Promoting health and wellness: A Survey on corporate wellness practices in Emilia-Romagna (Northern Italy)

Introduction

Corporate wellness encompasses activities and services provided by employers to support physical activity and healthier lifestyles among employees.^1,2 Common measures include access to on-site fitness facilities, the availability of healthier food options in workplace canteens, and the promotion of preventive health screenings. These initiatives are increasingly relevant in light of the high prevalence of unhealthy dietary patterns and physical inactivity among working-age populations.^3-5 
Unhealthy lifestyles are associated with a wide range of adverse health outcomes, including cardiovascular diseases, cancers, and metabolic disorders, with consequences for morbidity, mortality, and quality-adjusted life expectancy.⁶ National data indicate that a substantial share of workers spend more than 30 minutes commuting each way, which constrains the time available for physical activity.⁷ Nutritional risk factors such as inadequate consumption of fruit and vegetables – an established contributor to preventable morbidity and mortality worldwide⁸ – are widespread. Health prevention activities are also unevenly distributed in Italy. While participation in publicly organized cancer screening programmes is relatively high, individual uptake of routine health check-ups, such as cardiovascular or metabolic assessments, remains low at the national level.⁹ Regional data from the PASSI surveillance system indicate similar patterns for Emilia-Romagna Region (Northern Italy), with high participation in organised cancer screening programmes and lower uptake of routine health check-ups.
Given the time devoted to work and the influence of working conditions on daily behaviours, the workplace constitutes a suitable setting for health promotion initiatives and for improving access to healthier behaviours and preventive care.1 This paper examines these policies in Emilia-Romagna, a high-income Italian Region with a well-developed and diversified economy. This Region has a strong industrial base, particularly in manufacturing, and it is also known for its agricultural production. It includes several major cities, among which Bologna serves as an economic and cultural hub.
Emilia-Romagna consistently ranks among the leading Italian regions in terms of GDP per capita and overall economic performance¹⁰ and it benefits from a high standard of living and well-established social services. In 2024, the employment rate exceeded 70%. Despite generally favourable health indicators, excess body weight is common: 32% of adults aged 18-69 years are overweight, and 11% are obese.¹¹ Taken together, these features make Emilia-Romagna a suitable context for examining the diffusion of workplace health promotion practices.
This study focuses on the largest companies for two main reasons. First, these companies have a relevant impact on employment and their policies affect a large number of workers. Second, large companies are often at the forefront of implementing innovative initiatives and can serve as a reference point for smaller companies, which may face greater financial and organisational constraints in adopting wellness programmes.²
This survey examines several corporate wellness initiatives that companies can implement, including support for active mobility, the promotion of healthy eating and physical activity, and the provision of health check-ups. It also assesses companies’ perceptions of the benefits associated with these initiatives. While workplace wellness interventions have the potential to yield advantages such as improved organisational climate, enhanced recruitment, and better employee well-being, the empirical evidence on productivity and economic outcomes is mixed.^12-16
Given the limited evidence available for Italy and the absence of regional studies on corporate wellness practices, the objective of this paper is to provide a systematic description of the wellness initiatives implemented by large companies in Emilia-Romagna and to assess the perceived effects associated with these practices. Another aim is to document the types of initiatives adopted, exploring differences across domains – such as mobility, nutrition, physical activity, and prevention –, and identifying companies’ perceived benefits and unmet needs, particularly their interest in further support from public institutions.

