more inclined to offer employee health insurance and wellness programs than those in small businesses. it is critical for workplace wellness to have increase participation, provisions under insurance coverage for small employers to increase incentives expands participation for small businesses. the affordable care act (aca) includes the prevention and public health fund whereby provisions are created to address and expand community prevention, public health infrastructure and training, clinical prevention, and workforce wellness research in the large american working demographic. the role of the aca increases programs for worksite wellness is a strategy to tackle the growing rate of chronic diseases in the united states. in a study by the cdc, the implementation of worksite wellness incurs a three-time investment over a dollar spent and have been reported positively by companies such as johnson & johnson, citibank, duke university, chevron etc. included in the affordable care act are chronic diseases management to be offered in the essential health benefits. as workers age, health care costs and chronic diseases such as depression, anxiety and diabetes are proportional to its growing increase. owing to this increase, the negative effect on workplace productivity and presentism is declining. aca implements these management benefits to reduce the declining and negative effects. in the cdc study on workplace wellness and aca, the solution resolves to health culture and its strength in workplaces given that only 26% reported that their employees have strong culture of health in their organizations. in 2014, it was found that the affordable care act expands incentive limit by 10 percent. implementing incentives such as discounts that puts value in health choices and behavior illustrated a 73% positive feedback. in addition, increasing tax on sugar-sweetened drinks, would decrease obesity levels in us adults by 3.5%. the study then concluded towards preventative practices and reform promotes health and quality on workers and increasing productivity. included with aca's incentive plan is a non-discriminatory law or hipaa to requiring availability to alternative wellness programs if need be. the affordable care act has importance in contextualizing health care promotions in the workplace. the affordable care act, in its revisions and improvements not only persuades workspaces both low and high wage industries to implement health care promotion. small employers often are underrepresented in the surveys and data for aca, low wage industries in the past have been underrepresented under the affordable care act, however, with improvements in representation to cover both low and high earning workers, more participation can be seen in workplace wellness. monetization of workplace wellness with shift in employee's attitude towards mental and physical wellness, organizations are realizing the rising importance of workplace wellness initiatives which would in-turn increase employee productivity. valued usd 50.2 billion in 2022, the workplace wellness market is anticipated to reach usd 80.1 billion by the year 2031. the growth of the market is attributed to the businesses prioritizing workforce health to increase productivity and efficiency. program components healthy people 2020 is a blueprint for a 10-year national initiative to improve the health of all americans, "providing 42 topics and over 1,200 objectives to guide evidence-based practice". "a shorter list of high priority topics are categorized into leading health indicators (lhis) highlighting collaborative actions that can be taken to impact american health outcomes." employers can use healthy people 2020 objectives to focus business-sponsored health promotion/disease prevention efforts and measure worksite and community-wide outcomes against national benchmarks using evidence-based practices. as defined by healthy people 2020, a comprehensive worksite health promotion program contains five program elements: health education, which focuses on skill development and lifestyle behavior change along with information dissemination and awareness building, preferably tailored to employees' interests and needs. supportive social and physical environments. these include an organization's expectations regarding healthy behaviors, and implementation of policies that promote health and reduce risk of disease, including leadership support. integration of the worksite program into your organization's structure. linkage to related programs like employee assistance programs (eaps) and other programs to help employees balance work and family. worksite screening programs (health risk assessments, blood draws, biometric screening, genetic testing, etc.), ideally linked to medical care to ensure follow-up and appropriate treatment as necessary. partnership for prevention includes two additional components: support for individual behavior change with follow-up interventions. evaluation and improvement processes to help enhance the program's effectiveness and efficiency. additionally, the center for disease control and prevention (cdc) indicates that a workplace health program will be "coordinated and comprehensive" if strategies include "programs, policies, benefits, environmental supports, and links to the surrounding community designed to meet health and safety of employees." furthermore, the centers for disease control and prevention's national institute for occupational safety and health (niosh), through its total worker health program, offers an extensive list of resources to assist employers, employees, and practitioners with their efforts to implement and develop programs in their organizations that integrate employee health activities. most of the publicly available reputable sources provides tips and tools but are not "off-the-shelf" or "turn-key solutions." organizations wishing to obtain more assistance will find there are numerous private companies offering fee-based services. the partnership for prevention offers extensive background and program-specific information in its healthy people 2020 and beyond report. workplace health model the center for disease control and prevention (cdc) has a workplace health model incorporating elements and fundamental ideas of the community guide's framework and healthy people 2020 in a coordinated approach to impact health at the workplace. this approach should be "coordinated, systematic and comprehensive". assessment program success and employee engagement require information to be obtained about the workplace, either formally (i.e. needs assessment) or informally (i.e. conversations with employees), collecting data regarding individual lifestyle, work environment, and organizational details. data should be collected for both employee interests and available aggregate data about health status, health issues or cultural survey data. engaging employees, including the leadership team, from the beginning of program planning and development will help drive commitment, responsibility, and participation; as well as, creating a culture of health and great place to work. additional information to assist with workplace assessment can be found using the cdc assessment module. program planning next is to develop a strategic plan that considers the pertinent assessment results from a vantage point of both the individual's