Driving Wellness

in the Workplace

Liezel Dreyer

Bloemfontein, April 2007

Globally, healthcare costs are mounting, but often in areas of preventable diseases

WHO Director General, Lee Jong-Wook

“The lives of far too many people in the world are being blighted and cut short by chronic diseases such as heart disease, stroke, cancer….”

Chronic diseases caused 60% of the 58 million deaths worldwide in 2005

Cause of Morbidity and Mortality in Developed Countries

Leading Cause of Death - US 2000 *

0 5 10 15 20 25 30

Alzheimer's Disease

Kidney Disease

Diabetes

Pneumonia / Influenza

Unintentional Injuries

Chronic Lower Respiratory Dis.

Stroke

Cancer

Heart Disease

% of all deaths

Alcohol consumption

Actual Cause of Death - US 2000 †

0 5 10 15 20

Sexual Behaviour

Drug Use

Firearms

Motor Vehicles

Toxic agents

Microbialagents

Poor Diet / Inactivity

Tobacco

% of all deaths

* Minino AM, Kochanex KD, Murphy SL, Smith SL, Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-20.† Mokdad AH, Marks JS, Stroup DF, Gerberding JL Actual causes of death in the United States, 2000. JAMA 2004;291(10): 1238-1 246.

19961991

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2004

Hansard references to obesity 1996

Source: Hansard (House of Commons Daily Debates)

0 100 200 300 400 500 600

Obesity

Weather

Number of mentions in Parliament

PARLIAMENTARY REFERENCES IN 1996

Hansard references to obesity 2006

Source: Hansard (House of Commons Daily Debates)

0 500 1000 1500 2000

Obesity

Weather

Number of mentions in Parliament

PARLIAMENTARY REFERENCES IN 2006

Global Trend

• Many Countries Affected

• USA, UK

• Australia

• South Africa

• China

• France

• Russia

• Etc

• Hence - WHO – DPAS, 2006

Leading Causes ofDeath in South AfricaLeading Causes ofDeath in South Africa

Non-communicable diseases

As a % of total deaths MEN WOMEN

Cardiovascular diseases (CVD)*

14% 19%

Cancers 8% 8%

Other chronic diseases 7% 6%

Respiratory 5% 4%

Diabetes 2% 3%

Total chronic diseases 36% 40%

Predominantly related to heart attacks and strokes Source: South African Health Review, 2003-2004

Relatively small lifestyle changes can have a significant impact on health

and the associated costs of healthcare

Probability of 15 year survival without coronary artery disease, stroke or diabetes

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

56%

Male aged 50:overweight smoker

71%

Step 1: quitsmoking

81%

Step 2: get active

86%

Step 3: loseweight

15 y

ear

surv

ival

pro

bab

ility

Source: Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men.Archives of Internal Medicine (1998), SG Wannamethee et al.

Impact of lifestyle

Despite this evidence, we must recognisethe barriers to healthier living

Why Wellness is elusiveU

nder

cons

umpt

ion

of

prev

entiv

e ca

re

Lack of information

Over-optimism

Hyperbolic discounting

True efficacy of different health and wellness approaches is not well understood

People tend to overestimate their abilities and health status

Future rewards of a healthy lifestyle are significantly undervalued relative to cost today

Wellness Defined

“ An intentional choice of a lifestyle characterised by personal responsibility, moderation and maximum personal enhancement of physical, mental, emotional and spiritual health.”

Worksite Wellness Defined

“An organised program in the worksite that is intended to assist employees (and their family members) in making voluntary behaviour changes which reduces their health and injury risks, improve their health consumer skills and enhance their individual productivity and well-being”

The importance of the workplace

‘A large proportion of the population is employed and spends more than a third of its waking hours at work. If the workplace

enables and supports health, employees are more likely to make healthier choices’

The key to national health improvement is more people making healthier choices more of the time’

Government White Paper, UK

Productivity

Absenteeism

Health Costs

Group Risk Costs

Retirement Funding

Morale

IncreaseReduce

When employees are healthier

Return on Assets

38%

85%

15%

62%

38%

62%

1982 19921 19982

Tangible Assets

Intangible Assets

Market Value

1. Brooking Institute

2. Baruch Lev analysis of S&P 500 Companies

Health-Work Cost Link

Direct Medical Costs

Indirect Medical Costs

Medical and Pharmaceutical25% ($116.2m)

Long-term disability1% ($6m)

Short-term disability6% ($27m)

Absenteeism6% ($27m)

Presenteeism63% ($311.8m)

Source: Harvard Business Review- Presenteeism

Workplace Health Promotion Shift

Rationale: “The right thing to do:

