When Comcare declared October to be “Healthy@work, Happy@home” month, they tapped into a growing trend within Australia.

Unions, business and government are increasingly interested in how work can be used to improve health.

From the government’s perspective, this is linked to a strategic focus on preventive health, and a strategy of addressing the “SNAP” risk factors for chronic illness (smoking, nutrition, alcohol and physical activity) in a variety of settings, including at work.

There are a wide variety of approaches that could be taken to enhance the health benefits of work. Currently, the federal government is focusing on providing the states and territories with money to deliver “healthy living programs” in workplaces.

Under the Healthy Workers Initiative, “Employers will be assisted to implement programs to reduce the risk profiles of their workforces, including risks from excessive use of alcohol, through risk assessment and modification services.”

There is no blanket program to be rolled out across the nation: the states and territories have a fair degree of latitude in how they choose to spend the $144.71 million they will receive over a six year period. However, there are parameters. The initiative aims to fund programs that:

• Focus on healthy living, covering topics such as physical activity, healthy eating, the harmful/hazardous consumption of alcohol and smoking cessation;
• Meet nationally agreed guidelines for these topics, and include support for risk assessment and the provision of education and information;
• Could include the provision of incentives either directly or indirectly to employers;
• Accommodate small and medium enterprises, who may require support from roving teams of program providers; and
• Have support, where possible, from peak employer groups such as chambers of commerce and industry.

Suggestions from the Federal government about how the funds might be spent include:

• Subsidising employers to provide risk assessment and counselling services to employees;
• Providing programs directly into workplaces; and/or
• Subsidising employers to structure physical activity and healthy eating into the workday.

The objectives of the Health Worker Initiative are very specific, comprising targets regarding risk factors for chronic illness:

• The proportion of adults who are overweight;
• The average number of daily serves of fruits and vegetables consumed by adults;
• The proportion of adults participating in at least 30 minutes of moderate physical activity on five or more days of the week; and
• The proportion of adults who smoke daily.

In 2013/14, each of the states and territories they will be assessed against benchmarks for the targets outlined above, and depending on their success in reaching these benchmarks they will then be eligible for reward payments of up to $144.71 million.

In short, the workplace has been identified as an arena for effective health promotion, aimed at reducing Australia’s incidence of chronic illness.

Dr Mary Wyatt, Occupational Physician and editor of RTWMatters, has some reservations about this approach.

“In the workplace, relationships and cultural factors come into play. The promotion of healthy living is unlikely to be effective if, for example, the workplace is seen as unsafe, or if there is bad blood between workers and the boss. How will a top-down approach take such factors into account?

“Moreover, while it is good to see the government taking action, the health promotion approach does not take into account the fact that work itself is a determinant of health.”

Are we seeing a medical / political framework imposed on the complex psychosocial issues around work and health?

According to Ged Kearney, the new president of the Australian Council of Trade Unions, health promotion does not make it onto the list of key thing Australian workers want from their workplace. Rather, they want:

• A secure job, a job at which they can earn enough to provide for their family without forfeiting precious time;
• To be safe at work;
• To be respected and consulted by their employer;
• Productive and satisfying work that they have some control over, and that encourages them to learn new skills;
• To be treated fairly and women, equally; and
• Their workplace to be environmentally and worker-friendly.

This wish-list is a far cry from the outcomes-based aims of the Healthy Worker Initiative, yet research on the relationship between health and work suggests that such needs play an important role in determining not only worker health, but also productivity.

With its focus on specific risk factor reductions, does the Healthy Worker Initiative neglect the role of psychosocial factors in determining the relationship between health and work?