1. The Impact of Health on Worker Attendance and Productivity in Brazil
Discussion Guide for
Proposed Study to be conducted in context of
U.S. Brazil Business Council
Health Care Task Force

2. RECENT APEC STUDY Objectives of the study:
To document the known impact of poor health on worker attendance and on productivity while at work, for six selected economies in the APEC region;
To describe the current prevalence of key NCDs in the six economies and their projected incidence over the medium term; and
To analize the potential impact of NCDs on worker attendance and on productivity over the medium term in the six economies.

3. METHODOLOGY OF THE APEC STUDY
The study assembled four main sources of information on the six economies and developed a model to use this information to analyze the potential impact of NCDs on worker attendance and on productivity over the medium term.
Information Sources:
Microeconomic studies of these effects in individual firms, and of the effect
of wellness programs within firms.  
Macroeconomic studies of these effects, to the extent to which they exist, using cross‐sectional national health survey data, panel or longitudinal studies or studies using administrative data from insurance systems or managed health care funds.
Disease based studies of the impact of a specific disease or disease type on worker attendance and productivity will also provide an important information source. The review focused on five disease areas: Heart disease and stroke, Cancer, Chronic obstructive pulmonary disease, diabetes and mental health.  
International (WHO, etc) and National Statistics Reports

4. APEC STUDY FINDINGS
NCDs and ageing populations impose an enormous toll on worker productivity
Confluence of ageing workforces and chronic disease produce a huge drag on economic growth translating into lost GDP growth
Mortality rates for NCDs in APEC dwarf communicable diseases
Populations and workforces will age rapidly in next 3 decades

5. BRAZIL AS A CASE STUDY
More than half of the Brazilian population is of working age*
NCDs are estimated to account for 74% of total deaths*
The probability of dying between the ages of 30 and 70 from the 4 main NCDs is 19%*
From World Health Organization – Non Communicable Disease Country Profiles 2014

6. BRAZIL AS CASE STUDY
The Brazilian government already has several programs in place to address NCDs.
the National Strategic Plan for NCDs (Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT) no Brasil),
National Policy on Health Promotion (Política Nacional de Promoção da Saúde - PNPS),
Popular Pharmacy Program (Farmácia Popular).
Data on economic impact could help change the narrative of price control vs. need to dedicate more funds to these increasingly problematic diseases.

7. Proposed Methodology for Brazil-focused Study
APEC study:
Examined trends in population ageing and implications for growth in
the labor force.
Reviewed the prevalence of particular NCDs and their impact on
absenteeism and presenteeism through changed levels
of labor force participation.
Projected these changes for GDP over time using population
and labor force projections Published by the (ILO).
Similar methodology would be followed in the study for Brazil using
information from a number of relevant large-scale surveys conducted
with respect to Brazil.

8. HOW TO MAKE STUDY RELEVANT TO BRAZILIAN STAKEHOLDERS?
A Brazilian partner could provide input regarding factors such as: regional differences, education levels, gender, ethnicity and income.
Support of the Brazilian Business Community is key
CNI
FIESP
AmCham
Interfarma
Others?
Co-authorship by a Brazilian University or Research Entity

9. POSSIBLE BRAZILIAN PARTNERS
Universidade de São Paulo (USP) – University of São Paulo
Faculdade Oswaldo Cruz (Fiocruz)
Universidade Federal de São Paulo (Unifesp) – Federal University of São Paulo
Universidade Federal do Rio de Janeiro (UFRJ)
Universidade de Brasília (UNB) – University of Brasília

10. OUTPUTS White paper Conference with speakers and stakeholders
Infographics (especially for use with lawmakers)
Possibility of additional media

11. Benefits of Using APEC Study Authors for Brazil Study
Authors have already developed an economic model (which could potentially be deployed for additional countries later)
The APEC study has been very well received by member countries, lending instant credibility
There should be cost-savings if same APEC methodology is used. Author estimates cost of $35,000 dollars
Author agrees to work with a Brazilian partner – would likely result in additional costs if we go academic route