to help kids who have terminal illnesses, such as AIDS, cancer, and diabetes. Foundation, St. Jude Children’s Research Center, and the Joslin Diabetes Center. …
The Scientific Research That Supports
Worksite Health Promotion Activities
Adapted from The Health Promotion First Act prepared by David Anderson,
PhD, StayWell Health Management
Employee Lifestyles Impact Employee Health
Approximately 40 of all deaths in the United States are premature at
least 900,000 deaths annually and are due to unhealthy lifestyle
choices such as tobacco use, poor diet, sedentary lifestyle, misuse of
alcohol and drugs, and accidents Other contributors to early death
include genetic predisposition 30, social circumstances 15, poor
access to quality medical care 10, and environmental exposures
5[i]
Unhealthy lifestyle is the primary contributor to the six leading
causes of death in the US - heart disease, cancer, stroke,
respiratory diseases, accidents, and diabetes - which collectively
account for over 70 of all deaths[ii],[iii],[iv],[v]
People with healthier lifestyles live an average of 6 to 9 years
longer,[vi] postpone disability by 9 years and compress disability
into fewer years at the end of life[vii]
The prevalence of obesity among US adults rose to 30 in 1999-2000,
a 33 increase from a decade earlier,[viii] and the prevalence of
diabetes also rose by 33 during approximately the same period 1990
to 1998[ix]
About two-thirds of American adults are overweight or obese,8 55 do
not get enough physical activity,[x] 26 are completely inactive,10
and only 25 eat recommended amounts of fruit and vegetables[xi] If
diet/physical activity patterns continue worsening at their current
rate, these behaviors will soon surpass tobacco use as contributors to
mortality3
Among young people, the prevalence of overweight has more than
quadrupled in the past 20 years to 16,[xii] daily participation in
high school physical education classes has dropped from 42 in 1991 to
28 in 2003,[xiii] more than 60 eat too much saturated fat, and
almost 80 do not eat recommended amounts of fruit and
vegetables[xiv]
Lifestyle diseases disproportionately affect women, racial and ethnic
minorities, the poor and seniors:
The prevalence of diabetes among African Americans is about 70
higher than among white Americans, and the prevalence among
Hispanics is nearly double that for white Americans[xv]
Women comprise more than half of the people who die each year of
cardiovascular disease[xvi]
Chronic conditions significantly limit daily activity for 35 of
persons over 65 years of age[xvii]
Financial Impact of Lifestyle
It is estimated that lifestyle-related chronic diseases account for
70 of the nations medical care costs,[xviii] which translates to
over 11 of the entire US gross domestic product
Two comprehensive scientific reviews identified 83 peer-reviewed
studies reporting that people with unhealthy habits have higher
medical costs[xix],[xx]
Research conservatively estimates that high health risks high blood
cholesterol, high blood pressure, etc account for at least 25 of
total medical costs [xxi]
Recent research indicates a direct relationship between modifiable
lifestyle risks and lower worker productivity,[xxii],[xxiii] and
relevant data suggest that the costs to employers in lost productivity
due to poor employee health may be substantially
more than the direct
medical and disability costs[xxiv],[xxv]
Unhealthy lifestyles often lead to chronic disease, many of which
cannot be cured and require years or decades of expensive treatments
Below are estimated annual costs of selected unhealthy lifestyles and
chronic diseases including obesity,[xxvi],[xxvii] smoking,[xxviii]
hypertension,[xxix] diabetes,[xxx] stress,[xxxi] and
inactivity[xxxii]
Worksite Health Promotion Improves Health and Yields Major Savings
Comprehensive scientific reviews identified 378 peer-reviewed studies
showing that worksite health promotion programs improve health
knowledge, health behaviors, and underlying health conditions[xxxiii]
Research has demonstrated that lifestyle modification may often be
more effective and cost-effective than medical intervention in
reducing morbidity[xxxiv] and mortality[xxxv]
Several scientific reviews indicate that worksite health promotion
programs reduce medical costs and absenteeism and produce a positive
return on investment20,[xxxvi],[xxxvii],[xxxviii] The most definitive
review of financial impact reported
that:
18 studies indicated that these programs reduce medical costs, and
