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Webinar with HPCareer.net

June 10, 2011

L. Casey Chosewood, MD – Sr. Medical Officer, Total Worker Health

National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention

Safe, Healthy, and Engaged How Protecting and Promoting the Health

of Your Employees Can Build a Culture of Wellness

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• The mention of organizations and commercial entities and

products in this presentation is for illustrative purposes only

and does not represent an endorsement by CDC or the US

Department of Health and Human Services.

• The views herein represent those of the authors and

presenter. For official guidance from the Centers for Disease

Control and Prevention, visit www.cdc.gov.

Disclaimer

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• Yet, among all countries of the world, the U.S. ranks:

• 35th in infant mortality prevention

• 30th in life expectancy at birth

The U.S. Has a Critical Shortage of HealthThe U.S. spends > $2 trillion every year on healthcare…

more than any other country.

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• The US is one of the leading countries for cancer risk-- largely due to tobacco

• Coronary heart disease rates are high, diabetes rates and risk factors are increasing

• High levels of violence-related death are present

• Leading causes of premature death: tobacco, poor diet and physical inactivity, alcohol, microbial agents, toxic agents, motor vehicle crashes, firearm-related incidents, sexual behaviors, drugs

The U.S. Has a Critical Shortage of Health

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“We spend less than four cents of every health care dollar on prevention and public health even though eighty percent of the risk factors involved in the leading causes of death are behavior-related and thus preventable.”

President Barack Obama

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What’s Driving Up the

Cost of Healthcare?

• Increasing prevalence of disease

Especially obesity, diabetes, and heart disease

• Continuing technological innovations

• Increasing treatment intensity and duration

• Delivery system inefficiencies

• Over- and under-utilization

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Between 1987 to 2005, healthcare utilization

increased significantly

• Mental Health Conditions 242%

• Elevated Lipids 860%

• High Blood Pressure 62%

• Diabetes 100%

• Pulmonary Disease 94%

• Back Pain 180%

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Quick Quiz Question

Compared to one generation ago, how much

would a dozen eggs cost today if they had risen

in price at the same rate as healthcare?

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Quick Quiz Answer

$80.25

(that’s $6.69 per egg)

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Extreme environment

Extreme aging

The Deadliest Threats Facing CDC

Extreme diet

Extreme convenience

CardiovascularDisease

Cancer

Diabetes

Preventable Injury

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Obesity Trends* Among U.S. Adults, 1990

No Data <10% 10%-14% 15%-19 20%-24% 25%

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

Source: Behavioral Risk Factor Surveillance System, CDC

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Obesity Trends* Among U.S. Adults, 2008

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: Behavioral Risk Factor Surveillance System, CDC

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

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Isn’t Behavior Change Enough?

Sir Michael Marmot

― It is unreasonable to expect people to change their

behavior when the social, cultural and physical environments

around them fully conspire against them….‖

Adapted from M. Marmot/Institute of Medicine Report

What is health?

Am I healthy?Do I care if others in my life are healthy?

What influences my health?

Does this job help make me healthier?

How can my workplace help me change my health?

Does my boss care if I am healthy?16

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A comprehensive worksite health promotion program

contains…o Strong senior leadership commitment

o Worker protection and respect as the primary cornerstone

o High quality occupational health and safety programming

o Adequate social, technical and programmatic support

o A variety of opportunities for health enhancement for persons at all

ages, interests, abilities, and health and fitness levels

o Frequent, clear communication, marketing, and branding

o Strong evaluation and process improvement process

o See all 20 at http://www.cdc.gov/niosh/docs/2010-140

Does Your Company Have These Policies to

Support Health?• Tobacco-free campus

• Flexible work/schedule policies

o Leave, telework, job share, parental/dependent care

• Nutritious foods-at-meetings policy

• Healthy transportation policies

• Smoke-free meetings policy

• Time during work hours for wellness activities

o Training or educational opportunities, health fairs, events

o Screenings, health coaching, EAP

o Physical Activity (efforts in progress)18

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Key Work-Life Balance Truths

• Workers Want, Need and Will Seek Out More Flexibility

• Organizing Work around People Works Better than

Organizing People around Work

• Every workplace policy will have some effect on the health

and wellbeing of workers—take steps to make sure it is a

positive one

• View every workplace decision through the lens of ―the

health and wellbeing of the worker‖

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Work and Life: Acknowledge

the Balancing ActProvide links to your community’s parenting

and adult care resources: referrals, articles,

podcasts, webinars, forums, list servs, blogs

• Develop specific resource kits

around critical topics

o Prenatal period

o Lactation

o A New Parents Return to Work

o Child Safety

o College: Decision support and

Financing

o Children with ADHD

o Autism Information and Resources

o Parenting Teens

o Family Wellness, Nutrition and

o Adult Care-giving

o Grief and Loss

o Others from your own experiences

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Designing Healthier Workplaces

Can You Become a “Choice Architect”?

• Choice-making is never neutral

• Directing default options toward health can be powerful

• Subtle ―nudges‖ toward healthier choices can improve

health outcomes

• Policy interventions provide a strong basis for better

choices

• Incentives and spotlights can motivate

• Providing structure around complex choices helps

Themes from Thaler R, Sunstein, C: Nudge Improving Decisions About Health, Wealth, and

Happiness, 2008.

Does Your Workplace’s Built Environment

Allow Health to Thrive?

