Introduction
Many of the leading causes of death and disability in the United States are largely preventable through early detection, intervention, and changes in behavior. Agencies can help employees understand their risks for disease, obtain preventive health services, and make healthy lifestyle choices by offering programs at the workplace. Agencies can also review their policies and make maximum use of existing work schedule and leave flexibilities to allow Federal employees to take advantage of screening programs and other effective preventive measures.
Because most working Americans spend at least 30 percent of their time at work, the workplace is a logical place for employees to receive preventive health services. People meeting the challenges of work, family, and community responsibilities have limited time and attention to devote to preventive health activities. It is essential that employees have convenient healthcare opportunities and the information they need to spend their time wisely. Providing such services at the Federal worksite can be an effective way of meeting that need, and many of these services can be accessed without charge to leave.
This pamphlet answers many of the administrative questions agencies might have in implementing preventive health programs and provides relevant examples and resources.
What Are Preventive Health Services?
Preventive health services are offered to otherwise healthy individuals to help prevent disease, identify the risks for disease, or detect disease in its early, most treatable stages. Services include immunizations, screenings, exams and health behavior counseling and interventions. Blood pressure screening, cholesterol screening, pap smears, and mammography are some examples of effective screening measures. Health history questionnaires, health risk appraisals, and cardiac risk profiles are other kinds of screening tools used to identify a person’s risk for disease.
Health behavior counseling and intervention activities such as smoking cessation programs are a necessary component of preventive health services. According to the Guide to Clinical Preventive Services prepared by the U. S. Preventive Services Task Force, screening tests are an important preventive service, but must be accompanied by efforts to change personal health behaviors before disease develops. Growing literature links some of the leading causes of death in the U. S. to a handful of personal health behaviors, such as smoking, failing to use seat belts, driving while intoxicated, physical inactivity, dietary factors, and high risk sexual practices.
How Can Federal Employees Access Preventive Health Services?
Federal employees have access to preventive health services through the Federal Government’s health benefits program and through employee health programs provided onsite by their agencies.
Federal Employee Health Benefits Program (FEHB):
The FEHB is the largest employee sponsored health insurance program, serving more than 9 million Federal employees, retirees, and families. The health benefits available to all Federal employees who choose to participate in the program cover a broad range of preventive health services, including screening for prostate, cervical, colo rectal, and breast cancer and screening for sickle cell, blood lead level, and blood cholesterol level, as well as all recommended childhood immunizations, well child care, and adult preventive care visits.
Employee Health Programs:
Since 1946, agencies have been authorized to establish, within the limits of appropriations available, employee health programs to promote and maintain the physical and mental fitness of employees. Employee health programs are most commonly provided to employees through health units located at the workplace and include preventive services such as immunizations, physical examinations, and medical screening tests. Over the past few decades, many agencies have expanded the traditional scope of services and established more comprehensive programs with more emphasis on health education and intervention activities.
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The National Cancer Institute defines cancer screening as testing of people without prior suspicion of cancer to detect cancer in its early and most curable stages. Not all screening tests are helpful for all people. Doctors make recommendations for cancer screening based on patterns of cancer in the population, environmental and behavioral factors, and evidence that specific screening tests can reduce mortality and morbidity from cancer. Mammography, pap smear, and the fecal occult blood test are some examples of effective cancer screenings. www.nci.nih.gov
Employee Health Services that agencies may offer under 5 U. S. C. § 7901 include:
- Emergency Response/First Aid
- Administration of Treatments and Medications
- Physical Examinations
- Environmental Health Hazards Appraisals
- Health Education
- Health Services/Intervention Programs
- Disease Screening and Immunizations
- Physical Fitness Programs and Facilities
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How Are Employee Health Programs Administered?
Today, employee health programs can be delivered in a variety of settings and can be administered in a variety of ways. The scope of employee health programs may be broad or single-focused. Employee health programs can be either: (1) fully funded by the agency; (2) funded by a combination of employees’ fees and agency funding; or (3) fully funded by employee contributions or fees. Agencies are responsible for determining the best way to provide employee health programs based on the agency mission, employee health needs, program goals and objectives, and available resources. Typically, agencies use one or a combination of the following options:
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Agencies Can Conveniently Provide Preventive Services through Health Units.
