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Employee Wellness-India:Layout 1 09.09.

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Employee Wellness as a COMMITTED TO


IMPROVING THE STATE

Strategic Priority in India


OF THE WORLD

Preventing the Burden of


Non-communicable Diseases through
Workplace Wellness Programmes

Report of a Joint Event of


the World Economic Forum and
the World Health Organization Country
Office for India

In cooperation with
Public Health Foundation of India
World Health Organization Country Office for India

World Economic Forum


September 2009
Employee Wellness-India:Layout 1 09.09.09 17:24 Page 2

This report was written by Ambika Satija and Puja Thakker of the Public
Health Foundation of India, with support from Vanessa Candeias Teixeira
Rodrigues and Godfrey Carmel Xuereb of the World Health Organization,
J. S. Thakur and Kavita Venkataraman of the World Health Organization
Country Office for India, and Eva Jané-Llopis, Chronic Disease and
Wellness Initiative at the World Economic Forum.

The views expressed in this publication do not necessarily


reflect those of the World Economic Forum.

World Economic Forum


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E-mail: contact@weforum.org
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© 2009 World Economic Forum


All rights reserved.
No part of this publication may be reproduced or transmitted
in any form or by any means, including photocopying and
recording, or by any information storage and retrieval system.

REF: 150909
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Contents

Executive Summary 2

Commitment from the Meeting 3

1. Introduction: The Burden and Causes of NCDs 4

2. Rationale: Why Invest in Workplace Wellness? 6

3. Evidence: Workplace Wellness Works 8

4. The WHO India/World Economic Forum Joint Event on Employee Wellness as a


Strategic Priority in India 10

5. Barriers and Opportunities 11

6. Strategy for a Successful Programme 15

Model for Setting up a Workplace Wellness Programme 18

Monitoring and Evaluation 21

Bringing It All Together: The Power of Comprehensive Interventions 22

7. Conclusions and the Way Forward 25

Outcomes of the WHO India/World Economic Forum Joint Event 25

References 27

Annex 1: Agenda of the Joint Meeting of the World Economic Forum and World Health Organization

Country Office for India 29

Annex 2: List of Participants 32


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Executive Summary

Background: NCDs and Workplace Wellness coordinated manner: leadership, people, culture and
Non-communicable diseases (NCDs) are on the rise process. Only when all of these are addressed in a
globally, and the low and middle income countries comprehensive way can an employee wellness
(LMICs) are the worst hit – 80% of projected deaths programme be successful.
from NCDs in 2005 occurred in LMICs, according to
a World Health Organization (WHO) report. India is Model for Developing a Healthy Workplace
also on the brink of an NCD epidemic – the burden For workplace wellness programmes to accomplish
it faces is high in terms of mortality, morbidity and the above, they must be designed, implemented
economic productivity, and it stands to face and evaluated in a systematic manner. WHO India
significant loss if effective NCD prevention strategies has developed a schematic model to describe the
are not implemented. The good news, however, is process of developing, implementing and evaluating
that NCDs are to a great extent preventable, as their workplace wellness programmes. The process starts
main underlying causes are modifiable lifestyle- with the formation of a wellness committee that
related, behavioural and environmental factors. undertakes the baseline evaluations and situation
assessments, on the basis of which health policies
Focusing on the workplace for the prevention of are chosen, implemented and then evaluated.
NCDs has a double target: health and business
reasons. India’s growing working population and the Monitoring and Evaluation of Workplace
high NCD burden among its workforce make the Wellness Programmes
workplace ideal for NCD prevention. The economic One step in the above-mentioned model is the
benefits of NCD prevention at the workplace for monitoring and evaluation of wellness programmes.
employers are vast, including reduced absenteeism, It is essential that time and resources are invested in
reduced injuries and workers’ compensation costs, this, as it is only through constant monitoring at the
reduced healthcare costs, reduced employee baseline during the implementation process, as well
turnover, increased productivity and profits, greater as of the outcomes of the programme, that any
worker satisfaction, improved morale, and increased improvements can be made in the policies and
attraction of talent and potential employees to the processes of the programme and best practices
workplace. Thus, focusing on workplace wellness is documented. Also, it is only with the demonstration
supported by the ethics of corporate responsibility, of the success of the programme that the
as well as by the rationality of corporate profitability. investments made can be justified.

Barriers and Opportunities World Economic Forum and World Health


Various barriers and opportunities should be Organization Country Office for India Joint
considered and analysed while designing and Event
implementing employee wellness programmes. The World Economic Forum and the WHO Country
Barriers and opportunities are discussed in this Office for India jointly convened a meeting on
report with respect to attitudes, employers, “Employee Health as a Strategic Priority in India”.
employees and capacity development. While facing This joint event was held in New Delhi, India, on 14-
hurdles is disheartening, it must be remembered that 15 November 2008. Participants included key
barriers transform over time into facilitators, and that stakeholders from the commercial sector, academia,
every barrier has a hidden golden opportunity for non-governmental organizations (NGOs), the United
change and transformation – this is why every Nations and other international organizations.
perceived barrier has been presented with an Existing barriers and potential opportunities in
opportunity to overcome it. workplace wellness programmes in India were
discussed, as well as the rationale for workplace
Strategy for a Successful Programme wellness investment in India, strategies for
To overcome barriers and make optimal use of the successful programmes, how to implement these
available opportunities, an employee wellness programmes, their monitoring and evaluation, and
programme should follow a “strategy for success”. how to adapt these programmes to small and
This strategy has four key elements that must be medium enterprises.
incorporated into a wellness programme in a

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Conclusions and Way Forward talented individuals. Such an investment is in


Business leaders must join the fight to contain alignment with India’s economic and development
NCDs. It is not only altruism but also enlightened priorities as a nation and an essential step in the
self-interest. Investing in the health of employees fostering of a healthy workforce, nationally and
increases productivity, cuts down spending on globally.
healthcare costs, reduces turnover and attracts

Commitment from the Meeting

At the World Economic Forum and the WHO international organizations such as the World
meeting in New Delhi in November 2008, several Economic Forum and the World Health Organization
commitments were put forward to advance playing the foremost role of stewardship, was
employee health, which was unanimously recognized as the primary course of action. The
acknowledged as a strategic priority for India. Public Health Foundation of India was identified as a
Multistakeholder action was identified as the single key organization positioned to bring together
most effective vehicle for change. In line with this, multiple stakeholders on a platform for action.
the creation of a council inclusive of several Annexes 1 and 2 provide the agenda for the
ministries, corporate leaders and civil society, with meeting and a list of the participants.

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1. Introduction: The Burden and Causes of NCDs

As India pursues a pathway of accelerated India is no exception to this trend – the major NCDs,
economic development, growth in industrial and including CVDs, diabetes, cancer and chronic
service sectors offers more employment respiratory disease, accounted for 53% of all
opportunities. Promotion of employee health should projected deaths and 44% of DALYs in India in
be recognized as a prioritized need, as it represents 2005. Over the period 2005-2015, while deaths
a prudent investment for enhanced productivity and from infectious diseases, maternal and perinatal
also signs responsible corporate conduct. The conditions and nutritional deficiencies are expected
growing realization that health and economic growth to decrease by 15%, deaths from NCDs are
have a bi-directionally reinforcing relationship is now expected to increase by 18%, and, most
beginning to foster investment in workplace wellness significantly, deaths from diabetes are expected to
in many countries. Workplace health programmes increase by 35%3. The cost of this burden cannot be
provide protection against occupational health ignored.
hazards and first line treatment for medical
disorders. It is important that India adopts In 2005 alone, India lost US$ 9 billion of its national
“workplace wellness” as an important pillar of its income due to NCD deaths, and by 2015 is
growth strategy. projected to lose US$ 237 billion in national income
due to deaths from CVDs, stroke and diabetes4.
Burden of Non-communicable Box 1
Diseases
What is Health and Wellness?
In the preamble to the Constitution of the World
Globally, six out of 10 deaths are due to non-
Health Organization (1948), health is defined as
communicable diseases (NCDs – see box 1).
“a state of complete physical, mental and social
Cardiovascular diseases (CVDs) are the leading
well-being and not merely the absence of disease
cause of death in the world, particularly among
and infirmity”*. Health and wellness refer to a
women1. According to the World Health Organization
state of physical, mental, social and spiritual
(WHO) report Preventing Chronic Diseases, a vital
balance, and the ability to make choices that help
investment, 60% of the projected 58 million deaths
achieve or maintain such a state of balance.
in 2005 and almost 50% of the projected global
Workplace wellness in this sense refers to all
burden of disease for 2005, as measured by
those activities that are designed to help and
Disability Adjusted Life Years or DALYs*, in the world
support employees and their families follow
were due to NCDs, with the four major NCDs –
healthy lifestyles that are conducive to achieving
CVDs, cancer, diabetes and chronic respiratory
such a state of well-being.
disease – accounting for most of this burden. While
death from infectious diseases, maternal and
What is a Non-communicable Disease?
perinatal conditions and nutritional deficiencies are
A non-communicable disease is an illness that
expected to decline by 3% by 2015, deaths from
persists for a long duration. It usually progresses
NCDs are expected to increase by an alarming 17%
slowly, and unlike infectious diseases, cannot be
over the same duration2.
prevented by vaccinations, nor can it be
transmitted from person to person. The major
Although the rise in NCD burden is a global
NCDs include cardio-vascular diseases (CVDs)
phenomenon, it is the low and middle income
such as heart attack; stroke; diabetes; cancers
countries that face the biggest challenge. WHO
such as breast cancer and prostate cancer;
reports that a staggering 80% of deaths from NCDs
chronic respiratory disease (CRD) such as
occur in developing countries2.
asthma; bone and joint impairments such as
arthritis; vision and hearing impairments; oral
disorders, etc. Mental disorders, such as
* A measure of the years lost to disease, calculated by
combining the healthy years lost due to premature death depression, dementia, schizophrenia and anxiety
from the disease, and the number of years spent in ill disorders also fall in this category due to their
health due to the disease; one DALY can be taken to chronic nature.
mean one lost year of healthy life.

