Health Promotionin

The Work PlaceModels of Workplace Wellness

Yvonne Lewis. Director Health Education Division

OBJECTIVESOBJECTIVES

To:•Explore the concept of Health Promotion

•Explore the rationale for health promotion

•Examine the relevance of the health promotion approach in the workplace setting

WHAT IS HEALTH PROMOTION?WHAT IS HEALTH PROMOTION?

Health Promotion is based on a concept of health as not merely the absence of disease, but complete mental, physical, social and spiritual well-being (WHO)

Health promotion is an approach that ‘enables people, (individually and collectively), to take increase control over and improve their health’ (WHO, 1986)

Health as:A resource for living working, learning, loving, etc( A resource which gives people the ability to manage and change their surroundings)

A positive concept emphasizing social and personal skills and resources as well as physical capacities. (Physical capacities does not encompass key social and personal resources of people including relational, learning, coping capabilities)

Health is created and lived by people within the settings of their everyday lives; where they live,

learn, work, play and love

Health Promotion is often operationalised in different settings.

• School• Community• Workplace• Health• Institutions

Health Promotion in the workplace setting is called Workplace Health Promotion (WHP)

WORKPLACE HEALTH PROMOTION (WHP)WORKPLACE HEALTH PROMOTION (WHP)

The Workplace Health Promotion approach will:

1. Target organisation culture and practices. These will include changes in the organisational form as well as in the quality of co-operation between executives and employees (internal and external customers), and will include health promoting processes (health beneficial and health damaging processes)

“A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs: - health and safety concerns in the physical work environment;-health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture; -personal health resources in the workplace; and ways of participating in the community to improve the health of workers, their families and other members of the community(PAHO/WHO).”

WHY Workplace Health Promotion?WHY Workplace Health Promotion?

Health is created and lived by people within the settings of their everyday lives; where they live, learn, work, play and love ….. This includes the workplace

Health of the workplace impacts the health of employeesHealth of employees impacts the health of the workplace

Workplace health promotion creates the potential to combine productivity and health in the workplace

Some Approaches to Workplace Health Promotion

WHP as a component of Occupational Health and Safety: Reduction and elimination of physical risk factors in the workplace.

WHP as behavioural prevention in the workplace: Widely practiced approach with a focus on health education and behaviour directed prevention programs in the work place

Promotion & Education, Vol VI 1999/3

Some Approaches to Workplace Health Promotion

WHP as a component of organisational development strategy: Modern management concepts eg. TQM approaches, emphasize the function of human resources in order to realise economic aims. WHP creates the necessary pre-conditions for optimal creativity of employees and production by employees

Promotion & Education, Vol VI 1999/3

Other Approaches to promoting health Other Approaches to promoting health in workplace settingsin workplace settings

• Employee Assistance Program (EAP)• Occupational Safety and Health (OSH)• Onsite Health Centre/Nurse• Gym and Wellness Centre• Health Insurance• Health Education• Work-life Balance Support• Health Fairs

Workplace Health Promotion Workplace Health Promotion PolicyPolicy

December 13th, 2010

Presented by: Yvonne Lewis Director Health Education DivisionMinistry of Health

Health is: A resource for living (working, learning, loving, etc) A positive concept emphasizing social and personal

skills and resources as well as physical capacities Not merely the absence of disease, but complete

mental, physical, social and spiritual well-being (WHO)

What is Health Promotion?What is Health Promotion?

Health promotion is an approach that ‘enables people, (individually and collectively), to take increased control

over and improve their health’ (WHO, 1986)

Health Promotion is a strategic objective of the Ministry of Health , and an essential public health function

What is Workplace Health What is Workplace Health Promotion? Promotion?

Health Promotion is often operationalised in different settings;

School Community Workplace Health Institutions

Health Promotion in the workplace setting is called Workplace Health Promotion (WHP)

Why Workplace Health Promotion?Why Workplace Health Promotion?