A health unit or occupational health center can be a convenient and logical source for providing preventive health services to employees. The facilities are private, equipped for a variety of services, and professionally staffed. An occupational health registered nurse is the most common staff, however, occupational health physicians, physicians’ assistants, nurse practitioners, licensed practical nurses, and trained technicians may all be appropriate personnel depending on the size, scope, and complexity of the services required.
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Health Unit: More than 45 years ago the Census Bureau set up a small Health Unit centrally located in its main building to provide basic services to headquarters employees. The Health Unit’s functions have evolved from routine services to a broad-scope health program, providing comprehensive health screenings, health promotion activities, health education, and employee assistance services for employees. The Health Unit offers monthly health education programs and seminars on topics ranging from healthy backs, arthritis, and breast cancer to coping with holiday blues, healthy eating, and care giver issues. The annual health fair is extremely popular, with many employees taking advantage of screenings, risk profiles, and lectures. Mini health fairs are conducted for employees off- site. As a result of employee interest expressed at the fairs, the Health Unit developed more extensive seminars on topics such as stress management and financial management. The Health Unit provides blood pressure readings, conducts routine body fat analysis for employees, maintains a video library, provides a private room where new mothers may express milk for their babies, and publishes a bimonthly newsletter called the "Census Health Beat." |
- Agencies Can Provide Preventive Health Services Through Onsite Fitness Centers.
Many agencies provide more than just exercise activities at their fitness centers. These facilities can be used to provide comprehensive health education and intervention activities, as well as health screenings. Many fitness centers require some type of screening to identify health risks before membership is granted. On- site facilities can be sponsored by the agency, a consortia, and employee organizations.
- An Agency Can Create a Program Exclusively for their Employees or Share Services with Other Agencies.>
Some agencies find it more cost effective to share employee health services with other agencies. For example, in a building or location with multiple agencies, one program can be developed to provide health services to participating agency employees. This can be done through interagency agreements or consortia.
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FEDERAL OCCUPATIONAL HEALTH, U.S. PUBLIC HEALTH SERVICE, operates occupational health clinics across the country. Its mission is to provide comprehensive, cost-effective occupational health services that improve the health, safety, and productivity of the Federal workforce. www.foh.dhhs.gov 800/457-9808
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- Agencies Can Hire Employees or Use Existing Agency Personnel. Health promotion staff may be employed either full-time, part-time, or assigned the duties on a collateral basis. Many agencies organize all of their employee health staff and programs into one division for more efficient coordination. Sometimes agencies form employee health committees with representatives from various offices to integrate services and coordinate and promote programs.
- Agencies Can Contract with Vendors. Contractors can be sponsored by an agency, consortia, and employee organizations. Sources of vendors might include commercial health clubs, community centers, local hospitals, nonprofit organizations, private consultants, or universities. An agency might choose to use one contractor to provide all of its employee health program services. Sometimes it is only necessary to contract for a specific service such as administration of a health risk appraisal program or development of an annual health fair.
- Agencies Can Provide Health Activities Through Volunteer or No-cost Arrangements. Many local non-profit health organizations provide free speakers and materials such as pamphlets, videos, and posters, especially if they tie in with a national health campaign such as the Great American Smokeout. Many agencies with offices across the country rely on employees who volunteer to coordinate and communicate health promotion activities at their office locations. Volunteers should have the skill, qualifications, and knowledge to deliver health activities.
- Employee Organizations Can Sponsor Health Activities. Employees can form a non-profit employee organization to provide health activities. Many Federal fitness centers are operated this way. The employee organization enters into an agreement with the agency which provides support such as space and equipment. An employee organization can collect fees directly from employees to cover the costs of services.
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PUT PREVENTION INTO PRACTICE is a Federally sponsored initiative to improve delivery of preventive care. Materials are available, with information for patients as well as clinicians, about recommended preventive services. Contact the Agency for Healthcare Research and Quality at www.ahrq.gov/clinic/ppipix.htm or 1-800-358-9295.
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What Services Do Other Agencies Offer?
Agencies are currently offering a wide variety of preventive health services. Agencies choose the services that best meet their needs, and the level of services varies from agency to agency. Below are some examples.
