Worksite Health Promotion: Lessons Learned by CDC

Thomas L SchmidPhysical Activity and Health Branch

Centers for Disease Control and Prevention

Active Caribbean 2009 Workshop, Barbados

Public Health has many viewsPublic Health has many views

The 10 Leading Causes of Death as a Percentage of All Deaths

United States, 1900 and 1996

The average life expectancy in 1900 was 47.3 years of age. In 1993, it was 75.7 years of age.

SOURCE: CDC, National Center for Health Statistics

0 10 20

Diphtheria

Senility

Cancer

Injuries

Liver Disease

Stroke

Heart Disease

Diarrhea/Enteritis

Tuberculosis

Pneumonia

0 5 10 15 20 25 30 35

Chronic Liver Disease

Suicide

HIV

Diabetes

Pneumonia/Influenza

Accidents

Chronic Lung Disease

Stroke

Cancer

Heart Disease

1900 1996

Percentage Percentage

Chronic Diseases and Related Risk Factors

*National Vital Statistics Report; 47 (9) November 10, 1998†McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12Note: Dark shading denotes conditions and behaviors addressed by NCCDPHP

0 5 10 15 20 25 30 35 40

Most Common Causes of Death,United States, 1996*

Percentage (of all deaths)

Total cardiovascular disease(includes ischemic heart and stroke)

Cancer

Chronic obstructive pulmonarydisease and allied conditions

Injuries

Pneumonia/influenza

Diabetes

HIV infection

Suicide

Chronic liver disease/cirrhosis

Actual Causes of Death, United States, 1990†

0 5 10 15 20

Percentage (of all deaths)

Tobacco

Poor diet/lack of exercise

Alcohol

Infectious agents

Pollutants/toxins

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

U.S. Department of Health and Human Services

U.S. Department of Health and Human Services

SECRETARY

Administration for Children & Families

Administrationon Aging

Health Care FinancingAdministration

Agency for HealthCare Policy & Research

Centers for DiseaseControl & Prevention

Agency for ToxicSubstances &

Disease Registry

Health Resource& Services

Administration

National Institutesof Health

Food & DrugAdministration

Program SupportCenter

Indian HealthService

Substance Abuse & Mental Health

Services Administration

Healthy People in a Healthy World,

Through Prevention

Centers for Disease Control and Prevention(for now)

CC for Health PromotionNCCDPHP, NCBDDD,

Office Genomics

CC for Health Information& Service

NCHS, NCPHI, NCHM

CO for Global Health

CC for Environmental Health &Injury Prevention

ATSDR, NCEH, NCIP CO for Terrorism Preparedness &

EmergencyResponse

Office of the Director

CC for Infectious Disease

NCID, NIP, NCHSTP

Office of the Director

National Center for Chronic Disease Prevention and Health Promotion - CDC

Nutrition,Physical

Activity and ObesityReproductive

Health

Smoking andHealth

Cancer Prevention and

Control

DiabetesTranslation

Oral Health

AdolescentAnd School

Health

Adult andCommunity

Health

Heart Disease &Stroke Prevention

“Nutrition” “Obesity”

“Physical Activity”CDC-WHO CC

Division of Nutrition, Physical Activity And Obesity

Office of the Director

“Program & Evaluation”

Physical Activity and Health BranchPhysical Activity and Health Branch

• Vision– Active People in an Activity-Friendly World

• Mission– Understand and Promote Physical Activity to

Enhance Health and Quality of Life

• Guiding Principles– We are a science-driven organization.– We Focus on population-based public health

research and programs.– We are accountable to our public health

constituents.– We conduct our work with integrity and follow

ethical standards.

• Vision– Active People in an Activity-Friendly World

• Mission– Understand and Promote Physical Activity to

Enhance Health and Quality of Life

• Guiding Principles– We are a science-driven organization.– We Focus on population-based public health

research and programs.– We are accountable to our public health

constituents.– We conduct our work with integrity and follow

ethical standards.

