Taking Workplace Health Promotion Global: The Art of Cultural Integration

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Although migration has been occurring since the origins of the human race, the recent era of expanding globalization has led to the increased movement of the global workforce across and within national boundaries. The social, political, and economic aspects of worker mobility have been the focus of numerous studies1,2 and have led employers to pay closer attention to the impact that worker mobility may have on business continuity. As more multinational corporations (MNC) are starting to place workers in low- and middle-income countries (LMIC; eg, high-tech companies based in the US relocating assets to LMIC such as Bangalore, India), the health status of employees may be negatively affected by the new environment. Conversely, some countries might confer a protective effect as well. Better understanding of how subpopulations relocating to different countries might experience different health outcomes after deployment may provide further insight in the complexities that lead to health outcomes within migrant populations.

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This article explores the implications of a financial budget devoted to EAP services and how it either promotes or limits, the opportunities for creating effective partnerships and key integration. I summarize key points from my EAP Talks keynote presentation on the Organizational Health Map conceptual model at EAPA’s 2016 World EAP Conference in Chicago. Parts: 1) The Organizational Health Map. 2) EAP Utilization: "Free" EAP vs. Direct Pricing Models. 3) Delivering Greater ROI. 4) Promise or Peril for Integration of EAP? 5) Summary. The seventh article in 10-part series published in the Journal of Employee Assistance (Employee Assistance Professionals Association) on the theme of Integration of Employee Assistance Services.
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Aims This review provides an up‐to‐date curated source of information on alcohol, tobacco, and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods Online data sources were identified through expert review. Data were mainly obtained from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation. Results In 2015, the estimated prevalence among the adult population was 18.3% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8%, 0.77%, 0.37%, and 0.35% for past‐year cannabis, amphetamine, opioid, and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardised prevalence of alcohol dependence was 843.2 per 100,000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100,000 people, respectively. High‐Income North America region had among the highest rates of cannabis, opioid, and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco (110.7 deaths per 100,000 people), followed by alcohol and illicit drugs (33.0, and 6.9 deaths per 100,000 people, respectively). Attributable age‐standardised mortality rates and DALYs for alcohol and illicit drugs were highest in Eastern Europe; attributable age‐standardised tobacco mortality rates and DALYs were highest in Oceania. Conclusions In 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing a further tens of millions. Europeans proportionately suffered more but in absolute terms the mortality rate was greatest in low and middle income countries with large populations and where the quality of data was more limited. Better standardised and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.
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L′intérêt grandissant en programmation de la santé mentale en milieu de travail a créé une opportunité inouïe pour la psychologie. Je décris une approche globale en matière de santé mentale en milieu de travail axée principalement sur la prévention, l’intervention et l’accommodation. J’y souligne que la pratique dans ce domaine doit aller au-delà de la préconisation et se concentrer sur des interventions basées sur des données probantes conçues pour améliorer la santé mentale en milieu de travail.
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Background As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. Methods Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. Results Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. Conclusions The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries – a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.
