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 India and insights from Dr. Nimitha Menon, who leads Health Risk Management Consulting services for Marsh, India in a senior vice president role.
With establishment of the National Health Policy of India (NHP) in 1983 and its extension with NHP 2002, India’s government aims to provide basic primary health care services to the nation, but governance and operations of the health system are divided between national and state governments.1 As a result, the most sophisticated care is available only in urban areas, while lack of access in rural communities often requires hours of travel to urban facilities for basic care.2 The public health care infrastructure is strained by the demand and quality of service, so most people of working age (15 to 64 years old) in India rely on the private medical sector for care and on employer-sponsored health insurance.
Professional work environments in India are often characterized by long and irregular working hours, night shifts, challenging performance targets, traffic issues and frequent travel.3 Such environments drive high stress levels, poor quality sleep, unhealthy nutrition habits and sedentary lifestyles which contribute to the growing rate of non-communicable diseases. Corporate organizations (corporates) in India are increasingly investing in wellness programs to better address prevention and healthy lifestyles in an attempt to contain rising health insurance costs and health-related absenteeism and productivity costs. Yet, many corporates have not yet accepted the workplace as an important setting for wellness, and as a result, the programs that are offered are often piecemeal and lack a unified strategic approach tied to measurable objectives. Even among the large multinational corporates offering basic health check-ups and health counselling, participation rates are often poor due to lack of employee awareness or competing priorities with challenging work targets.3 A survey fielded by the Associated Chambers of Commerce and Industry of India (ASSOCHAM) found 52% of corporate employees surveyed said their company provides no wellness services and 62% of those that had wellness offered by their employer said it needed improvement.4
The International HERO Scorecard is useful to employers in India because it reinforces the need to use a more strategic and integrated approach to the provision of more comprehensive health and well-being initiatives grounded in achieving measurable objectives. While 73% of India corporates responding to the Scorecard said they had a written strategic plan for their health and well-being (HWB) initiatives, most written objectives focused on participation in programs (96%) or employee satisfaction/morale (78%). While 65% of corporates have measurable objectives for health impact associated with their HWB initiatives, only 33% collect physical health data and 24% collect mental health data to evaluate and manage their efforts. Health care utilization and cost data are more predominantly used for evaluation (55%). Another driver of corporate investment in workforce health and well-being is the desire to reduce health-related absences. Half of the Scorecard respondents say they use absence data to inform HWB strategic planning and 52% have written measurable objectives for absenteeism reductions in their strategic plan. However, only 17% of India corporates completing the Scorecard have attempted to measure absenteeism impact associated with their HWB initiatives. Measurement of productivity outcomes (41%) is more common in India’s performance-driven corporate environment. It is important to note that these statistics are based on only 34 responses from organizations based in India, and it is likely that organizations drawn to complete the HERO Scorecard rely more heavily on data to support strategic planning, program design and evaluation than is typical of most corporates in India.
India corporates drawn to complete the HERO Scorecard represent very strong practices related to organizational and cultural support for workforce health and well-being. Nearly two-thirds of respondents (65%) report their senior leaders consistently articulate the value and importance of health and more than half (53%) report that employee health and well-being is included in their organization’s goals and value statements. A majority of organizations report their senior leaders view HWB initiatives as being connected to broader business results to a great extent (52%) or to some extent (36%). This is particularly impressive considering one-third of the respondents represent technical/professional services organizations and 18% represent manufacturing/mining organizations. Employees represented by HERO Scorecard respondents are predominantly non-union (97%), male (73%) and younger (average age is 33 years).
Health-related policies and built environment supports are highly prevalent among India corporates responding to the HERO Scorecard, as evidenced in the following statistics:
- 94% report safety is a priority within the environment.
- 85% encourage physical activity through features or resources available at work, such as onsite gyms, walking trails or standing desks.
- 79% have policies supporting work-life balance (for example with flex time or job share options).
- 74% support psychosocial health or behavioral health.
- 71% provide healthy eating choices through onsite cafeterias, canteens or vending machines.
- 62% provide opportunities for employees to use work time for stress management and rejuvenation.
- 62% support healthy eating choices (for example by requiring healthy options at company-sponsored events).
- 56% allow employees to take work time for physical activity.
- 56% stipulate a tobacco-free work environment.
These statistics are in alignment with the National Health Policy 2017 of India which emphasizes “preventive and promotive health care” to reduce stress and improve safety at work.5 These organizational approaches to health and well-being augment the programmatic strategies implemented by India corporates, which are notable. Just more than half of respondents (55%) offer biometric screenings through labs, home test kits or off-site options, while 45% provide onsite or near-site screenings. However, only 44% have a referral and follow-up process in place for individuals whose results are out of range. A majority of organizations (59%) provide some type of health behavior change programs, and most of these are provided using multiple delivery modalities, including in-person (75%), telephone-based (65%) and/or email or mobile-supported (60%). Many of the programs also include a social support component (63%) and are structured as challenges or encourage people to form teams. Onsite or near-site medical clinics (73%) are a prominent strategy for supporting workforce HWB, and 39% report integrating their HWB partners internally or externally to refer individuals to programs and resources provided by other partners. Integration efforts largely focus on linking lifestyle management and condition management partners (69%) but behavioral health management is often integrated with lifestyle management (44%) or condition management (50%) as well. Disability management is far less likely to be integrated as only 32% of corporates report any type of integration with HWB initiatives. Safety and injury prevention initiatives represent another opportunity for integration as only 39% of corporates include safety as elements of their HWB strategy and vice versa.
Attracting employees to participate in HWB programs is challenging given the competing priorities associated with demanding performance targets. Incentives for participation most often take the form of token gifts, such as t-shirts or water bottles (41%), and many corporates (41%) rely on no incentives to motivate employees to participate. India corporates are more likely to rely on social support and gamification strategies to encourage participation in HWB initiatives, such as through health competitions and challenges (68%) and peer support (47%). Technology-based resources are often used in the form of web-based resources (56%) or mobile applications (41%). Strong communications strategies are also evident amongst India corporates responding to the Scorecard with 69% reporting using of multiple communication channels, 59% investing in uniquely branded materials and 56% using year-round communications.
In conclusion, organizations in India 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 87 points to the best practice position of at least 125 points.6,7
This commentary was authored by Jessica Grossmeier, PhD, MPH and based on data from the Q2 2019 HERO Scorecard International Benchmark Report.
- Chokshi M, Patil B, Khanna R, Neogi SB, Sharma J, Paul VK, and Zodpey S. Health systems in India. Journal of Perinatology. 2016; 36:S9-S12.
- Brennan D. India is introducing free health care for 500 million people. Newsweek. August 16, 2018.
- Banerjee P, Gavaravarapu SM. Wellness programmes in the workplace in India. The Lancet. 2018;3:e515. Available at https://doi.org/10.1016/S2468-2667(18)30199-3
- Corporate wellness can save India Inc revenue to US$20 billion. Available at https://www.ASSOCHAM.net
- Ministry of Health and Family Welfare. Government of India. National Health Policy 2017. Available at http://cdsco.nic.in/writereaddata/National-Health-Policy.pdf
- 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: https://hero-health.org/hero-scorecard/#1501274504651-9c0e44e5-2fe6
- Grossmeier J. Can workplace wellness signal superior stock performance? 2016 HERO Scorecard Annual Report. 2016: 15-18. Available at: https://hero-health.org/hero-scorecard/#1501274504651-9c0e44e5-2fe6