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Special Report: International Companies Starting to Take Wellness to Heart

Health programs get off the ground internationally, but local conditions can create challenges.

September 1, 2012

In Russian, there's no word for "assistance."

This proved to be a stumbling block when Harris, Rothenberg International Inc. was launching its employee assistance program and work-life and wellness services in the eastern European nation.

HRI grappled with what to call its confidential counseling and referral services. Using the word "assistance" was a nonstarter, and the notion of seeking help in Russia can carry a certain stigma because it implies that you can't do something yourself, explains the company's CEO Edward Trieber.

So the EAP provider framed its services to Russian workers as support.

"We have to talk about what we are providing in a culturally relevant way," Trieber said of the Russian example.

Similarly, HRI had to tread lightly in Russia when promoting and discussing its alcohol-abuse counseling services—one of its core competencies—because of the strong culture around drinking there. "We don't always promote alcohol services in Russia," Trieber says. "Instead, legal services are very needed and so we will lead with that."

Employers in Russia are also keen to address alcohol abuse through the lens of workplace safety, he says. HRI is now rolling out an on-site alcohol counseling program at an industrial site in a remote region of Russia. The goal is to improve workplace safety by reducing alcohol consumption. HRI plans to expand the program to other employers in Russia if it is successful.

HRI's experience in Russia is just one instance where a U.S. company is attempting to adapt and recast its workplace wellness programs for employees overseas.

Workplace wellness and work-life balance services are becoming more in demand as multinationals see the potential upside to having a healthier, more productive workforce in all corners of the globe, experts say.

"There's a changing view of human capital today," says Lorna Friedman, partner of global health management at Mercer Health & Benefits. "Human capital is increasingly seen as an asset. Companies want to attract and retain employees and create a sustainable work environment."

Additionally, new markets this century tend to be global markets, Friedman says. "So labor is really important in fostering your brand in an emerging market," she says. "Clearly, in this era of ruthless transparency, how you treat people becomes very clear very fast."

In 2008, at the World Economic Forum in Davos, Switzerland, CEOs from 13 multinationals called on fellow business leaders to strengthen action on workplace wellness around the globe. Population projections indicated that, by 2020, corporations will face a human capital shortage because of a combination of an aging population, rise in chronic disease and poor educational opportunities in many parts of the world.

In Western Europe, a lack of up to 45 million skilled workers is projected by 2030. And noncommunicable diseases, such as cancer, diabetes, depression and heart disease, are forecast to cost $47 trillion over the next two decades, according to a 2010 World Economic Forum report.

Even in countries with young populations, the report stated, multinationals see a race for talent because of uneven educational systems. Only 20 percent of Russian and 25 percent of Indian professionals, for instance, are currently viewed as employable by multinationals.

Workplace wellness programs, especially those with proven success in the United States, could help multinationals achieve a competitive edge, the corporate leaders suggested at Davos. Instead of viewing workers in emerging markets as expendable and replaceable, corporations should invest in their health and well-being, the leaders said.

Following up on the meeting in 2010, a consortium of CEOs launched the World Economic Forum Workplace Wellness Alliance, aimed at advancing successful wellness initiatives and sharing knowledge. The alliance today has more than 100 member companies, including American Express Co., General Electric Co., General Mills Inc., Humana Inc., Nestle, PepsiCo Inc. and Unilever, representing 4 million workers.

"By applying metrics and best practices, the alliance will enable employees to achieve their full potential while making optimum contributions to their enterprises' growth and success," Humana CEO Michael McCallister wrote in the 2012 alliance annual report.

Contributing to the growing interest in workplace wellness is the rising cost of health care abroad, Friedman says. "The quality of care globally has improved," she says, and multinationals are increasingly using global insurance brokerage arrangements, which resemble a self-insured plan. In these arrangements, costs are based on the health of the workforce and other factors. "So it starts to matter whether people are healthy or not."

But even in countries that have not seen a dramatic rise in health care costs in recent years, such as Canada and parts of Western Europe and Latin America, employers are becoming more interested in strategies to improve productivity and reduce absenteeism and disability costs.

Competition in the global marketplace is a main driver, says Francois Millard, chief actuary of the Vitality Group, a South Africa-based global workplace wellness provider. "As companies feel more economic pressure, they will look for ways to decrease costs or improve productivity of their workforces," Millard says.

Still, employers and wellness vendors are realizing that, as in HRI's experience in Russia, many on-the-ground factors need to be considered before rolling out an appropriate local program.

The Vitality Group recently entered the China market, and though some elements of traditional workplace wellness programs such as rewards for health behavior are showing success, messaging has had to change, Millard says.

In China, "physical screenings are more comprehensive than in the United States. People there are more accustomed to many physical screens when they see a physician," Millard says.

EAPs have also proven popular in China and in other parts of Asia, says Russ Hagen, CEO of Chestnut Health Systems, a behavioral health company in Bloomington, Illinois. In China, many workers prefer phone counseling because of poor transportation to get to a counselor's office. Across Asia, phone counseling has helped address the cultural issue of "saving face" that can obstruct treatment, he says.

