Food and the Bottom Line: Decreasing Health Care Costs and Increasing Productivity by Upgrading the Corporate Food Environment

1
Food and the Bottom Line Decreasing Health Care
Costs and Increasing Productivity by Upgrading
the Corporate Food Environment

• Karrie E. Bergman, MPH Student
• Walden University
• PUBH-6165-4
• Instructor Dr. Stephen D. Arnold
• Spring Quarter, 2010

2
What We Will Cover

• Overview of the Issue
• The State or Our Health
• The Cost of our Health
• Costs to Employers
• Can Changes Improve the Bottom Line?
• Upgrading the Food Environment
• Why Upgrade Food?
• What is a Food Environment?
• Ideas for Upgrading the Food Environment

3
Learning Outcomes

• Why Employee Health Matters to your Profit Margin
  and Stakeholders
• Why Food is Key to Employee Health
• Types of Upgrades

4
The State of Our Health

• The Health of Adults in the U.S.
• 2005 1 out of 2 adults had a chronic disease
  (CDC, 2009)
• 2007-2008 33.8 of adults overweight, 68.0 of
  adults were overweight or obese (Flegal et al.,
  2010)
• 2007 23.5 million adults had diabetes (CDC,
  2008)
• 2003-2006 20 of adults had hypertension (CDC,
  2010)
• Prevalence of Health Risk Factors (Food RDA)
• In 2004 (CDC, n.d.)
• Only 40 of people eat at least two daily
  servings of fruit
• Only 4 of people eat three daily servings of
  vegetables (with 1/3 being dark green or orange)
• Only 13 of people have a daily sodium intake
  less than 2,400 mg

References Centers for Disease Control and
Prevention. (n.d.). Focus Area 19 Nutrition and
Overweight. Retrieved from ftp//ftp.cdc.gov/pub/H
ealth_Statistics/NCHS/healthy_people/focus_areas/f
a19_2.xls Centers for Disease Control and
Prevention. (2008). 2007 National Diabetes Fact
Sheet. Retrieved from http//www.cdc.gov/diabetes/
pubs/estimates07.htm Centers for Disease Control
and Prevention. (2009). Chronic Diseases and
Health Promotion. Retrieved from
http//www.cdc.gov/chronicdisease/overview/index.h
tm Centers for Disease Control and Prevention.
(2010). Hypertension. Retrieved from
http//www.cdc.gov/nchs/fastats/hyprtens.htm
Flegal, K. M., Carroll, M. D., Ogden, C. L.,
Curtin, L. R. (2010). Prevalence and Trends in
Obesity Among US Adults, 1999-2008. The Journal
of the American Medical Association, 303(3), pp.
235-241. doi10.1001/jama.2009.2014.
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The Cost of Our Health

• Cost of Health Care in the U.S.
• 2007 Total Health Expenditures - 2.2 Trillion
  (NCHS, 2010)
• Expenditures have tripled since 1990 (CMS, 2008)
• 75 goes to treat chronic disease (Anderson, 2004)

• References
• Anderson, G. (2004). Chronic conditions making
  the case for ongoing care. Baltimore, MD John
  Hopkins University
• Centers for Medicare and Medicaid Services.
  (2008). National health expenditures aggregate,
  per capita amounts, percent distribution, and
  average annual percent growth, by source of
  funds selected calendar years 19602007.
  Retrieved from http//www.cms.gov/NationalHealthEx
  pendData/downloads/tables.pdf
• National Center for Health Statistics. (2010).
  Health, United States, 2009 With Special Feature
  on Medical Technology. Retrieved from
  http//www.cdc.gov/nchs/data/hus/hus09.pdf123

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Costs to Employers

• Employee Health Care Costs
• 1999-2009 Insurance premiums for family coverage
  increased 131 (Kaiser/HRET, 2009)
• Being Overweight Males 170 more/year Females
  495 more per/year (Peng, 2008)
• 2005 Cost of health care added 1,110 to 1,500
  to the cost of each of the 4.65 million vehicles
  sold (Appleby and Silke Carty, 2005)

• References
• Appleby, J. Silke Carty, S. (2005, June 24).
  Ailing GM looks to scale back generous health
  benefits. USA Today. Retrieved from
  http//www.usatoday.com/money/autos/2005-06-22-gm-
  healthcare-usat_x.htm
• Peng, T. (2008, August 15). Five Financial Costs
  of American Obesity. Newsweek. Retrieved from
  http//www.newsweek.com/id/153309
• The Kaiser Family Foundation and Health Research
  Educational Trust. (2009). Employer Health
  Benefits 2009 Summary of Findings. Retrieved
  from http//ehbs.kff.org/pdf/2009/7937.pdf

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Costs to Employers, Cont.

