2013 UNIDAS Congress

1. 2013 UNIDAS Congress Health Promotion Programs (A Perspective) Presented by Professor Robert C. Karch, Ed.D. American University School of Education, Teaching, and Health Washington, DC, USA.

2. AMERICAN UNIVERSITY College of Arts and Sciences School of Education, Teaching and Health BS in Health Promotion (18 Years) MS in Health Promotion Management (33 Years) National Center for Health and Fitness 33 Years and 30 Million Dollars in External Research/Contract Activity

4. Some Facts • Based in Washington, DC at American University • Unique global forum of established Health Promotion Professionals and prestigious institutions • Personal and institutional links in 60+ countries • Global communication network with interdisciplinary partnerships • Currently establishing Regional Coordinating Centers - ( IIHP-RCC) • 33 Years of experience in Health Promotion Education • Developing On-line Executive/Professional Education Programs

5. Health Promotion Programs Why? What? Who? Where? How?

6. WHY? Why Health Promotion? Why now? Why Your/My/Every Country? Why UNIDAS Nacional? Why You? – Why Me?

7. TheWHY? Humanistic/Civil Issues Business/Competitive Issues Cost - $/Savings/ROI Productivity Sustainability Competitiveness (National/Global) Recruitment - Retention Growth • Cost - Not just $- Other • The Human Condition • Civil Society • Humanistic Concerns • Spiritual Concerns • The right thing to do!!!

8. Unsustainable Cost Pressure Source: 2011 Milliman Medical Index

9. Or to look at it another way… Source: Alliance of Community Health Plans

10. Or to look at it a third way… Income: $59,858 Source: Alliance of Community Health Plans

11. Drivers of health Where money spent Health is more than health care Medicalservices 20% Where do U.S. health care dollars actually go? Medical services 88% Social and economic factors 40% 4% Healthy behaviors Healthy behaviors 8% Other 30% Physical environment 10%

12. Why You?? Why Me?? Why US?? andWhy UNIDAS & Why Self Insure??My Answer!!!

13. Shorter Lives, Poorer Health The U.S. health disadvantage has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social valuesthat shape those conditions.

14. My “WHY” Punch Line It is a sobering (sickening) thought; we might live longer than our children!! According to the World Health Organization we are the first generation whose children's life expectancy may not be as long as their parents if present trends continue. This Fact Drives Me!!

15. The WHAT?What is Health Promotion??What can/does it mean for a company? (Owners, Management, Employees, Dependents, Customers, Competitors)

16. LANGUAGE“If language is not correct, then what is said is not what is meant. If what is said is not what is meant, then what must be done remains undone.Hence, there must be no arbitrariness in what is said. This matters above everything.” - Confucius R.C. Karch

17. Prevention vs. Promotion To Prevent or Prevention Pre - Coming before Vent – Letting/Getting out To Promote or Promotion Pro - For and/or in support of Motion – Action - Movement - Advocate

18. Promotion and Prevention Pro – motion “To start” Pre – vention “To stop” R.C. Karch

19. World Health OrganizationPAHO Definition of Health Promotion “Health promotion is a process of enabling people to increase their control over, and to improve, their health” (Empowerment) R.C. Karch

20. Mental Health WHO defines mental health as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health promotion is an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health. R.C. Karch

21. Positive Health State of health beyond an asymptomatic state. Concept of positive health usually concerns the quality of life and the potential of the human condition.Notion of positive health may include self-fulfillment, vitality for living and creativity. The concept of positive health is central to the philosophy of health promotion. R.C. Karch

22. Total Health A state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity. In the context of health promotion, health is considered less as an abstract state and more as a means, as a resource which permits people to lead an individually, socially, and economically productive life. R.C. Karch

23. Health Continuum Disability Signs Attitudes Health Behaviors Premature Death Symptoms Knowledge Health Promotion Traditional Medicine No discernible illness or wellness Wellness Illness Source: Michael O’Donnell - Definition of Health Promotion American Journal of Health Promotion Summer, 1986 R.C. Karch

24. Health Education Prevention HealthProtection A model of health promotion; Downie, Fyfe, & Tannahill, 1992 R.C. Karch

25. Optimal Wellness The American University’s National Center for Health Fitness Optimal Wellness Model To obtain optimal wellness individuals must assume responsibility for the continual development and maintenance of the Physical, Spiritual, Emotional, Social, Intellectual, and Environmental components of their health, consistent with the culture in which they reside. R.C. Karch 1979

27. WHO Healthy Workplace Framework

28. Empowerment Promotion of the abilities of people so that they can form their social conditions and rule their own lives. Their self-esteem is reinforced, their capabilities are promoted. They are most likely to work together with other people to achieve their goals. R.C. Karch

29. Empowerment (Cont.) In this approach even people with little ability or in extreme critical situations are seen as having strengths and resources. (Key Point) Processes of empowerment can not be produced only promoted! R.C. Karch

30. The Last What slide -What is Driving Change? • Unsustainable costs of health care • The Patient Protection and Affordable Care Act • The obesity epidemic* • The increase in diabetes • The overall relative decline in health • The recognition that health is more than health care

31. For Today A Dual Task We must attempt to Prevent Diseases while We Promote a Healthy and Self- Empowered Active Lifestyle! A Big and Complex Challenge!!

