Measuring presenteeism is not fully accepted as a valid method and measurement instruments are often scrutinized, including in the U. A greater emphasis is placed on satisfaction scores outside of the U. A number of valid tools with a track record are being used in various countries, like the Work Ability Index or the Q12 Engagement Survey. Back to the significance of the "how" of workplace health promotion: the body of evidence of what works, and what does not, is much thinner outside of the U. One can attest the lack of documentation of successful or good practices across the globe.
The WHO model provides guidance for a comprehensive and systematic approach on a global scale. Four main areas of influence are identified see exhibit B :.
The Healthy Workplace model also follows a continual improvement process, such as highlighting the need for evaluation, and places leadership engagement and worker involvement as central priorities. Perhaps most importantly, the very center of the model exemplifies that promoting health at the workplace is both the right thing ethical and the smart thing adds value to do.
While not a blueprint for successful programming, the Healthy Workplace model does provide a much-needed framework and starting point relevant anywhere in the world. Based on the existing evidence in the U. Wolf is a globally recognized expert on health promotion and well-being with on-the-ground experience in many different countries. Connect with him at wk wolfkirsten. Does Corporate Wellness Work? Invest in Workplace Health Promotion?
Global Perspectives in Workplace Health Promotion
Four main areas of influence are identified see exhibit B : 1. Subscribe to receive new content, industry news, and more delivered to your inbox! By Michelle Dix on August 26, By Micheal D. Shaw on August 21, By Joanne Criss on September 6, Go Up. Subscribe to our list for new content, industry news and insights, events, and more! You can unsubscribe at any time.
Global Perspectives on Health Promotion Effectiveness
The leading causes of burden of disease in developing nations are very similar to those recorded globally, with the exception of the statistics for malaria and tuberculosis TB. As indicated in Table 1 , out of the top ten causes of death, eight belongs to the Group I, however the leading causes in developed nations are all NCDs, with the exception of road traffic accidents which is the tenth leading cause of death [ 29 - 30 ].
In a broader perspective depression is now known to be among the leading cause of disease burden among young adult women with mental disorders that are known as the main source of lost years of healthy life for women of aged 15—44 years [ 23 ]. Mental disorders make up three of the ten leading causes of disease burden in developing countries, and four of the leading ten in developed countries.
Promoting health – global perspectives
Case of self-inflicted injuries have been reported to be among the leading ten causes for the developing economies [3, 11, and 30]. Injuries have also been shown to be important for boys beyond infancy, however, the causes of burden of disease are broadly similar for boys and girls but with, a marked sex differences that is seen between the age range of 15—59 years.
The burden of reproductive problems is generally restricted to developing nations, and this is vital such that the maternal conditions make up two out of the ten leading causes of disease burden in women of age groups 15—44 years [ 29 - 30 ]. In sub Saharan African and in the South-East Asia regions, the disease burden from maternal conditions is responsible for about eight percent of the total global disease burden shown in women between the aged groups of 15—59 year [ 32 - 34 ].
In developing countries great contribution can be made towards reducing the burden of disease by developing strategies aim at reducing loss of healthy years that can be enhanced by putting in place better facilities to implement proper care for pregnant women, promote antenatal and neonatal care, years loss Almost all of this loss of healthy years of life is avoidable.
The Millennium Development Goal provides an opportunity for women to have access to a skilled birth attendant during childbirth.
This opportunity where available has reduced to a greater extent the disease burden through the prevention maternal and neonatal deaths. The burden of NCDs are derived from various past and cumulative risks; and the future burden are now determined by current population exposures to risk factors. Studies have shown that the major risk factors for NCDs epidemics are more complex than those for infectious disease and are well known to be responsible for most of such risk factors.
Many populations are exposed to the most common groups of NCDs. There are some modification of these NCDs within individuals and location but generally the mode of action is the same worldwide [ 9 - 12 ]. Some determinants on NCD epidemics involves the increase in aging population, low fertility and the decreasing child survival potential. The increase in NCDs globally has been caused by a significant change in lifestyle of the population especially in developing economies.
