View
33
Download
0
Category
Tags:
Preview:
DESCRIPTION
Worksite Health Promotion: Lessons Learned by CDC Thomas L Schmid Physical Activity and Health Branch Centers for Disease Control and Prevention. Active Caribbean 2009 Workshop, Barbados. Public Health has many views. 1900. 1996. Pneumonia. Heart Disease. Tuberculosis. Cancer. - PowerPoint PPT Presentation
Citation preview
Worksite Health Promotion: Lessons Learned by CDC
Thomas L SchmidPhysical Activity and Health Branch
Centers for Disease Control and Prevention
Active Caribbean 2009 Workshop, Barbados
Public Health has many viewsPublic Health has many views
The 10 Leading Causes of Death as a Percentage of All Deaths
United States, 1900 and 1996
The average life expectancy in 1900 was 47.3 years of age. In 1993, it was 75.7 years of age.
SOURCE: CDC, National Center for Health Statistics
0 10 20
Diphtheria
Senility
Cancer
Injuries
Liver Disease
Stroke
Heart Disease
Diarrhea/Enteritis
Tuberculosis
Pneumonia
0 5 10 15 20 25 30 35
Chronic Liver Disease
Suicide
HIV
Diabetes
Pneumonia/Influenza
Accidents
Chronic Lung Disease
Stroke
Cancer
Heart Disease
1900 1996
Percentage Percentage
Chronic Diseases and Related Risk Factors
*National Vital Statistics Report; 47 (9) November 10, 1998†McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12Note: Dark shading denotes conditions and behaviors addressed by NCCDPHP
0 5 10 15 20 25 30 35 40
Most Common Causes of Death,United States, 1996*
Percentage (of all deaths)
Total cardiovascular disease(includes ischemic heart and stroke)
Cancer
Chronic obstructive pulmonarydisease and allied conditions
Injuries
Pneumonia/influenza
Diabetes
HIV infection
Suicide
Chronic liver disease/cirrhosis
Actual Causes of Death, United States, 1990†
0 5 10 15 20
Percentage (of all deaths)
Tobacco
Poor diet/lack of exercise
Alcohol
Infectious agents
Pollutants/toxins
Firearms
Sexual behavior
Motor vehicles
Illicit drug use
U.S. Department of Health and Human Services
U.S. Department of Health and Human Services
SECRETARY
Administration for Children & Families
Administrationon Aging
Health Care FinancingAdministration
Agency for HealthCare Policy & Research
Centers for DiseaseControl & Prevention
Agency for ToxicSubstances &
Disease Registry
Health Resource& Services
Administration
National Institutesof Health
Food & DrugAdministration
Program SupportCenter
Indian HealthService
Substance Abuse & Mental Health
Services Administration
Healthy People in a Healthy World,
Through Prevention
Centers for Disease Control and Prevention(for now)
CC for Health PromotionNCCDPHP, NCBDDD,
Office Genomics
CC for Health Information& Service
NCHS, NCPHI, NCHM
CO for Global Health
CC for Environmental Health &Injury Prevention
ATSDR, NCEH, NCIP CO for Terrorism Preparedness &
EmergencyResponse
Office of the Director
CC for Infectious Disease
NCID, NIP, NCHSTP
Office of the Director
National Center for Chronic Disease Prevention and Health Promotion - CDC
Nutrition,Physical
Activity and ObesityReproductive
Health
Smoking andHealth
Cancer Prevention and
Control
DiabetesTranslation
Oral Health
AdolescentAnd School
Health
Adult andCommunity
Health
Heart Disease &Stroke Prevention
“Nutrition” “Obesity”
“Physical Activity”CDC-WHO CC
Division of Nutrition, Physical Activity And Obesity
Office of the Director
“Program & Evaluation”
Physical Activity and Health BranchPhysical Activity and Health Branch
• Vision– Active People in an Activity-Friendly World
• Mission– Understand and Promote Physical Activity to
Enhance Health and Quality of Life
• Guiding Principles– We are a science-driven organization.– We Focus on population-based public health
research and programs.– We are accountable to our public health
constituents.– We conduct our work with integrity and follow
ethical standards.
