Wellness Matters at Tacoma-Pierce 

County Health Department: Case Study

National Center for Chronic Disease Prevention and Health Promotion 

Division of Population Health

Organization Background 

Tacoma-Pierce County Health 

Department

« Established in 1971

« Industry: Governmental 

public health 

« Location: Tacoma, Washington

« 253 Employees

CS257190L

Tacoma-Pierce County Health 

Department tackles known and 

emerging health risks through 

policies, programs, and treatment 

in order to protect public health. 

Through activities such as preventing 

and controlling disease outbreaks, 

educating food workers, and 

inspecting septic systems, the Health 

Department promotes healthier 

communities where people live, work, 

and play throughout Pierce County. 

Its vision of “Healthy People in 

Healthy Communities” includes its 

own employees.

Tacoma-Pierce County 

Health Department applied 

principles of implementing 

a comprehensive health 

promotion program learned 

during the NHWP by putting 

in place a combination of 

programs, policies, and 

environmental supports to 

address multiple areas of 

employee health.

Participating in the CDC’s National Healthy 

Worksite Program

Getting Started 

Tacoma-Pierce County Health Department had a wellness program in 

place for a few years, but it ended because of a lack of funding. Staff 

learned from that experience, and when they heard about the Centers 

for Disease Control and Prevention’s (CDC’s) National Healthy Worksite 

Program (NHWP), they saw an opportunity to use the NHWP’s 

comprehensive assessment and technical assistance components to 

build a new wellness program. 

Because the mission of the 

Health Department is to 

safeguard and enhance the 

health of communities in 

Pierce County, senior leaders 

and wellness committee 

members were confident 

that they could use the 

NHWP’s technical assistance 

to build a comprehensive and 

sustainable wellness program. 

The Health Department 

had already integrated 

staff wellness into its 5-year 

strategic plan, and its leaders 

saw participation in the NHWP as a way to share its comprehensive 

wellness program experience and expertise with other employers in 

Pierce County. Wellness Coordinator Diane Evans led the charge for 

the organization to create its “Wellness Matters” program.

Setting Goals

One of the first NHWP activities that the Health Department 

completed was a baseline assessment of its employees’ health in 

2013. The assessment included employee health surveys covering 

health conditions, healthy behaviors, and perceptions about the work 

environment, as well as biometric screenings. Like all of the employers 

participating in the NHWP, the Health Department also completed 

the CDC Worksite Health ScoreCard, a validated organizational tool 
designed to help employers assess the extent to which they have implemented evidence-based health promotion 

interventions in their worksites.

The assessment highlighted priority focus areas based on the health risks most prevalent among Health 

Department employees. The wellness committee set four goals and specific, measurable, relevant, and timebound objectives to be achieved by the NWHP follow-up assessment in 2015. These goals and objectives are 

as follows:

• Goal: Healthy Eating.

° Reduce the percentage of obese employees by 2%.

° Increase the percentage of employees who eat 5 or more servings of fruit and vegetables a day by 

at least 5%.

• Goal: Physical Activity.

° Reduce the percentage of employees who engage in little or no physical activity by at least 5%.

• Goal: Stress Management.

° Increase the percentage of employees who agree that the Health Department has provided them with the 

opportunity to manage their stress by at least 5%.

• Goal: Organizational Climate and Support.

° Increase the percentage of employees who agree that the Health Department has provided opportunities 

to be physically active and eat a healthy diet.

Evans participated in all NHWP trainings and webinars that addressed the main developmental stages for a 

wellness program, which are assessment, planning, implementation, and evaluation. She also participated in 

monthly technical assistance calls with CDC staff to share updates, get advice, and learn about resources. Evans 

spends half of her time at the Health Department on wellness duties. The wellness committee meets monthly and 

has eight members, including a sponsor from the Health Department’s management team. Committee members 

spend an additional 1 hour each month supporting workplace health activities.

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Program Overview

Communication Is Key

The wellness committee uses a variety of strategies 

to share information about wellness and its 

Wellness Matters activities. Committee members send 

e-mails, make announcements at staff meetings, 

post information on bulletin boards, and put flyers 

in employee breakrooms. The committee uses all 

opportunities to get employees’ attention, including 

posting flyers in the restrooms for “stall talks.”

The Health Department also produces a biweekly 

newsletter for staff, and senior leaders contribute 

health tips and share stories about how they are 

embracing wellness. During the Health Department’s 

participation in the NHWP, the wellness committee 

created an employee website to post information 

about wellness program activities; healthy recipes; 

and articles designed to promote the program, 

highlight success stories, and feature management 

role models.

