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Driving Wellness in the Workplace Liezel Dreyer Bloemfontein, April 2007 Driving Wellness in the Workplace Liezel Dreyer Bloemfontein, April 2007

Globally, healthcare costs are mounting, but often in areas of preventable diseases Globally, healthcare costs are mounting, but often in areas of preventable diseases

WHO Director General, Lee Jong-Wook “The lives of far too many people in the WHO Director General, Lee Jong-Wook “The lives of far too many people in the world are being blighted and cut short by chronic diseases such as heart disease, stroke, cancer…. ” Chronic diseases caused 60% of the 58 million deaths worldwide in 2005

Cause of Morbidity and Mortality in Developed Countries Leading Cause of Death - US Cause of Morbidity and Mortality in Developed Countries Leading Cause of Death - US 2000 * Actual Cause of Death - US 2000 † Heart Disease Tobacco Cancer Poor Diet / Inactivity Stroke Alcohol consumption Chronic Lower Respiratory Dis. Microbial agents Unintentional Injuries Toxic agents Pneumonia / Influenza Motor Vehicles Diabetes Firearms Kidney Disease Drug Use Alzheimer's Disease Sexual Behaviour 0 5 10 15 20 % of all deaths 25 30 0 5 * Minino AM, Kochanex KD, Murphy SL, Smith SL, Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15): 1 -20. † Mokdad AH, Marks JS, Stroup DF, Gerberding JL Actual causes of death in the United States, 2000. JAMA 2004; 291(10): 1238 -1 246. 10 15 % of all deaths 20

Obesity Trends* Among U. S. Adults BRFSS, 1991, 1996, 2004 (*BMI 30, or about Obesity Trends* Among U. S. Adults BRFSS, 1991, 1996, 2004 (*BMI 30, or about 30 lbs overweight for 5’ 4” person) 1991 1996 2004 No Data <10% 10%– 14% 15%– 19% 20%– 24% ≥ 25%

Hansard references to obesity 1996 PARLIAMENTARY REFERENCES IN 1996 Weather Obesity 0 100 200 Hansard references to obesity 1996 PARLIAMENTARY REFERENCES IN 1996 Weather Obesity 0 100 200 300 400 Number of mentions in Parliament Source: Hansard (House of Commons Daily Debates) 500 600

Hansard references to obesity 2006 PARLIAMENTARY REFERENCES IN 2006 Weather Obesity 0 500 1000 Hansard references to obesity 2006 PARLIAMENTARY REFERENCES IN 2006 Weather Obesity 0 500 1000 1500 Number of mentions in Parliament Source: Hansard (House of Commons Daily Debates) 2000

Global Trend • Many Countries Affected • USA, UK • Australia • South Africa Global Trend • Many Countries Affected • USA, UK • Australia • South Africa • China • France • Russia • Etc • Hence - WHO – DPAS, 2006

Leading Causes of Death in South Africa Non-communicable diseases As a % of total Leading Causes of Death in South Africa Non-communicable diseases As a % of total deaths MEN WOMEN Cardiovascular diseases (CVD)* 14% 19% Cancers 8% 8% Other chronic diseases 7% 6% Respiratory 5% 4% Diabetes 2% 3% Total chronic diseases 36% 40% Predominantly related to heart attacks and strokes Source: South African Health Review, 2003 -2004

Relatively small lifestyle changes can have a significant impact on health and the associated Relatively small lifestyle changes can have a significant impact on health and the associated costs of healthcare

Impact of lifestyle Probability of 15 year survival without coronary artery disease, stroke or Impact of lifestyle Probability of 15 year survival without coronary artery disease, stroke or diabetes 15 year survival probability 100% 90% 81% 80% 71% 70% 60% 86% 50% 40% 30% 20% 10% 0% Male aged 50: overweight smoker Step 1: quit smoking Step 2: get active Source: Lifestyle and 15 -year survival free of heart attack, stroke, and diabetes in middle-aged British men. Archives of Internal Medicine (1998), SG Wannamethee et al. Step 3: lose weight

Despite this evidence, we must recognise the barriers to healthier living Despite this evidence, we must recognise the barriers to healthier living