Health is created and lived by people within the settings of their everyday lives; where they live, learn, work, play and love ….. This includes the workplace

Health of the workplace impacts the health of employees. Health of employees impacts the health of the workplace – Is the workplace supportive of workers achieving and maintaining optimal well-being and

Why Workplace Health Promotion?Why Workplace Health Promotion?

Workplace health promoton creates the potential to combine productivity and health in the workplace

• A healthy lifestyle reduces the risk of negative effects on the body. – It is a promotive factor which enables people to

achieve optimal well-being, a resource for life

– It is a protective factor against the development of negative health effects like chronic diseases.

Why Workplace Health Promotion?Why Workplace Health Promotion?

– It can help persons with illnesses manage their disease and achieve optimal well-being

– Workplace health promotion is a component of occupational health and responds to the MOH OSH Policy

Part 1-B (m) “Promote good health and be concerned

with the prevention of occupational and non-occupational disorders and diseases through health counseling and education”

Workplace Nutrition & Workplace Nutrition & Physical Activity PolicyPhysical Activity Policy

ContextContextObjectives Objectives

Policy Guidelines Policy Guidelines

Context cont.’Context cont.’

Chronic Non-Communicable Diseases threaten both the quality of life of individuals, the productivity of the population and the economic viability of the nation.

Over the last twenty years, chronic diseases (heart disease, cerebro-vascular diseases, diabetes, cancer) have been the top four leading causes of deaths in Trinidad and Tobago. Together, they account for over 60% of all deaths.

RankRank Cause of DeathCause of Death No.No. % of Total % of Total DeathsDeaths

Rate per Rate per 100,000100,000

1 Heart Diseases 2,425 23.8 189.1

2 Diabetes Mellitus 1,427 14.0 111.3

3 Malignant Neoplasms 1,324 13.0 103.2

4 Cerebrovascular Disease

1,022 10.0 79.7

5 Accidents & Injuries 835 8.2 65.1

6 Respiratory Diseases

587 5.8 45.8

7 AIDS / HIV Disease 410 4.0 32.0

8 Digestive System Diseases

333 3.3 26.0

9 Perinatal Period Conditions

286 2.8 22.3

10 Genitourinary Diseases

243 2.4 18.9

Total All Causes 10,206 100

Fig 1: Deaths and Death Rates for the Ten Leading causes by Rank and % of Total Deaths, T&T, 2003

• Actions on the modifiable risk factors and determinants of NCDs – behavioral risk factors – Biological determinants– environmental determinants and

global influences.

RISK FACTORS AND DETERMINANTS OF CNCDsModifiable Behavioral Risk Factors

Modifiable Biological Risk Factors

Environmental Determinants

Global Influences

Tobacco use

Unhealthy diet

Physical inactivity

Alcohol abuse

Overweight & obesity

High cholesterol levels

High blood sugar

High blood pressure

Political, Social, Economic, and conditions

Physical Infrastructure

Education

Environment

Access to health Services and Essential medicines

Globalization

Urbanization

Technology

Migration

The Goal Of The Workplace Health Promotion The Goal Of The Workplace Health Promotion Policy IsPolicy Is

• To develop a comprehensive, integrated set of actions which enhances the health of public sector employees, by creating a supportive social and physical environment in the workplace which make health promoting behaviours and choices relating to healthy eating and physical activity, easier choices and promote primary prevention of chronic diseases by impacting on these two risk factors.

Objectives Objectives

To assist in the development of supportive workplace environments and services which promote and enhance the health and productivity of staff

To build personal health skills of employees and support them to adopt health promoting behaviours with emphasis on healthy eating, physical activity and smoking cessation

To standardize guidelines for healthy eating at worksites

Policy GuidelinesPolicy Guidelines

Healthy Eating

Monitoring & Evaluation

Physical Activity

Mechanisms to support Implementation

Healthy Eating in the WorkplaceHealthy Eating in the Workplace

Policy Guidelines:

Certified food handlers and food premise licensed

No food for meetings shorter than two (2) hours or meetings held after lunch, or after supper hours.

