Chapter one – The case for worksite health promotion

1. HLED 411, Fall 2008 Chapter one – The case for worksite health promotion

2. Layoffs • Strikes • Corporate takeovers • Bankruptcy • Plant closings • Rising cost of health care • For many, employee health care represents approximately 50% of profits. • In 2006, businesses paid over 40% of Nation’s total health care bill. What is the future of business?

3. Over a 4-Year Period: • Average individual wages increased 12.4% while employee health care insurance premiums increased nearly 36%. • In 26 states employee health insurance premiums rose over 40%. • On average employer-paid premiums increased 32%. • # of Americans who had personal health care costs exceeding 25% of earnings rose from 11.6 million to 14.3 million (about 1 out of every 10 working adults) Lewin Group study:

5. Worksite Health Promotion: A combination of educational, organizational, and environmental activities designed to improve the health and safety of employees and their families. Report of the 2000 Joint Committee on Health Education Terminology definition

6. 1879 – Pullman Company formed an athletic association for it’s employees. 1884 – National Cash Register Association’s president John R. Patterson organized morning pre-work horseback rides. He later implemented morning and afternoon exercise breaks, built an employee gym and added a 325-acre recreation park. 1930’s – Hershey Foods Corporation – built an employee recreation complex with an indoor swimming pool. early History

7. 1941 – National Employee Services and Recreation Association (NESRA) was formed, resulting in increased interest in WHP programs. 1953 – Texas Instruments established a recreation program and later built a 8-acre recreational center for employees and families. Early 1950’s – Scania Corporation offered health education, skill-building courses and support to help make healthier lifestyle choices. Late 1950’s – PepsiCo established a physical fitness program. History – 1940’s – 1950’s

8. Early 1960’s – Sentry Insurance established a fitness program in the basement coal bunker. Rockwell International and Xerox Corporation – established well-known fitness programs. 1968 – American Can & NASA initiated employee fitness programs, with NASA publishing program evaluations in 1972. History – 1960’s

9. First established in larger worksites in the 1950’s. Currently, more than 10,000 companies have EAP’s. Initially developed to help employees with alcohol programs. 1970’s – expanded to include stress management, flexible work schedules, eldercare, flexible spending accounts, financial planning, retirement counseling & personal counseling. Quality of Work Life Programs (QWL) – broader program that includes EAPs to create a more cost-effective approach. Employee Assistance programs

10. Occupational Safety and Health Act (OSHA) – established in 1970 to clean up and regulate the worksite environment and create safer work practices. 1976 – Osaka Gas Company set up a health care system to improve health & fitness of employees. 1979 – Kimberly-Clarke Corporation built a $2.5 million health management complex 1981 – Mesa Petroleum built $2.5 million, 30,000 sq. ft. fitness center. 1980’s – WHP programs expanded to a more holistic wellness model. History – 1970’s & 1980’s

11. Personal Responsibility Movement – resulted in expansion of many programs to include medical self-care, post-pregnancy accommodations, ergonomic assessments, and exercise classes such as body shaping, kick-boxing, spinning, and self-defense or martial arts. Japan & Canada embraced WHP, offering sporting events, exercise programs, health counseling and EAP programs. History – 1990’s

12. Only 50% of American worksites with more than 750 employees provide some type of WHP programs to their employees. Only 38% of worksites employing 250 to 749 employees have WHP programs. Only 33% of worksites employing fewer than 49 employees have WHP programs. Healthy People 2010 recommends worksite health promotion. Current Challenges

13. Most common reasons for offering WHP programs: • Attract & retain good employees • Keep workers healthy • Improve employee morale • Improve employee productivity • Reduce employee health care costs WHP is good business

14. Absenteeism: approximately half of all unscheduled absences are a result of minor ailments related to modifiable behaviors. Accessibility: can reach many people at one time. Aging Workforce: every 8 seconds someone turns 50, older workers experience more health problems, many are related to lifestyle. Business Contacts: community events provide new business contacts. Competition: incentives and perks enhance hiring and retention. WHP is good business

15. Growing interest: public and media attention on personal health and health care costs. Health Insurance Premiums: premiums have doubled in the past decade. Image: WHP programs can boost image among workers, community, and industry peers. Productivity: healthy employees outperform unhealthy employees. Workers’ Compensation Costs: up to ½ of all claims involve musculoskeletal strains & sprains, tied to poor fitness levels. WHP is good business

16. “A healthier workforce is a happier and more productive workforce at work, at home, and in retirement. It’s that simple.” —Bill Bunn,VP of Health, Safety and Productivity, International Truck and Engine Corporation • “One of the best ways to attract and retain the best people in the world is to provide a set of benefits and rewards that are particularly appropriate for the people you are trying to attract.” —Glenn Gienko, Executive Vice President and Director of Human Resources, Motorola Why Invest in Health Promotion?