Physical Activity- BenefitsPhysical Activity- Benefits

• Walking 2+ miles/day => 50% lower mortality• Exercise in 80+ y.o. women => 32% fewer falls• Strength training causes comparable reduction in Sx

of depression as medication• Exercise improves smoking cessation rates• 1 case of hypertension prevented for every 26 men

who walk 20+ minutes to work• 31% reduction in CVD rates if walk 35 min/day

• Walking 2+ miles/day => 50% lower mortality• Exercise in 80+ y.o. women => 32% fewer falls• Strength training causes comparable reduction in Sx

of depression as medication• Exercise improves smoking cessation rates• 1 case of hypertension prevented for every 26 men

who walk 20+ minutes to work• 31% reduction in CVD rates if walk 35 min/day

Hakim NEJM; Campbell BMJ; Fiatarone J Gerontol; Marcus Arch Int Med; Hayashi Ann Intern Med; LaCroix J Am Geriatr Soc

Physical Activity - BenefitsPhysical Activity - Benefits

• 6 bouts per day of 2-3 minutes of stair climbing improves cholesterol and fitness in college women.

• Type II diabetes can be prevented (58% reduction in risk) by 30+ minutes of activity/day and appropriate diet (fat/fiber/calories) in high-risk subjects

• Walking 112+ blocks/week reduces risk of dementia by 33% in older adults.

• Health care costs 4.7% lower per active day per week; 49% lower in non-smoker, BMI=25, active 3 days/week

• 6 bouts per day of 2-3 minutes of stair climbing improves cholesterol and fitness in college women.

• Type II diabetes can be prevented (58% reduction in risk) by 30+ minutes of activity/day and appropriate diet (fat/fiber/calories) in high-risk subjects

• Walking 112+ blocks/week reduces risk of dementia by 33% in older adults.

• Health care costs 4.7% lower per active day per week; 49% lower in non-smoker, BMI=25, active 3 days/week

Boreham Prev Med 2000;30:277; Tuomilehto. NEJM;344:1343. Yaffe. Arch Intern Med 2001;161:1703. Pronk JAMA 1999;283:3335

Preventive EffectsPreventive Effects• Long-standing consensus:

– Cardiovascular disease, high blood pressure, diabetes, obesity, colon cancer, osteoporosis,

• Substantial evidence: – depression, cholesterol & lipids, fall injuries,

stroke, functional status in older adults• Emerging evidence:

– gall stones, sleep, immune function, some other cancers, dementia, ‘brain health’, academic performance.

• Long-standing consensus:– Cardiovascular disease, high blood

pressure, diabetes, obesity, colon cancer, osteoporosis,

• Substantial evidence: – depression, cholesterol & lipids, fall injuries,

stroke, functional status in older adults• Emerging evidence:

– gall stones, sleep, immune function, some other cancers, dementia, ‘brain health’, academic performance.

Therapeutic Effects of Physical Activity

Therapeutic Effects of Physical Activity

Clinical practice guidelines exist for physical activity in many diseases:

- high blood pressure - chronic lung disease - cholesterol management - cardiovascular disease - diabetes - osteoporosis - arthritis - obesity

Clinical practice guidelines exist for physical activity in many diseases:

- high blood pressure - chronic lung disease - cholesterol management - cardiovascular disease - diabetes - osteoporosis - arthritis - obesity

Leisure Time Physical Activity Trends 1986-1999

All States Reporting Physical Activity each year, BRFSS

0

5

10

15

20

25

30

35

40

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Recommended Activity Physical Inactivity

S. Ham, CDC, 2000. Recommended Activity = Moderate or Vigorous Activity

Percent of Employers Offering Health Benefits to Employees 2000-

2005

Percent of Employers Offering Health Benefits to Employees 2000-

2005

60%66%

69%

0%

10%

20%

30%

40%

50%

60%

70%

2000 2003 2005

60%66%

69%

0%

10%

20%

30%

40%

50%

60%

70%

2000 2003 2005

Source: “Employer Health Benefits 2005 Survey,” (#7315), The Henry J. Kaiser FamilyFoundation and Health Research and Education Trust, September 2005