- Health Fairs
- Mobile Health Vans
- Health Talks
- Cafeteria Tours
- "Lunch and Learn" Sessions
- Health Newsletters
- Online Health Programs
- Health Program Web Page
- Video Lending Libraries
- Emails on Health Services
- Self-Care Materials
- Health Education Brochures
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- Medical Health Exams
- Blood Pressure Readings
- Cholesterol Screenings
- Health Risk Appraisals
- Blood Screenings
- Body Fat Analysis
- Cancer Screenings
- Fitness Assessments
- Exercise Prescriptions
- Individual Counseling
- Self-Help Support Groups
- Awareness Classes
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- Smoking Cessation
- Weight Control
- Healthy Food Selection
- Stress Management
- AIDS Awareness
- CPR Instruction
- Healthy Back
- Cancer Prevention
- Women’s Health
- Ergonomics
- Fitness Classes
- Walking Clubs
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THE WELLNESS COUNCILS OF AMERICA, a non-profit organization dedicated to worksite health promotion, publishes the HEALTHY WORKPLACE: HEALTH FAIRS FOR YOUR WELFARE can be contacted at http://www.welcoa.org or 402-827-3590
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What Preventive Health Strategies Can Agencies Develop for Their Employees?
1. Educate Employees: Agencies can provide information to help employees understand their risks for disease and the tools for making healthy lifestyle choices. Also, by providing information on the value of preventive health screenings, employees can make informed choices for better management of their health. Agencies should encourage employees to review their individual health insurance plans to identify the types of preventive health services that are covered. Agencies can also:
- Distribute health education brochures and pamphlets on a variety of preventive health topics.
- Distribute an employee health newsletter with a regular feature about preventive health services.
- Create a web page with links to other important screening information.
- Offer "lunch and learn" sessions on preventive health issues.
- Conduct health risk appraisals or other types of risk questionnaires.
- Make videos and reading materials available through a lending library.
2. Offer Preventive Health Screenings at the Worksite: Agencies can make it convenient for employees to receive health screenings by offering them on-site. Some popular screenings that are easy to administer are body fat, cholesterol and blood pressure measurements, health risk appraisals, and cardiac risk profiles.
- Bring screenings to the employee with mobile health screening vans or conduct screenings such as a blood pressure measurement at the employee’s work station.
- Establish an annual health fair and offer preventive screenings and health information on a variety of topics. Use this checklist to make health fair planning as easy as possible. Check with other agencies to gather health fair ideas.
- Obtain agency permission before proceeding with any plans.
- Determine if and when employees can be excused from work to attend.
- Consult with and involve local union representatives.
- Organize and plan the fair at least eight weeks prior to the actual date.
- Stay organized.
- Identify goals and audience.
- Develop a theme to attract participants.
- Make sure fair theme is not too broad.
- Consider audience’s needs.
- Select a fair date and time.
- Select a day in the middle of the week.
- Avoid scheduling around a major holiday.
- Check that no other agency events are scheduled that day.
- Get approval of the schedule and secure building space from building services.
- Ensure that space is accessible to employees with special needs.
- Send a letter to building services about the event.
- Inform building services of any changes in the schedule.
- Make security arrangements.
- Notify building security of all fair plans.
- Hold meetings with building security to discuss their concerns.
- Discuss movement of vendors in and out of the building.
- Notify building security of planning changes.
- Develop a list of health fair activities.
- Offer non-traditional activities such as seated massage to draw a wider audience.
- Prepare a list of organizations to invite to the fair.
- Include national and local groups.
- Consider available space for table set up.
- Contact vendors.
- Invite organizations by phone.
- Mail a formal written invitation to all parties.
- Ask organizations that cannot attend to send materials.
- Use a tracking form to record important information about the vendors.
- Construct a floor plan, assigning each organization and activity to a particular table.