Setting the Tone with a Worksite Wellness Policy

Evans worked with the Health Department’s human 

resources department and management team to 

develop a formal worksite wellness policy. The policy 

promotes and supports employee wellness and 

provides wellness committee members time to be 

involved in the program through monthly meetings 

and other activities. 

Promoting Healthy Eating

In 2009, the Health Department developed a 

healthy eating policy that set standards for meals and 

refreshments served at agency-sponsored events. For 

the 2014 employee picnic, the wellness committee 

created a healthy menu for the 200 employees who 
attended. The Health Department also organized 

a scavenger hunt that led employees on a walking 

route with markers along the way linked to the jersey 

numbers of Seattle Seahawks. The markers had 

information about healthy options in office vending 

machines, the location of the employee fitness center, 

and the location of on-site massage services. At the 

end of the scavenger hunt, employees were told 

that they could use the route and time for a walking 

meeting. It was a fun way for employees to learn how 

easy it is to conduct a walking meeting.

The wellness committee also promoted Community 

Supported Agriculture by distributing the 2014 

Pierce County Farm Guide at the Health Department’s 

Employee Benefits Fair in December 2014. It 

promoted local farmers’ markets and distributed 

locally grown fruits and vegetables to help entice 

employees to use the markets. Committee members 

used the new employee wellness website to share 

healthy recipes and eating tips. 

For a fun demonstration that combined healthy 

eating and physical activity, the committee brought 

a “smoothie bike” into the employee breakroom 

for a few hours. 

Employees were 

encouraged to 

make their own 

healthy snacks 

with foot power. 

The bike had a 

pedal-powered 

blender over the 

front fender to 

mix fruits and 

vegetables into a 

smoothie. 

Encouraging 

More Physical 

Activity

The wellness committee promoted multiple ways for 

employees to be physically active. Employees have 

access to an on-site exercise facility, and walking 

meetings are widely promoted and modeled by staff 

and management at all levels. The committee also 

found short video clips and posters of stretches and 

other exercises that employees could perform at their 

desks. These 

were posted 

in common 

areas and on 

the employee 

wellness website. 

The Health 

Department 

promotes 

physical activity 

opportunities during the workday, and managers and 

supervisors support employees’ use of short breaks 

for stretching and exercise. 

Moving More on Two Feet and Two Wheels

The wellness committee also helped set up employee 

walking groups and promoted a local walking guide 

to encourage employees to walk with their families 

outside of work. About 30 employees regularly 

participated in walking groups in 2014. 

With leadership support, the wellness committee 

recruited a team of 29 employees and family 

members for the American Heart Association’s (AHA’s) 

Heart Walk in 2014. Other employees supported the 

event by bidding on silent auction items during the 

employee picnic. The team raised more than $2,000 

and, employees said they enjoyed the walk so much, 

they want to do more in the future. 

Also in 2014, the committee promoted a “bike to 

work month” and learned that employees and visitors 

had limited places to park their bikes at the Health 

Department. The committee worked with the City of 

Tacoma to install additional bike racks for free.

Providing Ways to Reduce Stress 

The wellness committee partnered with another 

NHWP worksite, Greater Lakes Mental Healthcare, 

to deliver a presentation on stress management 

and depression to staff and to promote the Health 

Department’s employee assistance program (EAP). 

Fifty-four employees attended the presentation. Its 

popularity prompted the committee to offer monthly 

self-care discussion groups during which staff shared 

their personal and professional challenges and got 

advice and acknowledgment from their colleagues. 

About 30 employees attended.

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Health Department employees walking with the 

Director of Health. 

Photo provided by Tacoma-Pierce County Health Department. 

Diane Evans tests out the “smoothie bike” 

in the employee breakroom.

Photo provided by Tacoma-Pierce County Health Department.
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“Many of our employees model healthy 

behaviors at work and in their own lives, and we 

support them.” 

—Dr. Anthony L-T Chen, Director of Health, 

Tacoma-Pierce County Health Department

The wellness committee also used the Pierce 

County Worksite Wellness Community Resource Guide 

to identify local stress management resources. 

It promoted these resources, as well as stress 

management support services from the EAP. It also 

made sure employees were aware of the individual 

stress management counseling available through 

the EAP and the Health Department’s insurance plan. 

To address stress from a different angle, the Health 

Department brought in a massage therapist to 

provide on-site, seated massages each month. 