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Background Nonmedical prescription drug use (NMPDU) refers to the self-treatment of a medical condition using medication without a prescriber’s authorization as well as use to achieve euphoric states. This article reports data from a cross-national investigation of NMPDU in five European Countries, with the aim to understand the prevalence and characteristics of those engaging in NMPDU across the EU. Methods A parallel series of self-administered, cross-sectional, general population surveys were conducted in 2014. Data were collected using multi-stage quota sampling and then weighted using General Exponential Model. A total of 22,070 non-institutionalized participants, aged 12 to 49 years, in 5 countries: Denmark, Germany, Great Britain, Spain, and Sweden. Lifetime and past-year nonmedical use of prescription medications such as stimulants, opioids, and sedatives were ascertained via a modified version of the World Health Organization’s Composite International Diagnostic Interview. Information about how the medications were acquired for NMPDU were also collected from the respondent. Results Lifetime and past-year prevalence of nonmedical prescription drug use was estimated for opioids (13.5 and 5.0 %), sedatives (10.9 and 5.8 %), and stimulants (7.0 and 2.8 %). Germany exhibited the lowest levels of NMPDU, with Great Britain, Spain, and Sweden having the highest levels. Mental and sexual health risk factors were associated with an increased likelihood of past-year nonmedical prescription drug use. Among past-year users, about 32, 28, and 52 % of opioid, sedative, and stimulant nonmedical users, respectively, also consumed illicit drugs. Social sources (sharing by friends/family) were the most commonly endorsed methods of acquisition, ranging from 44 % (opioids) to 62 % (sedatives). Of interest is that Internet pharmacies were a common source of medications for opioids (4.1 %), stimulants (7.6 %), and sedatives (2.7 %). Conclusions Nonmedical prescription drug use was reported across the five EU countries we studied, with opioids and sedatives being the most prevalent classes of prescription psychotherapeutics. International collaborations are needed for continued monitoring and intervention efforts to target population subgroups at greatest risk for NMDU.
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Objective: Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. Methods: In June 2014, 75,678 people were observed in eight parks over 12days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Results: Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6 – 9am and when the temperature was below 30°C. Conclusions: Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.
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Objectives Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper–gold mining company workers in Papua, Indonesia. Methods Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper–gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18–68 years employed for ≥1 year during 2008–2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. Results Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. Conclusions Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks.
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It is common practice in many professions, fields, and industries to disseminate comparative information. Absent this vital resource an individual company cannot accurately evaluate their performance against a similar cohort and therefore must rely upon anecdotal information. The findings of this study address this deficiency in the Employee Assistance Program (EAP) field by reporting empirically derived comparative data for external providers of EAP services. During 2012 the National Behavioral Consortium obtained a convenience sample of 82 external EAP vendors, located primarily in the United States and Canada and 10 other countries and ranging in size from local providers to global business enterprises. The combined customer base represented by these vendors included more than 35,000 client companies and over 164 million total covered lives. The 44 survey items addressed eight categories: (1) company profile, (2) staffing, (3) customer profile, (4) utilization metrics, (5) survey tools and outcomes, (6) business management, (7) business development, and (8) forecasting the future of EAP. Results reveal a wide range between vendors on most of these factors. Comparisons were also conducted between vendors based on market size, country, and pricing model. Implications for operational practice and business development are discussed along with considerations for future research.
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Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods: We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings: Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation: For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
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Current literature sees expressions of popular racism in twentieth-century European state-socialist societies either as directly deriving from the official ideology of the state or else as happening despite it. This article argues that the ways in which Vietnamese workers were racialised in 1980s Czechoslovakia were neither directly derived from the state’s official ideology, nor did they arise in opposition to that ideology. Instead, it suggests that they are more usefully seen as reworkings of certain elements of the state’s official ideology. Most important among those elements were: the insistence that racism did not exist in Czechoslovakia; the centrality of ‘honest socialist work’; and the conception of the overseas foreign workers programme as a socialist civilising mission of sorts. In most cases, some or all of these notions worked in tandem, and, moreover, also built upon existing discourses in regard to the Roma.
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Historical Development of PAPsPAP Core TechnologyThe Diffusion of Work-Based Assistance Programs Outside of the USAPAPs in IsraelDiscussionReferences
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Global migration has dramatically increased over the past decade and is at an all-time high, approaching 200 million persons per year. Demographics and economic interdependence suggest that immigration will continue for the near future at record high levels. A review of the few studies that have investigated occupational injury and illness rates among immigrant populations. Existing data indicate that higher rates of fatal and non-fatal injuries are common compared to native populations. This increase is in part due to immigrants working in higher risk occupations (e.g., agriculture, construction), but occupational morbidity and mortality is higher among immigrants than native-born workers within occupational categories. Research is needed to identify the causes of increased risk among immigrants and to provide direction to effective public health interventions. Research methods must be adapted to different epidemiologic characteristics of immigrant populations, including lack of standard sampling frames, different language and culture from the dominant culture, and precarious work status.