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Tremendous gains can be made with even the


smallest of reductions – according to WHO, an
additional 2% annual reduction in NCD death rates
between 2005 and 2015 would result in an
accumulated gain in income of around US$ 15
billion in India2.

The Causes

One characteristic feature of most NCDs is that they


are mainly caused by lifestyle, behavioural or
environmental factors, most of which are modifiable.
A small number of such modifiable lifestyle-related
determinants are accountable for most of the major
NCDs. The most important of these are an
unhealthy diet and excessive energy intake, physical
inactivity (all of which lead to overweight/obesity) and
tobacco consumption. Other important changeable
risk factors include excessive alcohol consumption,
psycho-social factors such as stress, and
environmental toxins. In conjunction with the non-
modifiable risk factors of age and genetic heredity,
these account for most of the NCD burden we see
today2.

India’s risk factor profile has been worsening over


the decades, and is now a cause for concern.
Around 17% of males and 15% of females above
the age of 15 years have a body mass index (BMI)**
above 254, and these figures are even higher in
urban areas, being 22.2% and 28.9% respectively5.
In fact, some risk factors such as physical inactivity,
inadequate fruit and vegetable consumption and
unhealthy alcohol consumption have been found to
be higher among Indians and South Asians relative
to individuals in other regions6.

** BMI is a statistical measure of a person’s weight relative to


height. A BMI of 25 kg/m2 is considered the global cut-off
for overweight, and that of 30 kg/m2 is considered the
global cut-off for obesity.

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2. Rationale: Why Invest in Workplace Wellness?

NCDs are costly to employers in a direct way.


Modifiable risk factors such as smoking, lack of
exercise, alcohol use, poor nutrition, obesity and
hypertension increase an employer’s healthcare
expenditures by 25% and are currently estimated to
account for 2.1% of gross domestic product in
India. In today’s market-driven, competitive world, a
capable and resilient employee is an important
resource and fundamental to productivity. NCDs are
the prime cause of lost work time in the working-age
population. An Indian industry survey identified that
lifestyle-related illnesses account for 27% of illnesses
among employees. A quarter of the respondent
firms lost approximately 14% of their annual working
days due to sickness7. In India, productive years of
life lost to cardiovascular disease alone will almost
double between 2000 and 20302.

Being lifestyle-related diseases, NCDs must be


tackled at all stages of an individual’s life and in all
spaces that an individual occupies – at home, at
school and in the workplace. Globally, 65% of the
population over the age of 15 is in the productive
years and spending one fourth of its time in the Interventions to improve nutrition, encourage regular
workplace. In absolute terms, this translates into physical activity and avoid the use of tobacco and
3.18 billion people, a figure that is projected to harmful alcohol use are cost-effective and can
increase to 3.68 billion by 20208. In India, 58.5% of reduce up to 80% ill health and premature deaths
the population aged 15 years and above is currently due to NCDs. Reducing just one health risk
economically active7. Thus, the working population in increases an employee’s on-the-job productivity by
India is a huge, concentrated population which is 9% and cuts absenteeism by 2%. In fact, preventive
easy to target and, by implication, one in which healthcare activities at the workplace have been
results can show quickly and be substantial. found to be related to increased profits of Indian
companies7,9.

Benefits of Workplace Wellness Programmes NCD prevention through workplace wellness


to Companies programmes is also important in the context of the
• Reduced absenteeism increasing sedentary nature of work. The service
• Reduced injuries and workers’ compensation sector is increasingly becoming the predominant
costs employment sector in the world – globally in 2006,
• Reduced healthcare costs for the first time the share of employment in the
• Reduced employee turnover service sector overtook that of agriculture, with 40%
• Increased productivity and profits of employees working in the former9. In India the
• Greater worker satisfaction employment share of services has also been steadily
• Improved morale increasing, from 18.1% in 1965 to 23.5% in 200010.
• Increased attraction of talent and potential The workplace is also full of the pressures and
employees to the workplace strains of deadlines and performance, and the high
levels of stress and burnout reported by Indian
employees confirms this. A recent survey by the
Associated Chambers of Commerce and Industry of
India (ASSOCHAM) found that work-related stress

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Why the Workplace is Ideal for NCD


Prevention
• An easy, concentrated population to target
• Multiple levels of influence can be used –
direct, such as the provision of healthy food,
and indirect, such as creating a supportive
environment
• Possible to link workplace health promotion to
other programmes at the workplace, such as
occupational safety programmes
• Concentration of lifestyle-related risk factors at
the workplace
• The workplace has been recognized
internationally as an important health
promotion setting

and mental fatigue are common problems reported


by Indian employees not only in the areas
traditionally associated with work stress such as the
IT and BPO sectors, but also in many other sectors,
including construction, shipping, banking, media,
small-scale industries, trading houses and
government hospitals11. The high concentration of
lifestyle-related NCD risk factors in the workplace
makes it imperative that preventive efforts be
focused there.

A healthy population is an economically productive


population, and it is in the benefit of companies to
safeguard public health. Given the heavy
contributions of the private sector to the economy,
employee wellness programmes are not only a
strategic priority for India, but also an economic
imperative for corporations.

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3. Evidence: Workplace Wellness Works

There is considerable evidence suggesting that


Behavioural Outcomes
workplace wellness programmes aimed at
preventing NCDs through lifestyle changes are
The three most important lifestyle-related
effective, although this evidence is by no means
determinants of NCDs are physical inactivity, diet
exhaustive. Employee wellness programmes have
and substance abuse, in particular tobacco
been seen to have various types of effects, with
consumption. Workplace wellness programmes have
improvements observed in anthropometric*,
been found to improve all these behavioural risk
behavioural, psychological and economic outcomes.
factors.

Anthropometric Outcomes Physical Activity


A number of techniques have been used to
A review of workplace intervention programmes encourage physical activity at the workplace. A
focusing on weight control found that these were systematic review of the effectiveness of workplace
able to produce a reasonable amount of short-term physical activity interventions found the use of
weight loss among the employees12. Similar results pedometers to increase daily step counts, walking to
were found by Petersen et al. (2008) for an Internet- work (active travel) and workplace counselling to
based employee weight-management programme – have a positive impact on physical activity
in fact, increased website use was associated with behaviour16. Counselling as a technique to increase
increased weight loss13. The effect of such wellness energy expenditure and cardio-respiratory fitness
programmes on other physiological risk factors such was found to be effective in a Randomized Control
as hypertension14 and endothelial function**,15 has Trial as well17. Another study found a
also been found to be positive. communications-based campaign to be effective in
increasing knowledge of physical activity and
encouraging walking18.
* Anthropometry refers to the measurement of the human
body; in this context, it implies all body dimension and Diet
physiological measurements such as BMI and blood
pressure. A diet high in fats and sugars and low in fruits and
** Endothelial function refers to the functioning of the vegetables has been identified by WHO19, WCRF20
endothelium, which is the layer of cells lining the interior of and many other international organizations as a risk
blood vessels and the heart.
factor for NCDs. Several interventions at the workplace

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are aimed at improving the dietary habits of


Economic Outcomes
employees. For instance, the Heartbeat Award (HBA)
scheme, which is a nutrition labelling scheme in
Various types of programmes have been observed
England was found to be effective in increasing four
to enhance productivity and profitability. One study
healthy dietary behaviours – increased fruit
found work health promotion to decrease sickness
consumption, reduced fried food and sweets
absences and enhance work ability29, while another
consumption, and a switch to lower fat milk21. Another
study found an employer incentive/disincentive
comprehensive intervention programme designed to
approach to be effective in reducing illness-related
target multiple levels of influence22 was found to be
absenteeism30. Workplace physical activity
effective in increasing fruit and vegetable intake
programmes have also been seen to have positive
among employees. This increase was much more in
effects in this regard, and have been found to
the workplace-plus-family intervention relative to the
reduce health-related impairments in time
workplace-only intervention, highlighting the
management, physical work, output limitations,
importance of multi-component programmes.
overall work impairment and short-term disability
workdays lost31.
Substance Abuse
Programmes targeting substance use/abuse by
Another study found workday exercise to improve
employees have been found to be effective in
white-collar workers’ mood and self-reported
reducing tobacco consumption23 as well as alcohol
performance32. Overall workplace wellness
abuse24. These intervention programmes have also
programmes have been found to be economically
found to be economically profitable for companies25,
beneficial for organizations, brining about reductions
particularly since substance abuse can greatly
in sick leaves, health plan costs, workers’
hamper an employee’s productivity.
compensation and disability costs33.

