Background. Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have
been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing
health economics contention that return on investment (ROI) does not merit preventive health investment. Methods/Procedures.
Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and
alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value.The issues are presented in the
format of 3 conceptual dilemmas. Principal Findings. In some occupations such as nursing, the utility of patient survival and staff
health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting
and eliminating the drag of negative value radically change the CBA value. Significance. Simple monetization of a work life and
calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of
productivity and utility.