32. Example -The Complexity in -Tackling Obesity Complexity…Health as an outcome of a multitude of factors that interact in a highly complex, dynamic, and inter-related system Source: Vandenbroeck, Goossens, & Clemens. (2007). Foresight: Tackling Obesities: Future Choices –Obesity System Atlas.

34. WHO?? For today (this hour) it is just you and me!!! But then - Everyone!!!

35. WHERE?? Key Settings – Touch Points Government Agencies Workplace Settings* Workplace Health Associations (UNIDAS)* Faith Based Organizations Grocery Stores/ Pharmacies Schools Home Everywhere!!! (Do you know of a place where Health is not important??)

36. Where? - A Choice to Think About - The Doctor’s Office or The Workplace?? Total Non-sleep Hours 24 Hrs. Day ( – 8 Hrs. Sleep) = 16 Hrs. X 365 Day Year = 5840Hours per year!! Total working Hours 5 Days a week 8 hours a day = 40 Hours week X 50 weeks =2000 Hours year!! Question?-How many hours a year do you spend with your Doctor??? (2hrs = a 1000 to 1 Ratio!!) & (Proximity Increases Success!! ) Just so you know - I love seeing my Doctor!!!!

37. The Worksite Setting • Population access • Significant reach into the population(Again note Proximity) • Significant frequency to intervention exposure • Significant access to tools, vehicles, resources, etc. that may be mobilized to increase awareness and PA behavior change • Worksites can identify the population of interest • Employees • Employees and dependents • Targeted subgroups of interest • Interventions can be designed at various levels that interact with the individuals receiving the intervention • Individual - Inter-personal - Organizational & Environmental

38. The Worksite Setting • Work matters for health • Unemployment is a major determinant of health • Worker health may be affected by the organization of work, the policies at work, the relationships at work, etc. • Health matters for work • Chronic conditions may be exclusion criteria for job fit • Fitness for duty tests as indicators of inclusion criteria • Healthy workers and a healthy culture appear to be a good business strategy • Worksite health promotion also is a sound public health strategy and fosters economic growth in the community

39. Broader context Employer recognize the need to: • Reduce healthcare spending • Reduce illness burden • Reduce the likelihood of becoming ill • Make healthy choices easy choices • Maintain or improve economic vitality • Reduce waste • Increase longevity • Enhance national security • Prepare communities for the workforce

40. Opportunity and ResponsibilityAbout one half of all of the people of the world are Employees!!A Karch Maxim HE + HC1 + HC2 + HC3 = HW If companies create Healthy Employees - • Healthy employees will create Healthy Companies - • Healthy Companies will then create Health Communities - • Healthy communities will then create Healthy Countries - • Healthy Countries will then create A Healthy World!!

41. Workplace Health Promotion: a Win-Win-Win Scenario!! Employers benefit: Improved morale, higher productivity, enhanced recruitment and retention ( corporate image) Employees benefit: Improved quality of life through better health, more control over work, better balance of work and social life Families and Communities Benefit ( But - Who is the First Winner??) R.C. Karch

42. HOW? Critical Elements for Successful Outcomes!!

43. Leadership & Culture!!

44. Organizational Culture and Leadership Develop a “Human Centered Culture” Demonstrate Leadership Engage mid-level management Program Design Establish clear principles Integrate relevant systems Eliminate recognized occupational hazards Be consistent Promote employee participation Tailor programs to the specific workplace Consider incentives and rewards Find and use the right tools Adjust the program as needed Make sure the program lasts Ensure confidentiality Program Implementation and Resources Be willing to start small and scale up Provide adequate resources Build accountability Communicate strategically Program Evaluation Measure and analyze Learn from experience Essential Elements ListGuidance toward Integrated Health and Safety Programs TOTAL WORKER HEALTH™ Source: NIOSH Essential Elements List (see http://www.cdc.gov/niosh/TWH/essentials.html).

45. Program Best Practices Leadership and Strategy • Organizational commitment • Shared program ownership • Identified wellness champions • Program connected to business objectives • Supportive policy, physical, and cultural environment Policy Development and Enforcement (Benevolent Policies) Evaluation • Program measurement and evaluation Integration and Data Practices • Integration of program components at the point of implementation • Integration across multiple organizational functions and departments • Integrated data systems • Efficient and effective data practices • Data privacy and confidentiality • Operations • Clearly defined operations plan • Effective communications • Scalable, sustainable, and accessible programs • Assessment, screening, and triage • Effective interventions • Meaningful participation incentives

46. Five Guiding Principles for a Healthy Workplace! • Meet the needs of all employees, regardless of their current level of health; (Do not forget the Dependents!!) • Recognize the needs, preferences and attitudes of different groups of participants; • Recognize that an individual’s “lifestyle” is made up of an interdependent set of health habits; • Adapt to the special features of each workplace environment; and • Support the development of a strong overall health policy in the workplace. (Health Canada) R.C. Karch