Psychological Outcomes

Frequently, workplace wellness programmes have a


mental health component aimed at relieving stress
and enhancing the feeling of well-being. In a review
of workplace interventions to promote mental well-
being, it was found that psychosocial intervention
courses, stress management training, counselling
and therapy, physical exercise and health promotion
interventions have a positive impact on mental well-
being26. Physical activity programmes at work in
particular have been shown to enhance subjective
well-being and enthusiasm of the employees at
work27, 28.

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4. The WHO India/World Economic Forum Joint Event


on Employee Wellness as a Strategic Priority in India

Following several recent consultations in Davos and


Dalian, the World Economic Forum and the World
Health Organization jointly convened a meeting on
“Employee Health as a Strategic Priority in India” in
New Delhi, India, on 14-15 November 2008.
Employee wellness was unanimously acknowledged
as a strategic priority for India.

A clear need for dramatic change was reiterated,


through ideas such as creating a new code on
public health to be adopted by companies, with
interventions extending not only to the employee but
also to families and communities. Multistakeholder
action was identified as the single most effective
vehicle for change. The next sections of this report reflect the scientific
evidence presented during the Joint Event, and
The immediate course of action identified at this highlight the key aspects discussed by the
meeting was the creation of a council inclusive of participants. Annexes 1 and 2 provide the agenda
several ministries, corporate leaders and civil society, for the meeting and a list of the participants.
with international organizations such as the World
Economic Forum and the World Health Organization
playing the foremost role of stewardship. The Public
Health Foundation of India was identified as a key
organization positioned to play a convening role in
bringing together multiple stakeholders on a platform
for action, with support from organizations such as
the Confederation of Indian Industry, the Indian
Association of Occupational Health, and the
International Labour Organization.

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5. Barriers and Opportunities

The increasing prevalence of NCDs is a relatively unique avenues of initiating and sustaining change.
new phenomenon in India, and the concept of The following section details the discussions of the
having wellness programmes at the workplace to meeting about barriers and opportunities relevant to
prevent them is an even newer one. Barriers to the India context.
implementation of workplace health promotion
programmes exist. However, many barriers become There are four main types of barriers and
facilitators over time, and it is important that we look opportunities – related to attitudes, employers,
for opportunities within these barriers, as well as employees and capacity development – in addition
aspects of the Indian context that provide us with to some general, overarching ones (see figure 1).

Figure 1: Potential Barriers and Opportunities Related to Implementation of Employee


Wellness Programmes in India

Barriers Opportunities

General Barriers and Opportunities


1. High NCD burden Possibility of making dramatic change

2. Global financial crisis affecting Health as an investment


Indian companies – global economy
will pose a challenge

Attitudinal Barriers and Opportunities


3. Lack of awareness of the Growing global recognition of NCDs, their potential impact and the opportunity to
implications of the NCD epidemic use national and local media to get the message across to the public
a. Health is getting linked to productivity and profitability

4. Health is considered a philanthropic b. Great opportunity to redefine human agenda to talk about human happiness
issue and human well-being
c. Idea of creating a new code on public health to be adopted by companies and
countries

5. Preventive care lacks incentive – a. Scope for appropriate policies and programmes for preventive healthcare
the focus is on curative health b. High quality expertise in IT and medicine providing resources for state-of-the-art
work interventions

Barriers and Opportunities Related to Employers


6. Lack of visibility of leadership – Reach out to chief executives (CEOs):
need to reach decision-makers • Through industry employee organizations
• Engage CEOs from outset to be champions
• Make and show business case
• Capture CEOs emotions
• Use the right language (tailor messages)
• Non-cost, high return, simple interventions (e.g. information, environment)
• Use of the media
• Goal setting – 10 commandments to implement this year
• Incentives – awards systems to best workplaces
7. Concern of employers regarding the How can it be integrated so it does not detract from time?
employees time a. Make the case that it is cost effective by being an investment
b. Find efficient delivery channels and structural support (e.g. sport, gym)
c. Identify a menu of options to choose from (adaptable to workforce at any time)
d. Management support medium and high levels
e. Identify existing opportunities for health in existing structures rather than adding
(e.g. canteen, design)
f. Go beyond individual education (environmental change)
g. Health as a human right and not just business

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Barriers Opportunities

Barriers and Opportunities Related to Employers


8. Employers are worried about issues Promote trade union leadership – getting unions engaged from the start
related to unionism (changing food
menus, etc.)
9. Issues related to high attrition in Workplace wellness as an incentive for employees to join the company and stay in it
companies

Barriers and Opportunities Related to Employees


10.Engaging employees in health Bottom-up approach (increase awareness to create demand for health):
programmes is difficult (lack of • Educate employees about their rights
visibility and transient, if any); and • Scope for creating healthcare opinion-makers among employees –
lack of interest of younger empowerment
employees in NCD prevention • Using other employees as vehicles for messages
• Employees as champions (incentives)
• Personal experience with diabetes and heart diseases
• Capitalizing on family ties

11.Issue with annual health check-up – Ensure employee trust in confidentiality


fear of losing job due to bad health
performance

Barriers and Opportunities Related to Capacity Development


12.Capacity gap a. Lack of a conceptual framework that explains why the change should happen
b. No Indian data showing that prevention is better than cure
c. Lack of more real-life data on the effect of NCDs on companies in India
d. Lack of HP material specific to industries
e. Create best practices in healthcare
f. Network of people for sharing what is being done, barriers faced and how they
are being overcome
g. Use existing organizations (e.g. CII) to disseminate information
h. Create a common set of HP materials to be used by all workplaces

13.Various interventions – what are the Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu
different options available and their of programmes:
costs? • Screening and medical check-up (tobacco, hypertension, diabetes, alcohol)
• Support provision of treatment (as ethical practice)
• Information and awareness raising
• Health styles change guidelines – health promoting environments (canteen, low
salt/sugar food, tobacco, alcohol); include stress and posture as key
• Structural and functional changes to workplace
• Informal sector: self-help groups sensitization
• Reimbursement for prevention/promotion
14.Management barriers – nobody to Ensure employee trust in confidentialityWhat should be provided as a WHP? Menu
manage workplace wellness of proNeed to create a cadre of management personnel
programmes
15.Environmental barriers: availability Structural and environmental changes are needed – do not only put the
and affordability to be physically responsibility on the individual to make this change
active and eat healthy

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The main overarching barrier to implementing programme might introduce (for instance, changing
wellness programmes at the workplace is the global food menus to substitute high fat and sugar options
financial crisis, which is bound to compromise the with healthier ones might create resentment at the
extent to which Indian companies and organizations withdrawal of acquired rights). Most of these
can spend on workplace wellness. However, if problems stem from a lack of awareness and
workplace wellness is seen as an investment as involvement. It is thus essential that all key payers –
opposed to an expenditure, the global economic the top leadership, the employees, the union, etc. –
downturn can become an opportunity to enhance are involved from the beginning in the planning,
and augment human resources and better secure execution and evaluation of the programme. Lastly,
the future of an economy that is increasingly service employers are worried about investing in wellness
sector dominated. programmes when turnover rates are high; however,
it might be that the high stress and unhealthy
The second set of barriers is attitudinal. Being new working conditions are parts of the reason for
to NCDs and having faced a disproportionately high attrition. There is an opportunity for companies to
burden of infectious diseases, pregnancy-related promote wellness programmes as an incentive to
conditions and under-nutrition for a considerable attract new talent as well as retaining it – a powerful
period of time, LMICs are only beginning to means for management to show it cares.
comprehend the seriousness of the potential
negative impact of a high NCD burden. Moreover, On the employee side, the main barrier is the
health has traditionally been perceived as a matter of difficulty of encouraging participation in wellness
social welfare that lies within the domain of the programmes. Again, the problem is mainly due to a
government, and not something in which the private, lack of awareness of the importance of maintaining a
corporate sector should be involved. Even where healthy lifestyle; this is particularly true of younger
health has been recognized as a priority, almost employees who feel invulnerable to disease and
complete focus has been on curative services, with disability. This barrier creates the opportunity to
not enough emphasis given to preventive care – high enhance awareness in the workforce regarding
health-care costs incurred by corporations attest to NCDs and their risk factors – the employees must
that. be educated about their rights and a bottom-up
approach must be adopted to create a true sense of
However, as more and more evidence highlights the ownership among the employees. The other barrier
economic gains to be made by corporations if they faced by employees is a fear of losing one’s job due
work towards enhancing the health of workers, the to bad health performance on annual health check-
global perception is rapidly changing from health as ups. It is crucial to maintain complete confidentiality
social welfare to health as business and an asset to of results, and ensure the employees that the results
productivity and profitability. India must align itself of health check-ups are completely separate from
with this global thinking, and look at its workforce as their performance appraisals on the job.
a vital human resource to be invested in for future
productivity. It must create and impart a new code Lastly, there are certain barriers and opportunities
on public health, specifically to be adopted by related to capacity development. In the area of
business firms and corporations, so that health public health, there is a huge capacity gap – the
becomes a part of the value system of all firms in requisite data, studies, personnel and body of
the country. knowledge to make the appropriate policy changes
are not available. This lack of knowledge creates an
There are also several barriers and opportunities ideal opportunity to start gathering data from
related to employers, the most important ones being existing sources and disseminating it for others to
lack of visibility of leadership in workplace wellness, use. It is no longer sufficient to follow best practices;
the perception that health interventions take up a India has the ability to create the next best practices.
considerable amount of time of employees, and A key point will be to create a network of
concerns about the reaction of union members to organizations, industries and stakeholders so that
the drastic changes a workplace wellness there is transparent sharing of experiences and the

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lessons to be learned. Certain key organizations,


such as the Confederation of Indian Industries (CII),
the Public Health Foundation of India (PHFI), can act
as nodal agencies for collecting, synthesizing and
disseminating information in the form of best
practices.

