Uneven distribution of workplace health projects

A 2008 report by the Central Federal Association of Health Insurance Funds shows that projects on workplace health promotion are unevenly distributed across sectors and enterprises. Workers in the services industry, women and migrant workers are much less likely to benefit from health promotion projects than workers in the manufacturing sector. The report illustrates that workplace health promotion is most widespread where works councils and trade unions are strongest.


In 2007, a change to paragraph 20 of the Social Security Code V (Sozialgesetzbuch) sought to improve workplace health promotion by strengthening the role of the health insurance funds and by regulating close cooperation between the various actors. The insurers now have to engage in workplace health promotion; more specifically, they have to cooperate with employers and employees, as well as with employers’ liability insurance associations, in detecting health and safety hazards and in conceptualising and applying prevention measures at the workplace. In practice, the role of health insurers can be restricted to the provision of information, but it may also extend to counselling, project leadership or the evaluation of projects. Ultimately, their role depends on the management’s decision.

As of 1 July 2008, the seven existing federal health insurer associations are represented by the Central Federal Association of Health Insurance Funds (Spitzenverband Bund der Krankenkassen, GKV-Spitzenverband Bund). In December 2008, the Medical Review Board of the Central Federal Association (Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen, MDS) published a report (in German, 3.2Mb PDF) (Präventionsbericht 2008) on the health promotion projects either realised or supported by German health insurers in 2007. One chapter focuses on workplace health promotion. The results present the findings in relation to 3,014 documented cases, based on the health insurers’ responses to a questionnaire issued by the MDS.

Although the report does not give detailed information on the role of the health insurers nor on the actual projects, it does highlight certain trends.

Study findings

Distribution of projects

The 3,014 documented case studies were carried out at 6,888 sites or enterprises. The report notes that in 88% of all cases, the promotion measure was merely implemented at one site of a company. Only in one case – namely, at a restaurant chain – did the project include a larger number of company sites. The majority of the enterprises or sites (59%) usually employed a workforce of 100 or more people in 2007 (Table 1).

Table 1: Workplace health promotion projects, by enterprise size, 2005–2007 (%)
Company size 1–9 employees 10–49 employees 50–99 employees 100–499 employees 500–1,499 employees 1,500 or more employees
2005 9 23 10 39 14 5
2006 11 23 11 37 13 5
2007 9 20 12 38 14 7

Source: MDS, Präventionsbericht, 2008 p. 81

Although the manufacturing sector accounts for only around 10% of all enterprises in Germany, about 40% of the health promotion projects were realised in this sector in 2007 (Table 2). In contrast, just under one third of all health promotion projects were implemented in private services.

Table 2: Workplace health promotion projects by sector, 2005–2007 (%)
  Manufactur-ing Health and social Services Construc-tion Retail Public sector Others
2005 45 11 10 9 9 8 9
2006 39 10 12 10 9 8 12
2007 40 14 10 9 8 8 12

Source: MDS, Präventionsbericht, 2008, p. 80

The distribution of projects according to target groups shows that men are more likely to profit from workplace health promotion projects than women (Table 3). Moreover, migrant workers are rarely identified as a specific target group.

Table 3: Workplace health promotion projects, by target group, 2005–2007 (%)
  2005 2006 2007
Groups facing specific health hazards 48 40 43
Workers in manufacturing/trades 43 35 38
Upper management 36 32 28
White collar/administration 30 31 26
Middle management 34 28 26
Trainees 20 15 18
Workers/services 23 18 17
Women 18 12 16
Older workers 10 8 8
Migrant workers 10 6 4

Source: MDS, Präventionsbericht, 2008, p. 84

Financing of projects

In 2007, German health insurers spent €32.2 million on workplace health promotion initiatives. Whereas employers are supposed to finance certain aspects of occupational safety – including safety equipment such as helmets – the insurers can (co-)finance various promotion measures. No precise information was available about the types of projects that the money was spent on.


The measures reached about 627,000 persons, according to the statements provided by the health insurers. The prevention report notes that the significant number of people covered is due to the broad application of mass media. Some 84% of the 627,000 people were reached through popular media such as the internet, flyers and video; only about 16% (around 94,000 persons) were targeted through ‘direct media’ such as manuals or illustrative materials.


The report illustrates that workplace health promotion is most widespread where works councils and trade unions are strongest. The networking of various actors has not yet led to an increase in projects in the services industry or among small enterprises.


Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen (MDS), Präventionsbericht 2008. Leistungen der gesetzlichen Krankenversicherung in der Primärprävention und der betrieblichen Gesundheitsförderung, Reporting year 2007, Essen, 2008.

Birgit Kraemer, Institute of Economic and Social Research (WSI)

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