• Vision– Active People in an Activity-Friendly World
• Mission– Understand and Promote Physical Activity to
Enhance Health and Quality of Life
• Guiding Principles– We are a science-driven organization.– We Focus on population-based public health
research and programs.– We are accountable to our public health
constituents.– We conduct our work with integrity and follow
ethical standards.
Physical Activity- BenefitsPhysical Activity- Benefits
• Walking 2+ miles/day => 50% lower mortality• Exercise in 80+ y.o. women => 32% fewer falls• Strength training causes comparable reduction in Sx
of depression as medication• Exercise improves smoking cessation rates• 1 case of hypertension prevented for every 26 men
who walk 20+ minutes to work• 31% reduction in CVD rates if walk 35 min/day
• Walking 2+ miles/day => 50% lower mortality• Exercise in 80+ y.o. women => 32% fewer falls• Strength training causes comparable reduction in Sx
of depression as medication• Exercise improves smoking cessation rates• 1 case of hypertension prevented for every 26 men
who walk 20+ minutes to work• 31% reduction in CVD rates if walk 35 min/day
Hakim NEJM; Campbell BMJ; Fiatarone J Gerontol; Marcus Arch Int Med; Hayashi Ann Intern Med; LaCroix J Am Geriatr Soc
Physical Activity - BenefitsPhysical Activity - Benefits
• 6 bouts per day of 2-3 minutes of stair climbing improves cholesterol and fitness in college women.
• Type II diabetes can be prevented (58% reduction in risk) by 30+ minutes of activity/day and appropriate diet (fat/fiber/calories) in high-risk subjects
• Walking 112+ blocks/week reduces risk of dementia by 33% in older adults.
• Health care costs 4.7% lower per active day per week; 49% lower in non-smoker, BMI=25, active 3 days/week
• 6 bouts per day of 2-3 minutes of stair climbing improves cholesterol and fitness in college women.
• Type II diabetes can be prevented (58% reduction in risk) by 30+ minutes of activity/day and appropriate diet (fat/fiber/calories) in high-risk subjects
• Walking 112+ blocks/week reduces risk of dementia by 33% in older adults.
• Health care costs 4.7% lower per active day per week; 49% lower in non-smoker, BMI=25, active 3 days/week
Boreham Prev Med 2000;30:277; Tuomilehto. NEJM;344:1343. Yaffe. Arch Intern Med 2001;161:1703. Pronk JAMA 1999;283:3335
Preventive EffectsPreventive Effects• Long-standing consensus:
– Cardiovascular disease, high blood pressure, diabetes, obesity, colon cancer, osteoporosis,
• Substantial evidence: – depression, cholesterol & lipids, fall injuries,
stroke, functional status in older adults• Emerging evidence:
– gall stones, sleep, immune function, some other cancers, dementia, ‘brain health’, academic performance.
• Long-standing consensus:– Cardiovascular disease, high blood
pressure, diabetes, obesity, colon cancer, osteoporosis,
• Substantial evidence: – depression, cholesterol & lipids, fall injuries,
stroke, functional status in older adults• Emerging evidence:
– gall stones, sleep, immune function, some other cancers, dementia, ‘brain health’, academic performance.