Underconsumption of preventive care Why Wellness is elusive Lack of information True efficacy of Underconsumption of preventive care Why Wellness is elusive Lack of information True efficacy of different health and wellness approaches is not well understood Over-optimism People tend to overestimate their abilities and health status Hyperbolic discounting Future rewards of a healthy lifestyle are significantly undervalued relative to cost today

Wellness Defined “ An intentional choice of a lifestyle characterised by personal responsibility, moderation Wellness Defined “ An intentional choice of a lifestyle characterised by personal responsibility, moderation and maximum personal enhancement of physical, mental, emotional and spiritual health. ”

Worksite Wellness Defined “An organised program in the worksite that is intended to assist Worksite Wellness Defined “An organised program in the worksite that is intended to assist employees (and their family members) in making voluntary behaviour changes which reduces their health and injury risks, improve their health consumer skills and enhance their individual productivity and well-being”

The importance of the workplace ‘A large proportion of the population is employed and The importance of the workplace ‘A large proportion of the population is employed and spends more than a third of its waking hours at work. If the workplace enables and supports health, employees are more likely to make healthier choices’ The key to national health improvement is more people making healthier choices more of the time’ Government White Paper, UK

When employees are healthier Reduce Productivity Absenteeism Health Costs Group Risk Costs Retirement Funding When employees are healthier Reduce Productivity Absenteeism Health Costs Group Risk Costs Retirement Funding Morale Increase

Return on Assets 15% 38% Intangible Assets 62% Market Value 85% 62% 38% 1982 Return on Assets 15% 38% Intangible Assets 62% Market Value 85% 62% 38% 1982 Tangible Assets 19921 1. Brooking Institute 2. Baruch Lev analysis of S&P 500 Companies 19982

Health-Work Cost Link Medical and Pharmaceutical 25% ($116. 2 m) Direct Medical Costs Indirect Health-Work Cost Link Medical and Pharmaceutical 25% ($116. 2 m) Direct Medical Costs Indirect Medical Costs Presenteeism 63% ($311. 8 m) Long-term disability 1% ($6 m) Absenteeism 6% ($27 m) Short-term disability 6% ($27 m) Source: Harvard Business Review- Presenteeism

Workplace Health Promotion Shift Rationale: “The right thing to do: Health cost containment Productivity Workplace Health Promotion Shift Rationale: “The right thing to do: Health cost containment Productivity enhancement Focus: Single illness or risky behaviours General health and well-being Target: Individual risk factors + broader environmental, social, and organisational risk factors Stance: Reactive Proactive

Wellness trends Recognition Companies understand that disease, absenteeism and wellness impact their financial performance Wellness trends Recognition Companies understand that disease, absenteeism and wellness impact their financial performance Co-ordination Current programmes often lead to duplicated costs, poorly co -ordinated interventions and ad-hoc reporting Integration Integrating disease management and wellness programmes lead to wellness strategies and higher returns Measurement Impact assessments, return on investment calculations and integrated views of different data sets are critical Engagement Rewards or incentive programmes are needed to drive participation

Components of Wellness Programmes Understanding Health Risks Ill health and incapacity management programmes Employee Components of Wellness Programmes Understanding Health Risks Ill health and incapacity management programmes Employee Assistance Programmes HIV and AIDS programmes Education and Awareness Programmes Integrated Reporting

Wellness tools to meet bold objectives Prevent lifestyle related diseases Consolidated, time-based reporting framework Wellness tools to meet bold objectives Prevent lifestyle related diseases Consolidated, time-based reporting framework allows impact and success to be measured Eliminate unnecessary sick leave Professional help is always only a phone call away Zero new infections, zero deaths from AIDS

Wellness days test lifestyle risks for all staff Health Risk Assessments Lifestyle Behaviours Health Wellness days test lifestyle risks for all staff Health Risk Assessments Lifestyle Behaviours Health Measurements Readiness to Change Station 3: Station 2: • Blood pressure • Body mass index • Waist circumference Station 1: Two final year medical students will conduct these measurements. Glucose and cholesterol screenings Two nurses will conduct these preventive screening tests Station 4: Health Risk Assessment reports and feedback A nurse will capture the results, produce a report and discuss the results Station 5: Welcome desk For employees to sign consent forms Education area and fun elements Station 6: Optional voluntary counselling and testing stand It will be done by qualified nurses. The number of nurses is determined by the number of employees Rich source of data for integrated reporting framework