There are still many questions that need to be


answered – how can interventions be translated into
other industry sectors? How can India tackle health
promotion in its large, unorganized sector? How can
we address issues of sustainability? These and other
questions cannot be dealt with by companies alone
– there is an urgent need for multistakeholder
discussions and collaborations. It is only when the
various government departments, civil society, the
corporate sector and academia come together that
we can begin to find solutions.

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6. Strategy for a Successful Programme

To overcome the above-mentioned barriers and


make optimal use of the available opportunities, an
employee wellness programme should follow a
strategy for success – it should appropriately take
into account and influence the leadership, people,
culture and processes deployed in the making of a
programme34 (see figure 2). The lack of leadership,
participation of employees, a health-promoting culture
and environment or effective processes can threaten
and weaken the effectiveness of a programme.
Thus, it is important to adequately address each of Health Education
the four elements to infuse commitment, efficacy Small lifestyle changes such as regular exercise and
and sustainability – essential ingredients required for healthy eating can prevent diabetes and
the success of a wellness programme. cardiovascular disease, yet awareness of them is
poor. Health education, through the dissemination of
Leadership health-related materials, seminars and talks delivered
Leaders are essential for the success of any by experts can help raise the profile of these
endeavour. Leadership lends visibility and sustainability avoidable conditions and motivate employees to
to workplace wellness programmes, and can entirely adopt healthy behaviours (see box 2).
determine the extent to which such programmes
operate within an organization. The lack of awareness Box 2
of workplace wellness among senior leadership is
Through Knowledge Comes Power: Health
often a barrier to committed action towards the health
Education at Reliance
of employees. Getting top leadership involved and
Health awareness and education forms a key
engaged to advocate change and be committed to
component of the health and wellness initiatives at
employee wellness is an essential component of a
Reliance. Reliance has medical teams that regularly
successful workplace wellness programme.
conduct awareness campaigns, educating
employees about lifestyle-related diseases and
People
stress management through exhibitions, lectures
In general, people want to be healthier, provided
and camps. These medical teams regularly
there is an environment that allows it. High rates of
conduct health promotion activities for advocating
participation are key to success and easier to
and bringing about improvement in the
achieve if the right strategies are deployed to reach
environment of the workplace. The Project CASHe,
out to employees.
Change Agents for Safety and Health, is an
endeavour to bring about a change in the attitudes
Figure 2: Key Elements of a Strategy to and behaviour of employees, to pave the way for a
Implement Workplace Wellness Programmes healthier life. The project aims to bring about
improvement in occupational health practices and
Leadership has been found to reduce work-related diseases
and injuries, decreased the rate of absenteeism
and improved productivity. The main result of this
project has been to bring about a change in
organizational culture – today, health and wellness
are priorities in themselves at Reliance.

References:
People Process 1. http://www.ril.com/html/aboutus/health_safety_environment.
html#policy (Last accessed January 2009)
Culture 2. Health, Safety and Environment, Reliance Industries Ltd 2004-05
3. Health, Safety and Environment, Reliance Industries Ltd 2005-06

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 16

advisory groups in which employees are


represented, such as employee-led walking clubs
and peer coaching, are some examples35.

Counselling
Private counselling of high-risk individuals has proven
to be an effective method of prevention (see box 4).

Culture
Culture plays an important role in conditioning the
way individuals think about their health. As
demonstrated in the previous section, several
barriers and opportunities are attitudinal due to the
prevailing socio-cultural perceptions. Inculcating a
Tailored Programmes
positive attitude towards prevention and wellness
In corporations, the pool of employees is often
among employees and creating an environment
diverse, including people of different ages, sex and
conducive to health-promoting activities are
health profiles. Thus, wellness programmes cannot
challenging yet desirable for an organization. Below
be one-size-fits-all; they need to be tailored to target
are some examples.
different audiences.

Age-specific programmes are such an example. In


Box 3
general, younger people (low-risk) assume a state of
good health, whereas the elderly (high-risk) are more Prevention is the Key: Medical Diagnostic
serious about prevention. Interest in different Screening and Targeted Interventions at
activities also differs by age group. Adventure sports Reliance
and team sports, for example, can be used to The Occupational Health Centres (OHCs) at the
attract the participation of younger employees. manufacturing divisions of Reliance are equipped
Programmes may also be disease-specific, or be with state-of-the-art facilities and apparatus, as
designed to protect employees from potential well as competent health professionals who
occupational health hazards (see box 3). conduct medical examinations of their prospective
employees and of their workers post-employment
Incentives on a regular basis. The results are used to create
Provision of incentives to employees who participate and implement targeted interventions among
can be extremely useful in increasing enrolment individuals and groups of individuals with similar
rates. Some corporations offer, for example, risk factor profiles. These OHCs are equipped to
wellness allowances which employees can use perform certain specialized tests, such as
towards the purchase of fitness equipment. biological monitoring, health risk assessment
However, incentives need not be financial – reward studies and audits for exposure to various
and recognition are also powerful tools. materials. The investment in the infrastructure and
manpower required to maintain such OHCs has
Engaging Employees paid off, as it has translated into at-risk-employees
A workplace wellness programme is most effective taking necessary preventive measures long before
when it caters to the precise needs of the employee. crippling lifestyle-related diseases are able to rob
Engaging the employee at each stage from them of their efficiency and productivity.
development to delivery not only provides the
constructive feedback needed in the eventuality of References:
applying mid-course corrections, but also hands 1. http://www.ril.com/html/aboutus/health_safety_environment.
html#policy (Last accessed January 2009)
over ownership of the programme to the employee,
2. Health, Safety and Environment, Reliance Industries Ltd 2004-05
thus ensuring greater responsibility towards 3. Health, Safety and Environment, Reliance Industries Ltd 2005-06
individual health. The creation of managerial or

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 17

Promoting Work-Life Balance the clock, even when at home. Such a high-stress
Today, the hours an employee spends at work are lifestyle is a major risk factor for NCDs, and can lead
getting longer, as fixed working hours are fading to productivity losses due to mental exhaustion.
away. With recent technological advances and Corporations can thus promote a healthy lifestyle
gadgets such as laptops, cell phones and handheld through defined working hours and offerings such as
devices, employees are essentially working round social gatherings and on-site exercise and
recreational facilities.
Box 4
Healthy Cafeteria
Offering a Helping Hand: Wipro’s “Mitr” Unhealthy food choices and a sedentary lifestyle,
Wipro, one of the leading global corporations often exacerbated by job profiles, are risk factors for
based in India, has a number of wellness NCDs. Offering healthy options at workplace
programmes running in both its IT and BPO cafeterias is an effective and immediate approach to
sectors. Essential components of the programmes reducing risk factors among employees.
are, for example, nutrition counselling, cafés
offering low-calorie foods, health centres, medical Reaching the Family
camps, regular medical lectures and employee Inclusion of the family in adopting healthy behaviour
well-being events. One of its most successful influences the employees’ broader social context.
initiatives has been the in-house counselling Family support and participation in making healthy
programme called “Mitr”, launched in 2003. changes increase the reach of such programmes
Literally meaning “friend”, the programme trains and enhance sustainability due to greater adherence
employees to provide counselling services to (see box 5).
colleagues that are facing stress at work or in their
personal lives. The employees trained for this Extending Outreach to the Community/Unorganized
purpose are volunteers, thereby ensuring high Sector
motivation and a desire to help. The selection of It is not enough to invest in the health of one’s
counsellors from among the employee volunteers employees and their families – it is essential that
is stringent, ensuring that adequate motivation and companies go into the community in which they
commitment are accompanied by the necessary reside and which sustains them. Such a holistic
skills required to be a counsellor. As a programme approach allows wellness initiatives to grow beyond
“for Wipro employees, by Wipro employees”, it is the boundaries of the corporation and impact
highly sustainable and provides employees with a surrounding areas. Some companies also offer
sense of ownership. The programme is highly subsidized healthcare to contractual workers and
publicized within the company, to ensure that as clients, in addition to their own workers, as part of
many employees as possible are aware of an corporate social responsibility.
available helpline, not only for work-related issues
but also for personal problems. Certain key Effective Messaging
elements of the programme have made it highly Communicating the goals of the programme and
successful – the use of technology such as the messaging effectively so that it cascades throughout
intranet, the involvement of key people and in the organization is essential. Effective and frequent
particular of top management, which gives it the messaging lends visibility to the programme and
necessary support and backing needed for gradually gets absorbed and accepted as an integral
sustainability and further scalability, and interaction part of organizational culture.
with external public health agencies and
companies dealing with specific diseases, as well
as with individual consultants.