Therapeutic Effects of Physical Activity
Therapeutic Effects of Physical Activity
Clinical practice guidelines exist for physical activity in many diseases:
- high blood pressure - chronic lung disease - cholesterol management - cardiovascular disease - diabetes - osteoporosis - arthritis - obesity
Clinical practice guidelines exist for physical activity in many diseases:
- high blood pressure - chronic lung disease - cholesterol management - cardiovascular disease - diabetes - osteoporosis - arthritis - obesity
Leisure Time Physical Activity Trends 1986-1999
All States Reporting Physical Activity each year, BRFSS
0
5
10
15
20
25
30
35
40
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Recommended Activity Physical Inactivity
S. Ham, CDC, 2000. Recommended Activity = Moderate or Vigorous Activity
Percent of Employers Offering Health Benefits to Employees 2000-
2005
Percent of Employers Offering Health Benefits to Employees 2000-
2005
60%66%
69%
0%
10%
20%
30%
40%
50%
60%
70%
2000 2003 2005
60%66%
69%
0%
10%
20%
30%
40%
50%
60%
70%
2000 2003 2005
Source: “Employer Health Benefits 2005 Survey,” (#7315), The Henry J. Kaiser FamilyFoundation and Health Research and Education Trust, September 2005
A Costly BenefitA Costly Benefit
Private industry employers’ average medical costs per employee*
Portion of private industry workers in a company health plan
*Includes all companies and employees, both with and without health benefits
Source: Bureau of Labor Statistics, Published in the new York Times
Relation of Business Size and Workforce Percentage
Business Size % Firms % Workforce
<499 employees 99% 50%
5000+ employees .04% 32%
Private Business Expenditures for Healthcare as a Percentage of Business
Profits 1993-2000
Private Business Expenditures for Healthcare as a Percentage of Business
Profits 1993-2000
66%61%
53%49%
44%41%
38% 37%34%
58%59%60%55%
40%40%40%
0%
15%
30%
45%
60%
75%
1993 1994 1995 1996 1997 1998 1999 2000
Pe
rce
nta
ge
of
Pro
fits
After-Tax Profits Before-Tax Profits
66%61%
53%49%
44%41%
38% 37%34%
58%59%60%55%
40%40%40%
0%
15%
30%
45%
60%
75%
1993 1994 1995 1996 1997 1998 1999 2000
Pe
rce
nta
ge
of
Pro
fits
After-Tax Profits Before-Tax Profits
Source: Cowan, CA et al. (2002) Healthcare Financing Review
Top Five Employer Priorities for 2005Top Five Employer Priorities for 2005
41%
42%
52%
56%
90%
0% 20% 40% 60% 80% 100%
41%
42%
52%
56%
90%
0% 20% 40% 60% 80% 100%
Control Healthcare Costs
Provide Rewards Programs
that Attract, Motivate, andRetain Talent
Address Employee Willingnessto Pay a Larger Portion of
Benefits CoverageIncrease Employee
Responsibility for ManagingTheir Own Rewards Budget
Manage RetirementBenefits Cost
Source: Deloitte Consulting (2004)
Clinical Preventive Services by Employer Size
Service Small Medium LargeNutrition counseling 19% 27% 21%Weight loss/mngmnt 17% 21% 18%PA counseling 14% 23% 11%
Bondi et al. Am J Health Promotion 2006;20:214
Bottom LineBottom Line• Can’t reduce health care costs without
improving the health of employees• Use evidence-based recommendations to guide
alignment of benefits, policies, and programs with employee health
• Use field studies to accelerate identification of what works
• Put policies in place that support employee adoption of healthy behaviors
• Can’t reduce health care costs without improving the health of employees
• Use evidence-based recommendations to guide alignment of benefits, policies, and programs with employee health
• Use field studies to accelerate identification of what works
• Put policies in place that support employee adoption of healthy behaviors
ROI: Worksite Health PromotionROI: Worksite Health Promotion
Analysis of 28 studies showed average ROI of $3.48 per $1 in cost
Analysis of 28 studies showed average ROI of $3.48 per $1 in cost
Citibank had a savings of $8.9 million over 2 years with a program cost of $1.9 million – for $4.70:$1 benefits:cost ratio
From 1990–1999 Johnson & Johnson generated savings of about $8.5 million/year
Sources: Ozminkowski et al. AJHP Jan/Feb 1999; Goetzel et al. J Occ Hlth & Environ Med 2002; Aldana AJHP May/June 2001.