14 studies indicated that they reduce absenteeism costs20
13 studies that calculated benefit/cost ratios all showed the
savings from these programs are much greater than their cost, with
medical cost savings averaging 348 and the absenteeism savings
averaging 582 per dollar invested in the programs20
Medical costs are expected to exceed 16 percent of US gross domestic
product GDP in 2005 and to grow at 72 percent annually through
2015, when medical expenditures will account for 20 percent of
GDP:[xxxix],[xl]
Per capita medical costs in the US are the highest in the world
and more than double the median for OECD countries see chart
below,[xli] yet the United States ranks 26th in terms of healthy
life expectancy[xlii]
Medicaid is the second largest item in most state budgets, and its
portion of the total budgets is increasing each year[xliii]
Rising medical costs for US employers continue to outpace general
inflation, averaging 12 percent
per year for the past 10 years
[xliv] This trend is causing a tremendous financial hardship on
US employers
References
———————–
[i] McGinnis JM, Foege WH Actual causes of death in the United States
JAMA 1993;270:2207-2212
[ii] Mokdad AH, Marks JS, Stroup DF, Gerberding JL Actual causes of death
in the United States, 2000 JAMA 2004;291:1238-1245
[iii] McGinnis JM, Foege WH The immediate vs the important JAMA
2004;291:1263-1264
[iv] McGinnis JM, Foege WH Actual causes of death in the United States
JAMA 1993;270:2207-2212
[v] Anderson RN, Smith BL Deaths: leading causes for 2002 National Vital
Statistics Report, Vol 53, No 17 National Center for Health
Statistics, March 7, 2005
http://wwwcdcgov/nchs/data/nvsr/nvsr53/nvsr53_17pdf
[vi] Stamler J, Stamler R, Neaton JD Low risk-factor profile and long-term
cardiovascular and noncardiovascular mortality and life expectancy
Findings for 5 large cohorts of young adult and middle-aged men and
women JAMA 1999; 282:2012-2018
[vii] Vita AJ, Terry RB, Hubert HB, Fries JF Aging, health risks, and
cumulative disability N Engl J Med 1998;338:1035-1041
[viii] Flegal KM,
Carroll MD, Ogden CL, Johnson CL Prevalence and Trends
in Obesity Among US Adults, 1999-2000 JAMA 2002;288:1723-1727
[ix] Diabetes trends in the US: 1990-1998 Mokdad AH, Ford ES, Bowman BA,
Nelson DE, Engelgau MM, Vinicor F, Marks JS Diabetes Care, 2000;
23:1278-1283
[x]Centers for Disease Control and Prevention Prevalence of Physical
Activity, Including Lifestyle Activities Among Adults — United
States, 2000-2001 MMWR 2003;5232:764-769
http://wwwcdcgov/mmwr/preview/mmwrhtml/mm5232a2htm
[xi] Serdula MK, Gillespie C, Kettel-Khan L, Farris R, Seymour J, Denny C
Trends in Fruit and Vegetable Consumption Among Adults in the United
States: Behavioral Risk Factor Surveillance System, 1994-2000 Am J
Public Health 2004;94:1014-1018
[xii] Centers for Disease Control and Prevention Overweight and Obesity
http://wwwcdcgov/nccdphp/dnpa/obesity/
[xiii] Centers for Disease Control and Prevention Participation in High
School Physical Education United States, 1991-2003 MMWR
2004;5336:844-847
http://wwwcdcgov/mmwr/preview/mmwrhtml/mm5336a5htm
[xiv] Centers for Disease Control and Prevention Nutrition and the Health
of Young People
http://wwwcdcgov/HealthyYouth/nutrition/factshtm
[xv] Department of Health and Human Services A systematic approach to
health, healthy people 2010 goals, Goal 2: Eliminate health
disparities Healthy People 2010 Conference Edition, in Two Volumes
2000; Washington, DC
[xvi] Centers for Disease Control and Prevention National Center for
Health Statistics Heart Disease
http://wwwcdcgov/nchs/fastats/hearthtm
[xvii] Centers for Disease Control and Prevention National Center for
Health Statistics Disabilities/Limitations
http://wwwcdcgov/nchs/fastats/disablehtm
[xviii] Fries JF, Koop CE, Soklov J, Beadle CE, and Wright D Beyond health
promotion: Reducing need and demand for medical care Health Affairs
1998;172:70-84
[xix] Aldana SG Financial impact of health promotion programs: A
comprehensive review of the literature American Journal of Health
Promotion 2001;15:296-320
[xx] Max W The Financial Impact of Smoking of Health Related Costs: A
Review of the Literature, American Journal of Health Promotion 2001;
15:321-331
[xxi] Anderson DR, Whitmer RW, Goetzel RZ, Ozminkowski RJ, Wasserman J,
Serxner S The relationship between modifiable
health risks and group-
level health care expenditures American Journal of Health Promotion
2000;15:45-52
[xxii] Burton WN, Conti DJ, Chen C, Schultz AB, Edington DW The role of
health risk factors and disease on worker productivity Journal of
