The Role of Leaders

There is growing literature on the important role that leaders play in advancing cultures of health in the workplace across different organizational settings.1 As the World Health Organization framework for risk and protective factors for mental health in this report indicates (see Table 7 on page 38 of the full PDF report), positive leadership is an attribute of work culture that influences the environment in a way that may support mental health in the workplace. By contrast, it appears that negative leadership styles have the potential to adversely impact physical and mental health.

Studies show that behaviors of leaders and supervisors influence the actions and job performance of employees2 and that unsupportive managers are associated with poorer employee health and higher turnover.3,4 More recent evidence builds on previous studies to show that having an unsupportive supervisor is also associated with poor heart health. A 2018 analysis of Gallup-Sharecare Well-Being Index data found that not trusting your supervisor was associated with an increased adjusted odds of having many risk factors for cardiovascular disease (based on the American Heart Association’s definition of ideal cardiovascular health called Life’s Simple 75 ). Among workers whose supervisor created a mistrustful environment, the odds ratios were the greatest (>20%) for having four or more Life’s Simple 7 risk factors, that is, having poor heart health.6
Having an unsupportive supervisor at work
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is correlated with increased heart health risk factors.

Although the workplace health literature points to several elements of workplace culture of health (COH) as important, there is sparse evidence on which elements are most strongly associated with employee physical and mental health outcomes.

Note: Recently, John Quelch from Harvard Business School has conceptualized COH as comprising four elements or pillars: healthy, products, healthy employees, healthy community and healthy environment.7 While the American Heart Association supports this approach, healthy products, communities, and environment were not part of the scope of this report.

A recent evaluation using 2013-2015 data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initative, evaluated the effect of seven workplace COH elements (environmental supports, policy supports, programmatic supports, leadership support, coworker support, employee engagement and strategic communications) on self-reported lifestyle risks (nutrition, physical activity and tobacco use).8

Data were evaluated from 825 employees from 41 companies that participated at the start of the study in 2013 and at follow-up in 2015. At the start of the study, leadership support, coworkers support and employee engagement were significantly associated with lifestyle risks. At follow-up, however, only leadership support was statistically significantly associated with lifestyle risk (p<0.05) and environmental and policy supports were marginally significant (p<0.10). Although the study design had many strengths, including measuring both employer and employee indicators and multilevel modeling, changes in mental health was not measured.

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Perceptions of a “good” organizational climate were significantly associated with positive employee mental health outcomes such as lower levels of burnout, depression and anxiety.

Studies on employee mental health outcomes have included measures of burnout. This burnout literature is predominantly set in healthcare settings (doctors, nurses and social workers). In a 2015 systematic review of studies in healthcare organizations on the effect of organizational climate and employee health outcomes found that perceptions of a “good” organizational climate were significantly associated with positive employee mental health outcomes such as lower levels of burnout, depression and anxiety.9 In this study, coworker support was the strongest indicator, although leadership support was also related to the mental health outcomes of nurses. While this may be the case in healthcare settings, more research is needed to evaluate which dimensions of workplace culture of health elements have the strongest effect on a range of mental health outcomes.

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The practical implications for employers is that paying attention to positive leadership and management styles, and stimulating a supportive atmosphere among employees, are actionable strategies for addressing employee mental health.


  1. Brownson R.C., Colditz G. A., &map; Proctor E. K. (2018). Dissemination and Implementation Research in Health: Translating Science to Practice: Oxford Scholarship Online.
  2. Lin Y. W., & Lin Y. Y. (2014). A multilevel model of organizational health culture and the effectiveness of health promotion. Am J Health Promot, 29(1), e53-63. doi:10.4278/ajhp.121116-QUAN-562.
  3. Munir F., Randall R., Yarker J., & Nielsen K. (2009). The Influence of Employer Support on Employee Management of Chronic Health Conditions at Work. Journal of Occupational Rehabilitation, 19(4), 333. doi:10.1007/s10926-009-9199-7. Retrieved from 10.1007/s10926-009-9199-7
  4. Maertz Jr C. P., Griffeth R. W., Campbell N. S., & Allen D. G. (2007). The effects of perceived organizational support and perceived supervisor support on employee turnover. Journal of Organizational Behavior, 28(8), 1059-1075. doi:doi:10.1002/job.472. Retrieved from
  5. American Heart Association. Workplace Health- Life’s Simple 7. Retrieved from
  6. Alterman T., Tsai R., Ju J., & Kelly K. M. (2019). Trust in the Work Environment and Cardiovascular Disease Risk: Findings from the Gallup-Sharecare Well-Being Index. International Journal of Environmental Research and Public Health, 16(2), 230. Retrieved from
  7. Quelch J. A., & Boudreau E. C. (2016). Building a Culture of Health: Springer International Publishing. Retrieved from
  8. Payne J., Cluff L., Lang J., Matson-Koffman D., & Morgan-Lopez A. (2018). Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk. Am J Health Promot, 32(7), 1555-1567. doi:10.1177/0890117118758235. Retrieved from
  9. Bronkhorst B., Tummers L., Steijn B., & Vijverberg D. (2015). Organizational climate and employee mental health outcomes: A systematic review of studies in health care organizations. Health Care Manage Rev, 40(3), 254-271. doi:10.1097/hmr.0000000000000026. Retrieved from