Atlantic Health and Wellness Institute, Research Affiliate 1 The Business Case of Comprehensive Workplace Health Lydia Makrides, PhD President, Creative Wellness Solutions Editor-in-Chief, International Journal of Workplace Health Management ECOSH/ROWER Conference September 17-18, 2009 Amsterdam

Atlantic Health and Wellness Institute, Research Affiliate Greetings from Halifax Nova Scotia!

Atlantic Health and Wellness Institute, Research Affiliate 3 Agenda Health Risks for Chronic Disease 10 Compelling Reasons Return on Investment

Atlantic Health and Wellness Institute, Research Affiliate 4 Health Risks for Chronic Disease

Atlantic Health and Wellness Institute, Research Affiliate 5 Chronic disease related deaths account for 56% of all deaths in the working-age population in the world (World Health Organization). High prevalence of major modifiable health risks contributes to the epidemic of chronic disease. Elevated BMI (BMI ≥25kg/m 2 )Obesity (BMI ≥ 30 kg/m 2 ) InactivitySmoking StressElevated blood pressure Elevated cholesterolHigh blood sugar Alcohol Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and worker’s compensation claims. Health Risks for Chronic Disease

Atlantic Health and Wellness Institute, Research Affiliate 6 N=6067: 2665 Males & 3402 Females 51 Organizations: Private companies (N=2859). Pulblic Companies (N=1425), Health Care Facilities (N=1783) Average age 41.3 years 70% overweight (BMI ≥ 25) - 31% obese (BMI ≥ 30) 49% inactive (less than 3 times per week) 38% elevated cholesterol (greater than 5.2 mmol/L) 20% daily cigarette smokers 16% elevated blood pressure (greater than 140/90 mmHG) 18% elevated stress scores Health Risks for Chronic Disease: Profile of Atlantic Canadian Employees

Atlantic Health and Wellness Institute, Research Affiliate 7 Multiple health risks compounding the health issues Average 2.4 health risks/employee Average Wellness Score - 46% Need to improve Wellness Score - 72% (scored 49% or lower) Chronological age yrs Achievable Health Age yrs Coronary risk moderate to high - 46% Health Risks for Chronic Disease: Profile of Atlantic Canadian Employees

Atlantic Health and Wellness Institute, Research Affiliate 8 Health Risks for Chronic Disease: Profile of Atlantic Canadian Employees* Number of Risk Factors** * AHWI Database **Inactivity, overweight, elevated cholesterol, blood pressure, smoking, high stress, illness days, alcohol use, life satisfaction, existing medical condition.

Atlantic Health and Wellness Institute, Research Affiliate 9 Atlantic Canadian vs. Healthy Company Profile Shift in risk factors after 4 years of workplace wellness program Number of Risk Factors *(Steelcase study: Amer. J. of Health Promotion, Vol. 6, No. 1:46-54, 1991)

Atlantic Health and Wellness Institute, Research Affiliate Compelling Reasons 1.The do-nothing strategy of waiting for sickness and then paying for treatment is a failed strategy. 2.Lifestyle related risk factors and behaviours of employees as well as unhealthy work environments and practices drive costs. High risk employees incur high costs whatever the outcome measure: pharmaceutical, absenteeism, compensation costs or productivity.

Atlantic Health and Wellness Institute, Research Affiliate Compelling Reasons Productivity Decreases with Number of Health Risks Excess Productivity Loss Productivity Loss (%) Base Cost Number of Health Risks (Journal of Occupational and Environmental Medicine 2005;47: (n = 28,375))

Atlantic Health and Wellness Institute, Research Affiliate Compelling Reasons Absenteeism Increases with Number of Health Risks Excess Work Loss Days / Year Work Loss Days (#/yr) Base Work Loss Days / Year Number of Health Risks ( Summary of 10 Mid-sized U.S. Corporations (n=5,142 employees))