References:
1. Working towards wellness: An Indian perspective. 2007,
PricewaterhouseCoopers

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Box 5 Process
Reaching Out to the Family: The TCS Maitree
While engagement of leadership, involvement of
Initiative
people and promotion of a culture conducive to
Under the leadership of Mala Ramadorai, wife of S.
health are necessary for the success of an employee
Ramadorai, Chief Executive Officer of Tata
wellness programme, they alone cannot guarantee
Consultancy Services (TCS), Maitree was initiated
results – it is essential that adequate attention is
in February 2003 to “weld TCSers and their
given to ensure that the processes to implement and
families” together. The main objective of Maitree
evaluate the programme are appropriate, efficient
has been to reduce alienation and stress at work
and cost-effective, and are put in place in a timely
and increase a sense of empowerment and
and systematic manner. The following sections deal
belonging among employees and their families.
with the process of setting up a workplace wellness
This is done by holding regular social gatherings to
programme in detail.
promote common interests and have a relaxed,
healthy atmosphere at work. Events include clubs
and workshops on diverse hobbies such as music,
Model for Setting up a Workplace
dance, yoga, trekking, origami, flower arrangement
Wellness Programme
and theatre. The events are open not only to TCS
employees but to their families as well – in
It has been clearly established that workplace
particular, the focus is to encourage the spouses
wellness programmes have great potential to benefit
of TCS employees to become a part of the TCS
not only the employees that are or potentially could
family. The company has open days during which
be suffering from debilitating NCDs, but also the
an employee’s family can visit the office to get a
organizations they work for in terms of increased
feel for the work environment. An effort is made to
productivity and profitability. However, the question
involve the children of employees as well, for
that remains is how such a wellness programme
whom special workshops and camps are
may be designed, implemented and sustained, and
organized. In addition, TCS Maitree provides
its benefits measured over time. Although there are
counselling services to the 30,000 employees and
numerous types of such workplace programmes,
their families, and there are several self-help
each targeting different aspects of health and
groups within the organization that anyone can
wellness, there are certain basic steps in launching
join. The idea is to build bridges between the
such a programme, as developed by WHO India,
company and its employees and their families, to
which must be followed in order to have a programme
encourage healthier, more meaningful lives.
that is successful, sustainable and scalable. These
steps have been illustrated in figure 3.
References:
1. “Saying tata to tedium”, The Hindu, Monday, July 23, 2003
2. http://www.careers.tcs.com/CareersDesign/Jsps/ Once the concept of having a workplace wellness
WorkingatTCSMaitree.jsp (last accessed January 2009) programme has been endorsed by industry and
3. Navare, S. Counselling at work place: A proactive human health departments, and the decision to implement
resource initiative. Indian Journal of Occupational and
Environmental Medicine, April 2008, 12(1), 1-2
one has been taken by the management of the
organization, a workplace wellness committee
should be established, with representatives from all
levels – employees that are potential participants,
individuals that might be involved in the
implementation and evaluation of the programme,
and top management36. In addition, a wellness
coordinator can be appointed to take charge of all
programme activities. This step is essential to a
successful programme, as research has shown that
programmes that have such committees and/or
coordinators in place to oversee them have more

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Figure 3: Model for Developing a Healthy Workplace

Endorsement by Industry Healthy Workspace Committee


and Health Departments (All stakeholders)

Evaluation of NCD Risk Factor Profiling by


Current Status a Standard and Short
Performance e.g. IDRS + TA

Workplace Level Situation Employees’ Level Health


Analysis Policies, Infrastructure Behaviour Survey – on a sample

Assessment of Mental
Health Status
Plan of Action
Assessment of Occupational
Health Specific for
the Industry
Health Promotion Policies:
Commitment from Management (HR)

Physical Work Environment Psychosocial Work Environment Promoting Healthy Practices


• Healthy canteen • Counselling facilities • Tobacco and alcohol free workspace
• Facilities for recreational activity • Social club formation and • Promotion of healthy lifestyle
• Reduction of occupational hazards improving co-worker relations • Health education messages on stress
• Availability of basic sanitary • Defined working hours reduction techniques
facilities • Periodic seminars to update • Periodic screening
• Availability of child care facilities knowledge • Frequent follow up of high-risk individuals
• Waste management • Healthy employer-employee • Access of health services by family
• Safety of employees relationship members of the employee
• Supportive work environment

Developed by World Health Organization Country Office for India

policy support to bring about environmental and Assessment36, profiling the risk factors of the
behavioural changes promoting healthier lifestyles employees for NCDs, on the basis of which an
among the employees37. overall organizational profile can be created. Such
a profile will indicate priority areas, as well as help
The wellness committee is encouraged to: identify high-risk individuals for targeted
interventions. It should also include an
• Undertake a detailed analysis of the situation at assessment of the mental health status of each
the workplace, also called an organizational employee.
health survey36, 37, to assess the extent to which • Depending on the nature of work, perform an
the organization has the necessary prerequisites occupational health assessment specific to the
in terms of its physical and psychosocial industry and type of work involved.
environment, work policies, management • Conduct an Individual Interest Survey36 to get an
relations, etc., to pursue a healthy life. idea of employee preferences for how they want
• Assess the physiological, behavioural and to receive information (e.g. electronically or
psychological characteristics of the employees pamphlets), the kind of group activities they
themselves, to ascertain the kinds of problems would be most interested in joining (e.g. dance or
and behaviours the programme should focus on, yoga), etc. This would ensure greater participation
both in terms of prevalence and perceived need. and commitment from employees.
Such an exercise should include a Health Risk

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This preliminary analysis will determine the type and extent of intervention chosen. The
forthcoming plan of action for the ensuing wellness organizational culture of the company and the
programme. The recommendations will be used by constitution of the workforce will also play a role in
the workplace wellness committee and/or top this decision. Small and medium enterprises, for
management to formulate the goals, strategies and example, may alter certain components of the
policies that will constitute the wellness process and still accomplish health goals (see box 6).
programme37. It must be ensured at this stage of
design that the formulated policies have the full Box 6
support of top management, human resources and
the decision-makers of the organization. This is one Workplace Wellness Programmes for Small
of the key components of any successful workplace and Medium-sized Organizations
wellness programme. Small and medium-sized organizations do not
have the same managerial and monetary
The plan of action will consist of the basic capabilities as large organizations to focus on
overarching goal or mission statement declaring employee wellness programmes. Nevertheless,
what the programme aims to achieve. Under this will there are several cost-effective interventions that
be the main goals or objectives through which the can be easy to implement:
programme will achieve the overarching goal – these • Outsource health check-ups and screenings to
objectives must be made measurable, with specific, save on full-time, on-site health facilities
realistic timelines so that it is possible to assess • Provide vouchers for use at local gyms rather
whether they have been achieved. Alongside this, a than on-site recreational facilities, or negotiate
budget should be developed so that the costs can be corporate rates at gyms
easily compared to the benefits of the programme • Distribute information on healthy eating and
and the feasibility of the programme determined. nutritional seminars in the absence of a canteen
offering healthy food choices
The mission statement and goals of the programme • Partner with community centres and local
will determine the kinds of health promotion policies events (e.g. marathons, exercise classes) open
that should be adopted to accomplish them. As the to employee enrolment
identified goals and objectives will come from the • Disseminate health information at the workplace
situation analysis, the policies selected on the basis
of these goals will be specifically designed to
address the particular needs of the workforce and
the organization, thereby allowing for tailor-made
interventions.

According to the specific needs of the organization,


a committee can pick and choose from a number of
available policy options listed in figure 3. These can
be classified into three broad categories:
1) Changing the physical work environment
2) Changing the psychosocial work environment
3) Promoting healthy behaviours and/or
discouraging unhealthy behaviours

These are not mutually exclusive and might be


chosen in combination to have a multilayered
intervention for maximum effect on the targeted
problem. The level of commitment by the company,
the resources available, and the seriousness of the
health issue targeted will in tandem determine the

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3) Third level – involves collecting information on the