By contrast, in Brazil, local laws prevent phone counseling, so EAPs must arrange for face-to-face encounters, he adds.

Caterpillar Inc., experienced these issues firsthand when rolling out wellness programs to workers overseas, says John Pompe, manager of behavioral health programs for the global construction equipment manufacturing company.

A lot depends on the level of interest and support locally, Pompe says. "In some cases there is a strong advocate of wellness locally, but the level of localized support may be variable."

Caterpillar is organized as a matrix structure, grouping employees by function and product. As such, top-down directives from headquarters are not the norm. "There are lots of different decision-makers around the world," Pompe explained during a webinar on global wellness hosted by HRI. "I don't have a singular authority to say, 'We are going to have these programs in every country around the world.' "

This kind of corporate structure is common among multinationals. Friedman says in her experience, many corporate wellness programs originate at local sites instead of being exported by U.S. corporate HR managers.

"It's typically not something that's being pushed out by headquarters," Friedman says. "It is often organic at sites, or by using local vendors or nongovernmental organization partners or the country or regional leadership is advocating for it."

Employers should be aware of what local services and laws might help them jump-start a particular program—and see these as assets, says Wolfgang Seidl, head of health-management consulting at Mercer in London.

For instance, the Brazilian government has a strong anti-HIV program that can be adapted to the workplace with little groundwork or investment. In Germany, federal law requires private insurers to pay for wellness programs. And in the United Kingdom, the National Health Service funds workplace smoking cessation programs, Seidl says.

"Overall, it's a picture of inconsistency," Seidl says of the international marketplace, adding that employers need to be clear about objectives with vendors and also flexible when considering local conditions.

Pompe of Caterpillar agrees. "It really does take an effort where you not only have a clear corporate plan but you have local buy-in."

In 2010, NYSE Euronext, which operates the New York Stock Exchange in the United States, began rolling out wellness programs to its workers overseas. The company has 3,000 employees globally, including offices in Amsterdam, Brussels, London, Lisbon and Paris. Sandi Stein, former vice president of global benefits for NYSE Euronext, says the company wanted to expand wellness programs to offices overseas to retain and attract top talent and improve overall worker satisfaction.

In 2010 and 2011, the company launched a wellness Web portal, evaluated and selected local programs, initiated a global physical-fitness campaign and started a "local champion" program that selected on-site leaders to promote the campaigns.

Global marketing and global HR teams tested wellness brands at each location to make sure they would resonate and be accepted, Stein said. Local programs included massage, yoga, gym memberships and coaching.

As of early 2012, 31 percent of all NYSE Euronext employees had registered to participate in wellness programs and workers had logged 600,000 minutes of physical activity, she says.

NYSE Euronext also started a company-wide pingpong competition. A total of 470 people in seven countries participated in more than 400 matches. Sixteen pingpong tables were set up in 11 corporate offices. In the end, Team Flamby of Paris defeated the Paddlheads of New York for the win at the finals held in Paris. The winning team won an all-expenses-paid trip to New York.

"You have to be very mindful of cultural differences," Stein said of rolling out wellness programs. "You cannot shove this down people's throats."

Expectations on return on investment also must be adjusted, experts say. The average return on investment for a workplace wellness program stateside is $3.27 for each dollar spent, according to a 2010 Harvard University study.

"In the U.S., the ability to get ROI and understand the impact of programs on claims is standard business practice for carriers and vendors," Friedman says. "Outside the U.S. you simply first must understand that changes won't be reflected in lower medical cost trends."

Instead, employers can measure effectiveness by looking at short- and long-term disability cost trends, sick days, level of service delivered, safety scores and employee engagement, Friedman says.

In some parts of the world, the costs of wellness programs might outweigh labor costs, making the business case difficult to make back home.

"In some locations around the world, personnel costs are relatively low, and EAP may amount to a larger percentage of total payroll costs, Caterpillar's Pompe says. "In such cases, value is harder to prove and the buy-in can be difficult to get."

Employers and vendors are also increasingly mindful of the fluidity of the global workforce today. The traditional notion of the expatriate has changed, for instance. While the number of Americans working abroad has remained relatively flat, there's been a rise in the number of so-called "third-party nationals"—individuals from a third country working for a U.S.-based company overseas. So, for instance, a Swede might move to Brazil to work for a U.S.-based corporation. EAPs and other services must be mindful of the cultural needs of these employees, HRI's Trieber says.

In these difficult economic times, it's expensive to send people around the globe so more multinationals are tapping local markets for hires and therefore needing services that cater to the local population, Trieber adds.

Ensuring that wellness services are effective while being culturally relevant and available to local markets is challenging, experts say. But Trieber says that in his experience, it's helpful to keep in mind our similarities instead of focusing on what sets us apart.

"People are more the same than different," Trieber says. "There are remarkable similarities around the world."

Rebecca Vesely is a writer based in San Francisco. Comment below or email editors@workforce.com.

Workforce Management, September 2012, pgs. 20-21 -- Subscribe Now!