Methods

The survey

The questionnaire, developed by the research team in collaboration with the institutional partners (the Emilia-Romagna Region and the Wellness Foundation), aimed to provide an encompassing view of wellness initiatives within companies by covering four domains: active mobility, healthy eating, physical activity, and prevention initiatives. It also included a set of exploratory items aimed at capturing the companies’ perceptions of the effects of wellness initiatives on organisational outcomes. Respondents were asked whether they perceived any impact of implemented wellness practices on productivity, absenteeism, employee turnover, working climate, employee health, and corporate attractiveness. These outcomes were measured through self-reported categorical responses and reflect perceived rather than objectively measured effects. The questionnaire included 29 multiple choice questions (excluding authorization for the use of data and privacy-related authorization) and 2 open questions for the identification of the firm. The prevalence of multiple-choice questions was aimed at simplifying the filling of the questionnaire, increasing the response rate, and simplifying the analysis. Once the design of the survey was completed, the research team ran pilots with institutional partners and, in particular, with offices which were not directly involved in the design of the survey to verify if any question was not clear and assess the functionality of the online interface. The survey took about 10 minutes to complete. The questionnaire was designed to minimize the time for completion, to reduce the likelihood of incomplete responses, and to increase the response rate.
The target population comprised the 200 largest companies in Emilia-Romagna by number of employees in 2022, the most recent year for which data were available.¹⁷ These firms were identified using administrative records from the Emilia-Romagna Chamber of Commerce. The survey was conducted in May and July 2024 as part of the activities of the Wellness Valley Observatory, a programme established by the Emilia-Romagna Region in 2023 in collaboration with the University of Bologna and the Wellness Foundation.
Companies were contacted through a two-stage process. Initially, researchers sent email invitations to institutional contact addresses where available or to general company email addresses. This was followed by telephone calls to non-respondents. Telephone contacts were used exclusively for follow-up and recruitment purposes; questionnaires were self-administered online and no assisted interviews were conducted. For companies that agreed to participate, reminder contacts were made as needed. Optional organisational identifiers (e.g., company name, contact email, VAT number) were collected only to facilitate potential follow-up and were not used for analysis. These identifiers were stored separately from survey responses and removed prior to data cleaning and analysis. All analyses were conducted on de-identified data and results are reported only in aggregated form.

Results

Researchers successfully reached approximately 150 companies via telephone, achieving a final response rate of 21% with 32 completed questionnaires.¹⁸ All responses were complete, with no exclusions due to missing data. Data collection took place between May and July 2024. Out of the 200 firms, 1 had been acquired and did not exist as an independent company anymore; 5 could not be contacted, because it was not possible to identify them or because they were partnerships of companies and it was unclear for whom they could answer; 4 refused to take part in the survey; in 4 cases, because their business could not apply these policies or refused to answer the questionnaire (e.g., because they hired employees only for a few hours per day and it was not feasible for them to provide these policies). In the remaining 40 cases, it was not possible to identify the proper contact or they did not answer the call/email despite several attempts to reach them (maximum of three attempts). The target respondents for the company were HR managers or white-collars in charge of wellness policies within the company or, for smaller companies, high-level managers such as CEO.  Figure 1 provides a visual description of the process.

Table 1 shows the characteristics of the respondent companies in terms of sector, location, and size together with some basic information on the actual respondents. As shown, respondents belonged to a variety of sectors (for simplicity, all sectors for which there were fewer than 3 respondents were grouped together in the “Other” category with companies that selected this category as their sector) with Manufacturing and Agriculture showing the largest share as single sectors (with 5 and 4 responses, respectively). In terms of location, respondent companies came from all provinces in the Region, although the provinces of Bologna and Ravenna represent about 22% of the sample each and Forlì-Cesena represents an additional 19%. As expected, the size of the respondent firms is very large with 75% of the respondents having more than 500 employees, well above the average Italian firm which was about 4 in 2021 according to the latest data reported by the Italian National Institute of Statistics (Istat)¹⁹. Finally, respondents to the survey were mostly from the Human Resources (HR) department (69%) and a similar share were managers within the firm. In most cases, managers were from the human resources department. The fact that the survey was completed by individuals in the HR department or in any case by managers supports the reliability of the responses, as these respondents are likely to be aware of company policies. 

The provinces contributing most to the survey were Bologna (7 responses), Ravenna (7 responses), and Forlì-Cesena (6 responses). The responding companies are generally larger than the average Italian company, with 8 companies employing between 100 and 500 workers, while the remaining companies employ more than 500 workers. In terms of economic sectors, manufacturing (5 responses) and agriculture (4 responses) were the most represented.
In almost 70% of the cases, responses came from personnel/staff in human resources departments, who tends to be aware of employee initiatives. In a further 10% of cases, responses came from offices that focus specifically on wellbeing issues, while a further 10% were submitted by the company management. The remaining responses came from other offices or consultants. The identity of respondents is relevant to assessing the reliability of reported information, as their organisational role influences awareness of wellness policies. In general, respondents showed they had direct access to relevant information and were likely to have complete access to information on these policies within the company. In terms of professional status, the majority of respondents were managers (60%), with the remainder being office workers.
The study results show that many companies are actively engaged in promoting employee health across various areas. Approximately 45% of companies promote active mobility by encouraging employees to use bicycles. In terms of healthy eating, 45% of surveyed companies have on-site canteens. A minority of companies promote physical activity and sports among employees: 20% of companies offer in-house gyms and 30% provide sports facilities or organise sports events. Finally, almost half of the firms support preventive activities such as screening and health assessments.
Nutrition is the most frequently reported area of intervention, with nearly all companies (97%) reporting some form of healthy eating initiative. Approximately 60% of companies report activities promoting physical activity and health monitoring, while 45% promote active mobility. Companies often engage in multiple domains simultaneously (Figure 2). 