A Costly BenefitA Costly Benefit

Private industry employers’ average medical costs per employee*

Portion of private industry workers in a company health plan

*Includes all companies and employees, both with and without health benefits

Source: Bureau of Labor Statistics, Published in the new York Times

Relation of Business Size and Workforce Percentage

Business Size % Firms % Workforce

<499 employees 99% 50%

5000+ employees .04% 32%

Private Business Expenditures for Healthcare as a Percentage of Business

Profits 1993-2000

Private Business Expenditures for Healthcare as a Percentage of Business

Profits 1993-2000

66%61%

53%49%

44%41%

38% 37%34%

58%59%60%55%

40%40%40%

0%

15%

30%

45%

60%

75%

1993 1994 1995 1996 1997 1998 1999 2000

Pe

rce

nta

ge

of

Pro

fits

After-Tax Profits Before-Tax Profits

66%61%

53%49%

44%41%

38% 37%34%

58%59%60%55%

40%40%40%

0%

15%

30%

45%

60%

75%

1993 1994 1995 1996 1997 1998 1999 2000

Pe

rce

nta

ge

of

Pro

fits

After-Tax Profits Before-Tax Profits

Source: Cowan, CA et al. (2002) Healthcare Financing Review

Top Five Employer Priorities for 2005Top Five Employer Priorities for 2005

41%

42%

52%

56%

90%

0% 20% 40% 60% 80% 100%

41%

42%

52%

56%

90%

0% 20% 40% 60% 80% 100%

Control Healthcare Costs

Provide Rewards Programs

that Attract, Motivate, andRetain Talent

Address Employee Willingnessto Pay a Larger Portion of

Benefits CoverageIncrease Employee

Responsibility for ManagingTheir Own Rewards Budget

Manage RetirementBenefits Cost

Source: Deloitte Consulting (2004)

Clinical Preventive Services by Employer Size

Service Small Medium LargeNutrition counseling 19% 27% 21%Weight loss/mngmnt 17% 21% 18%PA counseling 14% 23% 11%

Bondi et al. Am J Health Promotion 2006;20:214

Bottom LineBottom Line• Can’t reduce health care costs without

improving the health of employees• Use evidence-based recommendations to guide

alignment of benefits, policies, and programs with employee health

• Use field studies to accelerate identification of what works

• Put policies in place that support employee adoption of healthy behaviors

• Can’t reduce health care costs without improving the health of employees

• Use evidence-based recommendations to guide alignment of benefits, policies, and programs with employee health

• Use field studies to accelerate identification of what works

• Put policies in place that support employee adoption of healthy behaviors

ROI: Worksite Health PromotionROI: Worksite Health Promotion

Analysis of 28 studies showed average ROI of $3.48 per $1 in cost

Analysis of 28 studies showed average ROI of $3.48 per $1 in cost

Citibank had a savings of $8.9 million over 2 years with a program cost of $1.9 million – for $4.70:$1 benefits:cost ratio

From 1990–1999 Johnson & Johnson generated savings of about $8.5 million/year

Sources: Ozminkowski et al. AJHP Jan/Feb 1999; Goetzel et al. J Occ Hlth & Environ Med 2002; Aldana AJHP May/June 2001.

Examples of Approaches: Physical ActivityExamples of Approaches: Physical Activity

Health Checks / Fitness appraisals

Health education – i.e. written materials with / without support

On-site exercise facilities / classes

Web based advise and support

Subsidized membership at off-site gyms / facilities

Stair use / Active travel

Types of Workplaces Often Involved

Types of Workplaces Often Involved

Public sector• Government offices• Police• Fire service• Utilities – gas / electric

Private Sector – (larger)• Pharmaceutical• Food companies• Retail companies• Legal firms• Banks

Public sector• Government offices• Police• Fire service• Utilities – gas / electric

Private Sector – (larger)• Pharmaceutical• Food companies• Retail companies• Legal firms• Banks

