A duty of care beyond statistics and numbers is often the subject of focus when discussing workforce health. The last few years have witnessed increased attention and energy, by organisations and their leaders, on improving workforce health. The need for greater retention, improved productivity and medical cost inflation continue to put pressure on companies and make wellness a key agenda item for Human Resources (HR) teams and boardroom discussions. Early and regular workforce health assessments are a useful first step in structuring effective health and wellness programmes. Often, concerns around privacy prevent organisations from collecting critical health data and employees from being forthcoming in providing information. A worrying trend is that the individuals themselves are often not aware of their own health risks—a crucial starting point. The solution is to provide employees with control over their own data with the help of a simple, easy-to-understand and quick method of submitting important data that, when analysed, can help them improve their own health and wellness while giving their organisation vital information on maintaining a healthy workforce.

Between 2019 and 2020, several organisations within the Kingdom of Saudi Arabia adopted Milliman RapidHRA, a clinically valid and evidence-based tool designed to help their health and wellness programmes become more effective. While individual and company-specific data is secure and confidential, we used the aggregate summary of risk profiles of over 8,000 employees, who participated in the various wellness campaigns over this period, to develop health and wellness risk benchmarks. This provides a useful snapshot into workforce health across these organisations and allows for an insightful analysis of several important physical and mental wellness indicators that can serve as points of focus for any organisation looking to improve its own workforce wellness management strategy. As with all such snapshots, the data and analysis is provided to increase general awareness and should be used carefully, primarily as a starting point for a deeper analysis on potential healthcare issues risks.

RapidHRA data allows us to map the workforce across 15 parameters, grouped into six main categories:

1. Health status (biometrics, body mass index [BMI], preventive health checks)
2. Risk and control of chronic diseases (diabetes, hypertension, cardiac diseases, arthritis, chronic pain)
3. Lifestyle: Habits and behaviours that are health risk indicators (diet, activity, smoking)
4. Mental wellness (sleep, stress management, work-life balance, work satisfaction)
5. Safety at work
6. Readiness to change (intent and willingness of individuals to modify behaviour)

In this article we’ll examine the responses, highlight the key areas of concern and present an overall perspective on the health of the workforce in the Kingdom. This can also provide other companies within the Kingdom with reference benchmarks to compare against their own workforce data.

Health Status

Figure 1: Body Mass Index

With 65% of the workforce on the upper end of the BMI scale and recorded as overweight, obese or morbid obese, this registers as an area of focus. BMI is an appropriate measure for screening for obesity and its health risks. With BMI a reliable predictive indicator of health and wellness,¹ this means that a very high proportion of employees are at significant risk of poor health outcomes. In fact, across all parameters, this was the leading category, with the highest proportion of employees at risk. And with 21% of the overall workforce being in the top two high-risk categories (obese/morbid), it is certainly an area to which employers and the affected employees themselves should pay close attention and keep on their radar. A deeper dive into the variations across different age groups reveals that the proportion of employees who are either overweight or obese tends to increase with age across both genders. This is in line with the reported obesity rates from a recent survey in the Kingdom, at 38% overweight and 20% obese.² Health and wellness teams can use the individual and aggregate data (company-level or department-level) to plan interventions or programmes designed to focus on reducing obesity levels. By measuring this against other parameters, such as diet and activity, appropriate support for employees at both an individual and a workforce level can be planned.

More than 97% of participants disclosed that they were not up to date with recommended or requisite preventive checkups. Because these checkups are helpful in identifying medical conditions at an early stage,³ a shift in focus on wellness rather than just disease management requires that employees be encouraged to undergo these checkups regularly. Depending on the size of the company and an understanding of the options available, these areas of focus could range from increasing awareness to inclusion of preventive checks in employee wellness programmes. In organisations with more structured programmes they could be subsidised, incentivised or included as part of wellness rewards programmes.

Risk and control of chronic diseases

Figure 2: Risk of developing a chronic disease

Of the major chronic disease risk factors, hypertension presents the highest potential future risk for participants in the survey. More than three in four employees (78%) have a significant risk of developing hypertension in the future based on the prediction equation in the RapidHRA tool that is adapted from the Framingham study.⁴ While genetics and age profiles can be contributing factors, unhealthy lifestyle choices play a major role.⁵ Increasing levels of physical activity, curbing smoking and improving BMI levels can greatly alleviate the risk.

Figure 3: Disease control and management

Nearly half of the workers surveyed reported that they were afflicted with some kind of chronic medical condition. Chronic pain, hypertension and diabetes were the most common health conditions disclosed. This is consistent with the known trend of increased ergonomic and posture-related problems of the young corporate workforce and the rise in metabolic disease conditions in Asia and Middle East. With a majority of participants reporting only moderate control of chronic pain and hypertension, there is plenty of scope for improvement in this area. Team leaders and HR teams could provide support to ensure that the working environment offers opportunities for employees to better manage their conditions.

Some of these strategies could be as straightforward as better ergonomics with chairs, desks and IT equipment, regular cleaning of ventilation, healthier snacks available around the office and structured physical activity programmes (running, yoga etc.) either at an office level or via membership programmes with fitness providers.

Lifestyle: Habits and behaviours

Figure 4: Physical activity and diet

As many as 72% of participants are in a high or moderate risk category according to their physical activity levels. This is consistent with low activity levels reported in other surveys in the Kingdom. For example, in a 2019 household survey, 80% of respondents reported insufficient physical activity. Company-sponsored runs, walkathon challenges, step challenges, group competitions, gym memberships and intercorporate sports teams are a few of the initiatives companies promote to encourage greater levels of physical activity.

