Employers typically view health and health care as costs to be managed and have been changing the structure of their health benefit programs to create incentives for employees to seek better value in the health care they consume. And many larger employers such as Maine Health, Bath Iron Works, Cianbro and others are encouraging employees to improve their health status with incentives and support for healthy lifestyles through work site health improvement initiatives.

There is increasing evidence that these changes and investments are helping employees prevent and manage chronic health problems, saving employers money by reducing increases in health care expenditures and improving worker productivity. Several studies that have reviewed the research on workplace health promotion have estimated a return on investment of between $1.40-$1.70 for every dollar invested. Unfortunately, these efforts have not been enough to reduce the growth in health system costs or to significantly improve the health of Maine’s communities and citizens.

A number of organizations such as America’s Health Rankings annually measure and rank the health of the states. The good news is that Maine has ranked in the top 10 states for the last five years. The bad news is that if one looks carefully at the measures that comprise the rankings, Maine has some serious health challenges. Moreover, there is considerable variation across the state with some areas such as Oxford, Somerset and Washington counties that rank well below the state average on many of the measures.

Improving the health of Maine’s workers is certainly challenging given the predominance of small employers in many areas of the state, and especially in the poorly performing counties. These small employers often do not have the capacity to mount work site wellness programs, and Maine has historically had a limited public health infrastructure for helping these employers adopt effective strategies for improving employee health. There is reason for optimism, however.

There are multiple examples in Maine of small employers effectively mounting work site wellness programs by working with the state’s public health system and other organizations to develop the shared capacity needed to implement effective programs. This is what is being done in Somerset County where Micro-Wellness, a collaborative venture of small employers, the local Healthy Maine Partnership, and Medical Care Development are partnering to deliver state-of-the-art work site health and wellness programs to micro-employers throughout Somerset County (one of the areas in Maine with poor health rankings). This initiative recently has been recognized nationally by the Centers for Disease Control and Prevention in Atlanta, which has chosen Somerset County as one of a handful of sites to test the development of a comprehensive work site health improvement program to address physical activity, nutrition and tobacco use in the workplace.

Another reason for optimism is that employers increasingly understand the importance of becoming engaged in helping to improve the health of families and communities, rather than just seeing health as an employee problem that needs to be managed. After all, employees’ health is deeply affected by the families, communities and states in which they live.

Employers are beginning to recognize, for example, that reducing the epidemic of obesity will require changes at all of these levels. They are partnering with other employers, philanthropy, public health and community organizations to promote health-improving changes, such as expanding and promoting opportunities in the community for physical activity for children and adults, changing school policies and advocating for state policies that support healthy eating and physical activity.

Employers cannot be public health agencies, which is why it is critical that the growing community-level collaborations between employers, Maine’s public health system and Healthy Maine Partnerships, and health care provider organizations continue and expand. Managing the costs of health insurance, one employer at a time, is not enough to address complex problems such as obesity, mental illness and many of the chronic conditions affecting Maine’s work force.

How do we move forward? Unfortunately the capacity of Maine’s public health system is threatened by continuing state budget cuts. Although Maine was among the visionary states that dedicated its tobacco settlement funds to health improvement and public health priorities, this vision is being lost. It needs to be reclaimed with support from employers who understand the economic importance for their business and the state of healthy workers and communities.

As Andrew Webber, president and CEO of the National Business Coalition on Health has suggested, employers do not perceive the incentives or benefits of investing in community health improvement. Yet, the experience of many business coalitions and other employers clearly demonstrates that such investments pay off in the areas of worker productivity, absenteeism and recruitment and retention benefits.

To move forward, public and private sector employers need to work in partnership with Maine’s public health system, community organizations such as local hospitals, and others to identify community health needs such as asthma or diabetes that, if addressed through collective action, would benefit both employers and the community.

Although Maine is a leader among states in national health rankings, we cannot ignore the fact that health care costs in this state have risen sharply in the last decade. Reducing the burden of disease will benefit employers and communities.

Dr. Andrew Coburn is chair of the master of public health program at the University of Southern Maine’s Muskie School of Public Service. He is a national expert in rural health and also directs the population health and health policy research program within the Muskie School’s Cutler Institute for Health and Social Policy.