Introduction Health promotion programs may succeed in mid- to large-size companies, but what can be done to reach the small enterprises where the majority of people work? Furthermore, how successful can these efforts be and what is the value of investing in small business employee health? This presentation will examine the nexus of workers’ compensation (WC), health promotion, productivity and small businesses.

Methods Three-hundred and fourteen businesses and 16 926 of their employees participated in a multi-year worksite wellness program offered by a WC insurer in the United States from 2010–2014. Yearly self-report health risk assessment data and WC claims data were collected. In a series of studies using logistic and generalised linear models, we examined the relationship between employee health, safety and productivity. Additionally, using data from employees who participated in the program for 2+years (n=5,766), we examined the change in health during the WWP.

Results A greater number of small businesses (<500 employees) participated in the WWP than large businesses (500+employees). Additionally, small businesses had higher employee participation rates than large businesses.

WC claims were best predicted by the occurrence of a previous WC claim and poor behavioural health (e.g., depression). Productivity at work was best predicted by previous WC claim, increasing numbers of chronic health conditions, and work task difficulty.

Small businesses gained the most from the WC insurer-driven WWP, compared to large businesses. Small businesses (<500 employees) saw improvements in job health culture, stress, depression, overall health rating, smoking, nutrition, and exercise from baseline to 1 st and 2nd follow-up.

Discussion Our results demonstrate the value of investing in employee health generally and the value of doing so through local, intermediary organisations. Employers who control jobsite safety hazards and promote employee health can observe gains in productivity and reductions in injury.