17. Overall, worksite health promotion can improve a firm’s productivity by: attracting superlative workers in a competitive global marketplace; reducing absenteeism/lost time; improving on-the-job decision-making and time utilization (reduced “presenteeism”); improving employee morale and fostering stronger organizational commitments; reducing organizational conflict by building a reservoir of good-will toward management; and reducing employee turnover. Health promotion is an investment inhuman capital.

18. Economic Factors: Inflation – medical care services often rises 2 to 3 times as fast as other items in the Consumer Price Index. Cost Shifting – “hidden tax” that doctors and hospitals shift to employers and paying customers to compensate for patients who cannot or do not pay their bills. Technology – innovative and can extend lives but carry a huge price tag. Rising health care costs

19. Economic Factors: Catastrophic Illness – transplant operations, HIV/AIDS, kidney dialysis, premature infants and complications increase costs. Malpractice Suits – Insurance to protect doctors and hospitals is passed on to patients and employers. Defensive Medicine – doing more procedures than necessary in an effort to protect themselves from potential lawsuits. Rising health care costs

20. Demographic Shifts: • The aging workforce. • People live longer and use more health care services • 35-54 year olds make up more than 50% of America’s workforce. • Eldercare costs – 8.0 million need some form of long-term care (nursing homes or home care), fewer than 1/3 of all companies provide eldercare assistance benefits. Rising health care costs

21. The entry of more women into the workplace. • Comprise approximately 60% of the workforce (childcare and maternity costs) • The rising proportion of people of color working in many countries • Disproportionate number in low-paying jobs without benefits • The growing number of people who have to work two jobs to make ends meet. Rising health care costs

22. Rising health care costs • Excess stress • High blood pressure • Cigarette smoking • Back injuries • Overweight • Alcohol abuse • High blood cholestol • Drug abuse • Depression • Other mental health problems Major Employee Health Risks:

23. WHP programs may become economic necessity – to help high risk, unhealthy employees reduce risk factors to qualify for health insurance. Cost sharing requires employees to pay for part of their health insurance through higher deductibles and co-payments. Results of a nationwide poll of 1500 US CEOs – 90% ranked rising health insurance premiums as their greatest cost concern, and 80% reported cost sharing as the preferred method of containing these costs. Cost sharing

24. Aetna: Five fitness centers = nearly $300 lower than nonexercisers British Columbia Hydro: WHP program = 3:1 benefit-to-cost ratio Canada Life Insurance: WHP program = 3.43:1 benefit-to-cost ratio in 1 year City of Birmingham, AL: HRA screenings & interventions = $1 million annual savings L.L. Bean: Healthy employees = health ins. premiums half the national average Coors Brewing Co.: On-site fitness, cardiac rehab & rec. programs = $600,000 savings per year Health costs and health promotion

25. Johnson & Johnson: health screening = $13 million in decreased absenteeism & health care costs. Osaka Gas Company: WHP program = increased morale & productivity, decreased smoking & premature mortality. Quaker Oats: Integrated Health Management Approach = health ins. premiums half the national average. Steelcase: Personal Health Counselors = $20 million savings over 10 years. Tenneco Corporation: WHP program with fitness center & health education = 43% drop in acute health care costs. Union Pacific Railroad: WHP program = more than $3 million annual savings in hypertension & smoking-related costs. Health costs and health promotion

26. Demand Management: A management approach to control the demand for health services. Demand management includes a variety of interventions to reduce unnecessary and/or potentially preventable visits to healthcare providers by a) decreasing illness and injury in the first place; and/or b) helping people better discern when professional care is necessary. Two major activities of demand management are medical self-care and consumer health education. Worksite Health Promotion Terms

27. Health and Productivity Management (HPM): A management approach to improve the health and productivity of a workforce. HPM uses a variety of interventions to help employees change unhealthy behaviors and create a work/corporate culture that promotes health and productivity. In its broadest sense, HPM can include disability management, workers’ compensation, health benefits, occupational health services, and other health-related employee programs. Worksite Health Promotion Terms