Minimal amount of added fats and oils, low sodium entrees, sauces and condiments

Safe, potable water made availabe to workers close to their work stations

Nutritious and safe food and beverage choices should be provided at all meetings, workshops, and other functions

sponsored by Government Ministries, Statutory bodies and agencies

Physical Activity in the WorkplacePhysical Activity in the Workplace

The ministry/agency shall create an enabling environment that promotes and

encourages employee participation in regular, moderate physical activity

Physical Activity in the Workplace con’t…Physical Activity in the Workplace con’t…

One or more active breaks shall be included in meetings greater than two hours in length.

Each Ministry shall develop workplace based physical activity programmes including, ‘Take the Stairs’ campaign, walking/hiking clubs, and recreational sports.

Each Ministry/agency shall develop a workplace wellness centre management

Health education material on nutrition, physical activity and health shall be provided for all staff on an ongoing basis, and health education seminars and workshops shall be conducted at least once per quarter

Prepared by Yvonne Lewis. Director Health Education Division, Ministry of Health. Trinidad and Tobago. May 2012

Healthy Lifestyle Passport

Check Yourself … Know your Numbers

Blood Glucose Summary Profile:

Approximately thirty percent (30.3%), had blood glucose

levels within the range of 120-179mg/dL

which is within the acceptable range for

postprandial screens (CHRC 2011).

However, just over thirteen percent (13.4%) had levels ≥180 mg/dl indicating high

risk of being either pre-diabetic or diabetic.

(Results detailed in Fig 2)

5%

27.97% 30.51%33.05%

3%

No.of people

B.M.I Levels

Total Percentage BMI Levels of both Males and Females

Both Male and Female

Body Mass Index Summary Profile:

Approximately twenty-eight percent (27.97%) of the individuals screened had a healthy weight which was a B.M.Iwithin the range of 18.5 to 24.9Five percent (5%) of the individuals screened had B.M.I Levels which were in the underweight range of less than 18.5.Approximately two thirds of staff, (66.6%) were overweight or obese, with BMI levels above 25, as detailed in Fig 3.

The Cost of Chronic Disease The Cost of Chronic Disease is Mountingis Mounting

• In 2004 the public expenditure on drugs for the treatment of cardiovascular disease, diabetes, cancer, hypertension was 34 million TTD (USD 5.4 million). In 2009, that figure has more than tripled to 121.8 million TTD or 19.3 million USD.

• Over a six year period (2004-2009), public expenditure on drugs for treatment of the following CNCDs: cardiovascular disease, diabetes, cancer, hypertension, increased by over 250%.

The Cost of Chronic Disease is The Cost of Chronic Disease is MountingMounting

• Graph 1: Shows the Total Public Expenditure on drugs for CNCDs (US$)

TOTAL PUBLIC EXPENDITURE ON DRUGS FOR CNCDS (US$$)

$5.4

$8.3$9.2

$13.0

$17.7$19.3

$0.0

$5.0

$10.0

$15.0

$20.0

$25.0

2004 2005 2006 2007 2008 2009

Years

US

Do

llar

s

THANK YOU… THANK YOU…

Q & A

Some Major Health Some Major Health Issues Impacting the Issues Impacting the

Health of the Health of the Population in Trinidad Population in Trinidad

and Tobagoand Tobago

THE CHRONIC DISEASE THE CHRONIC DISEASE CHALLENGE: CHALLENGE:

The five (5) leading causes of death in Trinidad and The five (5) leading causes of death in Trinidad and Tobagopercentage distribution, 2000 – 2006 (Central Tobagopercentage distribution, 2000 – 2006 (Central

Statistical Office)Statistical Office)