In the following subsections, the specific initiatives implemented in each domain are detailed.

Mobility

This section focuses on policies that support employee mobility, in particular policies that provide the opportunity to replace private or public transportation with cycling.
The most common initiatives are the provision of parking spaces and showers and changing rooms, offered by approximately 38% and 25% of companies, respectively. Approximately 10% of companies provide employees with bicycles directly (Figure 3). It is noteworthy that a considerable number of companies are engaged in the promotion of mobility and cycling. Nearly 20% of companies collaborate with associations to organize these activities, while 12% have organized competitions among employees. In a minority of cases (approximately 5% of companies), economic incentives are provided for bicycle use (Figure 3). Additionally, approximately 12% of companies report implementing other types of bicycle-related initiatives (Figure 3).Approximately 15% of companies also promote walking to work. This mode of mobility aligns with the promotion of active commuting, but is viable only when the distances between employees’ homes and workplace allow for walking.

Nutrition

The promotion of a healthy lifestyle encompasses not only the encouragement of increased physical activity, but also the adoption of a balanced diet, which includes a variety of foods, such as fruits and vegetables, and the provision of lower-calorie meals to assist in the reduction of excess weight. A considerable proportion of the workforce lacks the opportunity to consume meals at home, where they could more effectively manage their diets and select healthier, lower-calorie options. Consequently, it is essential for companies to facilitate access to nutritionally balanced meals for their employees.
The majority of the interviewed companies reported engaging in activities to improve employee nutrition. Most companies provide their employees with a designated meal area, which is available in approximately 80% of the sample (Figure 4a). In these areas, employees are allowed to consume meals brought from home or purchased from outside, as well as meals from vending machines, which are present in approximately 70% of companies (Figure 4a). It is noteworthy that, when vending machines are available, 86% offer nutritionally balanced options, such as dried fruit and unsweetened beverages (Figure 4a). A smaller proportion of companies facilitate employee meals through external agreements (approximately 20%) and through the company canteen (approximately 45%) (Figure 4a).
The company canteen represents an important initiative, as it requires not only adequate space, but also the organization of meal preparation and, in some cases, the employment of external staff for management and distribution. By offering this service, companies can directly influence the types of meals served and the options available to employees. As shown in Figure 4b, all companies with a canteen provide employees with fruit and vegetables, which are essential components of a diet aimed at reducing the risk of non-communicable diseases. Approximately 50% of these companies are actively working to reduce the caloric content of meals and to promote a balanced diet.

Physical activity

Physical activity is essential for employee health and preventing excess weight. Work schedules can hinder the ability to engage in physical activity, particularly if employees lack easy access to gyms or exercise spaces. In this context, providing corporate physical activity services can be beneficial for health and cost-effective in terms of time and expenses.
Data indicate that many companies do not actively implement corporate wellness programmes related to gym access or sports activities. As shown in Figure 5, the percentage of companies responding “Don’t apply/Don’t know” exceeds 50% for both questions. Nonetheless, a notable share of companies does provide access to company-related gyms. Almost 35% of companies have agreements with external facilities, while 20% have in-house gyms. Approximately 50% of companies directly or indirectly promote sports activities, with approximately 30% directly offering sports facilities and organising internal events. Additionally, about 30% provide information on sports activities in the area close to the company, while approximately 20% promote participation in external sport events.
It is noteworthy that 32% of companies encourage the use of stairs, while 25% promote active breaks. The adoption of standing desks remains extremely limited, with only 6% of companies implementing them. This indicates an untapped potential for improving physical well-being in the workplace, as standing desks represent a relatively low-cost investment for companies. Overall, the promotion of physical activity at work appears to be inadequately incentivized. Despite encouraging basic levels of work-compatible mobility – such as using stairs instead of elevators or incorporating active breaks – these solutions are rarely adopted. While they are easily implementable and low-cost, they remain relatively uncommon.