Monitoring and Evaluation
intermediate effects of wellness programmes and
includes all the social, cultural and psychological
Monitoring and evaluation (M&E) is an essential
factors that are believed to influence health
component of any wellness programme and to a
behaviours, such as self efficacy, perceived
great extent determines its success or failure. A
environment, social support, etc.
consistent M&E element must be incorporated in the
design and implementation of the programme, and
4) Fourth level – consists of assessing energy
follow-ups must be made and recorded at regular,
balance-related behavioural change, or all those
predetermined intervals, so that:
behaviours that actually impact health, such as
• Progress can be recorded
fruit and vegetable consumption, physical activity,
• Policies can be changed and improved
smoking, alcohol consumption, etc., as well as
• Comparison between intended deliverables with
biological measures such as weight and blood
actual outcomes can be made
pressure, and environment-level changes such as
• Better results can be observed and documented,
availability of healthy foods and walking trails.
justifying the investment made in the programme
Economic outcomes such as absenteeism and
sick leave should also be assessed as part of this
This process must be accompanied by constant
level.
documentation of best practices and, if possible,
dissemination of the same.
5) Fifth level – consists of assessing the long-term
effects of a wellness programme, i.e. a reduction
M&E is intricately tied to all preceding stages of
in the incidence of disease among the
development and implementation of workplace
employees.
health programmes38. The different levels of
evaluation indicate this. Figure 4 illustrates the levels
All outcome evaluations must be done in a sustained
of evaluation of a workplace health intervention39:
manner, starting with baseline level assessments
(which are equivalent to the situation analysis
1) First level – known as formative evaluation, is
mentioned earlier), followed by periodic
undertaken at the beginning and assesses the
assessments, while the programme is being
employees’ opinions and preferences of the
implemented, that continue into the long term.
policies to be implemented. In addition, it can
include a stakeholder interview to assess the
Monitoring and evaluating a workplace wellness
probability of success of the programme. The
programme should be initiated by ensuring there is
results of this first stage of evaluation should be
recognition of and commitment to M&E at the initial
kept in mind while taking decisions regarding the
planning stages among both policy formulators and
nature of policies and processes of
decision-makers. The next step is to look, from
implementation to be adopted.
existing record keeping or monitoring activities, for
those activities or records that are relevant for the
2) Second level – is called process evaluation, as it
impending wellness programme, and to use this
refers to the monitoring of the processes involved
existing data to inform and improve the policies of
in the actual implementation of the programme.
the programme. For instance, if some records are
This aspect of M&E must be done in a
already available of sales in workplace cafeterias,
continuous manner as the policies are
then these can be used to determine the need for a
implemented. Examples of process outcomes
food policy. Similarly, from existing records on sick
include the extent to which the programme
leave and the causes of disability and sickness, the
reaches the target population, the costs incurred,
disease conditions requiring immediate attention can
the numbers and profiles of the individuals
be ascertained38.
actually implementing the policies, etc.

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policies for better results should be put in place.


Figure 4: Levels of Evaluation in a Workplace
Periodic repetition of the M&E activities should be
Wellness Programme
done so that a sustainable monitoring system can
be established and records are maintained
1st level: Collect information on
systematically over a period of time. The entire step-
program feasibility by-step process of planning, developing,
(formative evaluation) implementing and evaluating a workplace wellness
programme is summarized in figure 5 for quick
reference.
2nd level: Continuously collect data on

success or failure
Interpretation of
program preparation preparation and
implementation (Process evaluation)

3rd level: Collect data on intermediate Bringing It All Together: The Power of
outcome (i.e. behavioural determinants) Comprehensive Interventions

Several organizations, instead of focusing on


4th level: Collect data on energy balance
related behavioural change (i.e. PA and modifying one aspect of the work environment or on
WHPP success;
Health impact

dietary outcome, biological disease changing one unhealthy behaviour of their


indicators, environmental changes)
employees, have opted to introduce more inclusive
5th level: Collect data on long term wellness programmes which aim to bring about
outcome of a WHPP. If possible change in multiple environmental and behavioural
(i.e. reduction in disease incidence) outcomes, so as to impact the health of their
employees in a holistic manner34 – being so
Adapted by Engbers (2007)38 from Bauman et al. (2006)39
comprehensive in nature, they tend to have a
substantial effect on the health of their employees.
The following are a few examples.
Having identified existing and needed M&E activities,
the appropriate indicators or outcomes for the M&E Infosys40, 41
activities must be identified. While it is imperative Infosys has adopted a very inclusive and
that the outcome indices chosen are practical and comprehensive approach to health and wellness.
economically viable, it is also necessary that they are The company has regular health check-ups, eye
valid and objective to minimize error and bias. For camps, dental camps, etc., performed by in-house
instance, while self-reported questionnaires doctors, as well as professional counselling services
assessing food intake look appealing, they are very for employees. In 2005-2006, it introduced annual
prone to bias, and hence objective measures such health checks for contractual employees as well.
as food purchases in workplace cafeterias, being There are several heath clubs at the Infosys
more objective, should supplement such measures. campuses, which have been seeing a steady rise in
The background paper on M&E prepared for the membership. In line with this increasing participation,
WHO India/World Economic Forum joint event on they have been expanding their gymnasiums and
preventing NCDs in the workplace, held in Dalian, adding to the existing recreational facilities, such as
People’s Republic of China, in September 200738, bowling alleys. The health clubs provide employees
includes a review of indicators used by workplace with various facilities, including regular yoga and
wellness programmes. aerobics sessions, as well as on-site
physiotherapists to help alleviate workers’
The actual implementation of these evaluation ergonomics-associated problems such as
activities starts from a baseline record before the spondylitis.
programme is initiated, followed by assessments at
appropriate intervals after the onset of the
programme. The findings of these evaluations
should then be systematically analysed and
appropriate changes to improve the wellness

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Figure 5: Quick-step Guide to Constructing and Implementing a Workplace Wellness Programme

Establish a Workplace Wellness Committee

Have the Committee undertake a Situation Analysis

Organisational Health Survey Health Risk Assessment Individual Interest Survey

Develop a Plan of Action on the basis of the Recommendations of the Committee


1. Formulate the Mission Statement of the programme
2. Develop the specific Goals and Objectives to accomplish the mission statement
3. Develop a Timeline corresponding to these goals
4. Develop a Budget

Select specific Health Promotion Policies in accordance with the plan of action

Implement the policies

Monitor & evaluate the policies to assess their effectiveness

Change the policies as necessary

Document best practices for dissemination

Scale up the programme as necessary

The company’s most successful health initiative has In the same year, a workshop was organized on
been HALE, the Health Assessment Lifestyle ergonomics, educating employees about computer-
Enrichment programme, which has six extensive related injuries, training them on maintaining good
elements: health, safety, leisure, stress, fun at work posture, and teaching head and neck exercises. The
and team building. The health and safety elements stress element under HALE is covered by the HALE
are delivered through health awareness campaigns Hotline – a 24-hour/365-day counselling service
and lectures on relevant issues such as cardiology available to Infosys employees. A master health
and stress management; the spread of awareness check and stress-relief campaign called HALE
using enjoyable means such as health quizzes, Health Week was organized in March 2008, with
puzzles and competitions; health consultations on 6,000 employees receiving extensive health checks
nutrition, diabetes, women’s health etc.; and and expert consultations. For monitoring and
workshops and programmes on specific problems evaluation, the company has a HALE tool – an
or unhealthy behaviours. For instance, in 2005- online questionnaire, examining and addressing the
2006, Infosys conducted under HALE a nutrition causes of stress. Responses to this questionnaire
programme which focused on the eating habits of are regularly followed by the human resources
employees, advising them on maintaining a department, and appropriate action is taken in the
balanced diet. form of the “fun at work” and “team building”

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Aditya Birla Group43


A multinational corporation based in India, the Aditya
Birla Group has opted for a comprehensive set of
initiatives promoting the health of employees. It
provides employees with the physical infrastructure
necessary to maintain good health, including a well-
equipped gymnasium, and a cafeteria serving
nutritious food. Also, an onsite doctor caters to the
needs of workers. The company organizes regular
yoga sessions, and has a meditation room where
employees can take their mind of work and home-
related problems. In addition, clubs, auditoriums,
walking tracks and other facilities are open to the
families of employees, and the company offers the
elements, which include hobby sessions, team games facilities of various townships to the families of those
and movie screenings, ensuring that all sources of who join the organization. These include sports and
stress are minimized. Thus, an attempt is made at recreation, parks and gardens, and medical services.
Infosys to address every aspect of health at work. It also has several group events in which employees
as well as their families can participate, such as
Procter & Gamble (P&G)42 family picnics, Kids’ Day Out and Sawan Mela,
To encourage and enable employees to follow and further enhancing the feeling of well-being and
implement the newly initiated organizational structure connection among workers. Lastly, its health
and culture of Stretch, Innovation and Speed (SIS), programme has a strong monitoring and evaluation
Procter & Gamble Hygiene and Health Care component in the form of a biennial Occupational
launched the Vicks Wellness Programme in 2000, and Health Survey (OHS), which has proved useful,
headed by P&G’s Health Team. This entailed a full being the source of many of the health promotion
medical check-up for all employees, along with a initiatives of the organization.
fitness programme. It included interactive sessions
with experts in the field – nutritionists, stress
counsellors, yoga specialists, etc., who could advice
employees on how to adopt healthier lifestyles. It
also entailed changes in the work environment, to
make it a healthy place to work, both physically and
mentally. For instance, the canteen not only served
nutritious food, but was also converted into a
recreational area where employees could relax and
take a break from work. The programme also
included an evaluation component, with feedback
from employees informing the Health Team of the
programme’s impact on productivity.