Examples of Approaches: Physical ActivityExamples of Approaches: Physical Activity
Health Checks / Fitness appraisals
Health education – i.e. written materials with / without support
On-site exercise facilities / classes
Web based advise and support
Subsidized membership at off-site gyms / facilities
Stair use / Active travel
Types of Workplaces Often Involved
Types of Workplaces Often Involved
Public sector• Government offices• Police• Fire service• Utilities – gas / electric
Private Sector – (larger)• Pharmaceutical• Food companies• Retail companies• Legal firms• Banks
Public sector• Government offices• Police• Fire service• Utilities – gas / electric
Private Sector – (larger)• Pharmaceutical• Food companies• Retail companies• Legal firms• Banks
Universities
Hospitals
Blue collar and
White collar
Universities
Hospitals
Blue collar and
White collar
Less often
Retail and service industry
Manufacturing industry
Skilled / semi skilled
Voluntary sector
Small/medium size enterprises
CDC Projects Related to Worksites CDC Projects Related to Worksites
Community Guide Recs
Promising Practices
Translate Findings
Focus groups
Disseminate
Develop Cost
CalculatorEvaluate
Develop Toolkits
Implement
Evaluate
Worksites with Promising Practices
Preliminary SWAT Findings - What Works
Preliminary SWAT Findings - What Works
1. Focus on multiple levels, including individual behavior, environmental factors and organizational policy
2. CEO’s commitment - “culture of wellness”3. Often motivation is “the right thing to do”4. Implement population-based interventions - tailor
delivery to employee needs5. High participation rates 6. Systematically evaluate
1. Focus on multiple levels, including individual behavior, environmental factors and organizational policy
2. CEO’s commitment - “culture of wellness”3. Often motivation is “the right thing to do”4. Implement population-based interventions - tailor
delivery to employee needs5. High participation rates 6. Systematically evaluate
Sprint World HeadquartersOverland Park, KS 66251
Field studi
es
Field studi
esScientific literatureScientific literature
CG reviewCG review
TIDE ProcessTIDE Process
Task Force recsTask Force recs
Field studiesField studies
Gray literatureGray literature
DNPA reviewDNPA review
Promising practicesPromising practices
Field practicesField practices
Promising practicesPromising practices
Set Research AgendaSet Research AgendaImplementation and EvaluationImplementation and Evaluation
Translate and disseminate for Identify Research Gaps specific target audiencesTranslate and disseminate for Identify Research Gaps specific target audiences
DNPA reviewDNPA review
Promising PracticesPromising Practices
• Environmental and Policy strategies
• Informational and educational strategies
• Behavioral strategies
• Environmental and Policy strategies
• Informational and educational strategies
• Behavioral strategies
Environmental and PolicyEnvironmental and Policy
• Address the entire workforce/population and target physical and organizational structures through worksite and public policies that support healthy behaviors. They are likely to be sustained longer than individually oriented strategies
• Address the entire workforce/population and target physical and organizational structures through worksite and public policies that support healthy behaviors. They are likely to be sustained longer than individually oriented strategies
Environment: Enhanced accessEnvironment: Enhanced access
• Example: Male employees in a university maintenance shop in a 16 week exercise intervention – fitness trail/ par course. 19 strength and aerobic activities on 1.5 mile course. 90 minute classes offered free 2 X week. Public charts displayed exercise done at and outside work.
• Median effect size for 5 studies -3.4%
• Example: Male employees in a university maintenance shop in a 16 week exercise intervention – fitness trail/ par course. 19 strength and aerobic activities on 1.5 mile course. 90 minute classes offered free 2 X week. Public charts displayed exercise done at and outside work.
• Median effect size for 5 studies -3.4%
Informational and Educational Informational and Educational
• Exercise prescriptions– Specific recommendations for frequency,
type and intensity of exercise.• Median effect size for 14 studies was -4.8lbs
• Multi-component educational practices– Prescription plus brochures, pamphlets,
electronic messages (email, text message)• Median effect size -4.8 lbs
• Exercise prescriptions– Specific recommendations for frequency,
type and intensity of exercise.• Median effect size for 14 studies was -4.8lbs
• Multi-component educational practices– Prescription plus brochures, pamphlets,
electronic messages (email, text message)• Median effect size -4.8 lbs
Behavioral Behavioral
• Teaching behavioral management skills, structuring social environment to provide social support, individual/ group behavioral counseling- family friends.
• Modeling, participatory skill development feedback, incentives, disincentives, pedometers, journals.
• Teaching behavioral management skills, structuring social environment to provide social support, individual/ group behavioral counseling- family friends.