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons Healthcare Costs Rise with Number of Health Risks Excess Cost Health Claims (RR) Base Cost Number of Health Risks ( University of Michigan Study (n = 205,216) 13

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 3.One of the root causes of unsustainable increases in costs is natural flow of individuals from low risk → high risk →disease →higher employer costs – natural flow estimated at 2% - 4% per year. (Edington et al, 2009). 3.The Health Risk Assessment (HRA) is the tool used in Comprehensive Workplace Wellness to raise awareness and determine employee health risk status. 14

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 5.An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk. Employers costs go up as people age, regardless of their health risk status and as health risk status gets worse, costs go up regardless of age. 15

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 16 6.Risk clusters likely to be associated with high healthcare costs within a 2-3 year period: Metabolic syndrome: combinations of high blood pressure cholesterol, blood glucose and waist circumference/ BMI associated with higher risk for diabetes or heart disease. Pre-metabolic syndrome: combinations of one or two risk factors. ( Edington, 2009)

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 17 Relationship of Biometric Cluster to Diabetes and Heart Disease ( Edington, Zero Trends, 2009) Risks: Waist Circumference, Hypertension, Glucose Intolerance, Cholesterol Pre- Metabolic Syndrome Metabolic Syndrome Diabetes Heart Disease Retinopathy Neuropathy Nephropathy Costs to Employers: Health Care Costs Productivity Costs Cost to Individual: Quality of Life Morbidity Mortality

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 7.Changes in healthcare costs follow changes in health risk: As number of risks goes up, costs go up. As number of risks goes down, costs go down. (Wright et al, 2002) 8.Established relationship between lifestyle related risk factors (smoking, inactivity, obesity) and productivity absenteeism and health claims. (Buron et al,2005, Wellsource, 2006 & University of Michigan, 2006) 18

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 19 Absenteeism, Productivity Loss, Health Claims and Number of Risk Factors (Buron et al, 2005, Wellsource, 2006 & University of Michigan, 2006) Number of Risks Excess work loss days (%) Excess Productivity Loss (%) Increase Health Claims Cost 0 Risks000 1 Risk Risks Risks Risks Risks Risks

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons 9.Inverse relationship between health care costs and wellness score. 20 Relationship between Health Costs and Wellness Score (Yen et al, 2005)

Atlantic Health and Wellness Institute, Research Affiliate 10 Compelling Reasons Changes in employer costs follow participation in HRA and Workplace Wellness activities. Employees who participate in Health Risk Assessment at least twice have annual cost increases of 4.2% while employees who never participated or took HRA only once have annual increases of 12.6%. ( Edington, 2009) Participation in Workplace Wellness resulted in decreased annual absenteeism of 2.4% for participants vs 3.6% for non- participants.

Atlantic Health and Wellness Institute, Research Affiliate Return on Investment 22 From a review of 73 published studies: Average $3.50 saved per $1 invested in reduced absenteeism and health care costs. From a meta review of 42 published studies: Average 28% reduction in sick leave Average 26% reduction in health costs Average 30% reduction in WCB and disability claims Average $5.93 saved per dollar invested (The Art of Health Promotion, 2003) Comprehensive Workplace Health Program at Citibank: $4.56 – 4.73 saved per $1 invested in reduced health care costs (Amer. Journal Health Promotion, 1999)

Atlantic Health and Wellness Institute, Research Affiliate Return on Investment 23 OrganizationDollars Saved/ Dollars Spent Bank of America$5.95/ $1 PacBell$3.10/ $1 Wisconsin School District Insurance Group$4.47/ $1 Prudential Insurance U.S.$2.90/ $1 Bank of America$4.73/ $1 General Mills$3.50/ $1 DuPont$2.05/ $1 Citibank$ /$1 BC Hydro$2.74/ $1 Review of 13 studies$3.45-$5.82/$1 (Chapman L., 1996.; Wellness Councils of America, May 1995.; Blair S., Pacific Bell 1996).

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