Universities

Hospitals

Blue collar and

White collar

Universities

Hospitals

Blue collar and

White collar

Less often

Retail and service industry

Manufacturing industry

Skilled / semi skilled

Voluntary sector

Small/medium size enterprises

CDC Projects Related to Worksites CDC Projects Related to Worksites

Community Guide Recs

Promising Practices

Translate Findings

Focus groups

Disseminate

Develop Cost

CalculatorEvaluate

Develop Toolkits

Implement

Evaluate

Worksites with Promising Practices

Preliminary SWAT Findings - What Works

Preliminary SWAT Findings - What Works

1. Focus on multiple levels, including individual behavior, environmental factors and organizational policy

2. CEO’s commitment - “culture of wellness”3. Often motivation is “the right thing to do”4. Implement population-based interventions - tailor

delivery to employee needs5. High participation rates 6. Systematically evaluate

1. Focus on multiple levels, including individual behavior, environmental factors and organizational policy

2. CEO’s commitment - “culture of wellness”3. Often motivation is “the right thing to do”4. Implement population-based interventions - tailor

delivery to employee needs5. High participation rates 6. Systematically evaluate

Sprint World HeadquartersOverland Park, KS 66251

Field studi

es

Field studi

esScientific literatureScientific literature

CG reviewCG review

TIDE ProcessTIDE Process

Task Force recsTask Force recs

Field studiesField studies

Gray literatureGray literature

DNPA reviewDNPA review

Promising practicesPromising practices

Field practicesField practices

Promising practicesPromising practices

Set Research AgendaSet Research AgendaImplementation and EvaluationImplementation and Evaluation

Translate and disseminate for Identify Research Gaps specific target audiencesTranslate and disseminate for Identify Research Gaps specific target audiences

DNPA reviewDNPA review

Promising PracticesPromising Practices

• Environmental and Policy strategies

• Informational and educational strategies

• Behavioral strategies

• Environmental and Policy strategies

• Informational and educational strategies

• Behavioral strategies

Environmental and PolicyEnvironmental and Policy

• Address the entire workforce/population and target physical and organizational structures through worksite and public policies that support healthy behaviors. They are likely to be sustained longer than individually oriented strategies

• Address the entire workforce/population and target physical and organizational structures through worksite and public policies that support healthy behaviors. They are likely to be sustained longer than individually oriented strategies

Environment: Enhanced accessEnvironment: Enhanced access

• Example: Male employees in a university maintenance shop in a 16 week exercise intervention – fitness trail/ par course. 19 strength and aerobic activities on 1.5 mile course. 90 minute classes offered free 2 X week. Public charts displayed exercise done at and outside work.

• Median effect size for 5 studies -3.4%

• Example: Male employees in a university maintenance shop in a 16 week exercise intervention – fitness trail/ par course. 19 strength and aerobic activities on 1.5 mile course. 90 minute classes offered free 2 X week. Public charts displayed exercise done at and outside work.

• Median effect size for 5 studies -3.4%

Informational and Educational Informational and Educational

• Exercise prescriptions– Specific recommendations for frequency,

type and intensity of exercise.• Median effect size for 14 studies was -4.8lbs

• Multi-component educational practices– Prescription plus brochures, pamphlets,

electronic messages (email, text message)• Median effect size -4.8 lbs

• Exercise prescriptions– Specific recommendations for frequency,

type and intensity of exercise.• Median effect size for 14 studies was -4.8lbs

• Multi-component educational practices– Prescription plus brochures, pamphlets,

electronic messages (email, text message)• Median effect size -4.8 lbs

Behavioral Behavioral

• Teaching behavioral management skills, structuring social environment to provide social support, individual/ group behavioral counseling- family friends.

• Modeling, participatory skill development feedback, incentives, disincentives, pedometers, journals.

• Teaching behavioral management skills, structuring social environment to provide social support, individual/ group behavioral counseling- family friends.

• Modeling, participatory skill development feedback, incentives, disincentives, pedometers, journals.

Behavioral- competitions and incentives

Behavioral- competitions and incentives

• Competitions and incentives alone

• Teams compete for total miles walked or weight lost.