Health monitoring

At the company level, survey results indicate that about half of companies are involved in some form of health monitoring. Specifically, 25% of companies directly organise periodic health check-ups, i.e., preventive assessments offered or facilitated by the company, such as general medical examinations, cardiovascular risk screening, or age-appropriate cancer screening invitations. A further 25% of respondents do not provide these services internally, but encourage employees to participate in external monitoring programmes. The relatively limited diffusion of both direct and indirect initiatives may be related to the organisational resources required for their implementation.
Furthermore, several companies undertake initiatives aimed at discouraging unhealthy lifestyles and behaviours through information campaigns and awareness activities (Figure 6). Among these measures, anti-smoking campaigns are the most common, implemented by about 30% of companies, followed by initiatives promoting weight control (18%) and those addressing alcohol consumption (15%). Given their relatively low implementation costs, information campaigns can represent an effective approach to increasing employee awareness of health risks associated with these behaviours, supporting healthier lifestyle choices and potentially reducing the incidence of related conditions, including oncological and cardiovascular diseases.

Impact on company productivity

As an exploratory component of the survey, companies were asked whether they perceived any effects of implemented wellness initiatives on organisational outcomes, including productivity, absenteeism, employee turnover, working climate, employee health, and corporate attractiveness. Results are based on self-reported perceptions and should be interpreted as descriptive evidence rather than objective measures of performance. The data collected in the survey, presented in Figure 7, provide some insights into companies’ perceptions of the benefits derived from implementing wellness policies. Approximately 60% of companies report benefits from the implementation of these initiatives. Among them, 70% observe an improvement in the working climate, 65% report better employee health, and 60% find an increase in corporate attractiveness. However, only about 22% of companies perceive improvements in worker productivity, and only a few report lower employee turnover. Notably, no firm indicated a reduction in employee absences. Overall, the perceived benefits appear to be primarily associated with a more positive working environment, with limited effects on worker performance. It remains possible that additional benefits may materialize in the long term, particularly in terms of reducing chronic diseases.
The survey also assessed the potential role of external consultants and service providers in influencing the perceptions of wellness impact at the corporate level. These professionals can assist companies in defining optimal wellness programmes, thereby reducing development costs and maximizing the beneficial effects of such programmes. Even though a considerable number of companies reported that they had not engaged with external consultants, 31% of companies used consultants for at least 10% of the wellness programmes that they implemented. Furthermore, 46% of companies indicated that they would have adopted a greater number of wellness initiatives if they had received greater public support. This highlights an opportunity for public policy to incentivise such initiatives through training or financial incentives. The involvement of external actors, both private and public, could facilitate the adoption of corporate wellness programmes.