Occupational and Environmental Medicine 1999;41:863-877
[xxiii] Boles M, Pelletier B, Lynch W Relationship between health risks
and work productivity Journal of Occupational and Environmental
Medicine 2004; 46:737-745
[xxiv] Integrated Benefits Institute Linking Medical Care to Productivity,
February 2001 http://wwwibiweborg/publications/download/402
[xxv] Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W
Health, absence, disability, and presenteeism cost estimates of certain
physical and mental health conditions affecting US employers Journal
of Occupational and Environmental Medicine 2004;46:398-412
[xxvi] Centers for Disease Control Prevention Overweight and Obesity
Frequently Asked Questions FAQs Costs are estimated for the year
2000 http://wwwcdcgov/nccdphp/dnpa/obesity/faqhtm
[xxvii] Finkelstein EA, Fiebelkorn IC, Wang G National medical spending
attributable to
overweight and obesity Health Affairs - Web Exclusive,
May 14, 2003; W3:219-226
http://contenthealthaffairsorg/cgi/reprint/hlthaffw3219v1
[xxviii] Centers for Disease Control and Prevention Annual Smoking-
Attributable Mortality, Years of Potential Life Lost, and Economic
Costs — United States, 1995-1999, MMWR 2002; 5114:300-303
http://wwwcdcgov/tobacco/research_data/economics/mmwr5114highlightsh
tm
[xxix] National Heart, Lung, and Blood Institute National Blood Pressure
Education Program High Blood Pressure in the United States
http://hp2010nhlbihinnet/mission/abouthbp/abouthbphtm
[xxx] Hogan P, Dall T, Nikolov P Economic costs of diabetes in the US in
2002 Diabetes Care 2003;26:917-932
[xxxi] Davis JA Workers compensation claims for stress-related diseases
Journal of Occupational Medicine 1985;27:821-825
[xxxii] Estimate includes only direct medical costs; indirect costs are not
included Source: Pratt M, Macera CA, Wang G Higher Direct Medical
Costs Associated With Physical Inactivity The Physician and Sports
Medicine 2000;2810:63-70
http://wwwphyssportsmedcom/issues/2000/10_00/pratthtm
[xxxiii] Wilson M, Holman P B,
Hammock A A Comprehensive Review of the
Effects of Worksite Health Promotion on Health-Related Outcomes
American Journal of Health Promotion 1996;10:429-436
[xxxiv] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM,
Walker EA, Nathan DM; Diabetes Prevention Research Group Reduction in
the incidence of type 2 diabetes with lifestyle intervention or
metformin New England Journal of Medicine 2002;346:393-403
[xxxv] Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC,
van Staveren WA Effect size estimates of lifestyle and dietary changes
on all-cause mortality in coronary artery disease patients: a
systematic review Circulation 2005;112:924-934
[xxxvi] Pelletier K A review and analysis of the clinical and cost-
effectiveness studies of comprehensive health promotion and disease
management programs at the worksite American Journal of Health
Promotion 2001;16:107-116
[xxxvii] Pelletier KR A review and analysis of the clinical and cost-
effectiveness studies of comprehensive health promotion and disease
management programs at the worksite: 2000-2004 update VI Journal of
Occupational and Environmental
Medicine 2005; 47:1051-1058
[xxxviii] Chapman LS Meta-evaluation of worksite health promotion economic
return studies: 2005 update American Journal of Health Promotion
2005;196:1-11 Art of Health Promotion Section
[xxxix] Centers for Medicare Medicaid Services National health
expenditure projections 2005-2015, forecast and selected tables
http://wwwcmshhsgov/NationalHealthExpendData/03_NationalHealthAccount
sProjectedaspTopOfPage
[xl] Borger C, Smith S, Truffer C, Keehan S, Sisko A, Poisal J, Clemens MK
Health spending projections through 2015: Changes on the horizon
Health Affairs - Web Exclusive, February 22, 2006; 25:w61-w73
http://contenthealthaffairsorg/cgi/content/abstract/hlthaff25w61
[xli] Reinhardt UE, Hussey PS, Anderson GF US health care spending in an
international context Why is US spending so high and can we afford
it? Health Affairs 2004;233:10-25
[xlii] The World Health Report, 2006 World Health Organization, 2006
Healthy life span data is located in Annex Table 1, which is accessible
at http://wwwwhoint/whr/2006/annex/06_annex1_enpdf
[xliii] Hogan B States eye deep Medicaid cuts AARP Bulletin, January,
2003
[xliv] Mercer Human Resource Consulting US National Survey of Employer-
Sponsored Health Plans November 22, 2004
http://wwwmercerhrcom/pressrelease/detailsjhtml/dynamic/idContent/116
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