HEALTH FAIR: The Government Printing Office sponsors an annual Health Fair for its employees, offering a safe, non-threatening environment to learn about health, fitness, safety, and employee assistance issues. The primary goal of the annual Health Fair is to provide specific, individualized medical information to help employees improve their own health status. Over 2,000 employees attend the event to receive health information, medical screenings, health risk appraisals, and a variety of physical assessments. Employees can take advantage of video presentations, interactive sessions, small group discussions, and aerobics demonstrations. GPO’s in-house staff, vendors, and nonprofit organizations provide many of the services. The Occupational Health and Environmental Service Committee plans and executes the fair. The Committee develops an annual theme to capture the attention and interest of employees. One year the theme was, "Your Health: You Can’t Live Without It." The Health Fair is widely advertised through written notices, articles, an Intranet web site, bulletin boards, posters, and video testimonials. Health Talks are given the week prior to the annual Health Fair. Utilizing the information collected at the Health Fair and the results of the health risk appraisals, an integrated set of health and wellness programs are provided to GPO employees throughout the year.
3. Provide Follow-up Feedback: Agencies can offer appropriate follow-up to screenings by giving employees the results of their tests with healthy behavior tips. Encourage employees to share results of screenings with their health providers. Health services provided at the worksite should not be a substitute for the regular source of care employees have through their healthcare provider.
- Conduct health risk appraisals that include an individual evaluation of the results.
- Make arrangements for a professional to share the results of the screening tests and offer healthy solutions.
- Provide one-to-one counseling or group education opportunities.
4. Offer Intervention Programs: Agencies should look at ways to encourage positive behavior change. Agencies can offer intervention activities such as smoking cessation classes or nutrition counseling. It is also important to evaluate whether workplace policies, practices, and physical environment support these measures. A supportive environment is critical to helping people maintain newly acquired healthy behaviors.
- Provide a variety of opportunities for employees to learn about, or to make, healthy behavior changes through classes, videos and self-help materials.
- Choose health topics that meet Healthy People 2010 goals, a broad-based initiative led by the U.S. Public Health Service to improve the health of Americans.
- Survey employees to develop programs around their interests.
- Develop policies that allow flexible work schedules to permit participation in health activities.
- Stock the cafeteria, snack bars and vending machines with healthy food choices.
- Provide a shower or locker room for those who exercise at work and a bike rack for those who ride a bike to work.
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, Office of Disease Prevention and Health Promotion publishes a Health Observances Calendar and information on Healthy People 2010 on their web site at www.odphp.osophs.dhhs.gov or www.healthfinder.gov
5. Launch a Marketing Campaign:
- Agencies should find effective ways to promote their preventive health programs.
- Begin with communicating the purpose of the program and the agency’s commitment to the program.
- Assure that personal health information will be kept confidential and make special efforts to encourage those less likely to participate.
- Make the programs accessible and enjoyable for employees.
- Keep the program visible and continue to find ways to make it better.
- Use a wellness committee to get marketing ideas and to help promote the program.
- Use technologies such as email, voice mail and Internet and Intranet web pages.
- Look at the entire year’s events in order to schedule activities at the most convenient and effective times.
- Coordinate activities with national health observances. Health observances are special months, weeks or days devoted to promoting particular health concerns, and many health organizations have free or low cost promotional materials to go along with the observance.
- Look for opportunities on the agency’s calendar to schedule activities. For example, schedule a health screening or educational session at a supervisory training session, coordinate a fun run at the annual picnic, or introduce the employee health program at new employee orientations.
What Kinds of Work and Leave Flexibilities Can Agencies Provide to Employees?
The Federal personnel system provides employees with considerable flexibility in scheduling their hours of work and taking time off for medical needs, including routine examinations and preventive screenings. Examples of the work and leave flexibilities available to employees for preventive health activities include the following:
Alternative Work Schedules. Federal agencies may establish flexible or compressed work schedules, collectively referred to as "alternative work schedules." Alternative work schedules allow for a variety of working arrangements tailored to fit the needs of individual employees.
Annual leave. Most employees accrue 13, 20, or 26 days of annual leave each year, depending on years of service (which accumulates to a maximum of 240 hours each year).
Excused Absence. Agencies may grant excused absence to employees to participate in agency sponsored preventive health activities, such as health fairs, mobile health van screenings, and smoking cessation and stress reduction classes.
Sick leave. Most employees accrue 13 days of sick leave each year without regard to length of service (which accumulates without limit in succeeding years).
Advance leave. Supervisors may advance annual and sick leave to employees who do not have available paid leave for preventive health screenings or for additional examinations and follow-up treatments.