• Median effect size for 12 studies, -6.5lbs

• Competitions and incentives alone

• Teams compete for total miles walked or weight lost.

• Median effect size for 12 studies, -6.5lbs

BehavioralBehavioral

• Behavioral practices with incentives• Includes modeling, skill building, feedback

social support and incentives/ disincentives. – 10 lunch hour sessions on behavioral change,

goal setting nutrition ed, self monitoring, self control cognitive restructuring, contingency management, physical exercise, social support. Tailored feedback on progress.

– Monetary prizes awarded at end of treatment.

• Median effect for 15 studies -5.1lbs

• Behavioral practices with incentives• Includes modeling, skill building, feedback

social support and incentives/ disincentives. – 10 lunch hour sessions on behavioral change,

goal setting nutrition ed, self monitoring, self control cognitive restructuring, contingency management, physical exercise, social support. Tailored feedback on progress.

– Monetary prizes awarded at end of treatment.

• Median effect for 15 studies -5.1lbs

Behavioral PracticesBehavioral Practices

• Behavioral practices without incentives• Example

– Building maintenance company during work hours, employees given lectures, practical training, individual counseling, group discussion, self-education session. Individual goals set and with follow up and feedback from supervisor, spouse and family.

• Median effect for 36 studies -5.8lbs

• Behavioral practices without incentives• Example

– Building maintenance company during work hours, employees given lectures, practical training, individual counseling, group discussion, self-education session. Individual goals set and with follow up and feedback from supervisor, spouse and family.

• Median effect for 36 studies -5.8lbs

Promising PracticesPromising Practices

• Enhanced access to PA opportunities + health education

• Exercise prescriptions alone• Use of multi-component educational practices• Use of (weight loss) competitions and

incentives• Use of behavioral practices and incentives• Use of behavioral practices without incentives

• Enhanced access to PA opportunities + health education

• Exercise prescriptions alone• Use of multi-component educational practices• Use of (weight loss) competitions and

incentives• Use of behavioral practices and incentives• Use of behavioral practices without incentives

CDC Healthy Worksite

CDC-wide Assets & Needs Assessment

Policies Health promotion

• Exercise (1/2 hour approved absence)• Lifestyle centers• Allow leave for preventive screenings

Food/cafeteria choices• Modify GSA contracts• Vending Choices

Tobacco-free worksite

CDC-wide Assets & Needs Assessment

Physical environment Facilities audit CDC walkability audit (e.g., Rhodes-

Columbia) Fresh produce vendor Healthy building standards Chamblee trail Lactation rooms Stairwell projects

BeforeBefore

AfterAfter

Barriers to Stair UseBarriers to Stair Use

Marshall et al.

• Already use the stairs enough

• No time• Too busy• Too lazy

Marshall et al.

• Already use the stairs enough

• No time• Too busy• Too lazy

Mutrie et al

Barriers• Too lazy• Lack of Time

Motivators• Save time• Improve Health

Mutrie et al

Barriers• Too lazy• Lack of Time

Motivators• Save time• Improve Health

Study Example: Government Office [CDC, USA]

Study Example: Government Office [CDC, USA]

Baseline data

Intervention 1Paint and carpet

Added pictures

Added music

Follow up data

Over 3+ years

♫♪ ♫♪ ♫♪

Added Signage

ResultsResults

0

2

4

6

8

10

12

14

16

Art work Signs Music

Month 1-3 Month >3

% C

han

ge

in t

rip

s p

er o

ccu

pan

t fr

om

bas

elin

e 3.7%

4.2% 4.7%

CDC Walkability AuditCDC Walkability Audit

Mean Walking Segment ScoresMean Walking Segment Scores

• Chamblee67.2

• Corporate 59.5• Executive 53.6• Roybal

51.1• Koger

39.5

• Chamblee67.2

• Corporate 59.5• Executive 53.6• Roybal

51.1• Koger

39.5

0-39 High risk, unattractive40-69 Moderate risk70+ Low risk, pleasant

Impact of Financial Incentives on Weight Loss (> 5%) among Overweight Employees

Group % Losing >5%

$ 0 for each 1% 4%

$7 for each 1% 8%

$14 for each 1% 17%

Incentives to increase physical Activity

$0 2.3 hr week

$17.50 4.1hr week

Finkelstein et al, JOEM, 2007, Prev. Med 2008

The Obesity Cost Calculator

Estimates or calculates workforce obesity costs based on medical costs and absenteeism (presenteeism and workman’s compensation not included)