Rank 1980 1990 2000 2005

1 Heart disease Heart disease Heart disease Heart disease

2 Cerebrovascular disease

Malignant neoplasm

Malignant neoplasm

Malignant neoplasm

3 Malignant neoplasm

Diabetes mellitus Diabetes mellitus

Diabetes mellitus

4 Respiratory diseases

Cerebrovascular disease

Cerebrovascular disease

Accidents & Injuries

5 Accidents/Injuries

Accidents& Injuries

Accidents & Injuries

Cerebrovascular disease

THE CHRONIC DISEASE THE CHRONIC DISEASE CHALLENGE: CHALLENGE:

The five (5) leading causes of death in Trinidad and The five (5) leading causes of death in Trinidad and Tobago percentage distribution, 2000 – 2006 (Central Tobago percentage distribution, 2000 – 2006 (Central

Statistical Office)Statistical Office)

Causes of Death 2000 2001 2002 2003 2004 2005 2006

Heart Disease 25.3 23.6 25.1 23.8 24.8 24.2 24.6

Malignant Neoplasms(Cancers)

12.7 12.4 13.0 13.0 13.8 13.8 13.8

Diabetes 13.6 13.7 13.0 14.0 13.9 14.1 13.6

Cerebrovascular Disease (Stroke)

10.1 10.0 10.4 10.0 9.6 9.1 9.0

Injuries and Accident 7.1 8.2 7.4 8.2 9.2 10.0 10.6

Trinidad and Tobago has one on the highest Trinidad and Tobago has one on the highest mortality rates for Diabetes in the Caribbeanmortality rates for Diabetes in the Caribbean

PAHO Basic Health Indicators 2009DM - diabetes; IHD – Heart disease; CVA - stroke

Adjusted Mortality Rates /100,000, Selected CARICOM countries vs. Canada 2003 - 2005

0

20

40

60

80

100

120

140

160

Trinidad & Tobago Guyana Suriname Bahamas Canada

DM IHD CVA

From the Office of Yvonne Lewis. Director Health Education Division

0

10

20

30

40

50

60 P

reva

len

ce (

%)

1970s 1980s 1990s

YEARS

Trends in Adult Overweight/Obesityin the Caribbean

Male

Female

From the Office of Yvonne Lewis. Director Health Education Division

Leading Causes of Death in CARICOM Countries by Sex, 2004

1. Heart Disease2. Cancers3. Injuries and violence4. Stroke5. Diabetes6. HIV/AIDS7. Hypertension8. Influenza/pneumonia

1. Heart Disease2. Cancers3. Diabetes4. Stroke5. Hypertension6. HIV/AIDS7. Influenza/pneumonia8. Injuries and violence

MALES FEMALES

(Source: CAREC, based on country mortality reports)

The Top five Causes of The Top five Causes of Mortality in Trinidad and Mortality in Trinidad and

Tobago (2009)Tobago (2009)

• Cardiovascular disease (CVD)• Cancer• Diabetes• Accidents and Injuries • Cerbrovascular disease

The Chronic Disease The Chronic Disease ChallengeChallenge

• Heart disease is the #1 cause of death in Trinidad and Tobago accounting for a quarter (25%) of all deaths.

• The diabetes prevalence rate is approximately 12%-13%

• Taken together, heart disease, cancer, diabetes and cerebrovascular disease, account for over 60% of all deaths

THE DECLARATION OF PORT OF SPAIN THE DECLARATION OF PORT OF SPAIN CALLED FOR CRITICAL ACTIONS ON THE CALLED FOR CRITICAL ACTIONS ON THE

RISK FACTORS OF CNCDsRISK FACTORS OF CNCDs

• Actions on the modifiable risk factors and determinants of NCDs – behavioral risk factors – Biological determinants– environmental determinants and global

influences.

Adoption of healthy lifestyles is not only dependent on an individual’s choice… but on the capacity of that person to make and implement that choice. Behaviour and lifestyle are embedded in the social and economic context in which people live.

Health promotion recognizes that the determinants of health are varied. They go beyond lifestyles and disease prevention and include peace, shelter, education,food, income, equity, sustainable resources.