Employees signed up online for time slots during the 

workday and paid for their own sessions. The time 

slots were filled every month, and 37 employees 

took advantage of the massages in 2014.

Improving Organizational Climate and Support

In 2014, Dr. Anthony L-T Chen, the Health 

Department’s Director of Health, expanded the 

department’s management team to include middle 

managers and supervisors. This expansion helped 

to ensure that managers and supervisors at all levels 

were focused on the same priorities, including 

employee wellness. One of the team’s focus areas 

for the year was self-care, which aligned with the 

efforts of the Wellness Matters program. Dr. Chen 

encouraged management team members to make 

self-care a priority for themselves and to mentor and 

support their employees to do the same.

Super Power Gram delivery to a health department employee. 

Photo provided by Tacoma-Pierce County 

Health Department.

Raising Funds and Morale

Instead of holding its usual bake sale to raise money 

for the United Way in 2014, the wellness committee 

found a way to incorporate its Wellness Matters 

objectives of improving healthy eating and building 

a supportive environment into the fundraising 

campaign. To encourage coworker support and 

recognition, 

the committee 

built on the 

2014 campaign 

theme of “Be 

a Super Hero” 

and encouraged 

employees to 

recognize their 

colleagues’ 

“super powers” by sending them “Super Power Grams” 

in exchange for United Way donations ranging from 

$1 to $10. Because Health Department leaders believe 

that good employee morale promotes health and 

productivity, they supported using the annual United 

Way campaign to leverage the Health Department’s 

supportive culture to raise morale and promote 

employee health. 

In all, 103 Super Power 

Grams were delivered 

to employees. During 

the campaign, staff 

were encouraged to 

express themselves 

through “gratitude 

graffiti” on large 

sheets of paper 

posted on the walls of 

conference rooms. 

I’m grateful for...“My 

health...family & friends...

supportive boss...my 

dog...helpful team 

members...anything 

that makes me laugh...

coffee... chocolate...new 

opportunities.”

—Examples of “gratitude 

graffiti” at Tacoma-Pierce 

County Health Department

Program Success

The Health Department set up a comprehensive 

health promotion program that addressed multiple 

health risks with a combination of programs, policies, 

and environmental supports. Evans said she believes 

that the recognition the Health Department has 

received from others show how successful its efforts 

have been. For example, in 2015, the Association of 

Washington Cities Employee Benefit Trust named 

the Health Department one of 111 cities and public 

agencies to win its WellCity Award. Winners had 

to meet nine WellCity standards (e.g., policies and 

procedures, management support, evaluating 

progress toward objectives). The award included a 

$54,000 reduction in medical premium costs for 2016. 
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The Health Department also attained Gold Level FitFriendly Worksite status from AHA by implementing 

at least six of AHA’s physical activity criteria, two of 

its nutrition criteria, 

and at least one of 

its culture criteria 

(e.g., organization 

appoints an 

internal wellness 

program 

coordinator to 

be available to 

employees for 

consultation). 

After it finished the NHWP in 2015, the Health 

Department completed the CDC Worksite Health 

ScoreCard again as part of its follow-up assessment. 

The Health Department improved its total ScoreCard 

score from 101 to 174 out of a possible 264 points 

by increasing its score in several areas, including its 

goal areas of nutrition, physical activity, and stress.

Some examples of the evidence-based strategies 

that the Health Department received points for in its 

2015 ScoreCard, that is did not have in place in 2013, 

included the following:

• Offering and promoting an on-site or nearby 

farmers’ market where fresh fruits and 

vegetables were sold.

• Providing organized physical activity programs 

for employees.

• Providing stress management programs.

• Training managers to identify and reduce 

workplace stress.

The Health Department made the largest gains in 

its score for the Organizational Supports module, 

which assesses the extent to which organizations 

have a foundation and infrastructure in place to 

support and maintain a workplace health promotion 

program. The Health Department now promotes 

and markets health promotion programs to 

employees; uses examples of employee role models 

for appropriate health behaviors or success stories in 

marketing materials; uses and combines incentives 

with other strategies to increase participation 

in health promotion programs; and sets annual 

organizational objectives for health promotion. 

Diane Evans accepts the Gold Level Fit Friendly 

Worksite award from Jessica Sire of the American 

Heart Association. Photo provided by TacomaPierce County Health Department. 

