Healthy Business Bloomington Breakfast August 15, 2013

 U.S. has the highest level of medical care spending  U.S. ranks either all or below most other wealthy countries on many health indicators ◦ Life expectancy at birth ◦ Mortality rates among people aged <50 including rates of infant, maternal, and child mortality ◦ Rates of low birth weight and premature birth ◦ Prevalence and mortality rates for heart disease, diabetes, respiratory disease, infectious diseases, and both intentional and unintentional injuries ◦ Disability rates Source: RWJF Commission to Build a Healthier America, Overcoming Obstacles to Health in 2013 and Beyond, 2013

Source: America’s Health Ranking, 2012 Annual Report ( High smoking rate (adults) High obesity rate (adults) High chronic disease rate One of the lowest amounts of public health funding Health disparities

 Most costly, common, and preventable  Obesity, Smoking, Diabetes, High Blood Pressure, High Cholesterol rates are higher than U.S. rates  Leading cause of death and disability  Heart disease leading cause of death  Almost half of adults reported history of at least one chronic disease (2010)

1. Reduce Infant Mortality 2. Reduce Adult Smoking 3. Reduce Adult Obesity 4. Increase Childhood Immunizations (19-35 month-olds primary focus)

Total Infant Mortality Rates by State, 2010 Source: Murphy SL, Xu JQ, Kochanek KD: Final Data for National Vital Statistics Reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics =7/1000 LB

Black Infant Mortality Rates by State, 2010 No color: less than 20 deaths, rates unstable and suppressed Source: Murphy SL, Xu JQ, Kochanek KD: Final Data for National Vital Statistics Reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics =13/1000 LB

Smoking Prevalence Among U.S. Adults, BRFSS, 2012 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, =25%

Obesity Prevalence* Among U.S. Adults, BRFSS, 2012 *BMI=> or a person 5 feet 6 inches tall weighing 186 or more pounds. Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, =30%

Percent of Adults with >=150 Minutes of Physical Activity per Week, BRFSS, 2011 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011 >54.3% % <=48.1%

Adults Consuming Fruits/Vegetables Five or More Times per Day by State, BRFSS, 2009 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, % % %

Depression* Prevalence Among U.S. Adults, BRFSS, 2012 *Ever told you have a form of depression. Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, % % %

Good or Better Health* Among U.S. Adults, BRFSS, 2012 *Adults reporting their general health status as excellent, very good or good Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, % % %

 143,479 worksites in Indiana  85% have 50 employees  2,440,507 paid employees  Top industries (55% of worksites)  Retail; other services (except public administration); healthcare and social assistance; construction; and professional, scientific, & technical services Source: 2011 County Business Patterson (NAICS).

Lost Productivity (Indirect Costs) Presenteeism Short-term Disability Long-term Disability Absenteeism Workers Compensation Healthcare (Direct) Medical Pharmacy Impact of Employee Health Visible Costs Non-Visible Costs Indirect costs represent 2-3 times direct health- care costs Source: Adopted from the CDC National Healthy Worksites Program.

For every wellness dollar spent, medical costs fall about $3.27, productivity increases, and absenteeism costs fall by about $2.37.  Increase health care costs  Most illnesses can be avoided  The work week is getting longer  Technology  Increased employee stress levels  Increased diversity in workforce Source:

Workplace Health Program Health- Related Program Health- Related Policies Health Benefits Environ- mental Supports Comprehensive Worksite Health Program = Results Evidence-based Strategies and Interventions

 Use multiple interventions, such as program and policy interventions, for a single health issue  Use interventions that address multiple health issues at the same time, which is more effective than addressing each single health issue separately

 Increases value of incentives from 20% to 30% (50% for tobacco cessation) in existing HIPPA nondiscrimination regulations  Separates worksite wellness into two categories  Participatory  Health-contingent ▪ Activity-only wellness program ▪ Outcome-based wellness program

 Employers and other community organizations/entities usually have a common goal of population health improvement  Health of workforce is affected by community dynamics/health  Potential for greater return on wellness investment if there is synergy and connectivity with community health initiatives programs  Community prevention can increase capacity to develop worksite wellness programs for small businesses

 Improve the health and productivity of current and future workforce  Control direct and indirect costs to the employer  Create image and/or reality of a healthy community that may help recruit and retain talented workforce  Increase the buying power and consumption level for business products (i.e., nonmedical goods and services) by improving the health and wealth of a community.  Channel corporate philanthropy in a direction that will improve community relations, goodwill, or branding with the potential for a positive return for the business enterprise itself  Creates public/private partnerships and a multi-stakeholder community leadership team that can become the foundation for collaboration, cooperation, and community-based problem solving for other issues affecting the business community, such as economic development and education  MORE JOBS for Indiana!!

William VanNess, MD State Health Commissioner