When an employee needs additional medical attention, e. g., a serious health condition is identified by a screening process, the following additional leave programs are available:
The Family and Medical Leave Act of 1993 (FMLA). Under the FMLA, an employee is entitled to a total of 12 workweeks of unpaid leave during any 12- month period for certain needs, including an employee’s serious health condition. An employee may substitute annual leave or sick leave, as appropriate, for unpaid leave under the FMLA.
Leave Sharing. Employees who experience a personal or family medical emergency and who exhaust their available paid leave may receive donated annual leave from other Federal employees through the voluntary leave transfer or leave bank programs.
Information on leave programs is available on OPM’s web site at www.opm.gov/oca.
FEDERAL RESOURCES FOR PREVENTIVE HEALTH SERVICES
The OPM’s Office of Work/Life Programs promotes the efficiency of the Federal workforce by providing agencies with guidance, resources and technical assistance on issues related to employee health and well- being.
U.S. OFFICE OF PERSONNEL MANAGEMENT
Office of Workforce Relations
Office of Work/Life Programs
1900 E Street, NW
Washington, DC 20415-2100
202-606-5520
202-606-0967 FAX
www.opm.gov/ehs
Agency for Healthcare Research and Quality (AHRQ)
U.S. Public Health Service
2101 East Jefferson Street, Suite 501
Rockville, MD 20852
1-800-358-9295
www.ahrq.gov
(AHRQ’s broad programs of research, clinical guideline development, and technology assessment bring practical, science-based information to medical practitioners and to consumers and other health care purchasers. AHRQ hosts the U. S. Preventive Services Task Force, which published the Guide to Clinical Preventive Services, Second Edition. It also sponsors the "Put Prevention into Practice" program.) see www.ahrq.gov/clinic/ppipix.htm
Centers for Disease Control and Prevention www.cdc.gov
National Center for Chronic Disease Prevention and Health Promotion
Division of Nutrition and Physical Activity
www.cdc.gov/maso/pdf/dnpd.pdf
770-488-5820
(CDC establishes initiatives on physical activity and nutrition.)
Federal Occupational Health
Program Support Center
www.foh.dhhs.gov
800-457-9808
(FOH operates occupational health clinics across the country. Its mission is to provide comprehensive, cost effective occupational health services that improve the health, safety, and productivity of the Federal workforce.)
National Cancer Institute
Public Inquiries Office
31 Center Drive MSC2580
Building 31, Room 10A31
Bethesda, MD 20892-2580
www.nci.nih.gov
800-4-CANCER
(The National Cancer Institute provides information on cancer to patients and their families, health professionals, and the general public.)
National Heart, Lung and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824
www.nhlbi.nih.gov
301-496-4236
or e-mail at nhlbiinfo@rover.nhlbi.nih.gov
(The National Heart, Lung and Blood Institute provides resources and publications on issues related to the heart, lungs, and blood.)
Office of Disease Prevention and Health Promotion (ODPHP)
U.S. Public Health Service
Department of Health and Human Services
Room 738G
Humphrey Building
200 Independence Ave., SW,
Washington, DC 20201
www.odphp.osophs.dhhs.gov
www.healthfinder.gov
202-401-6295
(The Office of Disease Prevention and Health Promotion establishes national health goals (Healthy People 2010) and coordinates DHHS policy and program development in the area of disease prevention and health promotion activities. (ODPHP publishes the Health Observances Calendar and sponsors the Healthfinder web site.)
ODPHP Communication Support Center
301-468-5960
(For copies of ODPHP publications)
ODPHP National Health Information Center
800-336-4797
(The National Health Information Center puts people with health and medical questions together with appropriate resources.)
Questions or comments may be mailed to the Office of Work/Life Programs, U.S. Office of Personnel Management, Room 7425, Theodore Roosevelt Building, 1900 E Street, NW., Washington, DC 20415-2000. You may call us at (202) 606-5520; fax (202) 606-2091; or email ehs@opm.gov.
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NOTE: Under Federal Law, the U.S. Office of Personnel Management (OPM) is prohibited from ranking, endorsing, or promoting agencies or organizations listed on its Web site.
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