The Health Impacts of Social Networking

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The Health Impacts of Social Networking

• Presenter
• Dr. Daniel Dunlop

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Scope of the Problem

• National Healthcare Spending
• Where are we now?

http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/proj2006.pdf
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Economic Impacts of Rising Health Care Costs
Source http//www.nchc.org/facts/Economy/effects_
on_business_operations.pdf
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FACTS

• 2/3 of American adults are overweight or obese
• Represents a 12 (overweight) and a 70 (obese)
  increase over the last decade alone
• 16 of children and adolescents ages 6-19 years
  are overweight (including obese)
• Represents a 45 increase over the last decade
• Increase occurred for all population subsets,
  including children, the elderly, and all
  racial/ethnic groups

Source http//arjournals.annualreviews.org/doi/ab
s/10.1146/annurev.publhealth.26.021304.144628
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Trends in Obesity
Source National Health and Nutrition Examination
Survey
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The Top 10 Most Costly Health Conditions
Goetzl, R JOEM 45(1) 5-14 2003
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Keeping People Healthy Makes Economic Sense

• Approximately 70 of total burden of disease can
  be traced back to illnesses that are preventable
• Modifiable health risk factors are precursors to
  many diseases and disorders, and premature death
• Many modifiable health risks are associated with
  increased health care costs within a relatively
  short time window
• Modifiable risk factors can be improved through
  effective health promotion and disease prevention
  programs
• Improvements in the health risk profile of a
  population can lead to reductions in health costs
  and improvements in productivity
• Well designed and well-implemented programs can
  be cost/beneficial-they can save more money than
  they cost, thus producing a positive return on
  investment (ROI)

Source Ron Goetzel, Ph.D. Rollins School of
Public Health Presentation January 2008
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How to Overcome the Obstacles?

• Technology
• Driving
• Fast Food
• Isolation

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The Opportunity

• Healthier Employees Mean
• Fewer medical claims
• Reduced absenteeism
• Higher productivity
• Increased retention
• Fewer workers compensation claims
• Less long-term disability

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The Wellness Continuum
preventionearly detectionearly
interventionmedical interventionmedical
managementend of life initiatives
wellness

• Click to add test

OPTIMAL HEALTH
CHRONIC ILLNESS
Prevention
Treatment
preventionearly detectionearly
interventionmedical interventionmedical
managementend of life initiatives
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Health Expenses
The goal is to nudge a Large part of the
population healthier
Disease and Case Management Attack the tail
Population Distribution
0
10,000
Cost
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Elements of a Robust Program

• What do the experts say?
• Measures of key indicators
• 80 program participation over any 3 year period
• 70 low risk
• Maintenance and improvements in work environment
• - Dr. Dee Edington

Source University of Michigan Health Management
Research Center
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The Science of Behavior Change
The challenge How do we drive long term
behavior changes?
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Prochaskas/DiClemente Transtheoretical Model of
Behavior Change
1 J.O. Prochaska and DiClemente, C.,
Transtheoretical Therapy Toward a More
Integrative Model of Change, Psychotherapy
Theory, Research and Practice, 19(3), 1982
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The Change Process

• The change process is linear and sequential.
• Intellectual ( informs )
• Emotional (engages )
• Visceral ( moves to action )
• Cellular (DNA )
• Prochaska-Stages of Change
• Pre-Contemplative
• Contemplative
• Preparation
• Action
• Maintenance
• At any one time only about 10 of people are
  ready to change.

