North Carolina Supplemental Cardiovascular Disease Prevention Project: Design and Objectives

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U.S. Health Care as a Percentage of the GDP
Today 15 of GDP
US Military uses 3.2
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Infant Mortality
2001, General Accounting Office, 2004
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Life Expectancy in the World
WHO, 2004
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Life Expectancy in the World
Japan
U.S.
WHO, 2004
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U.S. Health Care as a Percentage of the GDP
Today 15 of GDP
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U.S. Health Care as a Percentage of the GDP
9
U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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Doctor Day, January 1, 2226
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• Pharmaceutical companies
• Canada
• Malpractice and law suits
• High tech equipment
• Medical profession salaries
• Administration
• Waste/fraud
• Poor lifestyles

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No cost transparency
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• Managed care un-coupled the cost of consumption
  from the act of consumption.

...nobody spends somebody elses money as
wisely or as frugally as he spends his
own. Milton Friedman
Economist and recipient of the 1976 Nobel
Memorial Prize for economic science
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Employer Health Benefits 2005 Annual Survey
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A Few Facts About Health Care

• The cost health care will continue to rise
• All health care costs are paid by individuals
• Lower health care cost for companies and
  individuals is a function of shifting who pays a
  greater portion

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The Bottom Line
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
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Obesity Trends Among U.S. Adults1985
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Obesity Trends Among U.S. Adults1986
24
Obesity Trends Among U.S. Adults1987
25
Obesity Trends Among U.S. Adults1988
26
Obesity Trends Among U.S. Adults1989
27
Obesity Trends Among U.S. Adults1990
28
Obesity Trends Among U.S. Adults1991
29
Obesity Trends Among U.S. Adults1992
30
Obesity Trends Among U.S. Adults1993
31
Obesity Trends Among U.S. Adults1994
32
Obesity Trends Among U.S. Adults1995
33
Obesity Trends Among U.S. Adults1996
34
Obesity Trends Among U.S. Adults1997
35
Obesity Trends Among U.S. Adults1998
36
Obesity Trends Among U.S. Adults1999
37
Obesity Trends Among U.S. Adults2000
38
Obesity Trends Among U.S. Adults2001
No Data 1519 2024 25
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Obesity Trends Among U.S. Adults2002
(BMI ?30, or 30 lbs overweight for 54 person)
No Data 1519 2024 25
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Obesity Trends Among U.S. Adults2003
No Data 1519 2024 25
41
Obesity Trends Among U.S. Adults2004
No Data 1519 2024 25
42
Obesity Trends Among U.S. Adults2004
No Data 1519 2024 25
43
Obesity Trends Among U.S. Adults2005
No Data 1519 2024 2529
30
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Percent of adults who are overweight or obese
67
2/3 of adults are overweight or obese
45
Percent of adults who are overweight or obese
81
46
Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 200313824-32
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Diabetes Among Adults in the U.S.,BRFSS 1990
48
Diabetes Among Adults in the U.S.,BRFSS 1992
49
Diabetes Among Adults in the U.S.,BRFSS 1994
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Diabetes Among Adults in the U.S.,BRFSS 1996
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Diabetes Among Adults in the U.S.,BRFSS 1997
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Diabetes Among Adults in the U.S.,BRFSS 1998
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Diabetes Among Adults in the U.S.,BRFSS 1999
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Diabetes Among Adults in the U.S.,BRFSS 2000
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Diabetes Among Adults in the U.S.,BRFSS 2001
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Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 20032901884-1890
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Lifetime Risk of Diabetes for Children Born in
2000
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Venkat Narayan, JAMA 20032901884
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Lifetime Risk for Chronic Diseases
49
NCI 2006 Lancet 199935389
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How People Died in 2005
Cancer 24
Accidents Suicide Infections Kidney failure Lung
failure Others 40
Cardiovascular Disease 36
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How People Died in 2005
CVD
Cancer
Other
Up to 70 of all causes of death are lifestyle
related and preventable
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Percent of Chronic Diseases That Are Caused by
Poor Lifestyle
91
82
71
70
Sources Stampfer, 2000 Platz, 2000 Hu, 2001
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Portion of Health Care Caused by Preventable
Chronic Diseases
64
National prevalence of health risks
80
78
CDC, BRFSS, 2002
65
How did we get this way?
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5-a-day 1 million
Food Marketing 25 Billion
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Texas Double Whopper
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Employee Health
77
Typical Employee Distribution
30
50
20
78
Typical Employee Cost Distribution
15 of Employees 85 of Costs
85 of Employees 15 of Costs
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Typical Employee Cost Distribution
59 of next years cost group
80
Employee Health
81
Employee Health and Productivity Continuum
Unhealthy Low Productivity
Healthy High Productivity
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Health and Productivity Management (HPM)
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1,500-3,500 in Excess Claims for Each
Additional Health Risk
Source Dee Edington, Health Management Research
Center
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Average 2003 Medical Care Costs
N1,706
Source StayWell Health Management
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Average 1997-1999 Medical Care Costs
N43,687
Source StayWell Health Management
86
Days Absent in 2003
N941
Source StayWell Health Management
87
Percent with Workers Comp Claims in 2003
N23,916
Source StayWell Health Management
88
Percent with STD Claims in 2004
N23,916
Source StayWell Health Management
89
Fairview Health Services
-13
-2
15
N3,577
Source StayWell Health Management
90
DaimlerChrysler/UAW National Wellness Program
-4.0
0.0
4.0
N5,390
Source StayWell Health Management
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1. Show the connection between health and
productivity