28. Health Risk Appraisal (HRA): A paper-and-pencil or computerized questionnaire used to assess self reported risk factors (that is, risk factors that individuals report themselves). Often, HRA responses are analyzed to compile lists of modifiable risk factors, along with recommendations to change them. Also called a “health assessment questionnaire” or “health improvement questionnaire.” Worksite Health Promotion Terms

29. Medical Self-Care: Activities and interventions that help individuals identify common self-limiting medical problems, apply appropriate home treatments, and determine when professional medical advice and/or treatment is needed. Medical self-care often includes the use of a reference text, health advice line, or website with health information. Worksite Health Promotion Terms

30. Population Health Management (PHM): A new approach to that uses an annual health risk appraisal to create a health management database that can be used to help plan appropriate health promotion activities for targeted populations and evaluate the effectiveness of those interventions over time Focuses on changing modifiable risk factors and reducing the number of unnecessary visits to healthcare providers. It generally employs a “virtual” set of interventions that are not linked to the worksite directly, but reach individuals in their homes (via surface mail, telephone, or internet). Specifically designed to lower healthcare costs for defined populations. Worksite Health Promotion Terms

31. Risk Factors: Behaviors and conditions that place an individual at increased risk for illness or injury. For example, being female and having a family history of breast cancer are two uncontrollable risk factors for breast cancer. Smoking cigarettes and leading a sedentary lifestyle, on the other hand, are two modifiable risk factors for heart disease. Although it’s confusing, risk factors are also called “disease risks” or “health risks” (as in health risk appraisal). Worksite Health Promotion Terms

32. Virtual Wellness: A recently coined term that describes a style of health promotion programming that does not rely on worksite-based interventions. Information and support are generally provided to individuals in their homes. Virtual wellness typically includes: an annual health risk appraisal (HRA),wellness newsletter sent to the home, health advice line, ability to order self-help materials, a medical self-care text, access to a health management website, telephone follow-up with high risk individuals, and targeted mailings based on selected responses from the HRA. Virtual wellness interventions can be integrated with worksite-based interventions to strengthen their impact on behavior change. Worksite Health Promotion Terms

33. Work Promotion: A term used to emphasize the work enhancing effects of worksite health promotion interventions. These effects are usually associated with increased organizational profitability and worker productivity. Work promotion encompasses activities to “protect and enhance human capital” to achieve “meaningful employment and meaningful profits.” Worksite Health Promotion Terms

34. Influence demand for health care services Provide appropriate health benefits Provide comprehensive health promotion programs Monitor health care claims data Use quality cost-efficient providers Comprehensive health management framework

35. Wellness continuum Tertiary Care Primary Care Case Management Rehabilitation Secondary Prevention Worksite Monitoring Screenings EAP Primary Prevention Health Promotion Incentives Immunizations

36. Aset of national health objectives, with 10-year targets. • The overall goals of Healthy People 2010 are to: • increase quality and years of healthy life and • eliminate health disparities. • 467 objectives organized into 28 focus areas. • 10 Leading Health Indicators to help motivate national action around major public health concerns. Healthy People 2010

37. 75% of employers, regardless of size, to offer a comprehensive employee health promotion programs. 75% of employees to participate in employer-sponsored health promotion activities. Healthy People 2010 worksite-specific objectives

38. Employers occupy a prominent and influential position in the health environment, with unparalleled access to working Americans. They are in a unique position to contribute to the health of their employees and their communities. Consequently, they are in an essential position to help the nation achieve its health goals for the year 2010. Employers can use Healthy People objectives as well, in this case to focus business-sponsored health promotion/disease prevention efforts and measure worksite and community-wide outcomes against national benchmarks. Healthy People 2010 Essentials for Business

39. A comprehensive worksite health promotion program, as defined by Healthy People 2010, contains five elements: 1. Health education, which focuses on skill development and lifestyle behavior change along with information dissemination and awareness 2. Supportive social and physical environments, including an organization’s expectations regarding healthy behaviors, and implementation of policies that promote health and reduce risk of disease. 3. Integration of the worksite program into the organization’s structure. 4. Linkage to related programs like EAPs and programs to help employees balance work and family. 5. Worksite screening programs, ideally linked to medical care to ensure follow-up and appropriate treatment as necessary. As defined by Healthy People 2010 Elements of a Comprehensive Worksite Health Promotion Program

40. Develops and disseminates tools that employers can use to create a healthier workplace; Provides a forum for business leaders, organizations, and state and federal agencies to share best practices; Recognizes companies that show leadership in the health promotion arena. Partnerships for a HealthyWorkforce