ORIGINAL ARTICLE The Healthiest Company Index A Campaign to Promote Worksite Wellness in South Africa Deepak Patel, MD, MSc, Ron Z. Goetzel, PhD, Meghan Beckowski, MPH, Karen Milner, MA, PhD, Mike Greyling, MSc, Roseanne da Silva, BScHons, FIA, Tracy Kolbe-Alexander, BSc, PhD, Maryam J. Tabrizi, MS, and Craig Nossel, MBChB, MBA Objective: To describe a 2010 initiative to encourage companies in South Africa to adopt workplace health promotion programs. Methods: Data doc- umenting organizational efforts to improve workers’ health were collected from 71 participating employers and 11,472 workers completing health as- sessments. Organizational and employee health were scored on the basis of responses to the surveys that asked about facilities and programs of- fered, leadership support for health promotion, and employees’ health status. Results: In its first year, the initiative recruited 101 organizations and 71 qualified for the award. Results aggregated across these companies focus on elements constituting organizational and individual health, with specific measures that companies can review to determine whether they and their em- ployees are “healthy.” Conclusions: The Healthiest Company Index provided useful baseline data to support employers’ efforts to develop and implement effective and impactful health promotion programs. A cross the globe, and more recently in South Africa, the work- place is being recognized as an important setting for initiating health promotion programs aimed at improving the health and well- being of employees. 1–6 There are compelling reasons for this new interest, primarily related to the increasing burden of chronic dis- eases on individuals, organizations, communities, and societies. According to the World Health Organization, in 2005 noncom- municable chronic diseases (NCCD) accounted for approximately 35 million deaths worldwide, with 80% of these deaths occurring in middle- and low-income countries. 7,8 Current projections are that chronic diseases will be responsible for 388 million deaths glob- ally in the next 10 years, and that 36 million of these deaths could potentially be prevented. 9 What makes these statistics more worrisome is that we now have the tools at our disposal to address modifiable health risk fac- tors, including smoking, physical inactivity, poor diet, high stress, and excess alcohol consumption, but we are not fully leveraging these tools. 8 One underused tool is providing evidence-based health promotion and disease prevention programs at the workplace. De- spite mounting evidence recently assembled in careful literature reviews 10,11 that workplace programs improve the health of workers and lower organizational costs, only a minority of employers offer comprehensive and multicomponent programs—the kind likely to From the Discovery Health (Dr Patel), Johannesburg, South Africa; Institute for Health and Productivity Studies (Dr Goetzel), Rollins School of Public Health, Emory University, Atlanta, Ga; Truven Health Analytics (Dr Goetzel and Mss Beckowski and Tabrizi), Washington, DC; University of Witswaterstrand (Dr Milner, Mr Greyling, and Ms da Silva), Johannesburg, South Africa; University of Cape Town (Dr Kolbe-Alexander), Cape Town, South Africa; and Discovery Health (Dr Nossel), Johannesburg, South Africa. Authors were funded by Discovery Health. Address correspondence to: Ron Z. Goetzel, PhD, Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University, and Consulting and Applied Research, Truven Health Analytics, 4301 Connecticut Avenue, NW, Suite 330, Washington, DC 20008; E-mail: ron.goetzel@truvenhealth.com. Copyright C  2013 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e3182728d61 achieve population health improvements and cost savings. 12 Further- more, recent evidence suggests that worksite health promotion pro- grams can achieve a positive return-on-investment of approximately $3.00 saved to $1.00 invested for both medical- and absenteeism- related costs. 10 Other benefits include improved worker morale and positive company branding. Although there is substantial research being performed on this topic in the United States, 12–14 very little information is cur- rently available on the prevalence of health promotion initiatives at workplaces in other countries and on the state of health and well- being of international workers. Against this background, Discovery Health, a South African private health insurer, initiated a joint project with researchers from the Departments of Psychology and Statistics and Actuarial Science at the University of the Witwatersrand in Johannesburg, the Human Biology Department at the University of Cape Town, and the Institute for Health and Productivity Studies at Emory University to identify and study the “healthiest” companies in South Africa, on the basis of a set of metrics that evaluated individual employee and overall company “wellness.” This article describes the initial launch of the Healthiest Company Index initiative, which garnered participation from 71 employers and 11,472 of their workers. HEALTH PROMOTION IN SOUTH AFRICA In South Africa, the workplace has been a neglected arena for health promotion, particularly in the area of NCCD. Like other transitioning economies, South Africa is experiencing a burgeoning epidemic of NCCD linked to lifestyle. Relative to baseline values in 1997, NCCD showed a fivefold increase in 2004. 15 After human immunodeficiency virus and AIDS, lifestyle-related chronic diseases are the leading causes of death and disability in South Africa. 16 The epidemic growth of NCCD has been driven by major economic and social changes that include rapid urbanization and dramatic changes in individual lifestyle. 17 These changes have been recorded in all sections of the population but are most evident among employed individuals, with health insurance, living in urban areas. 18 There is limited evidence 18–20 that some companies in South Africa provide health promotion programs to their employees. According to Sieberhagen et al, 21 employee wellness programs were first introduced to the mining industry in the 1980s. In the last two decades, health promotion initiatives have been adopted by other industries as well. Programs common among employers include training in occupational safety, employee assistance program, and screening and counseling for human immunodeficiency virus and AIDS. Because of sparse financial and health improvement outcomes data, public knowledge and support for workplace health promotion in South Africa are limited. In conducting the Healthiest Company Index campaign, we sought to (1) publicize the workplace as a fruitful setting for health improvement, (2) document employer health promotion efforts in this area and recognize organizations adopting best practices, and (3) assess the health behaviors of employees at companies that aspire to become the healthiest companies in South Africa. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. JOEM  Volume 00, Number 00, 2013 1