There are significant concerns around the rising costs of health care associated with ageing populations and increased incidence of chronic diseases and conditions [17, 18]. Although the current Australian government policy focus is on containing the costs of hospitalisation and clinical management rather than on prevention and health promotion, in the longer term prevention and health promotion are the essential components needed to address preventable hospital admissions [17].
Work has become more sedentary contributing to the increased incidence of obesity, and musculoskeletal and other health issues [5, 7, 19,20,21,22,23,24,25]. These potentially impact on workplace productivity and are key reasons for employers to initiate workplace health promotion programs. In some sectors such as mining and construction, workers may live on-site for at least some of the time, especially when jobs are in remote areas. In these cases in particular, it could be argued that the employer has a responsibility to ensure that there are opportunities for employees to engage in healthy lifestyles.
Workplaces can provide opportunities for group activities and incentives to participate in health promotion that may not be available elsewhere. There is now a body of evidence that workplace health and wellbeing programs benefit both the individuals participating as well as the businesses for which they work [1,2,3,4,5,6,7]. Challenges remain, however, with involving individual businesses in workplace health and wellbeing programs.
As noted above, the IA senior executives interviewed indicated some confusion between government-mandated OH&S requirements (e.g. legislated requirements for workers in some industries to wear safety clothing) and workplace health and wellbeing programs (e.g. promoting Quit smoking and physical fitness programs in which workers can choose to participate or not). This may be particularly the case when the latter programs are being promoted by government which also monitors compliance with occupational safety legislation. Our research indicated that this confusion is shared by both IAs and their member organisations. Although confusion may not on the surface appear to be an issue, it could skew the data around uptake of programs. For example, when asked: does your organisation have a role in workplace health and wellbeing? some may respond in the affirmative when in fact they are involved in meeting the requirements of OH&S regulations rather than providing workplace health promotion activities. The confusion may also discourage health promotion program uptake, as organisations may feel they are already doing something and be reluctant to do more.
Reach is also an issue. When advocating for and supporting delivery of health and wellbeing programs, approaches to individual organisations may not be the most efficient or cost-effective approach for government. Although IAs may need to be provided with resources, they are likely to be a more cost-effective way to reach and support uptake of programs in hard-to-reach locations. The costs of introducing health and wellbeing programs can also be a barrier for workplaces, particularly small ones. In the Danish experience related by Kvorning and colleagues, regulators and other stakeholders including IAs, developed programs with financial and facilitator support to assist small enterprises with limited resources [26]. Credibility may also be an issue especially if programs are being promoted by government to the business sector [8, 26, 27]. Program credibility can be built and advocacy for programs can be delivered across large numbers of workplaces using the existing networks and capacity of IAs. IAs are therefore well placed to act as intermediaries between governments wanting program implementation and those directly involved ‘at the coalface’ [26].
Carmichael and colleagues summarised the necessity, before developing an intervention, of understanding the characteristics of the organisation, its work practices, work environment, policies and the workforce (including attributes such as health status and fitness for tasks, beliefs and perceptions) [4]. Through IAs, and their understanding of their member organisations, the language and appropriateness of promotional materials and resources can be refined. As one interviewee stated:
Mates in Construction [a construction industry health program] works because it is presented in the language and approach guys on the worksite understand, workers are positive about the program and it is relevant to them.
A basic mechanism for developing best practice is the provision of opportunities for like organisations working on similar initiatives to share knowledge and experiences [18, 28, 29]. IAs provide an excellent opportunity for doing this through their existing networks and processes such as member newsletters and forums. While outside experts can be brought in to provide additional perspectives, the IAs are likely to provide greater credibility and a more trusted space for discussion [15, 24, 27]. As a type of ‘intermediating organisation’, IAs can also coordinate the activities of would-be or early adopters, and shape the diffusion trajectory of commercial innovations [30].
Strengths and limitations
Themes presented in this investigation are specific to the 17 participating senior executives representing their IAs, and as such only those who were willing to discuss their views are included. There may have been other important and/or alternative views that were not canvassed. The senior executives who agreed to provide their views may have been more interested in workplace health and wellbeing than others who did not provide their views. Our findings may also have limited generalisability due to the small and varied sample. The views provided, however, represent a diversity of positions, drawn from senior executives in a range of IA types from the very small to the large and well resourced, and include broad coverage of the economically important industries in the state.
