HEALTH PROMOTION IN THE WORKPLACE: FRAMING THE CONCEPT; REVIEWING THE EVIDENCE

he term ''health promotion in the workplace'' is a multidimensional concept that embraces at least two major philosophies about what health is and how it is influenced.The first philosophy sees health as largely the product of individual behaviour and as an individual responsibility.It may acknowledge the role of genetics and environment to some degree, but the type of health promotion arising from this set of beliefs focuses on individual behaviour.Consequently, the workplace is seen primarily as a venue through which various programmes can be delivered.Examples of programme areas are: fitness, stress management, smoking cessation, back care, weight reduction/nutrition, medication.The second philosophy sees health as being influenced by a number of forces, a significant number of which are outside the individual's control.While acknowledging the individual's responsibility for his or her own health, this set of beliefs focuses on the role of the environment.Consequently, the workplace is seen as an influence on health in its own right.The attention here tends to be on the organisation and design of work in both its physical and psychosocial dimensions.Any workplace claiming to ''do'' health promotion can be characterised by the subscription of its senior managers to one or other of these philosophies or, more commonly, to some blend of the two.The 1997 Luxembourg Declaration on Workplace Health Promotion in the European Union 1 is an interesting document in this regard because it presents a ''blended'' philosophy as the ideal.Yet studies using the Luxembourg Declaration as a framework for research have revealed that by far the more common philosophy followed by organisations claiming to practice health promotion is that of focusing on the individual as opposed to the environmental. 2 Be this as it may, it needs to be acknowledged that health, as we experience and observe it in the workplace, is produced or manufactured by two major forces: c What employees bring with them to the workplace in terms of personal resources, health practices, beliefs, attitudes, values, and hereditary endowment c What the workplace does to employees once they are there in terms of organisation of work in both the physical and psychosocial sense.In practice, these forces do not act independently; they interact. 3For example, certain management practices can make it difficult for employees to care for their own health-things like unscheduled overtime or travel requirements, excessive time and energy demands, and so forth.On the other hand, a workplace located in an area infamous for its heavy drinking practices can make life difficult for managers and supervisors as they struggle to prevent excessive or inappropriate alcohol use from translating into absenteeism, illness, and accidents.Nevertheless, this glaring dichotomy in the practical world of health promotion provides a useful point of departure for our analysis of the subject since it reflects to a large degree the organisation of the research literature in this area.Research, until recently, was focused more on the first force (''personal health practices'', for short) than on the second force (''organisation of work'', for short), so there is more literature on the first than the second.Moreover, in regard to the organisation of work, a substantial amount has been written on the effects of the physical environment of work in the context of occupational health and safety, but the literature on the important psychosocial aspects of the organisation of work is still in its infancy.The connection between the physical and psychosocial environments, and hence the term ''organisation of work'' that includes both, has been made by the fact that both are heavily influenced by high level management choices and decisions about how work will be organised.][6] Moreover, the physical and psychosocial aspects of the working environment (organisation of work) can influence the abilities of individuals to care for their own wellbeing and to maintain 643 www.occenvmed.

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