Health cost containment

Productivity enhancement

Focus: Single illness or risky behaviours

General health and well-being

Target: Individual risk factors Individual risk factors + broader environmental, social, and organisational risk factors

Stance: Reactive Proactive

Wellness trends

RecognitionRecognitionCompanies understand that disease, absenteeism and wellness impact their financial performance

Integrating disease management and wellness programmes lead to wellness strategies and higher returnsIntegrationIntegration

Impact assessments, return on investment calculations and integrated views of different data sets are criticalMeasurementMeasurement

Rewards or incentive programmes are needed to drive participationEngagementEngagement

Current programmes often lead to duplicated costs, poorly co-ordinated interventions and ad-hoc reportingCo-ordinationCo-ordination

Components of Wellness Programmes

Understanding Health Risks

Ill health and incapacity management programmes

Employee Assistance Programmes

HIV and AIDS programmes

Education and Awareness Programmes

Integrated Reporting

Zero new infections, zero deaths from AIDS

Professional help is always only a phone call away

Eliminate unnecessary sick leave

Prevent lifestyle related diseases

Wellness tools to meet bold objectives

Consolidated, time-based reporting framework allows impact and success to be measured

Station 1:Welcome deskFor employees to signconsent forms

Station 2:• Blood pressure• Body mass index• Waist circumferenceTwo final year medical students

will conduct these measurements.

Station 3:Glucose and cholesterol screeningsTwo nurses will conduct these preventive screening tests

Station 4:Health Risk Assessment reports and feedbackA nurse will capture the results, produce a report and discuss the results Station 5:

Education area and fun elements

Station 6:Optional voluntary counselling and testing standIt will be done by qualified nurses. The number of nurses is determined by the number of employees

Wellness days test lifestyle risks for all staff

Rich source of data for integrated reporting framework

Health Risk AssessmentsLifestyle BehavioursHealth MeasurementsReadiness to Change

UNDERSTAND YOUR RISK:Current Age 34UNDERSTAND YOUR RISK:Current Age 34

Smoking Risk Factor

Body Mass Index

Daily Fruit and Vegetable Intake

Physical Activity

Cholesterol Reading

- Smoker

- 27.17

- 2 servings

- 60 minutes per week

- 5.8 mgDL

Real Age: 43

Smoking Risk Factor

Body Mass Index

Daily Fruit and Vegetable Intake

Physical Activity

Cholesterol Reading

- Never Smoked

- 24.76

- 5 servings

- 150 minutes per week

- 4.0 mgDL

Real Age: 32

UNDERSTAND YOUR RISK:Current Age 34UNDERSTAND YOUR RISK:Current Age 34

Eliminate unnecessary sick days through absenteeism analysis and interventions

Cumulative sick days taken

Bradford score

0

100

200

300

400

500

600

700

0 5 10 15 20 25 30 35 40 45

Bra

dfo

rd S

core

*

*Bradford score = number of occasions of absence2 * total days absent

•Recovery assistance

•Possible abuse reported to HR manager

•Possible illness identified. Refer to disease management or Employee assistance programme

Day 4 of absenteeism

Case manager calls staff member to assist

Statistical analysis triggers various interventions

Statistical analysis

Analysis of sick leave taken

Day 4 of absenteeism

Case manager calls staff member to assist

Different referrals from various analyses

Statistical analysis

integrationDetermine company wide recommendations on focus areas

Absenteeism data analysed against claims, risk assessments etc

Eliminate unnecessary sick

Frequency of event

Inte

nsity

of

inte

rve

ntio

nhigh

low

Life management

skills

- Legal advice- Social services- Financial advice

Telephonic counselling

Qualified psychologists

Face-to-face counselling

Qualified psychologists

CIM

Critical Incident ManagementComprehensive crisis management

Employee Assistance provides a professional support network

Integration of services leads to more effective utilisation of programme components

Actuarial modeling

and Knowledge, Attitude and

Practice Surveys

Policy setting

Education and

awareness

Peer educator coaching

HIV and AIDS Programme

Voluntary counselling and testing

Medical advice and counseling

Treatmentco-ordination

andmanagement

Eliminate stigma and discrimination Aim for 100% take-up

Reports

Implementing a Wellness strategy

Company participation and planning essential

Employer Wellness Committee

HIV Champion

Absence Champion

Wellness Champions

HIV Peer Educators

First Aid officers

Venue support

Management interventions

Calendar and planning

Product tools

Ease of implementation and administration

Wellness Manager

Absenteeism

Integrated wellness view of company

All Wellness data consolidated into reporting platform

Each event or measurement provides richer data set

Claims information

Health day information

Ris

k

ass

essm

ent

Medium

Low

High

HIV testing information

ClaimsM

ediu

m

LowHig

h Ongoing measurement (absenteeism, EAP, etc…)

