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Evidence-based Health Promotion into the Workplace
Jeff Harris, MD MPH MBA
Overview
Why do workplace health promotion (WHP)? Targeting highest need The start: large/mid-size workplaces Adapting: smaller workplaces
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Evidence-based Health Promotion into the Workplace Jeff Harris, MD - - PowerPoint PPT Presentation
Evidence-based Health Promotion into the Workplace Jeff Harris, MD - - PowerPoint PPT Presentation
Evidence-based Health Promotion into the Workplace Jeff Harris, MD MPH MBA Overview Why do workplace health promotion (WHP)? Targeting highest need The start: large/mid-size workplaces Adapting: smaller workplaces 2 3 WHY WHP? Chronic
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WHY WHP?
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Chronic Diseases Kill Workers
Cancer #1 Heart Disease #2 Diabetes #6 Emphysema #7 Stroke #8
WISQARS 2007, WA, Ages 18-64
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Costly Chronic Disease Iceberg
Absence & Lost Productivity Direct Health Care & Other $
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WHP Saves $
Meta-analysis of 22 WHP studies
6-fold ROI overall
Half from health care savings Half from productivity savings
Spent $150 per worker per year
Baicker K et al. Health Affairs 2010;29:1-8.
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NIOSH Interested in WHP
Holding conferences Publishing newsletter Funding research centers
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Sorensen G et al. Am J Pub Hlth 2011;101:S196-S207.
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WHP and the Affordable Care Act
Penalties for poor health habits Major funding to CDC
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Anderko, L et al. Prev Chron Dis. 2012;9:120092.
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TARGETING HIGHEST NEED
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Target: Low-SES Workers
By household income, U.S. Workers. BRFSS 2007-8. Harris J et al. JOEM 2011:53:132-8.
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Target: Health Behaviors
By household income, U.S. Workers. BRFSS 2007-8. Harris J et al. JOEM 2011:53:132-8.
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Target: Doing More of What Works
19 40 20 6 15 21 37 20 40 60 80 100 Tobacco Cessation Program No Smoking Policy Physical Activity Program Use the Stairs Signs Fitness Center On-Site Weight Program Healthy Foods Labeled % of Workplaces Linnan L et al. Am J Public Health 2008;98:1503-9
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Target: Smaller Workplaces
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58% 55% 57% 71% 69% 31% 26% 33% 39% 21%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Weight Loss Program Biometric Screening Lifestyle Coaching Smoking Cessation Program Gym Discounts or On-Site Exercise Facilities
All Small Firms (3-199 Workers) All Large Firms (200 or More Workers)
Kaiser HRET Employer Health Benefits Survey, 2013.
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THE START: LARGE/MID-SIZED WORKPLACES
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ACS Workplace Solutions
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Best Practices: Better Health Employer Practices Workers’ Behaviors Better Outcomes
Benefits Policies Programs Communicate Track progress ↓ Tobacco use ↑ Healthy eating ↑ Physical activity ↑ Clinical prevention ↑ Health ↑ Productivity Controlled costs
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Best Practice Examples
Benefits
Cover tobacco cessation, minimize co-pay
Policies
Access to healthy foods at worksite
Programs
Group-based physical activity program
Communication
Promote all of the above, part of the culture
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Workplace Solutions Process
Assessment Survey Recommendations Report Solution Sets
Assess current practices Overview of current practices Compare to Best Practices Prioritize 3-5 recommendations “Tool-kits” help implement Best Practices Provides options and resources
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Did it Work?
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35 33 32 47 44 38 50 100 Tobacco Physical Activity Nutrition Flu Ca Screening All Combined Best Practices In Place (%) Topic
Before
Eight PNW employers. Harris JR et al. Preventing Chronic Disease 2008;5(3).
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Big Improvement after WPS
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20 40 60 80 100 Tobacco Physical Activity Nutrition Flu Ca Screening All Combined Topic Best Practices In Place (%) Before After
Eight PNW employers. Harris JR et al. Preventing Chronic Disease 2008; 5(3).
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ACS Workplace Solutions 10 Years After
900 ACS staff trained WPS delivered to: 1,700 workplaces In 42 states With 6.9 million employees
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Moving Into Mid-sized Workplaces
Mid-size: 100 – 999 workers Average wage <$50,000/year Health insurance to full-time workers Headquarters in King County
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No Significant Improvement at Follow-Up
46 43 41 36 50 100
Control Intervention Best Practices in Place (%)
Baseline Follow-up
41 workplaces. Hannon PA et al. Am J Prev Med 2012;43:125-33.
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What We Started to Learn
Everyone we work with wants a wellness program Our approach to building a wellness program: Works great for some employers Helps other employers a little Doesn’t work at all for others If approach same, why varied effect?
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Ask Them: Focus Groups
Design: 5 focus groups (90 min) Setting: King County, Washington Sample: Human resources professionals Representing employers w/ 100-999 workers 5 large low-wage industries
Hannon PA, et al. Am J Health Promot 2012;27:103-10.
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Mixed Feelings About WHP
Potential: healthcare cost containment
“Wellness is part of being able to afford a health plan going forward.”
Potential: improved productivity
“You want them to feel well; you want them to be productive, and you want them to be at work…”
Delicate balance on intrusiveness
“…promoting health and quitting tobacco and losing weight – those are very personal subjects to people and they’re very touchy.”
Will it really improve health or reduce costs?
“They’re just really unhealthy and that’s not going to go away with a wellness program.”
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Key Barriers to WHP
Money
“…there are limits…on what we can afford”
Time
“…wellness comes back to HR, and we don’t really have enough people to keep it driving and moving forward…”
Logistics
“…with essentially ten locations and four states - plus a remote sales force of about 100 - I mean, how do we get to everyone?”
Lack of data
“It’s very difficult to get any metrics (proving WHP works)”
Culture
“If (WHP) is foreign to the culture, then people don’t have any…belief in it. It doesn’t have any credibility”
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Key WHP Facilitators
Turn-key programs and communications
“I need someone to give me the information…canned” “It needs to be turn-key. Here it is, now lay it out”
Employee-driven
“…when you have an employee who is enthusiastic…it’s just a lot easier for other employees to get around it (than a top-down approach)”
Management-level champions
“..if the executive staff are championing it, it’s a lot easier…”
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ADAPTING WPS FOR SMALLER WORKPLACES
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ACS HealthLinks
20-250 workers Four chronic disease behaviors ACS delivers to workers at worksite 6 months
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Comparing WPS and HealthLinks
WPS Assess/Recommend/Toolkits Target=large employers 15 Best Practices Includes insurance Connects employers with vendors HealthLinks Assess/Recommend/Toolkits Target=small/mid employers ~7 Best Practices Does not address insurance Connects employers with vendors & free services Wellness committees Direct education from ACS
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Connect Employees with Free Resources
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HealthLinks Pilot: Mason County, WA
Partner: WA Dept of Health 23 worksites
0% 20% 40% 60% 80% 100% Best Practice Implementation Baseline Follow-up
Laing S, et al. Prev Chronic Dis 2012;9:110186.
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Communities Putting Prevention to Work
Partner: Public Health- Seattle & King County 47 worksites
0% 20% 40% 60% 80% 100% Best Practice Implementation
Baseline Follow-up
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Acknowledgments
CDC NCI ACS Public Health--Seattle & King County Washington State Department of Health
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Collaborators
UW Kristen Hammerback, MA Peggy Hannon, PhD MPH ACS Sara Teague And 18 Others
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