UNDERSTAND YOUR RISK: Current Age 34 Smoking Risk Factor - Smoker Body Mass Index UNDERSTAND YOUR RISK: Current Age 34 Smoking Risk Factor - Smoker Body Mass Index - 27. 17 Daily Fruit and Vegetable Intake - 2 servings Physical Activity - 60 minutes per week Cholesterol Reading - 5. 8 mg. DL Real Age: 43

UNDERSTAND YOUR RISK: Current Age 34 Smoking Risk Factor - Never Smoked Body Mass UNDERSTAND YOUR RISK: Current Age 34 Smoking Risk Factor - Never Smoked Body Mass Index - 24. 76 Daily Fruit and Vegetable Intake - 5 servings Physical Activity - 150 minutes per week Cholesterol Reading - 4. 0 mg. DL Real Age: 32

Eliminate unnecessary sick days through absenteeism analysis and interventions Bradford score Day 4 of Eliminate unnecessary sick days through absenteeism analysis and interventions Bradford score Day 4 of absenteeism Analysis of sick leave taken 700 Case manager calls staff member to assist 600 • Possible abuse reported to HR manager Statistical analysis triggers various interventions Bradford Score* 500 Statistical analysis • Possible illness identified. Refer to disease management or Employee assistance programme 400 300 • Recovery assistance 200 100 0 0 5 10 15 20 25 30 Cumulative sick days taken *Bradford score = number of occasions of absence 2 * total days absent 35 40 45

Eliminate unnecessary sick Day 4 of absenteeism Case manager calls staff member to assist Eliminate unnecessary sick Day 4 of absenteeism Case manager calls staff member to assist Statistical analysis Different referrals from various analyses integration Determine company wide recommendations on focus areas Absenteeism data analysed against claims, risk assessments etc

Employee Assistance provides a professional support network high Intensity of intervention CIM Critical Incident Employee Assistance provides a professional support network high Intensity of intervention CIM Critical Incident Management Comprehensive crisis management Face-to-face counselling Qualified psychologists Telephonic counselling Qualified psychologists Life management skills - Legal advice - Social services - Financial advice low Frequency of event Integration of services leads to more effective utilisation of programme components

HIV and AIDS Programme Actuarial modeling and Knowledge, Attitude and Practice Surveys Policy setting HIV and AIDS Programme Actuarial modeling and Knowledge, Attitude and Practice Surveys Policy setting Education and awareness Eliminate stigma and discrimination Peer educator coaching Voluntary Medical counselling advice and testing counseling Aim for 100% take-up Treatment co-ordination and management

Implementing a Wellness strategy Calendar and planning HIV Champion Absence Champion Wellness Champions HIV Implementing a Wellness strategy Calendar and planning HIV Champion Absence Champion Wellness Champions HIV Peer Educators Product tools Wellness Manager Reports Employer Wellness Committee Ease of implementation and administration Company participation and planning essential First Aid officers Venue support Management interventions

Integrated wellness view of company All Wellness data consolidated into reporting platform sm ei Integrated wellness view of company All Wellness data consolidated into reporting platform sm ei te n se b Each event or measurement provides richer data set Claims information Health day information h Low Medium High Hig ium d Me HIV testing information ig h H ed iu m w M w Lo Lo Risk assessment A Claims Ongoing measurement (absenteeism, EAP, etc…)

Accumulated data sets provide powerful analysis of different groups Sample company of 1, 000 Accumulated data sets provide powerful analysis of different groups Sample company of 1, 000 employees BIANNUAL INTEGRATION REPORT: Employees allocated to key risk indicators Number of employees 120 100 80 60 40 20 0 h Hig s im cla ium ed M High s im cla Lo s aim l wc s laim hc Hig d Me Risk ium Med Risk a ium R ssessm cla ents a nd s im Lo s im la wc isk claims s s laim s im hc im cla ig H cla m w diu Lo Me Low Risk score Low absenteeism Medium absenteeism High absenteeism Absenteeism indicator