Discussion and conclusions

This study presents an exploratory analysis aimed at understanding the diffusion of wellness practices among large companies. To this purpose, a survey was conducted on large companies by number of employees in one of the most developed Italian regions, Emilia-
Romagna.
The findings of the survey indicate that most participating companies report being active in promoting corporate wellness activities, with a particular focus on nutrition and physical activity. The level of engagement across wellness domains varies considerably. Nearly all surveyed companies encourage healthy eating, about 60% report health-monitoring initiatives, and a similar share report physical-activity initiatives, and 45% have implemented measures supporting active mobility. These results suggest that some wellness practices are relatively well established among large firms, while other areas – particularly low-cost informational and preventive activities – may still offer scope for further development.
These patterns are broadly consistent with both international and Italian evidence on workplace health promotion. Previous studies show that nutrition-related interventions and health monitoring are among the most commonly adopted corporate wellness practices, as they are relatively easy to integrate into existing organisational structures and often involve limited behavioural change.^14,16 By contrast, initiatives promoting active mobility or structured physical activity are less widespread, likely because they require greater organisational investment, dedicated spaces, or supportive external infrastructure.²⁰ Italian and regional evidence similarly suggests that companies tend to prioritise interventions that are low-cost, highly visible, and easier to implement, while more complex or resource-intensive programmes remain less common. The observed heterogeneity across wellness domains may therefore reflect differences in implementation costs, organisational capacity, and perceived returns, rather than differences in awareness of health promotion goals. A particularly sensitive area concerns health monitoring and preventive check-ups offered or facilitated by firms. In this study sample, about half of participating companies reported engaging in some form of health monitoring, either internally or by encouraging participation in external programmes. The potential public-health value of these initiatives depends crucially on whether they align with evidence-based and risk-based prevention pathways (e.g., cardiovascular risk assessments for appropriate age/risk groups and organised cancer screening programmes) rather than undifferentiated general check-ups.^21,22 Regarding organisational outcomes, companies more frequently reported perceived benefits for workplace climate, employee well-being, and corporate attractiveness than for productivity or absenteeism. This is consistent with the mixed evidence in the literature on productivity-related effects of workplace wellness programmes, which may be difficult to detect in the short run and can depend on programme design, uptake, and time horizons.^15,20,23 In this context, the results of this study should be interpreted as descriptive and hypothesis-generating evidence on companies’ perceptions, highlighting areas where more rigorous longitudinal evaluation may be warranted.
While surveyed companies report perceived benefits of wellness policies in terms of improved corporate attractiveness and a more positive working environment, evidence of perceived improvements in performance or reductions in absenteeism is limited. Importantly, these findings reflect companies’ perception rather than objectively measured outcomes. The absence of widespread reported productivity gains does not imply that such effects are absent, but rather that they may be difficult to detect in a descriptive, cross-sectional survey and may emerge only over longer time horizons. As such, any potential productivity or economic benefits of corporate wellness initiatives should be interpreted as hypotheses for future research rather than as conclusions drawn from the present study. Accordingly, the findings on productivity should be interpreted as descriptive evidence of companies’ perceptions and as hypotheses for future research, rather than as estimates of causal or economic effects.
The survey also indicates that a substantial share of companies would consider expanding wellness initiatives if additional external support were available. This finding points to a potential role for public or private actors – through incentives, technical assistance, or information-sharing platforms – in facilitating the adoption of workplace wellness practices, particularly beyond large firms. However, given the descriptive nature of the evidence, these considerations should be viewed as indications of perceived needs rather than as prescriptive policy recommendations.
This study has several limitations that should be considered when interpreting the findings. First, the response rate was modest (21%) and the small sample of 32 companies limits statistical precision and may introduce non-response bias, as firms more interested in wellness initiatives may have been more likely to participate. Second, the geographic distribution of respondents is concentrated in some provinces of Emilia-Romagna, which may limit the representativeness of the sample and the generalizability of the results to the entire regional context. Third, all information was collected through self-reported answers and refers to perceived rather than objectively measured outcomes, which may be affected by social desirability and reporting biases. In addition, the survey captures the presence of company-level initiatives as reported by organisational respondents, but it does not measure employee-level awareness, participation, uptake, or intensity of use. Consequently, it cannot be assessed to what extent reported initiatives translate into concrete practices experienced by employees nor distinguish between symbolic or ‘on-paper’ policies and initiatives that are actively implemented and used. Fourth, the cross-sectional design does not allow for causal inference or assessment of changes over time. Finally, the descriptive nature of the analysis and the limited sample size prevent the estimation of precise effect measures or uncertainty indicators, such as confidence intervals. Despite these limitations, the study offers a valuable descriptive snapshot of corporate wellness practices in a major Italian Region and provides insights useful for generating hypotheses and guiding future research and policy discussion.

Conflicts of interest: none declared.

Funding: the survey was implemented as part of the activities of the Observatory. The authors had the financial support of the Emilia-Romagna Region and the Wellness Foundation. The research presented in this article was carried out within the activities of the 2020-2024 Osservatorio Wellness of the Emilia-Romagna Region.

Acknowledgements: the Authors thank Federica Aliberti, Marco Bigica, Sonia Bonanno, Fabio Longo, Federico Pettazzoni, Daniela Tamburini, the Emilia-Romagna Chamber of Commerce, the Emilia-Romagna Region, the Wellness Foundation, and all the participants in the Emilia-Romagna Region Wellness Observatory for their comments and suggestions.

Data availability: aggregated and anonymized survey data, together with the questionnaire, are available from the corresponding author upon reasonable request.

Ethical approval: the survey collected organisational-level information. Optional organisational identifiers (e.g., company name/contact details) were collected solely for potential follow-up, stored separately, and removed prior to analysis. Participation was voluntary and analyses were conducted on de-identified data; results are reported in aggregate form. Ethical approval was not required under the University of Bologna’s research policy for studies involving organisational respondents.

References and notes

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17. The Wellness Valley Observatory was created to collect, analyse, and disseminate information on corporate wellness initiatives across the region. It provided the conceptual framework for this survey, contributed to questionnaire development, and coordinated communication with eligible firms. Its broader mandate includes monitoring workplace health promotion practices and informing regional policy development.
18. Relative to the initial sampling frame (N. 200), the completion rate was 16% (32/200).
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