Canadian approaches to the promotion of health in small workplaces

The promotion of health in small workplaces is particularly challenging. Research was conducted to identify the types of agencies offering prevention and promotion services to small workplaces, and to describe the activities and strategies used to engage this "hard-to-reach" population. This paper reports on a survey of 58 agencies located across Canada. Agencies were mostly of recent origin, many having arisen in response to legislative and other government initiatives, and of two essential types: those that used the workplace as a site for addressing general lifestyle health behaviours, and those addressing the occupational determinants of health. Their location, staffing and program focus reflected their orientation. Factors believed by respondents to influence program effectiveness are summarized. The paper notes the top-down origins of many prevention/promotion efforts, their inherent management bias, and the differing perspectives that underlie the lifestyle and occupational approaches to workplace health. A call for integration of the two approaches is made.