• Present the evidence that supports worksite
  health promotion activities

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Evidence That SupportsWorksite Health Promotion
Activities

• David Anderson, Ph.D. StayWell Health Management

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Return on Investment (ROI)
32 studies
14 studies
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2. Expand the definition of productivity

• Not just measuring widgets
• Service oriented work
• Presenteeism and absenteeism

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3. Highlight current expenditures directed at
health and productivity management programs

• medical benefits
• short and long term disability
• workers compensation
• disease management
• demand management
• absence management
• human resources

• employee relations
• staff recruitment and training
• employee assistance programs
• work/life
• organizational development
• health promotion

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10,000
3,000
Indirect Costs
13,000
MEDSTAT Group
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4. Compare yourself to norms and best practices
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Leading by Example
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5. Commit to collaborate

• No more silos
• Form a wellness committee
• Work across departments
• Safety
• Medical
• EAP
• Facilities
• Benefits, etc

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6. Support Worksite Health Promotion Efforts
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What do we do about it?

• Awareness/education
• Motivation
• Tools, strategies
• Policy and environment

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Individual
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Individual
Family
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Individual
Family
Worksite
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Individual
Family
Worksite
Community
106
Nation/ world
Individual
Family
Worksite
Community
107
Successful Programs

• Educate / create awareness
• Motivate
• Build skills
• Change the employees environment

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Educate (Why and What)

• Create individual awareness
• Create organizational awareness and support
• Create buzz

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• Letter from Leaders
• Flyers
• Posters
• Email notifications
• Television/video programs
• Books

• Payroll stuffers
• Internet sites
• Magazines
• Lunch and learns
• Special speakers
• Newsletters

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Motivate

• Use incentives
• Before/after stories in newsletters
• Team competitions
• Include spouses and significant others

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Build Skills (How do I do this?)

• How to overcome barriers to exercise
• Choose healthier foods
• Healthy food substitutions
• How to make healthy foods
• Finding inexpensive healthy foods

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• www.fastfoodbook.com

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Change the Employees Environment

• Physical Environment
• Policy
• Culture

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• Physical environments
• Smoking policies
• Access to healthy foods in cafeterias, vending
  machines, and at meetings
• Opportunities to be physically active
• Walking paths
• Bike paths
• Access to fitness facilities

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• Policies
• Medical coverage for preventive services
• No smoking policies
• Flex time
• Rules that support healthy living

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Work Culture

• Birthday cake every week
• Worksite support for healthy behaviors
• Its okay to eat healthy food

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Fairview Health Services
-13
-2
15
N3,577
Source StayWell Health Management
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DaimlerChrysler/UAW National Wellness Program
-4.0
0.0
4.0
N5,390
Source StayWell Health Management
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Why Should I Care?
Morbidity
Lifespan in years
76
0
critical illness
Ann Intern Med, 2003139455-459
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Morbidity
Lifespan in years
0
?
76
86
critical illness
126
End of Life Benefits
Morbidity
Lifespan in years
10-20 Years
Morbidity
Lifespan in years
127
www.fastfoodbook.com