Over 95% of participants need to improve nutritional balance. This is consistent with a survey of large households in the Kingdom where fruit and vegetable intake amongst 93% of respondents was reported as insufficient.⁶

Mental wellness (sleep, stress management, work-life balance, work satisfaction)

Emotional health and stress management have come to the forefront recently in the current pandemic-driven external environment. Change and uncertainty increase stress levels. The data around emotional health suggests that, overall, 11% of employees were evaluated to have high risk and another 16% are at moderate risk of emotional stress. These high-risk employees reported frequently becoming overwhelmed with pressure or stress from responsibilities, situations or relationships and/or lack of social support or concerns with work and financial security. At an organisational level, clustering these employees by department or team can sometimes isolate patterns. At an individual level, offering options that are discreet and nonintrusive can range from simply creating awareness to increased work flexibility, activities helping relieve stress and access to counselling.

Figure 5: Mental wellness

Both workplace satisfaction and work-life balance (an area of increasing global concern) appear to be well managed, with employees overwhelmingly positive about these two areas.

Less than a third of participants appear to be getting sufficient sleep according to clinically valid standards, which could affect attentiveness and productivity, increase the risk of developing chronic conditions and reduce immunity levels. This relates closely to a general survey finding in the Kingdom where 81% of rural and non-Saudi respondents reported no difficulty with "sleeping" compared to 76% of the urban and Saudi respondents.⁷

Safety at work

Risk of occupational hazards and injuries are shifting patterns in the industry, especially with the workforce involved in desk-based jobs. Risks are shifting to repetitive strain and postural problems for many computer users. While 15% of participants reported chronic pain as a recurring problem, 69% reported following appropriate safety habits. A quarter of survey participants indicated moderate risk and may need support for better safety awareness and ergonomic advice.  

Figure 6: Workplace risks

Employee’s perspective: Readiness to change

A very important feature of Milliman’s RapidHRA tool is its ability to test the awareness of people about their risks and their willingness to change. This provides an employee’s perspective on their readiness to take action to improve one or more factors inhibiting a healthier life.

Figure 7: Readiness to change

Exactly half (50%) of all participants indicated that they would be willing to take action to improve their health and wellness scores. It’s encouraging to see that 77% of them (representing 39% of all participants) are keen on increasing their levels of physical activity, especially because less than 28% of overall participants are maintaining good levels of physical activity. However, there is clearly room to encourage more to be active, given the survey results.

Although a majority (64%) of the workforce is overweight (with 21% at high risk as obese or morbidly obese), only 7% have indicated a willingness to manage weight. Perhaps there needs to be an increase in awareness levels about the link between obesity and future health risks. Of greater concern is that only 1% want to take better control of their health conditions even though as much as half of the workforce has disclosed a medical condition and 8% have a chronic disease with poor control over it.

Conclusion

While there are several positive areas regarding the health of the workforce surveyed, there are a few red flags in terms of chronic medical conditions and risk factors, as well as behaviours that need immediate attention to reduce future health risks.

Several of these risks can be linked to lifestyle or behaviour. Providing education and opportunities to correct these behaviours offers immediate remedial solutions to some of the workforce. There is a need for an increase in awareness levels of the causes, risks and impact of a lack of physical activity, unhealthy diets and consequences of ignoring regular preventive medical checkups. Several initiatives and interventions can be organised that will help improve wellness and alleviate future health risks. These initiatives at a company and team level will vary depending on data and insights from the assessment (including historical data where available), organisation demographics, nature of work, budgets and availability of related vendors or partners. Apart from helping to create a healthier and potentially more productive workforce, such programmes can also help improve employee engagement and manage healthcare costs.

The RapidHRA tool encourages an annual assessment and provides comparative data across the years. Next year we will be in a position to track progress made by individuals, companies and the workforce across 2020 and 2021 across all the different dimensions, providing a snapshot on trends.

How Milliman can help

As advisors to over 80% of the world’s insurers, Milliman is well known to and has been trusted by insurers and healthcare provides across the globe for decades. Milliman consultants in the health space include not just actuaries and business consultants but also clinicians, who together with a well-managed data framework provide a complete spectrum for the healthcare industry. Milliman now offers that same expertise to corporates looking at improving their workforce health and wellness by helping them with their first step, a clinically valid employee health risk assessment. To know more about RapidHRA and how it can help you, click here.

¹https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf

²https://www.moh.gov.sa/en/Ministry/Statistics/Population-Health-Indicators/Documents/World-Health-Survey-Saudi-Arabia.pdf

³https://www.ajmc.com/view/population-health-screenings-for-the-prevention-of-chronic-disease-progression

⁴https://framinghamheartstudy.org/fhs-risk-functions

⁵https://apps.who.int/iris/bitstream/handle/10665/260422/WHO-NMH-NVI-18.1-eng.pdf;sequence=1

⁶https://www.moh.gov.sa/en/Ministry/Statistics/Population-Health-Indicators/Documents/World-Health-Survey-Saudi-Arabia.pdf

⁷https://www.moh.gov.sa/en/Ministry/Statistics/Population-Health-Indicators/Documents/World-Health-Survey-Saudi-Arabia.pdf