• Modeling, participatory skill development feedback, incentives, disincentives, pedometers, journals.
Behavioral- competitions and incentives
Behavioral- competitions and incentives
• Competitions and incentives alone
• Teams compete for total miles walked or weight lost.
• Median effect size for 12 studies, -6.5lbs
• Competitions and incentives alone
• Teams compete for total miles walked or weight lost.
• Median effect size for 12 studies, -6.5lbs
BehavioralBehavioral
• Behavioral practices with incentives• Includes modeling, skill building, feedback
social support and incentives/ disincentives. – 10 lunch hour sessions on behavioral change,
goal setting nutrition ed, self monitoring, self control cognitive restructuring, contingency management, physical exercise, social support. Tailored feedback on progress.
– Monetary prizes awarded at end of treatment.
• Median effect for 15 studies -5.1lbs
• Behavioral practices with incentives• Includes modeling, skill building, feedback
social support and incentives/ disincentives. – 10 lunch hour sessions on behavioral change,
goal setting nutrition ed, self monitoring, self control cognitive restructuring, contingency management, physical exercise, social support. Tailored feedback on progress.
– Monetary prizes awarded at end of treatment.
• Median effect for 15 studies -5.1lbs
Behavioral PracticesBehavioral Practices
• Behavioral practices without incentives• Example
– Building maintenance company during work hours, employees given lectures, practical training, individual counseling, group discussion, self-education session. Individual goals set and with follow up and feedback from supervisor, spouse and family.
• Median effect for 36 studies -5.8lbs
• Behavioral practices without incentives• Example
– Building maintenance company during work hours, employees given lectures, practical training, individual counseling, group discussion, self-education session. Individual goals set and with follow up and feedback from supervisor, spouse and family.
• Median effect for 36 studies -5.8lbs
Promising PracticesPromising Practices
• Enhanced access to PA opportunities + health education
• Exercise prescriptions alone• Use of multi-component educational practices• Use of (weight loss) competitions and
incentives• Use of behavioral practices and incentives• Use of behavioral practices without incentives
• Enhanced access to PA opportunities + health education
• Exercise prescriptions alone• Use of multi-component educational practices• Use of (weight loss) competitions and
incentives• Use of behavioral practices and incentives• Use of behavioral practices without incentives
CDC Healthy Worksite
CDC-wide Assets & Needs Assessment
Policies Health promotion
• Exercise (1/2 hour approved absence)• Lifestyle centers• Allow leave for preventive screenings
Food/cafeteria choices• Modify GSA contracts• Vending Choices
Tobacco-free worksite
CDC-wide Assets & Needs Assessment
Physical environment Facilities audit CDC walkability audit (e.g., Rhodes-
Columbia) Fresh produce vendor Healthy building standards Chamblee trail Lactation rooms Stairwell projects
BeforeBefore
AfterAfter
Barriers to Stair UseBarriers to Stair Use
Marshall et al.
• Already use the stairs enough
• No time• Too busy• Too lazy
Marshall et al.
