Commentary on 'The health promotion model as assessed by ageing workers'

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It is well established that a healthy workforce provides workplaces with many more benefits than if this were not the case. Investing in workplace-based health schemes equips organizations with motivated workforces, increased overall efficiency, subsequent higher morale, reduced personnel and welfare problems, reduced absenteeism, reduced industrial relationship disputes and an improved organizational per- formance, competitiveness and public image (Chu et al. 2000, Price et al. 2000). However, where such programmes are not in place, an increasing body of evidence identifies the substantial health burden and cost that workplaces suffer as a result of ill-health among their staff. The consequences for any organization that has an unhealthy workforce, irrespective of age, are many and include work-related accidents, high rates of absenteeism, high levels of stress, loss of productivity and high incidence of health-related litigation (Verow & Hargreaves 2000, Addley et al. 2001). Paula Naumanen’s (2006) article represents a useful contribution to the workplace-based health-related literature – especially as there is so little Occupational Health Nurse- based literature in the international press. This said her study needs to be tempered against the rationalization of a ‘true’ health promotion context and model framework for it to have real meaning in the health promotion community. In effect, the findings of this study are best located within a personalized and behavioural framework of reference – which is far more appropriately grounded in a health education context (see Whitehead 2001, 2003, 2004a, 2005a, Whitehead & Russell 2004). Naumanen’s (2006) article, one could argue however, is merely reflecting a majority of the existing occupational health workplace-based literature, which continues to focus on physical and psychological behavioural lifestyle-related objectives, processes and outcomes. This activity usually indicates smoking and alco- hol/illicit drug-monitoring, stress reduction, mental health schemes, employee fitness and exercise, weight control and healthy eating, prevention, early detection and screening programmes for serious diseases, health information and health paraphernalia (Harvey et al. 2000, Addley et al. 2001, Secker & Membrey 2003, Holdsworth et al. 2004). It is true that Naumanen’s (2006) study and model represents a departure from conventional health service- focused health education activity, as it extends to include the wider scope of workplace and its orientation/influence on the health of its workforce – rather than just the conventional health-related activities of medically orientated institutions. In this respect, Naumanen’s (2006) paper also reflects the World Health Organisation’s push to drive health promotion as it pertains to its strategy of focusing activities in particular health settings (Whitehead 2004b,c, 2005b–c, 2006a–b) – with the workplace being one of them (WHO 1995, 1999, 2004a–c). However, Naumanen’s study (2006) still fails to move beyond the scope and practice of the Occupational Health Nurse’s ‘traditional’ role of illness prevention, health education counselling and health screening, while an emerging movement advocates progress toward more holistic workplace-based health schemes that, instead, address the wider organizational, social and environmental determinants of workers in their workplace (Chu et al. 1997, Chu et al. 2000, Brown 2002). It is known that behaviourally orientated workplace health schemes tend to have, at best, ‘modest’ outcomes (Holdsworth et al. 2004). Individual risk factors are an important consideration for Occupational and Environmental Nurses (Stone 2000) – but are much less significant when compared with the broader social, societal, ecological and environmental issues as they impact on organizations and their surrounding communities. This is why Ennals (2002) prompts us to consider the world beyond the workplace – the wider community where workers are engaged as citizens. In reverse, community health action is also useful for encouraging healthy lifestyles in the workplace as part of a social normalization process (Price et al. 2000). Existing occupational health literature often fails to acknowledge the extension of a positive healthy culture in the workplace, as producing the added benefit of potentially influencing the health of immediate and wider family groups of employees and their communities overall. This fundamental aspect of workplace health is hardly ever addressed or acknowledged in occupational health, medicine and nursing fields – hence the lack of visible ‘health promotion’ activity. If Naumanen (2006) had explicitly addressed and endorsed the wider community/societal perspective, instead of just the specific workplace community, then her model would be more representative of a health promotion model – rather than a health education model in its current context. References Addley K, McQuillan P & Ruddle M (2001) Creating healthy workplaces in Northern Ireland: evaluation of a lifestyle and physical activity assessment programme. Occupational Medicine 51, 439–449. Brown E (2002) Connecting healthy workplaces with healthy people. Kai Tiaki: Nursing New Zealand 8, 10. Chu C, Breucker G, Harris N, Stitzel A, Gan X, Gu X & Dwyer S (2000) Health promoting workplaces – international settings development. Health Promotion International 15, 155–167. 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