Investing in Culture of Health Reduces Employee Health Risks

Companies that improve their "culture of health" realize some important benefits, including reductions in employee health risk factors, medical visits, prescription drug use, and health care costs, reports a study in the February 2019 issue of Journal of Occupational and Environmental Medicine.       

"Investments in internal culture of health predict improvements in some employee health risks and healthcare utilization," write Ron Z. Goetzel, PhD, of Johns Hopkins Bloomberg School of Public Health and colleagues. They analyzed changes in scores on the CDC Worksite Health ScoreCard for 21 large US employers from 2013 to 2015.

The scorecard includes measures of internal culture of health (COH-INT), focused on improving the health of workers; and external culture of health (COH-EXT), focused on improving the health of surrounding communities. The analysis included data on health risks and healthcare resource use for up to 64,000 employees.

At companies with rising COH-INT scores, employees who initially had health risk factors were less likely to be at risk two years later, including reductions in obesity, poor diet, and tobacco use. For employees not initially at risk, increased COH-INT scores were also associated with lower rates of most risk factors. Companies with rising COH-INT scores also had slower growth in healthcare costs; reduced inpatient, outpatient, and emergency department visits; and fewer filled drug prescriptions.

Improvement in COH-EXT scores was associated with lesser reductions in health risks. For reasons that are unclear, increases in COH-INT were associated with higher stress levels, especially for employees who initially had high stress.

The study adds to a growing body of evidence that building a culture of health can improve employee health and reduce healthcare costs. Strengths of the study include repeated assessment of COH-INT and COH-EXT scores using a validated scorecard and data on changes in health risks for a large number of employees. Dr. Goetzel and colleagues conclude: "Policymakers and public health practitioners considering initiatives to improve community health should take steps to encourage employers to create healthy workplaces."
About the Author
Dr. Goetzel may be contacted for interviews at
ACOEM (, an international society of more than 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About the Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Henke RM, Head MA, Kent KB, Goetzel RZ, Roemer EC, McCleary K. Improvements in an organization's culture of health reduces workers’ health risk profile and health care utilization. J Occup Environ Med. 2019;61(2):96-101.