• Already use the stairs enough
• No time• Too busy• Too lazy
Mutrie et al
Barriers• Too lazy• Lack of Time
Motivators• Save time• Improve Health
Mutrie et al
Barriers• Too lazy• Lack of Time
Motivators• Save time• Improve Health
Study Example: Government Office [CDC, USA]
Study Example: Government Office [CDC, USA]
Baseline data
Intervention 1Paint and carpet
Added pictures
Added music
Follow up data
Over 3+ years
♫♪ ♫♪ ♫♪
Added Signage
ResultsResults
0
2
4
6
8
10
12
14
16
Art work Signs Music
Month 1-3 Month >3
% C
han
ge
in t
rip
s p
er o
ccu
pan
t fr
om
bas
elin
e 3.7%
4.2% 4.7%
CDC Walkability AuditCDC Walkability Audit
Mean Walking Segment ScoresMean Walking Segment Scores
• Chamblee67.2
• Corporate 59.5• Executive 53.6• Roybal
51.1• Koger
39.5
• Chamblee67.2
• Corporate 59.5• Executive 53.6• Roybal
51.1• Koger
39.5
0-39 High risk, unattractive40-69 Moderate risk70+ Low risk, pleasant
Impact of Financial Incentives on Weight Loss (> 5%) among Overweight Employees
Group % Losing >5%
$ 0 for each 1% 4%
$7 for each 1% 8%
$14 for each 1% 17%
Incentives to increase physical Activity
$0 2.3 hr week
$17.50 4.1hr week
Finkelstein et al, JOEM, 2007, Prev. Med 2008
The Obesity Cost Calculator
Estimates or calculates workforce obesity costs based on medical costs and absenteeism (presenteeism and workman’s compensation not included)
Estimates cost:benefit of interventions based on targeted population, participation rate, effect size, potential adverse effects of intervention, costs, and duration
Obesity Cost Calculator: ObjectivesObesity Cost Calculator: Objectives
• To produce a tool that allows employers and/or insurers to estimate the following (based on specific characteristics of their population):– Prevalence of obesity – Medical costs of obesity– The cost of increased absenteeism due
to obesity– Number of years until break-even for an
obesity intervention under alternate scenarios
• To produce a tool that allows employers and/or insurers to estimate the following (based on specific characteristics of their population):– Prevalence of obesity – Medical costs of obesity– The cost of increased absenteeism due
to obesity– Number of years until break-even for an
obesity intervention under alternate scenarios
Thank You
Examples: Worksite Programmes on PA
Examples: Worksite Programmes on PA
– Stairs
– Incidental physical activity / accumulation / pedometers
– Travel to work
– Stairs
– Incidental physical activity / accumulation / pedometers
– Travel to work
Promoting Stair Use: SignagePromoting Stair Use: Signage
Example from a Hospital Workplace
Example from a Hospital Workplace
Marshall et al., 2002 [Health Education Research. 17(6):743-49]Can motivational signs prompt increases in incidental physical activity in an Australian health-care facility?
AIM: to provide ‘point of Choice’ motivational prompt to encourage stairs as an alternative to the elevator
ResultsResults
Marshall et al., 2002 [Health Education Research. 17(6):743-49]
P = 0.02 nsns
24%
ResultsResults
• Survey (50% < 40 years, ~80% female)– 90% recognised signage / foot prints– Of these 90%
• 30% recall signs• 30% recall foot prints• 18% recall both
Marshall et al., 2002 [Health Education Research. 17(6):743-49]
Pedometer Programmes: Example “First Step”
Pedometer Programmes: Example “First Step”
• Canadian workers with moderately to highly sedentary jobs
• 177 enrolled, 106 completed
• 4 week adoption phase– Weekly meetings with facilitator
– Goal setting, relapse prevention, self-monitoring
• 8 week adherence phase– Self-monitoring and goal setting
• Canadian workers with moderately to highly sedentary jobs
• 177 enrolled, 106 completed
• 4 week adoption phase– Weekly meetings with facilitator
– Goal setting, relapse prevention, self-monitoring
• 8 week adherence phase– Self-monitoring and goal setting
Tudor-Locke et al., (2004) Preventive Medicine, 39, 1215-1222 www.peifirststep.ca
Results: “First Step” ProgrammeResults: “First Step” Programme“Adoption” “Adherence”
Tudor-Locke et al., (2004) Preventive Medicine, 39, 1215-1222
49% in mean steps per day by week 4
Travel ProgramsTravel Programs
• Who would they not reach ?
Why do we try and use travel to work to promote physical activity?
Who might these programmes target best?
Walk in to Work OutWalk in to Work Out
• RCT to increase active commuting in 3 worksite settings (hospital trust, university, public sector)
• Intervention group received “Walk in to Work Out pack”
• RCT to increase active commuting in 3 worksite settings (hospital trust, university, public sector)
• Intervention group received “Walk in to Work Out pack”
Mutrie et al., 2002 [Journal of Epidemiol & Community Medicine 56:407-412]Walk in to Work out: A randomised controlled trial of a self help intervention to promote active commuting.