• Lost of Productivity
• 2003 Lost productivity from seven chronic
  diseases totaled 1.1 Trillion (DeVol and
  Bedroussian, 2007)
• Loss of Productivity By Disease
• Hypertenstion - 280 Billion
• Cancers - 271 Billion
• Mental Disorders - 171 Billion
• Diabetes - 105 Billion
• Heart Disease - 105 Bllion
• Pulmonary Conditions - 94 Billion
• Stroke - 22 Billion
• Absenteeism
• Obese workers may lose a week of work a year due
  to illnesses related to their weight (Peng,
  2008).
• Presenteeism
• Results in a loss of productivity several times
  greater than absenteeism (DeVol and Bedroussian,
  2007)

• References
• DeVol, R. Bedroussian, A. (2007, October). An
  Unhealthy America The Economic Burden of Chronic
  Disease Charting a New Course to Save Lives and
  Increase Productivity and Economic Growth. Milken
  Institute. Retrieved from http//www.milkeninstitu
  te.org/pdf/ES_ResearchFindings.pdf
• Peng, T. (2008, August 15). Five Financial Costs
  of American Obesity. Newsweek. Retrieved from
  http//www.newsweek.com/id/153309

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Can Changes Improve the Bottom Line?

• Changes in Prevention and Treatment (DeVol and
  Bedroussian, 2007)
• Avoid 40 million chronic disease cases
• Reduce disease impact by 27 or 1.1 billion/year
• Lower obesity rate could mean productivity gains
  of 254 billion/year

• References
• DeVol, R. Bedroussian, A. (2007, October). An
  Unhealthy America The Economic Burden of Chronic
  Disease Charting a New Course to Save Lives and
  Increase Productivity and Economic Growth. Milken
  Institute. Retrieved from http//www.milkeninstitu
  te.org/pdf/ES_ResearchFindings.pdf

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Why Upgrade Food?

• Foods Affect on Health
• Cardiovascular Disease and Diet
• Study of Low-fat Plant Diet (Esselstyn, 1999)
• Prior to study total cholesterol was 237mg/dl
• At 5 years total cholesterol was 137mg/dl
• At 10 years total cholesterol was 145 mg/dl
• Hypertension and Diet
• Dietary Approaches to Stop Hypertension (DASH)
  Trial (Svetkey et al., 2001)
• Diet low in fat, sodium and full of fruits and
  veggies
• In 3 weeks
• Hypertensive patients Decrease of 11.6/5.3 mm
  Hg
• Normotensive patients Decrease of 3.5/2.2 mm Hg

• References
• Esselstyn, C. B. (1999, August 1). Updating a
  12-Year Experience With Arrest and Reversal
  Therapy for Coronary Heart Disease (An Overdue
  Requiem for Palliative Cardiology). The American
  Journal of Cardiology, 84, 339-341
• Svetkey, L. P., Simons-Morton, D., Vollmer, W.
  M., Appel, L. J., Conlin, P.R., Ryan, D. H.,...
  Kennedy, B.M. (1999, February 8). Effects of
  Dietary Patterns on Blood Pressure. Archives of
  Internal Medicine, 159, pp. 285-293

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Why Upgrade Food, cont.

• You Determine Availability and Access
• Cafeterias
• Vending Machines
• Restaurants
• Pricing

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What is a Food Environment?

• Vending Machines
• What is in the vending machines?
• Cafeterias or Restaurants
• What types of food are they selling?
• Refrigerators
• Is there sufficient space for people to bring
  food?
• Catering
• Are you getting what you pay for?