Current trends indicates that more people spend longer period out of their homes working and eating fast food containing high cholesterol level which is a predisposing factor to metabolic diseases, with obvious implication linked to problems such as low fertility and sexual dysfunction [ 32 - 34 ]. World trade and marketing developments concepts is to orientate the nutrition and food strategies transition towards diets formulation with a high proportion of saturated fat and sugars with high cholesterol.
The consumption of high cholesterol diet, drug abuse, and common tobacco use with little or no physical activity can lead to worldwide predisposition of NCDs [ 15 - 17 ]. In developed countries, seven of the ten leading risk factors contributing to the burden of disease are for non-communicable disease, compared with six and three of ten in developing countries with low and high rates of mortality, respectively.
What Does the Rest of the World Think?
The NCD risks are higher in developing countries and dominate the disease burden of most developed countries, to the extent that they are considered as a health priority in the developed countries [ 11 , 35 ]. The developed countries have well-structured health programmes to manage the NCD risks which generally increase with age.
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It is therefore important to develop control measures of the different age distributions of populations through age-standardization of DALY rates, to reduce the apparent NCDs risks. Report on the age-standardized DALY rates, are higher in developing countries than in developed nations [ 35 - 37 ].
This disparity is due mostly to cardiovascular diseases, such as the heart disease and stroke, with age standardized burden are significantly higher in developing nations than in developed countries. Other disease burden under the group of sense disorders, vision impairment and ocular anomaly like hearing loss, is more common in developing economies than in the developed countries [ 35 - 37 ]. Due to economic decline and poor road infrastructural development there is a rapid increase in road traffic accidents most especially in the developing countries [ 12 , 38 ].
The relative importance of intentional injuries varies from regions to regions and these category of injuries includes aspects like self-inflicted injuries, suicide, violence and war [ 37 - 39 ]. This type of injury contributes to the increasing rate of the burden, mainly in economically oriented young adults.
In most developed nations, suicides top the cause of intentional injury burden, while low income economies aspects of violence and war leading the massive displaced and migratory population are the main cause. Highly politically unstable regions involve in unrest, civil wars like in the Central Africa sub regions, have rates of injury, death and disability among males that are similar to other developing countries [5, 30, and 39]. The death rate resulting from the effect of poisoning is significantly high developing countries than in any other region of the world.
Consumption of excess and deaths is also a main cause in developing countries where the unemployment rate is very high and provokes frustration among the youth. Record of the potential death rate resulting from injuries cause by fire is significantly higher for women population in the South-East Asia regions than for the women or men population globally [ 40 ]. The global forecast for the disease burden per capita is projected to potentially show a decrease in the global DALYs from 1.
The DALY rate general have been shown to decrease faster than the global death rate due to a potential shift in the chronic NCDs that has not only occurred in the last decade but has become an economic health issue, that has attained an epidemic magnitude globally [ 11 , 43 - 45 ]. Within the coming years the burden of chronic NCDs is anticipated to be on the increase particularly in sub Saharan Africa.
This projection raises a concern of the potential death of about million people in the population in the next decade from one or more forms of CNCDs. This health concern has provoked many states to put in place some action plans towards reducing a significant number of premature deaths. There is the possibility that poor feeding and excessive smoking are two important factors that contribute to the millions of preventable deaths that occur each year.
The effect of the present current era of globalization on health has to be debated and reconsidered in a wider perspective [ 5 , 52 ]. Greater emphasis and interest is now focused on the control strategies on the infectious diseases and the threats to world security, the supply of generic drugs and international trade partnership [ 41 , 52 ]. Mental health problems are known to be the leading cause of disease burden in most countries irrespective of its state of development and this contribute in many ways to the incidence and severity of many NCDs such as the cardiovascular disease and cancer [ 1 , 53 ].
The disease injury distribution has been grouped into world disease regions of Africa, the Americas, and the Eastern Mediterranean and European regions. This distribution are well illustrated in Table 1 , showing the disease injury categories and the DALY. It is observed that there is major variation between these world disease regions.