0 5 10 15 20 25 30

Organizational Supports

Nutrition

Physical Activity

Stress Management

2015 Score 2013 Score

CDC Worksite Health ScoreCard Overall Score 

in Wellness Programming, 2013-2015

In 2013, 58 employees completed the baseline health 

assessment. In 2015, 95 employees completed the 

follow-up assessment, including 60 of the original 

158. The assessment data related to the issues that 

the wellness committee focused its efforts on, are 

summarized in the tables below. 

2013 Employee Health Issues and Lifestyle Risks Profile

(Employees = 158)

Self-Reported Health Assessment Survey

Eat at least 5 daily servings of fruits and 

vegetables

13%

Engage in little or no physical activity 51%

High stress 39%

Biometric Screening

Overweight (Body mass index 25.0-29.9) 41%

Obesity (Body mass index >30) 32%

2015 Employee Health Issues and Lifestyle Risks Profile

(Employees = 95)*i

Self-Reported Health Assessment Survey

Eat at least 5 daily servings of fruits and 

vegetables

23%

Engage in little or no physical activity 27%

High stress 42%

Biometric Screening

Overweight (Body mass index 25.0-29.9) 45%

Obesity (Body mass index >30) 23%

*Percentages include all employees who provided data in 2015, 

including those who did not complete the 2013 assessment.
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When the data were analyzed for just 

the 60 employees who completed 

both health assessments, the 

Health Department found that the 

percentage who were eating at least 

5 daily servings of fruits and 

vegetables had increased from 

12% in 2013 to 26% in 2015. The 

percentage who were engaging in 

little or no physical activity decreased 

from 46% in 2013 to 31% in 2015. 

The percentage who were obese or 

overweight stayed the same: 27% and 

42%, respectively. 

In 2015, a higher percentage of 

employees said that the work 

environment at the Health 

Department supported their health 

and well-being at the organizational, 

supervisory, and coworker level. 

Percentage of Employees Who Agree or Strongly Agree

2013 (N = 158) 2015 (N = 95)

My organization encourages me to make 

suggestions about employee health and 

well-being.

56% 65%

My supervisor encourages healthy 

behaviors.

64% 70%

My coworkers would support my use of 

sick days for illness/mental health.

77% 86%

My employer has provided me with the 

opportunity to:

Be physically active 68% 71%

Eat a healthy diet 45% 53%

Manage stress 20% 40%

Leadership Support Is Critical

Evans said she thinks that having Dr. Chen as a strong advocate 

and role model of employee wellness was critical to the wellness 

program’s success. Dr. Chen’s perspective is that everybody in 

the Health Department plays a role in increasing wellness, not 

just the wellness committee. The Health Department’s expanded 

management team helped bring managers and supervisors 

on board. Staff and supervisors at all levels began to promote 

and support wellness and self-care in 2015, further integrating 

the Health Department’s wellness program with its overall 

organizational strategy. 

Challenges

The Health Department’s greatest challenge is 

being a government agency with public scrutiny of 

how money is spent on incentives and rewards for 

its employees. The Health Department has relied 

primarily on nonmonetary incentives and services, 

but other organizations have donated services (e.g., 

the on-site massages) in some instances. When 

the Health Department does receive resources for 

incentives, its leaders are thoughtful about how to 

use these resources to reinforce healthy choices. 

For example, the committee received tokens that 

could be used at the farmers’ market, and it strongly 

encouraged employees to use them to buy fresh 

vegetables. 

Another challenge, which is common for many 

organizations, has been maintaining the energy 

and commitment levels of the wellness committee 

members, given all of their regular job responsibilities. 

But Evans noted that they have accomplished quite a 

bit in a very short time.

The Health Department’s Heart Walk 2014 team of employees 

and family members. 

Photo provided by Tacoma-Pierce County Health Department.
What’s Next?

The Health Department plans to maintain the positive changes it has made to its worksite culture and employee 

health, and those employees involved in the NHWP efforts are looking for new areas to make improvements. 

Specifically, the Health Department plans to 

• Produce more walking maps to encourage employees to explore local areas on foot. 

• Introduce standing workstations for employees to use on a rotating basis and provide ergonomic guidelines 

for their correct use.

• Apply for the WellCity Award in 2016. 

The National Healthy Worksite Program was designed to help employers put into action 

science- and practice-based disease-prevention and wellness strategies that would lead 

to specific measurable health outcomes to reduce chronic disease rates. From 2013-2015, 

each participant received support, training, and technical assistance to put in place a 

combination of program, policy, and environmental interventions to support physical 

activity, good nutrition, and tobacco-use cessation.

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