Wellness programs, touted universally as a way to improve health outcomes and lower health care costs, are not being offered universally, research finds. According to a study by Rutgers University, well-educated, highly paid workers are more likely to have access to wellness programs, compared to less formally educated, low-income workers.

The John J. Heldrich Center for Workforce Development at Rutgers University finds that 46% of highly educated and affluent workers report that their employer offers a wellness program, while only 25% of employees with a high-school education or less say the same.

Moreover, 45% of salaried workers say they have access to some type of healthy lifestyle program through their employer, compared to 35% of hourly workers. Access to wellness programs also depends on income. About 45% of employees with incomes of $70,000 per year or more note they have wellness benefits, compared to 21% of those making $35,000 a year or less.

Unlevel playing field

Employers that offer wellness programs make them available to all of their workers.

However, low-skilled workers without college degrees are heavily employed by sectors of the economy where employers provide limited or no health care benefits, which means wellness programs are not an option, explains Dr. Carl E. Van Horn, director of the center.

The survey, a national telephone poll, provides a snapshot of workers' attitudes toward wellness programs, which includes access to the programs along socio-economic lines.

Conducted in March, the data represent the responses of 583 adults working full- or part-time jobs. Researchers outlined their findings in the report "Healthy at Work?: Unequal Access to Employer Wellness Programs."

Employers' perspectives on wellness programs have been well-documented, Van Horn says, but there "isn't a lot of systematic information on the topic of who has access to workplace wellness programs."

The center's researchers made it clear to respondents what they meant by a wellness program, defining it as a health-oriented program designed to maintain a level of well-being in workers through proper diet, exercise, stress reduction, disease management and illness prevention.

This may include an employer offering onsite exercise equipment or gym discounts, smoking cessation programs, and disease management assistance, or merely issuing a health newsletter. "We didn't have them guessing what we meant by a wellness program," says Van Horn.

Overall, nearly 40% of workers are offered some type of healthy lifestyle program through their employer, according to the survey report. Wellness benefits generally are offered at large companies.

"With public and private health spending predicted to reach $2.5 trillion in 2009 - a 17.6% share of the U.S. gross domestic product - many policymakers are arguing that effective, evidence-based, preventive services such as smoking-cessation programs not only promote health, but also offer high economic value," says Van Horn. "Workers are telling us that they want to participate in employer-based wellness programs, but many do not have access to them."

Yet across the economic spectrum, workers expressed mixed feelings about employers using a combination of carrots and sticks to encourage healthy behavior, the report's authors observe. "Employers . . . must be sensitive to privacy and fairness concerns. Workers on the lower rungs of the economic ladder feel highly exposed and worry about anything that could jeopardize their job security."

Cost, turnover cited as hindrances

Employers with a large low-skilled workforce, such as in the retail and food-service industries, cite high turnover rates as a hurdle to offering wellness programs.

Further, Van Horn believes businesses without wellness programs are not making a class-based decision. "It's really more a matter of what they can afford to do, when you consider that most businesses with limited financial resources tend to employ low-skilled workers with less formal education," he says.

Wellness advocates assert that to increase wellness programs at businesses where a high concentration of low-income workers don't have access to such programs, lawmakers will need to provide financial incentives and tax breaks to those companies.

As the debate on health care reform moves forward, "we think the topic of access to workplace wellness programs will receive more attention," Van Horn says.

"When you look at health data on obesity and tobacco addiction broken down by socio-economic [status] and educational levels, you will see that individuals who are at the lower spectrum tend to dominate the statistics on those conditions. Yet they are provided less access to wellness programs," explains Michael Samuelson, president of the Health & Wellness Institute, a Rhode Island-based health management company.

Research from the Department of Health and Human Services supports Samuelson's assertion. The department's Agency for Healthcare Research and Quality recently issued its 2008 report on health care disparities. When hospitalized, the percentage of obese adults who were given advice about exercise was significantly lower for people with less than a high-school education (50.5%) than for people with at least some college education (63.2%).

"For me, that represents a larger concern of disparity in that we are not providing enough awareness and access to wellness programs to those who really need them," Samuelson says.

Carrots and sticks debate

Three-quarters of workers (74%) say employers should give lower health care premiums to employees who participate in wellness programs. Workers, however, do not support penalizing employees who engage in potentially unhealthy behavior:

•  Just half (47%) of workers say employers should be allowed to charge smokers more for health insurance.

•  Barely 4 in 10 (43%) support higher rates for people who drink too much alcohol

•  Only one-quarter (26%) think people who are very overweight should pay more.