Global disease injury distribution in the world disease regions of Africa, the Americas, Eastern Mediterranean region and European Region [ 13 , 29 ]. There are all indications that communicable diseases in Africa cause more deaths than non-communicable diseases. NCDs contribute significantly to adult mortality with the highest rates recorded in central and eastern European sub regions [ 54 ].
They increase the problem of health inequalities within and between affected countries, mainly concerning poor populations due largely to the inequalities in the distribution of major risk factors [ 3 , 55 - 56 ]. The study on economic and financial globalization and the World Trade Organization WTO show that when the national and the international trade is regulated this can lead to improvement of the health status of the population, although this benefit has little impact in developing countries [ 7 ].
Many countries have put in a lot of efforts towards the regulation of national and international trade unfortunately, the limited resources and technical knowhow has not helped to promote the programme. WTO promotion of drug development and new chemical entities has enhance the access to many developed pharmaceuticals, but not all countries have same accessibility due to lack of limited resources. The development of NCD epidemics where there are limited access to medical care has been influence to some extend by globalization [ 1 - 3 ]. The effect of indirect effects of globalization are linked to national economic performance which act through changes in household income, government spending, and the foreign exchange, and prices regulation within the different countries [ 50 ].
National income play an important role in health development however in developing countries the resources for health promotion [ 51 - 43 ]. Some of the drawbacks of globalization on health can be exemplified by increase in production and commercialization of unfriendly health products such as alcohol, tobacco and other substances of health abuses readily available to the population.
These commodities unfortunately are very accessible to the population especially in the developing countries where trade regulation of these products where there exist are difficult to enforce. Significant efforts have been made towards the protection of essential local producers in high income economies and this has had an effect on the management of NCD epidemics. For instance the move by the European Union EU to subsidize agricultural products is aimed at regulating the competition that may arise from the primary producers.
There is little subsidize unfortunately for fresh produce in low income economies and therefore could reduce the national income [ 55 ]. The EU also subsidize the production of tobacco which has been generally considered as a policy anomaly because of the negative health effect tobacco has on the population of consumers.
Some attempts have been made through advocacy for the removal of the agricultural subsidies and this was endorsed in Doha and then in Johannesburg during the World Summit on Sustainable Development and most recently the declaration by the EU gave an indication that the process for lifting subsidies linked to production is in progress. Modern information and communication technologies ICT have been shown to have some positive and negative effects on health. It is evident that global commercialization of products like tobacco, alcohol, and other essential household products could be made available to all parts of the country ICT has made it possible for global commercialization shifting market target to the younger population [ 3 , 11 ].
In the USA for example millions of dollars are put into persuasive marketing that has encourage young people to develop interest in fast food with high cholesterol content, fizzy drinks, alcohol and tobacco. The power of media publicity and advertisements through the use of more sophisticated technology has promoted the persuasive marketing and also exploiting the poor regulatory environment to capture and penetrate the consumer market [ 21 - 26 ].
Nowadays there has been a great substitution of our natural organic traditional food rich in fruit, vegetables and fibers by diets rich in calories from animal fats and low in complex carbohydrates. The impact of this food substitution syndrome has had more impact in developing countries [3. Such changes has led to an increased rates of many NCDs in countries previously protected by balanced and healthy diets. Sub-Saharan Africa, Asia and some South American countries are undergoing a big shift in consumption patterns, and consumer life style transformation although rates of heart disease are still low compared to developed countries, and stroke rates have also reduced significantly in countries like Singapore and Japan [ 46 ]..
Globally there has been a steady increase transformation in farming [ 45 ] food processing, distribution [ 23 ] transportation [ 19 ] shopping practices [ 3 , 55 ] and the consumption of food outside of the home fast food, take away [ 27 ]. Cooking has changed with the development of microwave, ovens and other techniques and changing lifestyles, especially in the urban cities where people work long hours out of home [ 14 ].
Changing patterns of production and consumption underlie the emergence of NCD epidemics and poses a problem to achieving a sustainable development goals [ 56 ]. The impact of alcohol consumption in promoting non-communicable disease epidemics has become very complex and a significant correlation has been shown between alcohol consumption and liver cirrhosis, some cancers, and most causes of injuries and violence.
Related Global Perspectives on Health Promotion Effectiveness
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