HEALTH PROMOTION

ACTION

CARIBBEAN CHARTER FOR HEALTH CARIBBEAN CHARTER FOR HEALTH PROMOTION STRATEGIESPROMOTION STRATEGIES

REORIENTING HEALTH SERVICES

FORMULATING HEALTHYPUBLIC POLICY

CREATING SUPPORTIVE ENVIRONMENTS

EMPOWERING COMMUNITIES TO ACHIEVE WELLBEING

DEVELOPING AND INCREASING PERSONAL HEALTH SKILLS

BUILDING ALLIANCES WITH SPECIAL EMPHASIS ON THE MEDIA

Examples of:Examples of: Primary preventionPrimary prevention,, Secondary preventionSecondary prevention, and , and Tertiary careTertiary care activities activities

in a worksite setting. in a worksite setting.

Physical exams

Health fair

Health education

Fitness activities

Health screenings

Immunization

Safety Precautions

Health risk appraisal

Environmental interventions

Case management

Rehabilitation

Emergency responses

Source: Evaluating Worksite Health Promotion 2002, by David Chenoweth Phd.

Taken from Planning Health Promotion at the Worksite by D. Chenoweth, 1991, Dubique, IA: Brown and Benchmark

Human Resources

Health Services

Medical Center

External Services

Psychological Services

External Services

Referrals Referrals

ReferralsReferrals

Referrals

“Alcohol: Everybody’s Business”

Stress management

Referrals

Physical Fitness

Wellness Center

Weight control

Smoking Cessation

Nutrition

Evaluation

Referrals

The Integrated Health Management Framework used at the Adolph Coors Company

HEALTHFUL WORKPLACE/HEALTHFUL

CORPORATE POLICIES

Short-term benefits

Improved well-being

Improved risk profile

JOHNSON & JOHNSON EMPLOYEES

Slower increase in corporate health benefit costs

Decrease in absenteeism

Improved motivation, attitudes, and behaviour

Moderate risk reduction

Small decrease in health care utilization

Improved corporate commitment

Long-term benefits

Improved corporate commitment

HEALTH RISK APPRAISAL AND

LIFESTYLE EDUCATION

OTHER HEALTH PROMOTION PROGRAMMING

The LIVE FOR LIFE Conceptualization of Program Effects

Taken from Worksite Health Promotion by Dr. David Chenoweth, 1998

Note. From “Control Data’s Staywell Program: A Health Cost Management Strategy” by W.S. Jose and D.R. Anderson

Perspectives in Behavioural Medicine: Health at Work by S.M. Weiss, J.E. Fielding, and A. Baum (Eds.), 1991

HEALTH PROGRAM COMPONENTS

SUPPORTIVE ENVIRONMENT

•WORK

•HOME

PROGRAM PROMOTION

LOWER RISK

FACTORS

LOWER MORBIDIT

Y AND MORTALIT

Y

BEHAVIOUR CHANGE

HEALTH KNOWLEDGE ACQUISITIO

N

EMPLOYEE BENEFITS:

• Reduced personal health costs

• Improved quality of life

• More energy and vitality

HEALTH ATTITUDE CHANGE

HEALTH SKILLS

ACQUISITION

EMPLOYER BENEFITS:

• Reduced health care costs

• Reduced disability costs

• Reduced absenteeism

• Reduced turnover

• Increases productivity

The Staywell process model

RISK FACTORS AND RISK FACTORS AND DETERMINANTS OF CNCDsDETERMINANTS OF CNCDs

Modifiable Behavioral Risk Factors

Modifiable Biological Risk Factors

Environmental Determinants

Global Influences

Tobacco use

Unhealthy diet

Physical inactivity

Alcohol abuse

Overweight & obesity

High cholesterol levels

High blood sugar

High blood pressure

Political, Social, Economic, and conditions

Physical Infrastructure

Education

Environment

Access to health Services and Essential medicines

Globalization

Urbanization

Technology

Migration