“Walk in to Work Out”Mutrie et al., 2002
• Intervention: booklet with educational and practical info (routes, cycle storage etc), wall chart, workplace map
• Control group: Told they would receive it 6 months later
• 25% of the intervention group changed to “action/maintenance” at 12 months
• Very little change in levels of cycling 0
20
40
60
80
100
120
140
Baseline Follow Up
ControlControl InterventionIntervention
No walking at baseline
Walking at baseline
Aver
age
time
spen
t per
wee
k wa
lking
to w
ork
(min
s)
Updating Healthy Workforce 2010 Updating Healthy Workforce 2010
• Published in 2001• Enduring Popularity • Includes:
• Business case for WHP
• Healthy People 2010 • Program Design• Low-cost Resources
• Published in 2001• Enduring Popularity • Includes:
• Business case for WHP
• Healthy People 2010 • Program Design• Low-cost Resources
Worksite Health Promotion Triad (NGA)
SupportiveEnvironment
Personal Accountability
Health BenefitDesign
Benefits
Healthier WorkforceFewer medical visitsLower medical costsLower indirect costs
RecruitmentRetention
Competitive advantage
Study Example: Marshall et al., 2002Study Example: Marshall et al., 2002Weeks 1-3
Baseline data
Weeks 4-5
Weeks 6-7
Weeks 8-9
Weeks 10-12
Intervention
Control (‘wash out’)
Intervention
Control (‘wash out’)Baseline survey Follow up survey
Data CollectionData Collection
• Infra red (battery powered) counter on stairs (counting going up only!)
• Observation – 8-9am each morning– Provided validation of counter (10-15%
error on lift / 0-5% error on stairs)
• Infra red (battery powered) counter on stairs (counting going up only!)
• Observation – 8-9am each morning– Provided validation of counter (10-15%
error on lift / 0-5% error on stairs)
Another stair climbing exampleAnother stair climbing example
Mutrie & Blamey 2000 [Brit J Sports Med 34, page 144]
Blamey et al 1995 [ BMJ 311 page 289-290 ]
Strategy for Workplace Health and SafetyStrategy for Workplace Health and Safety
Promotes strategic partnerships to improve….
• Employment and productivity – by keeping those at work healthy and in work;
• Education – by instilling an appropriate understanding of risk management from an early age;
• Health and rehabilitation – by contributing to the nation’s health and well-being and dealing with health inequalities;
• Public service reform – by reducing sickness in the public sector and enhancing public sector delivery.
Promotes strategic partnerships to improve….
• Employment and productivity – by keeping those at work healthy and in work;
• Education – by instilling an appropriate understanding of risk management from an early age;
• Health and rehabilitation – by contributing to the nation’s health and well-being and dealing with health inequalities;
• Public service reform – by reducing sickness in the public sector and enhancing public sector delivery.
Promising Practices in HPM Organizations
1. Employ incentives consistent with core mission2. Operate at multiple levels – individual, policy,
cultural3. Target most important health issues for workforce4. Tailored to needs of individuals in workforce5. Achieve high rates of participation6. Achieve successful outcomes7. Based on clear definitions of success
Goetzel et al. In press
CDC Worksite Activities
Healthier Worksite InitiativeValidation of obesity cost calculatorGuide Translation
- CDC working group- RTI evaluation contract - Goetzel contract for “Promising Practices”
Kalamazoo Valley Community College
357 FTEs. Institutional support. Multicomponent – HRAs with free targeted counseling, on-site fitness facility, wellness programs, incentives.
ROI: 1:1 or 2:1. Health insurance costs increased 3.5%/y vs 8-9%.