Estimates cost:benefit of interventions based on targeted population, participation rate, effect size, potential adverse effects of intervention, costs, and duration

Obesity Cost Calculator: ObjectivesObesity Cost Calculator: Objectives

• To produce a tool that allows employers and/or insurers to estimate the following (based on specific characteristics of their population):– Prevalence of obesity – Medical costs of obesity– The cost of increased absenteeism due

to obesity– Number of years until break-even for an

obesity intervention under alternate scenarios

• To produce a tool that allows employers and/or insurers to estimate the following (based on specific characteristics of their population):– Prevalence of obesity – Medical costs of obesity– The cost of increased absenteeism due

to obesity– Number of years until break-even for an

obesity intervention under alternate scenarios

Thank You

Examples: Worksite Programmes on PA

Examples: Worksite Programmes on PA

– Stairs

– Incidental physical activity / accumulation / pedometers

– Travel to work

– Stairs

– Incidental physical activity / accumulation / pedometers

– Travel to work

Promoting Stair Use: SignagePromoting Stair Use: Signage

Example from a Hospital Workplace

Example from a Hospital Workplace

Marshall et al., 2002 [Health Education Research. 17(6):743-49]Can motivational signs prompt increases in incidental physical activity in an Australian health-care facility?

AIM: to provide ‘point of Choice’ motivational prompt to encourage stairs as an alternative to the elevator

ResultsResults

Marshall et al., 2002 [Health Education Research. 17(6):743-49]

P = 0.02 nsns

24%

ResultsResults

• Survey (50% < 40 years, ~80% female)– 90% recognised signage / foot prints– Of these 90%

• 30% recall signs• 30% recall foot prints• 18% recall both

Marshall et al., 2002 [Health Education Research. 17(6):743-49]

Pedometer Programmes: Example “First Step”

Pedometer Programmes: Example “First Step”

• Canadian workers with moderately to highly sedentary jobs

• 177 enrolled, 106 completed

• 4 week adoption phase– Weekly meetings with facilitator

– Goal setting, relapse prevention, self-monitoring

• 8 week adherence phase– Self-monitoring and goal setting

• Canadian workers with moderately to highly sedentary jobs

• 177 enrolled, 106 completed

• 4 week adoption phase– Weekly meetings with facilitator

– Goal setting, relapse prevention, self-monitoring

• 8 week adherence phase– Self-monitoring and goal setting

Tudor-Locke et al., (2004) Preventive Medicine, 39, 1215-1222 www.peifirststep.ca

Results: “First Step” ProgrammeResults: “First Step” Programme“Adoption” “Adherence”

Tudor-Locke et al., (2004) Preventive Medicine, 39, 1215-1222

49% in mean steps per day by week 4

Travel ProgramsTravel Programs

• Who would they not reach ?

Why do we try and use travel to work to promote physical activity?

Who might these programmes target best?

Walk in to Work OutWalk in to Work Out

• RCT to increase active commuting in 3 worksite settings (hospital trust, university, public sector)

• Intervention group received “Walk in to Work Out pack”

• RCT to increase active commuting in 3 worksite settings (hospital trust, university, public sector)

• Intervention group received “Walk in to Work Out pack”

Mutrie et al., 2002 [Journal of Epidemiol & Community Medicine 56:407-412]Walk in to Work out: A randomised controlled trial of a self help intervention to promote active commuting.