Me

diu

mL

ow

Hig

h

High Risk

High claims

Medium claims

Low claimsHigh absenteeism

Medium absenteeismLow absenteeism

0

20

40

60

80

100

120

Num

ber o

f em

ploy

ees

Risk assessments and claims score

Absenteeism indicatorHigh claims

Medium claims

Low claims

High claims

Medium claims

Low claims

Medium Risk Low Risk

BIANNUAL INTEGRATION REPORT:

Employees allocated to key risk indicators

Accumulated data sets provide powerful analysis of different groups

Sample company of 1,000 employees

HIV AND AIDS OR HEALTH

ABSENTEEISM

TRAUMA

EMOTIONALISSUE

LIFE MANAGEMENTISSUE

MANAGERIAL ISSUES

High claims

Medium claims

Low claimsHigh absenteeism

Medium absenteeismLow absenteeism

0

20

40

60

80

100

120

Num

ber o

f em

ploy

ees

Absenteeism indicatorHigh claims

Medium claims

Low claims

High claims

Medium claims

Low claims

102 employees with high absenteeism

High Risk

Risk assessments and claims score

Medium Risk Low Risk

EA

P f

ilte

r

Allows identification of and intervention in key focus areas

Sample company of 1,000 employees

BIANNUAL INTEGRATION REPORT:

Employees allocated to key risk indicators

Targeted data analysis drives intervention strategy

POST EVENT REPORT:

Knowledge and practice (KAP) survey report

Sample company of 1,000 employees

FemaleAge 24-

FemaleAge 25-30

FemaleAge 31-35

FemaleAge 36-40

FemaleAge 40+

MaleAge < 24

MaleAge 25-30

MaleAge 31-35

MaleAge 36-40

MaleAge 40+

-0.80

-0.60

-0.40

-0.20

0.00

0.20

0.40

0.60

0.65 0.70 0.75 0.80 0.85 0.90 0.95 1.00

Knowledge of HIV risk

Att

itu

des

to

war

ds

HIV

Poor attitude and knowledge of HIV prevalence

Measure impact of wellness and interventions over time

Sample company of 1,000 employees

Risk factor

65

27

2

28

1614

5

77 77

3842

24

17

BM

I

Chr

onic

Cho

lest

erol BP

Smok

er

Ex s

mok

er

Alc

ohol

F&G

Exer

cise

Stre

ss 1

Stre

ss 2

Perc

eptio

n

Hea

lthy

days

% o

f Em

ploy

ees

WELLNESS DAY REPORT:

Risk factor analysis

42% high

37% high

1 2 3 4 5 6 7 8

Number of risk factors

WELLNESS DAY REPORT:Change in Risk Factor Analysis

First assessment

1

6

20

14

6

2

26 26

Second assessment

7

10

24

23

11

5

2

19

High riskLow riskMedium

risk

Communicating Wellness

Email awareness campaigns for key events

Co-ordinated wellness strategy includes communication and support framework

24 hour Health advice and counselling

First aid training

Emergency support services

Wellness and lifestyle guidelines and awareness campaigns

Active promotion of employee assistance

How well are we doing?

Absenteeism

‘The Economic Impact of Sport’, Business and Economic Research Limited

Company Survey Program type Absenteeism

Blackmores Australia Gym 40% reduced absenteeism

Johnson & Johnson Fitness in factories 26% reduced absence than control

DuPont Corporation Health and fitness programmes

14% less sick days than control

UK Household Survey

Active sport 33 to 50% reduced absenteeism

Productivity

Source: Tasman Asia Pacific, Ernst & Young (1998)

Company Program type Productivity improvements

Union Pacific Railroad

Exercise 80% more productive75% more concentration

NASA Exercise control Stamina, endurance and decision-making 12.5% higher than non-participants

Signature corporation

Fitness for clerical/ operations

8% more productiveNon-members negative productivityFrequency of exercise correlated with productivity and absenteeism

Worksafe Australia

Lunch time exercise

Mood, productivity, cognitive functioning, reactive time, sensory motor perception, compared to control

ConclusionConclusion

1. The impact of unhealthy living is a cause of global concern

2. Relatively small lifestyle changes can have a significant impact on health

3. Lifestyle improvements are, however, subject to many barriers

4. Empower individuals and communities

5. Integrated Wellness programmes are key to healthy lifestyles and impact the overall health of organisations

6. Use integrated reporting to drive Wellness strategies

Our broader responsibilities

Driving Wellness

in the Workplace

Liezel Dreyer