driving wellness in the workplace liezel dreyer bloemfontein, april 2007
TRANSCRIPT
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
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
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
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