actions and environmental context in accordance with the direction from the governance structure. this should always be completed prior to implementation or evaluation; however, keeping the end in mind (how will i evaluate this program to know it was successful?) will help drive the overall plan. the recommended strategy for "direction leadership and organization" by the cdc includes: leadership support dedicated to championing wellness and modeling behaviors; workplace wellness committee, coordinator or council; development of a resource list of available assets; defined mission, vision, goals, objectives and strategies; comprehensive communication plan; evidence-based practices; and data collection and analysis. a thoughtful strategic plan will select and deliver interventions, policies, and programs that are most advantageous to the particulars of the employee population. additional resources can be found by visiting the cdc's planning/workplace governance module. implementation the implementation stage is where the rubber meets the road. employees often see this stage as the "wellness program", and typically do not understand what goes into the process to provide a comprehensive strategic plan. therefore, implementation occurs when the strategic plan executes the opportunities to support an employee's health. the cdc recommends four main categories for interventions or strategies that successfully influence health: "health-related programs; health-related policies; health benefits; and environmental supports". evaluation to determine impact and success, evaluation is crucial to the longevity of a workplace wellness program. everything from programs to policies to environment must be evaluated to determine return on investment (roi), value on investment (voi), health impact, employee satisfaction and sustainability. "according to the cdc (2016), evaluations can often be overwhelming, time-consuming and expensive; so, focusing on relevant, salient, and useful information is key to quality evaluation practices. an evaluation tool should be designed to support the program process, quality improvement, and identification of gaps for future strategic plans." workplace wellness best practices according to research completed by hoffman and kennedy-armbruster (2015), and published by the american college of sports medicine health & fitness journal, the top nine workplace/worksite wellness best practices include: leadership support (i.e., modeling, resource allocation, etc.) relevant and personalized programs (using employee interests and available aggregate data) partnership with employees, employer, organizations, and local community. comprehensive and evidence-based programs (using eight dimensions of wellness can be a helpful tool- emotional, environmental, financial, intellectual, occupational, physical, social, and spiritual) implementation that is well planned, coordinated, fully executed, and evaluated for success and accountability employee engagement through organization and planning wellness efforts formal and comprehensive communication strategies/plan data driven decisions that include measurement, evaluation, reporting, and analytics hipaa compliant programs." importance of leadership support leadership support has been indicated as a benefit, best practice and a key element of the cdc to be part of the workplace health model; therefore, understanding research to sustain these claims is important for the success of programs. below you find research to support how leadership involvement and commitment of wellness activities (i.e., physical activity) can impact health status (i.e., cardiovascular disease status). lawrence et al. (2015) indicates strengths and weakness of current worksite wellness models providing key considerations for the development of a strong program. key strengths indicated were "leadership commitment, organizational culture and environmental structure" to build a culture of health, ultimately promoting the improvement among non-communicable diseases. furthermore, lawrence et al. (2015) suggest that these characteristics are indicative of a "high-quality program regardless of the model used: 1) leadership support, 2) clear importance of health and wellness by organization culture and environment, 3) program responsiveness to changing needs, 4) utilization of current technology, and 5) support from community health programs". a recent survey conducted by harris poll and reported the american psychological association (apa) (2016) stated just over 30% of americans indicate participation in worksite wellness programs, and 44% indicate that employee wellness is supported by their workplace culture. furthermore, this data indicates when senior leaders are involved and committed to wellness program initiatives 73% of employees feel their organization supports a healthy lifestyle and their overall well-being; however, only 4 of 10 americans said that their leadership team supports wellness initiatives. further evidence reported by rand (2013) stated "evidence from case studies suggests that for programs to be a success, senior managers need to consider wellness an organizational priority to shift the company culture. buy-in from direct supervisors is crucial to generate excitement and connect employees to available resources." furthermore, hoert, herd, and hambrick (2016) used the leading by example instrument to find "employees experiencing higher levels of leadership support reported higher wellness program participation, lower stress, and higher levels of health behaviors". stokes, henley and herget (2006) reported on findings from a wellness initiative pilot program using the north carolina department of health and human services. this organization was selected as the pilot due to the leadership support model and its large size. this program focused on "reducing major chronic diseases (including cardiovascular diseases), demonstrating the effectiveness of a wellness program model that includes a full-time department-level director, establish wellness committees to sustain work environments that promote and support employee health and wellness, and change policies and environments to help employees be more active, make healthier food choices, avoid tobacco, and manage stress". results after the first year of this program indicated that 62% of employees participated in at least one wellness activity, 51% exercising more often, 50% stating wellness programs as the most popular activity, 49% eating more fruits and vegetables, 27% were closer to a healthy weight, and 106 employees stopped smoking and 149 reduced tobacco use. finally, ross et al. (2013) report the increased importance of physical activity at the workplace with the increasing sedentary job responsibilities, and the positive effect of worksite physical activity programs have on health outcomes, including cardiovascular disease and metabolic conditions. additionally, their research indicates appropriate models for these successes are through "a health and wellness culture driven by leadership support, specialized programs designed for the employee population, and strategic plans that partner with current organizational goals". program development and best practices example example the framework of the community guide, program components (goals and objectives) set out by health people 2020, the