“Walk in to Work Out”Mutrie et al., 2002

• Intervention: booklet with educational and practical info (routes, cycle storage etc), wall chart, workplace map

• Control group: Told they would receive it 6 months later

• 25% of the intervention group changed to “action/maintenance” at 12 months

• Very little change in levels of cycling 0

20

40

60

80

100

120

140

Baseline Follow Up

ControlControl InterventionIntervention

No walking at baseline

Walking at baseline

Aver

age

time

spen

t per

wee

k wa

lking

to w

ork

(min

s)

Updating Healthy Workforce 2010 Updating Healthy Workforce 2010

• Published in 2001• Enduring Popularity • Includes:

• Business case for WHP

• Healthy People 2010 • Program Design• Low-cost Resources

• Published in 2001• Enduring Popularity • Includes:

• Business case for WHP

• Healthy People 2010 • Program Design• Low-cost Resources

Worksite Health Promotion Triad (NGA)

SupportiveEnvironment

Personal Accountability

Health BenefitDesign

Benefits

Healthier WorkforceFewer medical visitsLower medical costsLower indirect costs

RecruitmentRetention

Competitive advantage

Study Example: Marshall et al., 2002Study Example: Marshall et al., 2002Weeks 1-3

Baseline data

Weeks 4-5

Weeks 6-7

Weeks 8-9

Weeks 10-12

Intervention

Control (‘wash out’)

Intervention

Control (‘wash out’)Baseline survey Follow up survey

Data CollectionData Collection

• Infra red (battery powered) counter on stairs (counting going up only!)

• Observation – 8-9am each morning– Provided validation of counter (10-15%

error on lift / 0-5% error on stairs)

• Infra red (battery powered) counter on stairs (counting going up only!)

• Observation – 8-9am each morning– Provided validation of counter (10-15%

error on lift / 0-5% error on stairs)

Another stair climbing exampleAnother stair climbing example

Mutrie & Blamey 2000 [Brit J Sports Med 34, page 144]

Blamey et al 1995 [ BMJ 311 page 289-290 ]

Strategy for Workplace Health and SafetyStrategy for Workplace Health and Safety

Promotes strategic partnerships to improve….

• Employment and productivity – by keeping those at work healthy and in work;

• Education – by instilling an appropriate understanding of risk management from an early age;

• Health and rehabilitation – by contributing to the nation’s health and well-being and dealing with health inequalities;

• Public service reform – by reducing sickness in the public sector and enhancing public sector delivery.

Promotes strategic partnerships to improve….

• Employment and productivity – by keeping those at work healthy and in work;

• Education – by instilling an appropriate understanding of risk management from an early age;

• Health and rehabilitation – by contributing to the nation’s health and well-being and dealing with health inequalities;

• Public service reform – by reducing sickness in the public sector and enhancing public sector delivery.

Promising Practices in HPM Organizations

1. Employ incentives consistent with core mission2. Operate at multiple levels – individual, policy,

cultural3. Target most important health issues for workforce4. Tailored to needs of individuals in workforce5. Achieve high rates of participation6. Achieve successful outcomes7. Based on clear definitions of success

Goetzel et al. In press

CDC Worksite Activities

Healthier Worksite InitiativeValidation of obesity cost calculatorGuide Translation

- CDC working group- RTI evaluation contract - Goetzel contract for “Promising Practices”

Kalamazoo Valley Community College

357 FTEs. Institutional support. Multicomponent – HRAs with free targeted counseling, on-site fitness facility, wellness programs, incentives.

ROI: 1:1 or 2:1. Health insurance costs increased 3.5%/y vs 8-9%.