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Upgrade Ideas

• Upgrading the Food
• Upgrading Ingredients
• Ex Pasture Fed Beef vs. Feedlot-Fed Beef
• Ex Switching to Whole Grains
• Upgrading the Menu
• Ex No Fried Items
• Ex Lots of fruits and vegetables fresh or
  cooked without oils
• Make it Delicious

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Upgrade Ideas, cont.

• Make Healthy Food as Easy (or easier) to Access
  as Unhealthy Food
• Physical Access
• Pricing
• Make it Easier to Bring Food From Home
• Vending Machines
• Creative Programs ex Farmers Market On Site

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Upgrade Ideas, cont.

• Education and Wellness Programs
• Provide Nutritional Information
• Wellness Programs
• Pamphlets and Newsletters
• Personal Lifestyle Change Classes
• Nutrition Classes
• Cooking Classes
• Moral Events

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Lets Review

• State of our Health
• The Cost of Health
• Food and Health
• Upgrading the Food Environment

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References

• American Dietetic Association. (n.d.). Boost Your
  Nutrition with Beans. Retrieved from
  http//www.eatright.org/Public/content.aspx?id644
  2452093termsbeansandlegumes
• Anderson, G. (2004). Chronic conditions making
  the case for ongoing care. Baltimore, MD John
  Hopkins
• University
• Appleby, J. Silke Carty, S. (2005, June 24).
  Ailing GM looks to scale back generous health
  benefits. USA
• Today. Retrieved from http//www.usatoday.com/mon
  ey/autos/2005-06-22-gm-healthcare-usat_x.htm
• Centers for Disease Control and Prevention.
  (n.d.). Focus Area 19 Nutrition and Overweight.
  Retrieved
• from ftp//ftp.cdc.gov/pub/Health_Statistics/NCHS/
  healthy_people/focus_areas/fa19_2.xls
• Centers for Disease Control and Prevention.
  (2008). 2007 National Diabetes Fact Sheet
  Retrieved from
• http//www.cdc.gov/diabetes/pubs/estimates07.htm
• Centers for Disease Control and Prevention.
  (2009). Chronic Diseases and Health Promotion.
  Retrieved
• from http//www.cdc.gov/chronicdisease/overview/in
  dex.htm
• Centers for Disease Control and Prevention.
  (2010). Hypertension. Retrieved from
• http//www.cdc.gov/nchs/fastats/hyprtens.htm
• Centers for Medicare and Medicaid Services.
  (2008). National health expenditures aggregate,
  per capita
• amounts, percent distribution, and average annual
  percent growth, by source of funds selected
  calendar years 19602007. Retrieved from
  http//www.cms.gov/NationalHealthExpendData/downlo
  ads/tables.pdf
• Center for Science in the Public Interest. (2004,
  May). Dispensing Junk How School Vending
  Undermines Efforts to
• Feed Children Well. Retrieved from
  http//www.cspinet.org/dispensing_junk.pdf
• DeVol, R. Bedroussian, A. (2007, October). An
  Unhealthy America The Economic Burden of Chronic
• Disease Charting a New Course to Save Lives and
  Increase Productivity and Economic Growth. Milken
  Institute. Retrieved from http//www.milkeninstitu
  te.org/pdf/ES_ResearchFindings.pdf

