and talk with us at www.xerox.com/hrconsulting.

Buck Analytics, Surveys and Co-sourcing We conduct a range of HR and compensation surveys that provide quality data that you can rely on to make decisions critical to your success. 200 Galleria Parkway, Suite 1900, Atlanta, GA 30339 353 Sacramento Street, Suite 800, San Francisco, CA 94111 Carretera Miguel Alemán # 1000, Parque Industrial Monterrey, Apodaca, Nuevo León, C.P. 66600, México

1.800.887.0509 [email protected] www.bucksurveys.com

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Documents

Table of Contents...Welcome to Working Well: A Global Survey of Health Promotion, Workplace Wellness and Productivity Strategies sixth edition, July 2014 , which investigates emerging