The international version of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (International HERO Scorecard) helps employers learn about best practices that advance workplace health and well-being and determine the extent to which their programs incorporate these best practices. The International HERO Scorecard is intended for use in any country and benchmark data are provided for any country from which at least 20 responses have been collected. This commentary is based on benchmark data from Brazil and insights from Diego Ramirez, who serves as Health Management LAC Regional Leader at Mercer Marsh Benefits.

In 1988, Brazil’s constitution established access to medical care as a right of all citizens, and care is provided to all permanent residents and foreigners in Brazilian territory through its Unified Health System (Sistema Unico de Saude, SUS).1 While the system is far from perfect, approximately 70% of Brazil’s population receives care from this system.2 Even so, those that can afford it opt for private care in order to avoid long lines and crowded health care facilities. Access to private care can be purchased individually or may be provided by employers as a work benefit.

Companies seeking to attract highly skilled professionals are especially interested in providing health and wellness benefits, but the employers also view health and well-being (HWB) initiatives as a way to manage health care costs associated with the provision of private health insurance. The desire to decrease health-related absence and increase worker productivity and safety is also driving employer interest in health promotion.3 The International HERO Scorecard is useful to employers in Brazil because it provides insights into what employers around the world are doing to support employee HWB and can be used to assess country-level consistencies and differences.

HERO Scorecard results for the 67 employers based in Brazil indicate 82% rely on medical/pharmacy claims review as an input to their HWB program planning. Employers also report using biometric screening/annual health check-up (71%) and occupational health claims (59%) as well as employee morale, satisfaction, or engagement data (64%) to inform planning. Unlike organizations in many other countries, most organizations in Brazil (69%) say they have a formal, written strategic plan for their HWB initiatives. Of those with such plans, many include measurable objectives for what they hope to achieve through HWB initiatives, including participation in programs (83%), health impact (74%), and employee satisfaction or engagement (63%). Given these observations, it’s no surprise that organizations in Brazil represent the highest scoring group in the Strategic Planning section of the HERO Scorecard (11 out of 20 possible points).

Organizations based in Brazil also report high adoption of many practices related to organizational and cultural support for HWB including

  • Inclusion of employee HWB in organizational goals and value statements (63%)
  • Policies related to provision of healthy foods at company-sponsored events (84%)
  • Provision of healthy options in company eating areas or in vending machines (78%)
  • Physical environment demonstrates safety as a priority area (90%)
  • Senior leadership having the authority to take action to achieve the organization’s HWB goals (84%)
  • Provision of opportunities for employees to provide input on HWB program content, delivery methods, future needs, and communication methods (90%)

Programmatically, a majority of organizations in Brazil favor delivery of in-person health improvement programs (79%) over web-based (55%) or phone-based (15%) delivery options. A majority of programs incorporate social connection (64%) as a way to support healthy behaviors and many provide onsite one-on-one coaching (57%). A majority also offer special health programs for executive leaders (73%) and more than half have an onsite or near-site medical clinic (55%). In order to encourage participation in programs, employers in Brazil are far more likely to rely on comprehensive communications strategies (79%) that are offered year-round (74%) than they are to provide financial rewards (7%) or token gifts (40%) for participation.

When it comes to program evaluation and measurement of initiative effectiveness, organizations in Brazil tend to rely on collection of program participation (80%), health care utilization/cost (85%), and occupational/absence data (59%). Data on program performance is most often shared with senior leaders (57%) and managers or supervisors (45%).

One of the largest opportunities for employers to improve their health and well-being offerings is to integrate employer-sponsored wellness activities with internal or external providers of related HWB services. More than half (61%) of employers in Brazil report they are not integrating HWB programs through cross-referrals or warm transfers into other programs or collaborating as a team to track progress towards common organizational goals or outcomes. Given the likelihood of mental health issues to be comorbid with physical chronic health issues, it is important for employers to better integrate behavioral health with lifestyle management, condition management, and case management; only 46%, 35%, and 23% of organizations say they integrate these areas, respectively. Disability management is also rarely integrated with HWB programs as 61% of employers in Brazil report these areas are not integrated in any way.

Other more programmatic areas of opportunity include initiatives to support a psychologically healthy workforce (only 32% provide), provision of information about community health resources (18%), medical decision support (48%), and nurse advice line services (26%). It is possible that the national health service provides some of these resources and when that is the case, employers have the opportunity to ensure employees are aware of them. Strengthening disability management is also important as few organizations report having formal return-to-work programs following a disability (35%), standards for ongoing supportive communication with employees during leaves (30%), and strategies to triage individuals with appropriate disabilities into relevant HWB programs (18%).

In conclusion, organizations in Brazil that complete the HERO Scorecard have many exemplary practices in place when it comes to strategic planning, organizational and cultural support, participation strategies, and program measurement and evaluation. Even so, there are many opportunities to improve upon these practices in order to increase the overall average HERO Scorecard score from 86 points to the best practice position of at least 125 points.4-5

This commentary was written by Jessica Grossmeier, PhD, and is based on data from the Q1 2019 HERO Scorecard International Benchmark Report.


  1.  Octavio Ocke-Reis C. Financial sustainability of the Brazilian health system and health-related tax expenditures. Ciencia & Saude Coletiva. 2018; 23(6). Available at
  2. World Health Organization. Flawed but fair: Brazil’s health system reaches out to the poor. Bulletin of the World Health Organization. 2008; 86(4): 241-320. Available at:
  3. IAWHP. An interview with Alberto Ogata. Worksite Health International. 2014; 5(1). Available at
  4. Goetzel RZ. Can the HERO Scorecard predict health care cost trends and employee health risks? 2014 HERO Scorecard Annual Report. 2014: 8-9. Available at:
  5. Grossmeier J. Can workplace wellness signal superior stock performance? 2016 HERO Scorecard Annual Report. 2016: 15-18. Available at:

©2024 Health Enhancement Research Organization ‘HERO’


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