Morbidity Associated with Inactivity
Morbidity Associated with Inactivity
• Coronary Heart Disease
• Obesity
• Diabetes
• Stroke
• Colorectal Cancer
• Coronary Heart Disease
• Obesity
• Diabetes
• Stroke
• Colorectal Cancer
Average Annual Premium Contribution for Family Coverage
1999-2005
Average Annual Premium Contribution for Family Coverage
1999-2005
$4,248 $4,819 $5,274 $5,866$6,656 $7,289
$8,169
$1,543$1,619
$1,787
$2,137
$2,412
$2,661
$2,713
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
1999 2000 2001 2002 2003 2004 2005
$4,248 $4,819 $5,274 $5,866$6,656 $7,289
$8,169
$1,543$1,619
$1,787
$2,137
$2,412
$2,661
$2,713
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
1999 2000 2001 2002 2003 2004 2005
Co
ntr
ibu
tio
ns
for
Fam
ily C
ove
rag
e
73.4% 74.9% 74.7% 73.3%
73.3%73.4
%
75.1%
% Employer ContributionEmployee ContributionEmployer
Note: Coverage is for a family of four.Source: Calculated based on “Employer Health Benefits 2005 Annual Survey,” (#7315), The Henry J. Kaiser Family Foundation and Health Research and Educational Trust, September 2005
National EstimatesNational Estimates
• Obesity-attributable (i.e., excess) costs are estimated using regression models– Costs of obesity are above costs for normal weight
employees– The average normal weight employee:
• Spends $1,950 in medical expenditures• Misses 2.6 days of work due to illness
• Not included (and therefore underestimates costs)– Presenteeism– Worker’s compensation costs
Intervention Module: DataIntervention Module: Data• Number of employees (by weight category)
from expenditure module• Estimates predicted from the data
– Predicted medical and work loss costs (in the absence of intervention)
• Used to estimate cost savings
• User-Specified or Default Inputs:– Intervention target– Intervention cost– Intervention effectiveness
• Number of employees (by weight category) from expenditure module
• Estimates predicted from the data– Predicted medical and work loss costs (in the
absence of intervention)• Used to estimate cost savings
• User-Specified or Default Inputs:– Intervention target– Intervention cost– Intervention effectiveness
Intervention Module: Inputs Intervention Module: Inputs
Target of intervention (obese, comorbidities)
Participation rate (by risk category)
Anticipated effect
Workdays missed due to intervention (surgery)
Anticipated costs
Copayment
Duration of effect
Target of intervention (obese, comorbidities)
Participation rate (by risk category)
Anticipated effect
Workdays missed due to intervention (surgery)
Anticipated costs
Copayment
Duration of effect
Intervention Module: OutputIntervention Module: Output• Output
– Estimated number of participants– Firm’s intervention-related costs– Annual cost savings– Number of years until break-even (if ever)
• Presented separately for:– Medical costs only– Medical + work loss costs
• Output – Estimated number of participants– Firm’s intervention-related costs– Annual cost savings– Number of years until break-even (if ever)
• Presented separately for:– Medical costs only– Medical + work loss costs
Input Data for the Calculator: Expenditures
Module
Input Data for the Calculator: Expenditures
ModuleOther information to increase the accuracy of obesity cost
estimates:– Type of industry (from a list of 12 industry categories)– State or territory– Number of employees overall, by gender or age category
Number of overweight or obese employees – Average wage information for employees – Proportion of employees receiving benefits
Other information to increase the accuracy of obesity cost estimates:
– Type of industry (from a list of 12 industry categories)– State or territory– Number of employees overall, by gender or age category
Number of overweight or obese employees – Average wage information for employees – Proportion of employees receiving benefits
Minimum Data Elements
Standard demographic variables: age, race, ethnicity, gender, household income, marital status, education
Medical • BMI, blood pressure, cholesterol, glucose, smoking• Annual Medical claims data with total charges or payments linked
to BMI Work loss • Annual missed work days due to illness or injury (i.e., sick leave)
linked to BMI • Salary of employee (to monetize the days missed) Capacity to link HRA to medical claims data and/or electronic time
sheet data over time
Obesity Cost Calculator: Expenditures Module
Obesity Cost Calculator: Expenditures Module
• The Obesity Cost Calculator allows companies to estimate their obesity-attributable costs based on the demographic characteristics of their employees (or enrolled population for insurers)
• At a minimum, the user must enter the number of employees in the company (or # of enrollees)
• The Obesity Cost Calculator allows companies to estimate their obesity-attributable costs based on the demographic characteristics of their employees (or enrolled population for insurers)
• At a minimum, the user must enter the number of employees in the company (or # of enrollees)
Recommended