• Safe, hazard-free workplace

• Welcoming, user-friendly, ergo-appropriate workspaces

• Commitment to employee respect, engagement, and input

• Stairs, walkways, paths, trails that are safe and inviting

• Onsite food choices that make eating healthier easy

• Transportation and parking options that enhance health

• Onsite or nearby health clinic or access to healthcare

providers

• Fitness facilities or opportunities for physical activity

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Does Stress Affect Your Workplace?

On the average workday in the

US, how many employees are

absent due to stress?

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Address the Stress

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• An estimated 1 million workers are absent every day due to

stress. 1

• Job stress costs U.S. businesses of over $300 billion yearly

due to absenteeism; employee turnover; diminished

productivity; medical, legal and insurance expenses; and

Workers' Compensation payments. 1

• Work stress vs home stress?

o Craft a less-stressful workplace first

o Build resilient workers second

• Find out more at www.cdc.gov/niosh/topics/stress

Source: 1. American Institute of Stress

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StairWELL ProjectSimple changes to dreary stairwells

increase usage

• Painting

• Carpeting

• Framed artwork

• Motivational signs

• Music

Low-cost, high-impact

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The Guide to Community Preventive Services

(The Community Guide)

• Summarizes what is known about the effectiveness,

economic efficiency, and feasibility of interventions to

promote health and prevent disease

• www.thecommunityguide.org

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Community Guide Worksite ReviewsPhysical Activity and Obesity Prevention

Promoting Physical Activity and Obesity Prevention

o Worksite programs to control overweight and obesity

(Recommended)

o Point-of-decision prompts to encourage use of stairs

(Recommended)

o Creation of or enhanced access to places for physical activity

combined with informational outreach activities (Recommended)

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Community Guide Worksite ReviewsAssessment of Health Risks with Feedback

to Change Employees’ Health Behaviors

Assessment of Health Risks with Feedback (AHRF)

o AHRF used alone

o Insufficient Evidence

o AHRF plus health education with or without other interventions

o Recommended

Community Guide Worksite ReviewsDecreasing Employee Tobacco Use

Incentives and Competitions to Increase Smoking Cessationo Incentives and competitions when combined with additional interventions

o Recommended, based on sufficient evidence of effectiveness in reducing tobacco use

among workers

o Incentives and competitions when used alone

o Insufficient evidence was found to determine whether or not worksite-based incentives

and competitions alone work to reduce tobacco use among workers

Smoke-free policies to reduce tobacco use among workerso Recommended, based on sufficient evidence of effectiveness in reducing tobacco use

among workers

Soler, et al. American Journal of Preventive Medicine, February 2010

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CDC LEANWorks!

www.cdc.gov/leanworks

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CDC Workplace Tools and Resources

Total Worker Health• NIOSH is dedicated to the preserving and

enhancing the Total Health of Workers

• Total Worker Health is a comprehensive

organizational strategy that integrates traditional

occupational safety and health protection efforts

with health promotion and other workplace activities

to prevent illness and injury, regardless of cause, so

that all workers have opportunities to achieve

optimal levels of health and well-being.

www.cdc.gov/niosh/TWH42

Total Worker HealthExamples of Integrated Programs

o Respiratory protection programs that comprehensively address tobacco abuse

o Ergonomic consultations that also discuss arthritis management strategies

o Stress management efforts that first seek to diminish workplace stressors, and

only then work on building worker resiliency

o Integrated training and prevention programs (falls, motor vehicle safety, first aid,

hearing conservation, stretching, flexibility and lifting programs)

o Comprehensive screenings for work and non-work risks

o Occupational health combined with a workplace primary care home model

o Full integration of: clinics, behavioral health, traditional safety, health promotion

programs, coaching, EAP, nutrition, disability and workers compensation.

Total Worker Health

• WorkLife National Centers of Excellence

o University of Iowa Healthier Workforce Center for Excellence

o Center for the Promotion of Health in the New England

Workplace• University of Massachusetts, Lowell

• University of Connecticut

o Harvard School of Public Health Center for Work, Health and Wellbeing

• Research partnerships and advisories with Veterans

Administration, Office of Personnel Management, and other

federal, labor and private sectors partners

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Resources

• Centers for Disease Control and Prevention

www.cdc.gov

• NIOSH WorkLife Initiative

http://www.cdc.gov/niosh/worklife

• Essential Elements of Effective Workplace

Programs and Policies for Improving Worker

Health and Well-Being www.cdc.gov/niosh/worklife/essentials.html

• HHS Physical Activity Toolkit

http://www.health.gov/PAGuidelines/toolkit.aspx.

• CDC Healthier Worksite Initiative

http://www.cdc.gov/hwi

• OPM’s Site for Workplace Resources

www.opm.gov/Employment_and_Benefits/WorkLife/He

althWellness/wellnessresources

• NIOSH: Worker Health and Safety

www.cdc.gov/niosh

• Alliance to Make US Healthiest

www.healthiestnation.org

• CDC’s Division of Nutrition, Physical

Activity & Obesity

http://www.cdc.gov/nccdphp/dnpao

• Smallstep

http://www.smallstep.gov

• Community Toolbox

http://ctb.ku.edu/en

• APHA - Healthiest Nation in 1 Generation

http://www.generationpublichealth.org

• CDC LeanWorks!

http://www.cdc.gov/leanworks