The aim of this systematic review was to determine the quality and comprehensiveness of guidelines developed for employers to detect, prevent, and manage mental health problems in the workplace. An integrated approach that combined expertise from medicine, psychology, public health, management, and occupational health and safety was identified as a best practice framework to assess guideline comprehensiveness. An iterative search strategy of the grey literature was used plus consultation with experts in psychology, public health, and mental health promotion. Inclusion criteria were documents published in English and developed specifically for employers to detect, prevent, and manage mental health problems in the workplace. A total of 20 guidelines met these criteria and were reviewed. Development documents were included to inform quality assessment. This was performed using the AGREE II rating system. Our results indicated that low scores were often due to a lack of focus on prevention and rather a focus on the detection and treatment of mental health problems in the workplace. When prevention recommendations were included they were often individually focused and did not include practical tools or advice to implement. An inconsistency in language, lack of consultation with relevant population groups in the development process and a failure to outline and differentiate between the legal/minimum requirements of a region were also observed. The findings from this systematic review will inform translation of scientific evidence into practical recommendations to prevent mental health problems within the workplace. It will also direct employers, clinicians, and policy-makers towards examples of best-practice guidelines.
Until recently the extractive industry has been largely unaware of the threat of emerging infectious diseases (EIDs), which have the potential to shut down entire operations. The 2014–15 West African Ebola outbreak changed this, drawing attention to the ramifications of disease outbreaks in terms of both human suffering and economic productivity. The Infectious Disease Risk Assessment and Management (IDRAM) pilot initiative in Katanga, Democratic Republic of Congo, has focused on an assessment of the kinds of risk reduction measures in place among selected companies; the industry’s attitudes towards infectious disease control interventions, and; opportunities for collaboration among multiple stakeholders. The initiative found that despite having infection and prevention control measures in place for workers in camps, extractive companies cannot control outbreaks by themselves due to the close interactions with local communities and weak local health systems. Results also showed that EID prevention and control plans benefit both the company and the community and can be feasibly implemented. Consequently, companies should strengthen their risk reduction role by properly assessing the health consequences of their projects through an integrated Environmental Impact Assessment. Finally, partnering with health authorities, other companies, and external stakeholders could help to prepare and respond to infectious disease events.
The current global economic environment is defined by unprecedented uncertainty, a premium placed on knowledge, and the threat of future talent scarcity. Key to an organization's success under these conditions is its ability to strengthen the links between people and performance. Creating Healthy Organizations provides executives, managers, human resource professionals, and employees an action-oriented approach to forging these connections by creating and sustaining vibrant and productive workplaces.A healthy organization operates in ways that benefits all stakeholders, including employees, customers, shareholders, and communities. Using a wide range of examples from a variety of internationally based industries, Graham Lowe integrates leading practices with research on workplace health and wellness, quality work environments, employee engagement, organizational performance, and corporate social responsibility to make a compelling business case for creating healthy, resilient, and sustainable organizations.Creating Healthy Organizations offers readers, whether CEOs or front-line workers, an innovative framework and practical tools for planning, implementing, and measuring healthy change in their workplaces.
This chapter addresses the topic of employee assistance programs (EAP) and their role in occupational health and wellness. The chapter is organized into three main parts. The first part is an overview of the nature of EAPs. The second part reviews the research evidence for EAPs. The third part describes seven major trends in the field of EAP. The expansion of EAP services into regions beyond North America closes the chapter. An extensive reference list is provided. © Springer Science+Business Media New York 2012. All rights reserved.
Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature. We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings. Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3-18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9-32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates. Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.
The globalisation of business activity can lead to the movement of key employees and their dependants from country to country. In their host country these expatriates often face health hazards not experienced at home. This paper describes the range of health issues of relevance to expatriates.
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