Workplace Health Promotion: Make It Easy Make It Popular Show Them How

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Workplace Health PromotionMake It EasyMake It
PopularShow Them How

• Jeffrey R. Harris, MD MPH MBA
• Health Promotion Research Center, U. of
  Washington
• A CDC-funded Prevention Research Center
• November 21, 2008

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Three Topics

• Why are chronic diseases so important?
• What behaviors do we want?
• How can employers help?

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Top Killers, MT Working Age
Montanans aged 18-64. CDC WISQARS, 2005.
http//www.cdc.gov
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How Do Killers Cost Us?
Health Productivity Management. Goetzel, JOEM
20014310.
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Productivity Losses Also Huge

• Productivity losses from chronic diseases
• Up to 4 times health care costs

Loeppke R et al. JOEM 2007 49(7)712-721.
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Behaviors We Want

• Lifestyle behaviors
• Avoid, stop tobacco use
• Be physically active
• Eat to maintain a healthy weight

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Behaviors We Want

• Clinical behaviors
• Get an annual flu vaccination
• Screen for cancer breast, cervical, colon
• Screen for ?BP, ?lipids
• Take meds control ?BP, diabetes, ?lipids

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Which Behaviors Matter Most?
For total U.S. population. Mokdad AH, et al.
JAMA. 20042911238-46. National Commission on
Prevention Priorities, 2007, www.prevent.org
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Behaviors That Save Money

• Colon cancer screening
• Flu vaccination
• Smoking cessation treatment

Cost-saving or neutral. National Commission on
Prevention Priorities. 2007. www.prevent.org
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MT Smoking Has Come Down
Source MT Behavioral Risk Factor Survey,
2001-2007.
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Good News on Obesity

• Nine randomized, controlled trials of lifestyle
  approaches
• More than 2 years of follow-up
• Average net weight loss 7 lb
• Source Powell L et al. American Psychologist
  200762234-46.

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More Good News on Obesity

• Randomized, controlled trial of lifestyle change
• 522 overweight people with glucose intolerance
• 2-year intervention, 4-year follow-up
• Average net weight loss 6 lb.
• Diabetes reduction 58
• Source Tuomilehto J et al. NEJM 20013441343-50.

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MT Workers OK but Room to Improve
Source BRFSS Montana workers w/ Ins., age
18-64, 2004-5.
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How Can Employers Help?

• Evidence from CDCs
• Guide to Community Preventive Services

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Why Do We Have Co-Pays?
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Low-Income Higher Risks
Source BRFSS Montana workers w/ insurance, aged
18-64, 2005.
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How Can Employers Help?

• Make it easy
• Make it popular
• Show them how

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Make It Easy in Health Care

• Cover preventive care, no out-of-pocket
• Smoking cessation (OTC NRT)
• Preventive care cancer screens, flu vaccination
• First-line drugs for chronic diseases
• Work with health plan on preventive care
• Track providers delivery

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Make It Easy At Work

• Be active, eat well, breathe well at work
• Walking routes, gyms
• Healthy food available and affordable
• Ban tobacco use on campus
• Bring preventive care to the worksite
• Flu vaccination

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Make It Popular
(Or at least appear to be popular)

• Worksite physical activity programs
• Walk-at-lunch bunch
• Physical activity competitions
• Stair-use reminders
• Reminders re preventive care
• Most likely from health plan

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Show Them How

• Labeling of healthy food choices
• Smoking cessation telephone quitlines
• Health coaches, by phone or on-line

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First, Make It Easy

• Get your benefits policies right
• Can reach actives, retirees, dependents
• Affect program non-participants
• Lasting

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Communicate and Promote

• Awareness for Make it easy, etc
• Market as if these were your products
• Trying to change long-standing behaviors
• Trying to change culture

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Evaluate

• Need to know where you are starting from
• Need to know whether making progress

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Health Promotion Is Cheap
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Employers OK, Room To Improve
471 U.S. Employers, ACS Workplace Solutions, 2008
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Tobacco Cessation Barriers Remain
471 U.S. Employers, ACS Workplace Solutions, 2008
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Smalls, Mediums Need Help
471 U.S. Employers, ACS Workplace Solutions, 2008
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ACS Workplace Solutions
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Pilot Study Results
Source Harris et al. Preventing Chronic Disease,
July 2008. Results for 8 employers, 13 mo
follow-up.
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Smaller Employers Key In Montana
Census Bureau, employees by employer size,
Montana, 2005
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Challenges for Smaller Employers

• No dedicated wellness staff
• Perceived inability to negotiate with insurers
• Lack of health promotion vendors to serve them

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Summary

• Worker behaviors short list, cost-effective
• Montana workers have room to improve
• Employer practices long list, effective
• U.S. employers have lots of room to improve
• Smaller employers need extra help--aggregrators
• Make it easy, make it popular, show them how