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Going 'global' with wellness

Balancing a global health strategy with local realities is a tough but necessary challenge for multinational employers.

By Kathleen Koster - EmployeeBenefit News
June 15, 2011


Although for the most part still in their infancy, global wellness programs are beginning to catch on. Unlike U.S. wellness initiatives that are driven largely by fighting rising health care costs, in Asia, the motive is a need to compete for top talent, and European multinationals are focused on reducing absenteeism and improving employees' health and safety, according to Towers Watson. Whatever the reason, formulating a global health strategy means balancing a universal mission with local realities.

Despite challenges, these programs are growing in popularity. While only 32% of all respondents in a Towers Watson survey currently have a global workforce health strategy in place (up 6% over last year), 47% plan to adopt one within two years.

Mercer also has found increasing interest in global wellness programs because health care costs are rising around the world. The 2011 global medical trend is 10.5%, according to Globex International. In response to rising costs, many foreign countries are adopting health care reform, debating the role employers should play in cost containment.

"I think we've moved beyond the idea phase [of global wellness programs]. I think the resurgence of wellness programs in the U.S. has caused many organizations to consider whether this should be a global initiative, as opposed to just isolated to one country within their global footprint," Susan DeGregorio, senior consultant for global health care at Aon Hewitt.

Francis Coleman, a senior international consultant for Towers Watson who advises U.S.-based multinationals on global benefits management programs, makes the business case simply: "[Global companies] need to take a leap of faith that wellness is the right thing to do; it improves not only our costs, but ultimately the productivity of our workers."


Defining a global health strategy

First, it's important for an organization to define the scope of health relative to what they're trying to achieve through their strategy, DeGregorio recommends. It may be improving the physical health of employees, or it may encompass their physical, mental, financial, work-life and maybe even spiritual health.

Define global objectives, such as engagement, control over trends in direct medical expenses and employee awareness of health. It must be specific enough to be meaningful and measurable, yet broad enough to be adopted at a local level.

It's important to find the balance between a global foundation and a regional- or country-specific perspective. On a macro level, headquarters may create the branding of a global wellness program, a communication campaign and a governance structure to align different regions. A regional view would include: analysis of health issues driving costs and how they differ in that particular country, as well as the demographics of the population, the country's health care delivery system, and how locals access health care and practice well-being, such as types of exercise and stress management techniques.

"[Our global wellness program] started with a set of core principles on a global level," which gave a framework to each country, echoes Elaine Beddome, vice president of global benefits and mobility at HP. Its "Winning with Wellness" program is built on the core principles of physical wellness, financial well-being and stress management.

The wellness initiative was piloted in the United States, then expanded globally to 15 countries, reaching approximately 75% of employees with the core elements of wellness, as well unique aspects to support local employee needs and interests. For example, in Singapore, HP launched with a walk/run to a nearby park, where the large group exercised together to music. In Australia, the launch was rolled out alongside a popular triathlon and included an onsite farmers market with dieticians on hand to help workers focus on healthful eating.

HP also established ambassadors in each country "to help voice the needs of the employees and create continuity and ongoing excitement," explains Beddome. "It wasn't global designing these programs; it was local expertise that really understood the cultural needs there. So in many ways it was very easy to create inspiration and excitement at the local level. We didn't need to worry about the local [component] because we already had flexibility built into the framework. This was very much their own wellness program."

In addition to the local initiatives, HP has launched a global wellness challenge, inviting more than 90 countries to join in. Individuals can join a globally diverse team to get social support and make it fun, and the competitive nature helps encourage healthy behaviors. There's a social networking Web tool where the employees can report and track their progress.


Leveraging cultural differences

There are many differences between countries surrounding how to engage employees in wellness. Currently, many are leading with sticks as opposed to carrots, observes Nancy Thompson, SVP and director of sales at CBIZ Employee Services, such as foreign employers' tendency to institute smoker surcharge programs, compared to more incentive-based solutions in the U.S.-based companies.

Global programs are beginning to adopt standard features, however, such as health risk assessments, biometric screenings, health education and condition management programs for illnesses like high blood pressure, high cholesterol and diabetes.

Even with a more universal foundation, multinational employers focusing on wellness should remember that "there really isn't a one-size-fits-all by country," says Dr. Lorna Friedman, lead on global health and wellness at Mercer.

For example, one way to curb health risk factors in some areas is to provide onsite vaccinations for preventable diseases like the flu, measles or hepatitis. These preventive initiatives are "highly valued by employees and valuable for employers," because sporadic epidemics can shut down operations and be costly, Friedman says.

Another strategy is to focus on chronic diseases, like high diabetes rates in Mexico, or on social risks, as in India, where traffic accidents are a major cause of disabilities, or in China, where 300 million residents smoke.

"You're not going to just take a U.S. program and transport that to the UK, China, India or Brazil. You're going to take the tenets upon which those initiatives were developed in the U.S., and you're going to create programs that are appropriate for those countries," DeGregorio advises.

"It's about global inclusivity," adds David Kasiarz, SVP of global compensation and benefits at American Express. "Regardless of how health care is delivered, it's about sending business and employees the right message about creating a culture of health and wellness. The only thing that is different is that you need to tailor local strategies based on local needs, opportunities and gaps."

American Express has three strategic planks: pay attention to prevention, know your numbers and rally your resources (utilize all of the benefits provided by the company). The region then figures out what the mission of health means to them on a local level. Based on these tent poles, in Mexico, the focus is on nutrition, in Singapore it's on kids' health, and it's physical activity in the UK.

The company introduces a topic with a local celebrity who tells their story, and the company links the individual to an event in the community, such as the captain of the Indian cricket team that won the World Cup.

In Singapore, where the initiative focused on kids' health, AmEx conducted an event where they made the world's longest and healthiest sandwich, garnering news coverage on multiple local TV channels. They also had employees' children draw what health means to them, then compiled the drawings in a calendar that helps workers educate their kids about healthy living.

"We're trying to improve access and reduce costs," Kasiarz says. "People think of health as treatment, and we want people to think of health as prevention, so we try to eliminate barriers for seeking care, which are often cost and access."