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7. Conclusions and the Way Forward

There is increasing global recognition of the benefits Tobacco Control, American Cancer Society (ACS).
of investing in employee wellness. Business leaders All four emphasized the need for creating a
must join to contain NCDs. It is not only altruism but congenial workplace environment, which can only be
also enlightened self-interest. Investing in the health achieved if companies commit to providing the
of employees increases productivity, cuts spending resources and awareness needed to maintain a
on healthcare, reduces turnover and attracts healthy diet, regular physical activity, and to avoid
talented individuals. While the search for low-cost, tobacco use in the workplace. This inaugural
high-return interventions continues in this economic session was followed by plenary sessions,
climate, examples of success exist in other countries interactive sessions and working group discussions.
and settings. Sharing knowledge and maintaining a The guest of honour, R. K. Srivastava, Director-
long-term vision for such investments is in alignment General, Health Services, Ministry of Health and
with India’s economic and developmental priorities Family Welfare, India, reaffirmed the commitment on
as a nation, and an essential step in fostering a the part of the Government of India to provide
healthy workforce, nationally and globally. measures to safeguard the health of Indian citizens
and, in particular, enforce the recently adopted
smoke-free rules in all public places, including
Outcomes of the WHO India/World
places of work. A significant outcome of the event
Economic Forum Joint Event
was the release of a resource kit entitled “Worksite
Wellness: A Resource Kit for Smoke-free
One of the outcomes of the WHO India/World
Workplaces” as well as two posters on smoke-free
Economic Forum joint event held in New Delhi in
workplaces, which are to be used as guiding tools
November 2009 was the identification of the Public
to help Indian corporations make their workplaces
Health Foundation of India (PHFI) as a key
smoke-free.
organization, entrusted with the task of creating a
platform for bringing together multiple stakeholders
for workplace wellness. Since then, several Worksite Wellness Initiative:
important events have taken forward the agenda for Promoting Smoke-free Workplaces in
workplace wellness in India. India, a Symposium in Mumbai, India,
9 March 2009
Worksite Wellness: A Resource Kit for
Smoke-free Workplaces, a Workshop As a follow-up to the 10 February workshop, PHFI
on New Delhi, India, 10 February 2009 and HRIDAY, in partnership with ACS, the World
Economic Forum, the Asian Heart Institute and
As a first step, PHFI in partnership with HRIDAY Research Centre (AHIRC) and the Indian Association
(Health Related Information Dissemination Amongst of Occupational Health (IAOH), organized a
Youth), the World Economic Forum, Confederation symposium on “Worksite Wellness Initiative:
of Indian Industry (CII) and the International Union Promoting Smoke-free Workplaces in India” on 9
against Tuberculosis and Lung Disease (The Union) March 2009 in Mumbai, during the 14th World
organized a workshop for corporate managers and Conference on Tobacco or Health (14th WCTOH),
medical officers on “Worksite Wellness: A Resource with participation from corporate leaders from
Kit for Smoke-free Workplaces” in New Delhi on 10 across the country. The aim of the symposium was
February 2009. The main intent of this workshop to discuss workplace wellness, promote smoke-free
was to build awareness of workplace wellness with workplaces in India and urge domestic and
special focus on smoke-free workplaces. multinational companies based in India to declare
their workplaces smoke free.
The workshop began with opening statements from
K. Srinath Reddy, President, Public Health Jeffrey P. Koplan, Director of the Global Health
Foundation of India (PHFI); Shaloo Puri Kamble, Institute, Emory University, USA, chaired the
Head, India Business Alliance, and Adviser, World symposium, and the Guest of Honour was
Economic Forum; Harpal Singh, Chairman, Impact Anbumani Ramadoss, Minister of Health and Family
Group, CII; and Catherine Jo, Manager, International Welfare of India. Other participants included John

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 26

Seffrin, President and Chief Executive Officer, ACS; economic research to improve workplace wellness,
Shaloo Puri Kamble, Head, India Business Alliance, and enable appropriate policy formulation in the
and Adviser, World Economic Forum; Shyam Pingle, country to achieve the ultimate objective of NCD
President, IAOH; Douglas Bettcher, Director, prevention among Indian adults.
Tobacco Free Initiative, World Health Organization,
Geneva; Ashish Contractor, the Asian Heart Institute; Impact of a Workplace Intervention Programme
and K. Srinath Reddy, President, PHFI. The global on Cardiovascular Risk Factors: A
youth delegates from the Global Youth Meet on Demonstration Project in an Indian Industrial
Tobacco Control, which had been held in Mumbai Population
on 6-7 March 2009, also took part in the
symposium. Many prominent corporate leaders The recent results of a study on workplace NCD
expressed their support for this venture and prevention funded by the World Health Organization
applauded the significant initiative to promote and the Ministry of Health and Family Welfare of the
smoke-free environments in the country. Government of India, and carried out by several
Indian academic organizations including the Centre
The event was followed by a press conference with for Chronic Disease Control (CCDC) and PHFI, were
Ramadoss and other participants at the symposium. published in the Journal of the American College of
There were 29 corporations represented at the Cardiology44. The study highlights the results of a
symposium, and 33 have signed the Statement of four-year comprehensive, multi-component
Commitment (SoC) entitled “The smoke-free workplace intervention programme carried out as a
workplaces initiative – Mumbai Declaration”. As a demonstration project in seven Indian industrial sites.
follow-up to this symposium, PHFI, HRIDAY and The intervention had significant impact, reducing the
their partners aim to increase the number of levels of several cardiovascular disease risk factors
organizations that have signed the SoC in favour of among the industrial workers, including weight, waist
a smoke-free workplace, and are following up with circumference, blood pressure, serum cholesterol
the companies invited to the symposium to ensure and plasma glucose.
that all signed SoCs are received before 2 October
2009, by which date a report will be released with The significance of these findings for a country with
the final list of signatories and their profiles. high rates of CVDs was highlighted in the editorial of
a leading national newspaper The Hindu, advocating
As an outcome of the above events, PHFI aims to for the government to scale up such workplace
partner with other organizations and agencies to intervention programmes at the national level. This
develop a comprehensive programme on NCD underlines the significance of high quality research in
prevention in workplaces, focusing on reducing the validating the crucial role that workplace wellness
three major behavioural risk factors of NCDs – can play in combating India’s impending NCD
tobacco use, physical inactivity and poor nutrition epidemic, and demonstrates that there is growing
among employees. To plan this comprehensive recognition in the country of the workplace as a
programme, PHFI, in collaboration with its partners, powerful platform for initiating the agenda of a
is working towards formulating a work plan to healthy India.
introduce workplace wellness in as many businesses
as possible. As a direct follow-up of the symposium,
the focus in 2009 will be on implementing smoke-
free workplaces, with a focus in 2010 on diet and
nutrition, and on introducing the importance of
physical activity at workplaces in 2011. The aim is to
provide tailored programmes that fit the specific
needs of different organizations.

In the long term, PHFI, in conjunction with other


organizations, aims to conduct high-impact, India-
relevant health, social, legal and, above all,

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Annex 1

13.30 - 14.00
Agenda of the Joint Meeting of the
Taj Mahal Hotel - Aftab Mahtab
World Economic Forum and World
Workshop
Health Organization Country Office for
Employee Health as a Strategic Priority
India
Opening remarks from the hosts of the event, the
Employee Health as a Strategic Priority 2008
World Economic Forum and World Health
Organization
New Delhi, India 14-15 November 2008

Co-Chairs
Programme
S. Habayeb, Representative, World Health
Organization (WHO), New Delhi
Friday 14 November
Sarita Nayyar, Senior Director, Head of Consumer
Industries, World Economic Forum
12.00 - 13.30
Taj Mahal Hotel - Pool Lawn
Moderated by
Opening Lunch and Welcome
K. Srinath Reddy, President, Public Health
The World Health Organization and the World
Foundation of India (PHFI), India
Economic Forum will jointly hold this meeting which
will bring together leaders from business,
government, select NGOs, IOs and academics to
14.00 - 16.00
understand how to create and stimulate effective
Taj Mahal Hotel - Aftab Mahtab
workplace wellness programmes with the goal of
Workshop
preventing chronic disease globally. Key
Success Stories in Workplace Health
recommendations from this meeting will be used by
Promotion in India
the World Health Organization, in India, to further
Through an interactive marketplace process which
develop its strategies in this area.
rotates participants between brief presentations on
existing knowledge, this session will bring all
The following key issues will be addressed:
participants up to speed on the state of workplace
• What are the economic benefits and cost-
health promotion in India. Participants will identify
effectiveness of chronic disease prevention
highlights and barriers they see in each case study
programmes in the workplace?
presented.
• How can chronic disease prevention programmes
in the workplace be best monitored and
Discussion Leaders
evaluated?
Rakesh Gupta, Consultant, Cancer Control
• What are the roles of different stakeholders, in
Strategies-Workplace, American Cancer Society
India, in developing and implementing these
(ACS), India
policies and programmes?
Paul Litchfield, Chief Medical Officer and Head,
• How can these strategies be sustained?
Health and Safety, BT, United Kingdom
Shrinivas M. Shanbhag, Medical Adviser, Reliance
Industries, India
Harpal Singh, Non-Executive Chairman, Ranbaxy
Laboratories, India

Moderated by
K. Srinath Reddy, President, Public Health
Foundation of India (PHFI), India

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16.00 - 16.30 Saturday 15 November