17
References, cont.

• Flegal, K. M., Carroll, M. D., Ogden, C. L.,
  Curtin, L. R. (2010). Prevalence and Trends in
  Obesity Among
• US Adults, 1999-2008. The Journal of the American
  Medical Association, 303(3), pp. 235-241.
  doi10.1001/jama.2009.2014
• Jeffery, R. W., French, S. A., Raether, C.,
  Baxter, J. E. (1994, November). An environmental
  intervention to
• increase fruit and salad purchases in a
  cafeteria. Preventive Medicine, 23(6), 788-792
• Mayo Clinic. (2008, May 23). Three main sources
  of sodium. Retrieved from
• http//www.mayoclinic.com/health/sodium/NU00284/NS
  ECTIONGROUP
• Mayo Clinic. (2008, May 31). Top 5 lifestyle
  changes to reduce cholesterol. Retrieved from
  http//www.mayoclinic.com/health/reduce-cholestero
  l/CL00012
• Mayo Clinic. (2008, August 7). High blood
  pressure (hypertension). Retrieved from
• http//www.mayoclinic.com/health/high-blood-pressu
  re/DS00100/DSECTIONrisk-factors
• Mayo Clinic. (2009, November 19). Dietary fiber
  Essential for a healthy diet. Retrieved from
• http//www.mayoclinic.com/health/fiber/NU00033
• Mikkelson, L., Erickson, C. S., Nestle, M.
  (2007). Creating Healthy Food Environments and
  Preventing
• Chronic Disease. In L. Cohen, V. Chávez, S.
  Chehimi (Eds.), Prevention is Primary (pp.
  287-311). San Francisco Jossey-Bass
• National Center for Health Statistics. (2010).
  Health, United States, 2009 With Special Feature
  on
• Medical Technology. Retrieved from
  http//www.cdc.gov/nchs/data/hus/hus09.pdf123
• Occupational Health Management. (2008, August).
  An Apple a day Workers eat healthy to stay
  healthy. Occupational
• Health Management, 90-91
• Park, M. (2009, June 3). Farmers markets bloom at
  hospitals. Retrieved from
• http//www.cnn.com/2009/HEALTH/06/03/farmers.marke
  ts.hospitals/index.html

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References, cont.

• Svetkey, L. P., Simons-Morton, D., Vollmer, W.
  M., Appel, L. J., Conlin, P.R., Ryan, D. H.,...
  Kennedy, B.M.
• (1999, February 8). Effects of Dietary Patterns
  on Blood Pressure. Archives of Internal Medicine,
  159, pp. 285-293
• The Kaiser Family Foundation and Health Research
  Educational Trust. (2009). Employer Health
• Benefits 2009 Summary of Findings. Retrieved
  from http//ehbs.kff.org/pdf/2009/7937.pdf
• Time. (2006, June 11). The Grass-Fed Revolution.
  Retrieved from
• http//www.time.com/time/magazine/article/0,9171,1
  200759,00.html
• United States Department of Agriculture. (2005).
  Dietary Guidelines for Americans 2005. Retrieved
  from
• http//www.health.gov/dietaryguidelines/dga2005/do
  cument/pdf/DGA2005.pdf
• United States Department of Agriculture. (2009,
  October 1). Why is it important to eat grains,
  especially whole
• grains?. Retrieved from http//www.mypyramid.gov/p
  yramid/grains_why.html
• United States Department of Agriculture. (2009,
  October 1). Why is it important to eat
  vegetables? Retrieved from
• http//www.mypyramid.gov/pyramid/vegetables_why.ht
  ml
• United States Department of Agriculture. (2009,
  October 1). Why is it important to eat fruit?
  Retrieved from
• http//www.mypyramid.gov/pyramid/fruits_why.html
• Washington State Department of Health. (2006,
  August). Worksite Wellness and Chronic Disease
  Prevention Resource
• Kit An Investment in Good Health, Improved
  Productivity and Lower Healthcare Costs.
  Retrieved from http//www.doh.wa.gov/cfh/Nutrition
  PA/our_work_sites/worksite_data/Worksite_wellness_
  toolkit.htm
• Zank, D. and Friedsam, D. (2005, September).
  Employee Health Promotion Programs What is the
  Return on
• Investment?. Wisconsin Public Health Health
  Policy Institute Issue Brief, 6(5)
• World Health Organization. (n.d.). Cardiovascular
  disease prevention and control. Retrieved from

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Additional Resources

• http//www.fruitsandveggiesmatter.gov/ - A web
  site from the CDC promoting the increased intake
  of fruit and vegetables
• http//www.mypyramid.gov/ - USDAs Food Pyramid
  web site
• http//www.cdc.gov/chronicdisease - CDC web site
  with information on chronic disease
• http//www.cdc.gov/obesity/ - CDC web site with
  information on overweight and obesity
• http//www.eatright.org/ - Home Page of the
  American Dietetic Association where you can find
  registered dietitians
• http//www.doh.wa.gov/cfh/NutritionPA/Documents/WA
  _Worksite_Wellness_Toolkit.doc - Worksite
  Wellness and Chronic Disease Prevention Resource
  Kit

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Questions?