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The Change Process

• The Science of Behavior Change
• Skinner and Behaviorism. The behavioral model
  derived by psychologist B.F. Skinner provides the
  foundation for most incentive programs.1 The
  diagram below illustrates the components of the
  model

1 B.F. Skinner, The Behavior of Organisms, 1938
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The Change Process

• Social Learning Theory.
• Most health behavior is voluntary and
  results from individual choice. According to
  Kurt Lewins and Albert Banduras social
  learning theory, 1 a number of
  counter-balancing factors affect a health
  behavior, such as cigarette smoking.
  Restraining factors, like stress relief, peer
  pressure, or beliefs that smoking helps to
  control weight, act to maintain the smoking
  behavior. In contrast, enhancing factors like
  social stigmas, awareness of lung cancer risk, or
  laws outlawing smoking in public places, act to
  change it. For change to occur, the balance
  between these factors must be disrupted by
  strengthening the factors leading to a healthier
  behavior and reducing those helping to maintain
  unhealthy behavior. Incentives aim to do the
  former.
• 1 A. Bandura, Social Learning Theory, 1977

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Sources of Influence- Peer Pressure and Social
Ability

• Never run after your Hat-
• others will be
• Delighted to do it
• why spoil their fun?
• -Mark Twain

Motivation
Ability
Surpass Your Limits
make the undesirable desirable
PERSONAL
Find Strength in Numbers
Harness Peer Pressure
SOCIAL
Design Rewards and Demand Accountability
Change the Environment
STRUCTURAL
Influencer-The power to change anything. page 167
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Wellness at Work

• A CDC report says 65 of U.S. adults can be
  reached through their workplaces, making them the
  perfect settings for fitness and wellness
  programs. Since the workplace also has a
  competitive edge, employees engage in friendly
  rivalries that enhance compliance and results.
  One study found more than half of workers in a
  12-week program that split participants into
  teams met their minimum goals. Reuters (02/09)

Source http//www.reuters.com/article/lifestyleMo
lt/idUSTRE5182R420090209?pageNumber1virtualBrand
Channel0
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Create a Company Culture of Health
The power of social networking and team based
health competitions

• Published in the New England Journal of Medicine,
  a recent Framingham study concluded that social
  networks can spread positive health behaviors.
  The authors wrote that weight loss interventions
  that provide peer support-that is, that modify
  the persons social network- are more successful
  than those that do not. People are connected,
  and so their health is connected. 1
• A recent study conducted by Buck Consultants
  found that 81 of surveyed U.S. employers plan to
  offer a health competition program within the
  next three years. 2

1The Spread of Obesity in a Large Social Network
over 32 Years. Christakis, Nicholas A., etal.
The New England Journal of Medicine 2007 2
Working Well A Global Survey of Health
Promotion and Workplace Wellness Studies. Buck
Consultants, Oct.2007
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People are connected, and so their health is
connected.-Nicholas Christakis
The Spread of Obesity in a Large Social Network
Over 32 Years Nicholas A. Christakis, M.D.,
Ph.D., M.P.H., and James H. Fowler, Ph.D.n engl j
med 3574 www.nejm.370 org july 26, 2007
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Obesity in Social Networks

• Chance of becoming obese increased by 57 if a
  person had a friend who became obese.
• If one sibling became obese, the chance that the
  other would become obese increased by 40.
• If one spouse became obese, the likelihood that
  the other spouse would become obese increased by
  37.

The Spread of Obesity in a Large Social Network
over 32 Years Nicholas A. Christakis, M.D.,
Ph.D., M.P.H., and James H. Fowler, Ph.D.
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Leverage the Power of Social Networks

• the relevance of social influence also suggests
  that it may be possible to harness this same
  force to slow the spread of obesity.
• Network phenomena might be exploited to spread
  positive health behaviors.
• Use the trusted social support network within
  companies to generate motivation and culture
  change

The Spread of Obesity in a Large Social Network
over 32 Years Nicholas A. Christakis, M.D.,
Ph.D., M.P.H., and James H. Fowler, Ph.D.
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Smoking Cessation in Social Networks

• Smoking cessation by a spouse decreased a
  person's chances of smoking by 67
• Smoking cessation by a sibling decreased chances
  by 25
• Smoking cessation by a friend decreased chances
  by 36
• Among persons working in small firms, smoking
  cessation by a coworker decreased the chances by
  34

The Collective Dynamics of Smoking in a Large
Social Network Nicholas A. Christakis, M.D.,
Ph.D., M.P.H., and James H. Fowler, Ph.D.
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Leverage teamwork

• Smoking- and alcohol-cessation programs and
  weight-loss interventions that provide peer
  support that is, that modify the person's
  social network are more successful than those
  that do not.