Taj Mahal Hotel - Pool Lawn
Networking Break 08.30 - 09.30
Taj Mahal Hotel - Pool Lawn
16.30 - 18.30 Continental Breakfast
Taj Mahal Hotel - Aftab Mahtab A buffet breakfast will be available for participants on
Interactive Session the lawn
Opportunities and Barriers
Discussion leaders will present the top highlights
and barriers back to the full group for agreement 09.30 - 12.30
through voting and discussion on the critical areas Taj Mahal Hotel - Aftab Mahtab Workshop
for focus in the second day of the workshop. A Deep Dive on the Question Areas
working draft of the group’s top recommendations Through an interactive group process, testing and
will be created. firming up ideas and recommendations, participants
will focus on key problem areas of evaluation,
Moderated by sustainability and resource mobilization as well as
K. Srinath Reddy, President, Public Health additional questions identified on the first day. Each
Foundation of India (PHFI), India group will prepare a presentation back to the full
group which will cover:
• Breakthrough idea
18.30 - 22.00 • Objectives and timeframes
Taj Mahal Hotel - Pool Lawn • Stakeholders
Reception and Dinner • Critical success factors
Join participants for an informal networking
reception and dinner Discussion Leaders
Shifalika Goenka, Senior Research Fellow, Center
for Chronic Disease Control, India
Mallika Janakiraman, Vice-President, Health and
Wellness, PepsiCo India Holdings, India
Anand Krishnan, Associate Professor, All India
Institute of Medical Sciences, India
Thirumalai Rajgopal, Vice-President, Medical and
Occupational Health, Unilever Asia, AMET
Scott Ratzan, Vice-President, Global Health and
Government Affairs & Policy, Johnson & Johnson,
USA
Shrinivas M. Shanbhag, Medical Adviser, Reliance
Industries, India
Paul Litchfield, Chief Medical Officer and Head,
Health and Safety, BT, United Kingdom

Moderated by
K. Srinath Reddy, President, Public Health
Foundation of India (PHFI), India

12.30 - 13.30
Taj Mahal Hotel - Pool Lawn
Networking Lunch

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 31

13.30 - 15.30
Taj Mahal Hotel - Aftab Mahtab
Workshop
Recommendations for Implementation
Discussion leaders of each group will report back.
The full group will build on these ideas then agree on
the final list of recommendations to present to
external stakeholders and state next steps for
participants themselves, individually and as a group.

Moderated by
K. Srinath Reddy, President, Public Health
Foundation of India (PHFI), India

15.30 - 16.00
Taj Mahal Hotel - Pool Lawn
Coffee Break

16.00 - 17.00
Taj Mahal Hotel - Aftab Mahtab
Workshop
Next Steps, Actions and Closing Remarks
A final group discussion around how the
recommendations can be translated into practical
actions. The Moderator and representatives of the
hosting organizations will then sum up what has
been learned, what recommendations can be
shared and what commitments have been made
during the workshop.

Closing Remarks by
Olivier Raynaud, Senior Director, Health Initiatives
and Healthcare, World Economic Forum
Paramita Sudharto, Public Health Administrator,
World Health Organization (WHO), New Delhi

Moderated by
K. Srinath Reddy, President, Public Health
Foundation of India (PHFI), India

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 32

Annex 2: List of Participants

Employee Health as a Strategic Priority 2008


New Delhi, India 14-15 November

Meenu Anand, Director, Operations and Strategic Initiatives, Kalendu Patel, Executive Vice-President, Emerging
American Cancer Society (ACS), USA Business, Best Buy Co. Inc., USA
Shekhar Banerjee, Vice-President, Corporate Affairs, Sunita Prasad, Consultant, MDR-TB, Eli Lilly and Co. India
Monsanto Company, India Pvt. Ltd, India
Vineet Bhatia, Technical Consultant, India Resource Centre Anil Purohit, Country Director, University of Washington,
(IRC), India India
Piroska Bisits Bullen, Manager, Medical Projects, Doug Quarry, Medical Director, International SOS
International SOS, United Kingdom (Australasia) Pty Ltd, Australia
Vanessa Candeias, Technical Officer, Global Strategy on Kumar Rajan, Cluster Assistant, World Health Organization
Diet, Physical Activity and Health, World Health Organization (WHO), India
(WHO), Switzerland Thirumalai Rajgopal, Vice-President, Medical and
Siraj Chaudhry, Country Director, Cargill India Private Ltd, Occupational Health, Hindustan Unilever Ltd, India
India Johanna Ralston, Vice-President, Global Strategies and
Tilak S. Chauhan, Asia Representative, TB Alert India, India Managing Director of International Affairs, American Cancer
Viraj Chouhan, General Manager, Public Affairs and Society (ACS), USA
Communications, Coca-Cola India, India Scott Ratzan, Vice-President, Global Health and
Ingrid Christensen, Senior Specialist on Occupational Government Affairs & Policy, Johnson & Johnson, USA
Safety and Health, International Labour Organization (ILO), K. Srinath Reddy, President, The Public Health Foundation
India of India (PHFI), India
Nivedita Dasgupta, Project Director, Modicare Foundation, Shrinivas M. Shanbhag, Medical Adviser, Reliance
India Industries Limited, India
Raymond M. DeMarco, Senior Director, Corporate Strategy Harpal Singh, Non-Executive Chairman, Ranbaxy
and Operations, Monsanto Company, USA Laboratories Limited, India
Alistair Dornan, Head, Health and Productivity V. K. Srivastava, Professor, Department of Social and
Management, Right Management (a Manpower company), Preventive Medicine, Chhatrapati Shahuji Maharaj Medical
United Kingdom University, India
Rakesh Dullu, Manager, Hero Honda Motors Ltd, India Paramita Sudharto, Public Health Administrator, World
Ashok Ghose, Chief of Environment, Health & Safety, Health Organization (WHO), India
Jubilant Organosys Ltd, India Puja Thakker, Research Associate, Health Systems, The
Shifalika Goenka, Senior Research Fellow, Center for Public Health Foundation of India (PHFI), India
Chronic Disease Control, India Nathu M. Thakre, Assistant General Manager, Indorama
Chris Gray, Director, International Policy, Pfizer Inc., USA Synthetics, India
Rakesh Gupta, Consultant, Cancer Control Strategies- J. S. Thakur, Assistant Professor, Department of Community
Workplace, American Cancer Society (ACS), India Medicine, Postgraduate Institute of Medical Education and
S. Habayeb, Representative, World Health Organization Research, India
(WHO), India Annapurna Vancheswaran, Associate Director, Sustainable
Jagdish Harsh, Co-Founder and Director, HIV ATLAS, India Development Outreach, The Energy and Resources Institute
Mallika Janakiraman, Vice-President, Health and Wellness, (TERI), India
PepsiCo India Holdings Pvt. Ltd, India Steven J. Veldhoen, Managing Director, Asia, Booz &
Sitanshu Kar, Cluster Assistant, World Health Organization Company (Japan) Inc., Japan
(WHO), India Kavita Venkataraman, National Consultant, World Health
Sai Krishna, Head, HIV/AIDS, Satyam Foundation, India Organization (WHO), India
Anand Krishnan, Associate Professor, All India Institute of Geetu Verma, Executive Director-Strategic Initiatives,
Medical Sciences, India PepsiCo India Holdings Pvt. Ltd, India
Nalini Krishnan, Director, The Hindu, India Janet Voûte, Partnerships Adviser, Noncommunicable
A. Laxmaiah, Scientist “E” - Epidemiology, National Institute Diseases and Mental Health, World Health Organization
of Nutrition, India (WHO), Switzerland
Paul Litchfield, Chief Medical Officer and Head, Health and Nevin Wilson, Director, India Resource Centre (IRC), India
Safety, BT Plc, United Kingdom Naveen Yelloji Chief Executive Officer, Satyam Foundation,
Sophia Lonappan, Research Associate, Institute India
Sustainable Development Outreach, The Energy and
Resources Institute (TERI), India From the World Economic Forum
Rekha M. Menon, Executive Vice-President, Accenture
Services Pvt. Ltd, India Eva Jané-Llopis, Project Manager, Working Towards
Debasish Mishra, Executive Director and Partner, Wellness, World Economic Forum,
PricewaterhouseCoopers Pvt. Ltd, India Helena Leurent, Director, Agriculture, Food & Beverage
Davison Munodawafa, Regional Adviser, Health Promotion Community, World Economic Forum,
and Education, World Health Organization (WHO), India Olivier Raynaud, Senior Director, Health, World Economic
P. K. Nag, Director, National Institute of Occupational Health, Forum,
India
Rama Naidu, Chief Executive Officer, Chronic Care From the World Economic Forum USA
Foundation, India
Harish Narula, President, Lupin Ltd, India Sarita Nayyar, Senior Director, Consumer Industries, World
Sudhir Nayar, General Manager, Corporate Affairs, Economic Forum USA
Hindustan Unilever Ltd, India

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Employee Wellness-India:Layout 1 09.09.09 17:24 Page 34

The World Economic Forum is an independent


international organization committed to improving
the state of the world by engaging leaders in
partnerships to shape global, regional and
industry agendas.

Incorporated as a foundation in 1971, and based


in Geneva, Switzerland, the World Economic
Forum is impartial and not-for-profit; it is tied to
no political, partisan or national interests.
(www.weforum.org)

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