| At the National WorkLife Symposium: Integrating Health Promotion with Health Protection | |
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By James Nash |
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Improving workers’ health – and cutting costs – by breaking down the organizational “silos” that often separate health promotion from health protection is the driving idea behind “WorkLife 2007,” a national symposium held Sept. 10-11 in Bethesda, Md. Dr. Howard was the opening speaker at the symposium, which was sponsored by NIOSH and supported by 25 other organizations, including ORC Worldwide. The event attracted a varied collection of experts from government, academia, labor, and industry who spoke to an equally diverse audience that included hundreds of public and private health practitioners. Below are some highlights of the sessions that may be of special interest to ORC members, along with links, where possible, to PowerPoint slide presentations. Additional background information on the symposium and the NIOSH WorkLife Initiative is available on the NIOSH Web page at: http://www.cdc.gov/niosh/worklife/ NIOSH plans to post the slides used by all speakers at the Symposium on the NIOSH website in the near future. Making the Economic Case for Workplace Health was the first of two break-out sessions co-moderated by ORC Consultant Ann Brockhaus. Tim Bushnell, PhD, MPA, an economist at NIOSH, opened the session with a review of a number of the many methods being used by organizations around the world to determine the costs and benefits of health and safety improvements. Presentation here. Sean Nicholson, PhD, Associate Professor, Department of Policy Analysis and Management, Cornell University, followed with, “Measuring the Value to an Employer of Reducing Absences and Presenteeism.” His presentation is available here. Dr. Nicholson’s research has led him to conclude there are a number of factors that may cause employers to underestimate the real cost of worker ill health:
Does presenteeism exist? According to studies cited by Dr. Nicholson, managers acknowledged sick workers are up to 28 percent less productive than healthy workers, depending on the disease. In addition, his research has revealed that in many cases the actual ‘workloss’ caused by an absent employee can be far larger than the worker’s wage, if the absence of a single worker affects the productivity of an entire team or when there is a time penalty for lost or postponed output. Is mental health the same as the absence of mental illness? Not according to Corey Keyes, PhD, Associate Professor, Emory University, who concluded the session with a fascinating thesis: only 20 percent of Americans are mentally healthy, while many others are neither ill nor healthy, but “languishing.” Companies cannot afford to ignore the costs of these ‘languishers,’ according to Dr. Keyes. Health promotion can and should focus on increasing the outcome of positive mental health, not just reducing the risk of illness. Dr. Keyes provided evidence that those who are mentally healthy are far less prone to absenteeism, presenteeism, and a number of physical diseases, than are those who are languishing. The slides of this presentation are also available. Barriers to Change and How to Overcome ThemMany companies encounter serious organizational obstacles to integrating health promotion with occupational health and safety protection. The speakers at this session, also co-moderated by Ann Brockhaus, provided examples of companies that overcame these barriers and implemented successful programs. The way work is organized was a major factor in resolving this problem. In fact, the organization of work turned out to be one of the major themes of the WorkLife Symposium, as it has a profound affect on the health of workers, the cost of their health care, and the health of the entire organization. The rising cost of health care has already captured the attention of CEOs and CFOs. But the real cost of illness is far higher, according to Kimberly Jinnett, PhD, Research Director, Integrated Benefits Institute (IBI). Traditionally, companies have used only direct payments out to calculate the cost of days away of work, e.g. group health, workers compensation, short and long term disability. The real cost of a lost work day is on average at least 45 percent higher than direct medical costs, according to IBI research, which Dr. Jinnett said has been confirmed by Dr. Sean Nicholson (see above) and others. The additional costs result from missed deadlines, paying overtime to complete the work, and losses that result because the replacement workers are less productive. Dr. Jinnett said the 45 percent figure is an average, as the cost multiplier varies by industry and the nature of the work that is being performed. “Presenteeism” is a second factor that is related to, yet somewhat independent of, absenteeism, according to Dr. Jinnett. She said research has confirmed that presenteeism results in an additional 45 percent cost due to lost productivity. In an interview after her presentation, Dr. Jinnett said that the problem of presenteeism should be seen in connection with Dr. Keyes’ research into the difference between true mental health and the mere absence of mental illness. Dr. Jinnett said workers who are “languishing,” yet showing no signs of mental illness, are far more likely to be suffering from presenteeism. According to Dr. Jinnett, one important strategy for employers managing health and productivity is to create an integrated data warehouse, but most employers need a pragmatic and low cost method to get started. For most employers who have concentrated on medical and pharmacy data, integrating employee self-reports can be an inexpensive way to begin to examine the full costs of health conditions, and to link the company’s health management strategy to its business strategy. Dr. Jinnett said IBI has developed an employee self-report tool, called the Health and Work Performance Questionnaire (HPQ), which captures data on absence and presenteeism lost time for chronic health conditions. Information on HPQ is available at: http://www.ibiweb.org/publications/download/640 Workplace Programs for Obesity Prevention and ReductionA growing body of literature connects obesity to higher health care costs, greater risks of safety incidents higher workers compensation claims, higher absenteeism and decreased productivity, or “presenteeism,” according to Paul Schulte, PhD. The first of four speakers at this breakout session, Dr. Schulte is the Director, Education and Information Division at NIOSH. He cautioned that while much of the evidence for these linkages is strong, “some evidence still needs more work.” Keshia Pollack, PhD, MPH, Assistant Professor, Johns Hopkins University, Bloomberg School of Public Health, then presented her research which demonstrated that in a manufacturing environment, the odds of injury increase for obese workers. While her study needs to be confirmed, she said it suggests that obesity is an added risk factor for injury among manufacturing workers. Weight bias is the most frequently highest form of reported form of discrimination among overweight white women, according to Mark Roehling, JD, PhD, Associate Professor, School of Industrial and Labor Relations, Michigan State University. “There’s lots of evidence that weight discrimination goes on in the workplace,” he asserted. “When you implement a weight loss program, you may make this situation better – or you may make it worse.” Dr. Roehling said that employers who set up weight reduction programs need to administer them properly and must ensure that those in charge are properly trained. Insensitive weight-related comments can be the basis for successful legal actions. On the other hand, the legal risks of voluntary programs are low and manageable, provided the focus is on providing carrots rather than sticks. Over 65 percent of the U.S. population is overweight and 30 percent is obese, according to Nico Pronk, PhD, Vice President and Executive Director, HealthPartners Health Behavior Group. The most alarming trend, he said, is that the number of those who are severely obese is are growing far more rapidly than any other category; and it is these most obese people who account for greatest burden on the health care system. “Within a decade 20 percent of all medical expenses will be tied to treating obesity,” predicted Dr. Pronk. Part of this is due to the growth in obesity, but another factor is the rapid increase of the severely obese. Dr. Pronk then presented data on the total cost of illness. Like several other speakers, he said that direct medical costs are only the “tip of the iceberg,” and offered the following breakdown of the total cost of illness:
Excess weight has an impact on both direct and indirect costs. According to his research, being obese equals 20 years of aging in terms of health care costs. Dr. Pronk ended with some practical advice on how to develop an effective weight reduction program, based on 80 studies of such programs. The research indicates that programs relying on a single factor, such as diet or drugs, are far less effective than multi-component programs. “I think programs that focus on both diet and exercise are the ones to choose,” he concluded.
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