The Spread of Obesity in a Large Social Network
over 32 Years Nicholas A. Christakis, M.D.,
Ph.D., M.P.H., and James H. Fowler, Ph.D.
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Challenges for Wellness Programs

• Low Participation Rates
• Low Completion Rates
• Low Long Term Engagement Rates

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Challenge 1 Low Participation

• Reasons
• 1. A top-down approach to wellness
• What are my employers motives?
• 2. Obsession with incentives
• If its so much fun, why do they have to pay me
  to do it?
• 3. Lack of leadership
• Why are the executives not participating?
• 4. Not comprehensive
• I dont need to lose weight, so why should I
  sign up?
• 5. Stigmatizing
• This program is only for people who have a
  weight problem
• 6. Lack of structure
• When do I start? How do I track my progress?

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Challenge 2 Low Completion

• Reasons
• 1. Loss of motivation
• How many people are at the gym in February?
• 2. No support from peers
• Everyone else is sedentary, not eating healthy
• 3. No mechanism to report progress
• How do you know if your employees are still
  improving?

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Challenge 3 No Long Term Engagement

• Reasons
• 1. Programs get stale
• Its hard for the employer to keep designing new
  programs
• 2. Initiatives not designed to instill long-term
  behavior change
• Short programs, one-time events, not evidence
  based
• 3. Environment and culture is not conducive to
  wellness
• Why are we still serving donuts in the cafeteria?

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Solutions

• 1. A bottom-up approach to wellness
• Employees must drive the wellness program
• 2. Use monetary incentives sparingly
• Design wellness programs that employees actually
  like
• 3. Leadership from the top
• Get your CEO in the program in a notable way!
• 4. Change the entire company culture
• Healthy cafeteria food, encourage stair usage,
  exercise breaks
• 5. You dont have to invent your own programs
• Let your employees tell you what they want
• 6. Focus on the entire workforce, not just
  at-risk individuals
• Focus on teamwork and a healthy lifestyle

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Understand What Motivates-Make It Fun!

• Appeal to the majority of the population and the
  individual
• Implement a variety of communication formats
  (web, phone, paper, onsite)
• Periodically energize your program
• (walking challenges, onsite sessions, etc.)
• Customize incentive offering
• Obesity is Contagiousso is losing weight and
  quitting smoking- Leverage teamwork and
  accountability

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Methods

• 16 week team competition
• Participants recruited from
• corporations and community
• Teams of 5 to 11 people
• Exercise hours
• Weight loss
• Pedometer steps
• Participants reported results online every two
  weeks

Source Wing etal. Brown Medical School, 2 The
Miriam Hospital, 3 Baruch College/CUNY, 4
University of Connecticut
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Success for Employees

• High Participation
• (up to 50 without incentives)
• High Completion (73)
• On average, employees
• Lose 7.4 lbs
• Reduce BMI by 1 point
• Exercise 41 mins daily
• Walk 4.92 miles daily

A 1- point BMI reduction is considered clinically
significant and has been associated with a
202.30 annual reduction in medical claims and
pharmaceutical costs per employee.1
1 Association of Healthcare Costs with Per Unit
Body Mass Index Increase. Wang et al. JOEM July
2006
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Long Term Results

• Shape Up Rhode Island
• Statewide Participation

Source Wing etal. Brown Medical School, 2 The
Miriam Hospital, 3 Baruch College/CUNY, 4
University of Connecticut
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The Solution Clients Wellness Calendar
Weight Mgt Classes
Lunch Learns
5ADay Challenge
Team Based Fitness Program
My Stress Solution
Nutrition Scavenger Hunt
Desktop Yoga
Guide to Self-Care
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You Could Make the Difference!

• Based on what you learned
• today
• What message will you
• take back to your clients?
• How will you change the Healthcare delivery
  system?
• How will you leverage social networking to
  promote health in your community?

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• For additional information and support, contact
• Dr. Daniel Dunlop
• dandunlop_at_charter.net