Allows identification of and intervention in key focus areas Sample company of 1, 000 Allows identification of and intervention in key focus areas Sample company of 1, 000 employees BIANNUAL INTEGRATION REPORT: TRAUMA 100 80 60 102 employees with high absenteeism E A P filt er Number of employees 120 Employees allocated to key risk indicators HIV AND AIDS OR HEALTH ABSENTEEISM EMOTIONAL ISSUE 40 LIFE MANAGEMENT ISSUE 20 0 s s laim im s s hc im s cla ig laim s im H cla m s hc iu im w cla s d ig o e laim L H cla s m im M iu w hc im cla o ig ed L H cla m M High w diu Risk Lo Me Med ium R isk Low Risk a Risk sse ssmen ts and claims score Low absenteeism Medium absenteeism High absenteeism Absenteeism indicator MANAGERIAL ISSUES

Targeted data analysis drives intervention strategy Sample company of 1, 000 employees POST EVENT Targeted data analysis drives intervention strategy Sample company of 1, 000 employees POST EVENT REPORT: Knowledge and practice (KAP) survey report 0. 60 Attitudes towards HIV 0. 20 0. 00 0. 65 Male Age < 24 Female Age 36 -40 0. 40 Male Age 31 -35 0. 70 0. 75 0. 80 -0. 20 -0. 40 -0. 60 Male Age 25 -30 Female Age 24 -0. 95 0. 90 Female Age 31 -35 0. 85 Female Age 25 -30 Female Age 40+ Poor attitude and knowledge of HIV prevalence -0. 80 Knowledge of HIV risk Male Age 36 -40 Male Age 40+ 1. 00

Measure impact of wellness and interventions over time WELLNESS DAY REPORT: Change in Risk Measure impact of wellness and interventions over time WELLNESS DAY REPORT: Change in Risk Factor Analysis 77 77 26 Risk factor analysis Sample company of 1, 000 employees 26 24 65 First assessment % of Employees 23 Medium risk Low risk Second assessment 19 20 High risk 42 42% high 38 14 28 27 37% high 24 16 17 11 14 10 6 5 7 Healthy days Stress 2 Stress 1 Perception Risk factor Exercise F&G Alcohol Ex smoker Smoker 6 BP Cholesterol Chronic BMI 2 5 2 1 2 3 4 5 6 Number of risk factors 7 8

Communicating Wellness Communicating Wellness

Co-ordinated wellness strategy includes communication and support framework 24 hour Health advice and counselling Co-ordinated wellness strategy includes communication and support framework 24 hour Health advice and counselling Wellness and lifestyle guidelines and awareness campaigns First aid training Email awareness campaigns for key events Emergency support services Active promotion of employee assistance

How well are we doing? How well are we doing?

Absenteeism Company Survey Program type Absenteeism Blackmores Australia Gym 40% reduced absenteeism Johnson & Absenteeism Company Survey Program type Absenteeism Blackmores Australia Gym 40% reduced absenteeism Johnson & Johnson Fitness in factories 26% reduced absence than control Du. Pont Corporation Health and fitness programmes 14% less sick days than control UK Household Survey Active sport 33 to 50% reduced absenteeism ‘The Economic Impact of Sport’, Business and Economic Research Limited

Productivity Company Program type Productivity improvements Union Pacific Railroad Exercise 80% more productive 75% Productivity Company Program type Productivity improvements Union Pacific Railroad Exercise 80% more productive 75% more concentration NASA Exercise control Stamina, endurance and decision-making 12. 5% higher than non-participants Signature corporation Fitness for clerical/ operations 8% more productive Non-members negative productivity Frequency of exercise correlated with productivity and absenteeism Worksafe Australia Lunch time exercise Mood, productivity, cognitive functioning, reactive time, sensory motor perception, compared to control Source: Tasman Asia Pacific, Ernst & Young (1998)

Conclusion 1. The impact of unhealthy living is a cause of global concern 2. Conclusion 1. The impact of unhealthy living is a cause of global concern 2. Relatively small lifestyle changes can have a significant impact on health 3. Lifestyle improvements are, however, subject to many barriers 4. Empower individuals and communities 5. Integrated Wellness programmes are key to healthy lifestyles and impact the overall health of organisations 6. Use integrated reporting to drive Wellness strategies

Our broader responsibilities Our broader responsibilities

Driving Wellness in the Workplace Liezel Dreyer Driving Wellness in the Workplace Liezel Dreyer