Morbidity Associated with Inactivity

Morbidity Associated with Inactivity

• Coronary Heart Disease

• Obesity

• Diabetes

• Stroke

• Colorectal Cancer

• Coronary Heart Disease

• Obesity

• Diabetes

• Stroke

• Colorectal Cancer

Average Annual Premium Contribution for Family Coverage

1999-2005

Average Annual Premium Contribution for Family Coverage

1999-2005

$4,248 $4,819 $5,274 $5,866$6,656 $7,289

$8,169

$1,543$1,619

$1,787

$2,137

$2,412

$2,661

$2,713

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

1999 2000 2001 2002 2003 2004 2005

$4,248 $4,819 $5,274 $5,866$6,656 $7,289

$8,169

$1,543$1,619

$1,787

$2,137

$2,412

$2,661

$2,713

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

1999 2000 2001 2002 2003 2004 2005

Co

ntr

ibu

tio

ns

for

Fam

ily C

ove

rag

e

73.4% 74.9% 74.7% 73.3%

73.3%73.4

%

75.1%

% Employer ContributionEmployee ContributionEmployer

Note: Coverage is for a family of four.Source: Calculated based on “Employer Health Benefits 2005 Annual Survey,” (#7315), The Henry J. Kaiser Family Foundation and Health Research and Educational Trust, September 2005

National EstimatesNational Estimates

• Obesity-attributable (i.e., excess) costs are estimated using regression models– Costs of obesity are above costs for normal weight

employees– The average normal weight employee:

• Spends $1,950 in medical expenditures• Misses 2.6 days of work due to illness

• Not included (and therefore underestimates costs)– Presenteeism– Worker’s compensation costs

Intervention Module: DataIntervention Module: Data• Number of employees (by weight category)

from expenditure module• Estimates predicted from the data

– Predicted medical and work loss costs (in the absence of intervention)

• Used to estimate cost savings

• User-Specified or Default Inputs:– Intervention target– Intervention cost– Intervention effectiveness

• Number of employees (by weight category) from expenditure module

• Estimates predicted from the data– Predicted medical and work loss costs (in the

absence of intervention)• Used to estimate cost savings

• User-Specified or Default Inputs:– Intervention target– Intervention cost– Intervention effectiveness

Intervention Module: Inputs Intervention Module: Inputs

Target of intervention (obese, comorbidities)

Participation rate (by risk category)

Anticipated effect

Workdays missed due to intervention (surgery)

Anticipated costs

Copayment

Duration of effect

Target of intervention (obese, comorbidities)

Participation rate (by risk category)

Anticipated effect

Workdays missed due to intervention (surgery)

Anticipated costs

Copayment

Duration of effect

Intervention Module: OutputIntervention Module: Output• Output

– Estimated number of participants– Firm’s intervention-related costs– Annual cost savings– Number of years until break-even (if ever)

• Presented separately for:– Medical costs only– Medical + work loss costs

• Output – Estimated number of participants– Firm’s intervention-related costs– Annual cost savings– Number of years until break-even (if ever)

• Presented separately for:– Medical costs only– Medical + work loss costs

Input Data for the Calculator: Expenditures

Module

Input Data for the Calculator: Expenditures

ModuleOther information to increase the accuracy of obesity cost

estimates:– Type of industry (from a list of 12 industry categories)– State or territory– Number of employees overall, by gender or age category

Number of overweight or obese employees – Average wage information for employees – Proportion of employees receiving benefits

Other information to increase the accuracy of obesity cost estimates:

– Type of industry (from a list of 12 industry categories)– State or territory– Number of employees overall, by gender or age category

Number of overweight or obese employees – Average wage information for employees – Proportion of employees receiving benefits

Minimum Data Elements

Standard demographic variables: age, race, ethnicity, gender, household income, marital status, education

Medical • BMI, blood pressure, cholesterol, glucose, smoking• Annual Medical claims data with total charges or payments linked

to BMI Work loss • Annual missed work days due to illness or injury (i.e., sick leave)

linked to BMI • Salary of employee (to monetize the days missed) Capacity to link HRA to medical claims data and/or electronic time

sheet data over time

Obesity Cost Calculator: Expenditures Module

Obesity Cost Calculator: Expenditures Module

• The Obesity Cost Calculator allows companies to estimate their obesity-attributable costs based on the demographic characteristics of their employees (or enrolled population for insurers)

• At a minimum, the user must enter the number of employees in the company (or # of enrollees)

• The Obesity Cost Calculator allows companies to estimate their obesity-attributable costs based on the demographic characteristics of their employees (or enrolled population for insurers)

• At a minimum, the user must enter the number of employees in the company (or # of enrollees)