Transcript Health Promotion Programs

2013 UNIDAS Congress
Health Promotion Programs
(A Perspective)
Presented by
Professor Robert C. Karch, Ed.D.
American University
School of Education, Teaching, and Health
Washington, DC, USA.
AMERICAN UNIVERSITY
College of Arts and Sciences
School of Education, Teaching and Health
BS in Health Promotion (18 Years)
MS in Health Promotion Management (33 Years)
National Center for Health and Fitness
33 Years and 30 Million Dollars in External Research/Contract Activity
Some Facts
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Based in Washington, DC at American University
Unique global forum of established Health Promotion Professionals and
prestigious institutions
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Personal and institutional links in 60+ countries
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Global communication network with interdisciplinary partnerships
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Currently establishing Regional Coordinating Centers - ( IIHP-RCC)
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33 Years of experience in Health Promotion Education
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Developing On-line Executive/Professional Education Programs
Health Promotion Programs
Why?
What?
Who?
Where?
How?
WHY?
Why Health Promotion?
Why now?
Why Your/My/Every Country?
Why UNIDAS Nacional?
Why You? – Why Me?
The WHY?
Humanistic/Civil Issues
• Cost - Not just $ - Other
• The Human Condition
• Civil Society
• Humanistic Concerns
• Spiritual Concerns
• The right thing to do!!!
Business/Competitive Issues
• Cost - $/Savings/ROI
• Productivity
• Sustainability
• Competitiveness
(National/Global)
• Recruitment - Retention
• Growth
Unsustainable Cost Pressure
$41,868
(2021)
Health care expenses for U.S. families:
2002-2021 (projected at present growth rate)
$38,767
$35,895
$19,393
(2011)
$9,235
(2002)
$33,236
$30,774
$28,496
$26,384
$24,430
$22,620
$20,944
$18,074
$16,771
$15,609
$14,500
$13,382
$12,214
$11,192
$10,168
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: 2011 Milliman Medical Index
Or to look at it another way…
Source: Alliance of Community Health Plans
Or to look at it a third way…
Income: $59,858
Source: Alliance of Community Health Plans
Drivers of health
20%
Health is
more than
health care
Where money spent
Medical
services
Healthy
30% behaviors
Social and
40% economic
factors
88% Medical
services
Where do
U.S. health
care dollars
actually go?
4% Healthy behaviors
Physical
10% environment
8% Other
Why You?? Why Me?? Why US??
and
Why UNIDAS & Why Self Insure??
My Answer!!!
Shorter Lives, Poorer Health
The U.S. health disadvantage
has multiple causes and
involves some combination of
inadequate health care,
unhealthy behaviors, adverse
economic and social
conditions, and
environmental factors, as
well as public policies and
social values that shape those
conditions.
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My “WHY” Punch Line
It is a sobering (sickening) thought; we might live longer
than our children!!
According to the World Health Organization we are the first
generation whose children's life expectancy may not be as long as
their parents if present trends continue.
This Fact Drives Me!!
The WHAT?
What is Health Promotion??
What can/does it mean for a company?
(Owners, Management, Employees, Dependents,
Customers, Competitors)
LANGUAGE
“If language is not correct, then what is said is not what is meant.
If what is said is not what is meant, then what must be done remains undone.
Hence, there must be no arbitrariness in what is said. This matters above everything.”
- Confucius
R.C. Karch
Prevention vs. Promotion
To Prevent or Prevention
Pre - Coming before
Vent – Letting/Getting out
To Promote or Promotion
Pro - For and/or in support of
Motion – Action - Movement - Advocate
Promotion and Prevention
Pro – motion
“To start”
Pre – vention
“To stop”
R.C. Karch
World Health Organization
PAHO
Definition of Health Promotion
“Health promotion is a process of enabling
people to increase their control over, and
to improve, their health”
(Empowerment)
R.C. Karch
Mental Health
WHO defines mental health as a state of well-being in which
the individual realizes his or her own abilities, can cope with
the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her
community. Mental health promotion is an umbrella term
that covers a variety of strategies, all aimed at having a
positive effect on mental health.
R.C. Karch
Positive Health
State of health beyond an asymptomatic state.
Concept of positive health usually concerns the
quality of life and the potential of the human
condition. Notion of positive health may include
self-fulfillment, vitality for living and creativity. The
concept of positive health is central to the
philosophy of health promotion.
R.C. Karch
Total Health
A state of complete physical, mental, and social
wellbeing and not merely the absence of disease and
infirmity. In the context of health promotion, health
is considered less as an abstract state and more as a
means, as a resource which permits people to lead an
individually, socially, and economically productive life.
R.C. Karch
Health Continuum
Disability
Premature
Symptoms
Death
Signs
Attitudes
Health
Knowledge Behaviors
Traditional Medicine
Health Promotion
No discernible illness or wellness
Illness
Wellness
Source: Michael O’Donnell - Definition of Health Promotion
American Journal of Health Promotion Summer, 1986
R.C. Karch
Health Education
Health
Protection
Prevention
A model of health promotion; Downie, Fyfe, & Tannahill, 1992
R.C. Karch
Optimal Wellness
The American University’s
National Center for Health Fitness Optimal Wellness Model
To obtain optimal wellness individuals must assume responsibility for the
continual development and maintenance of the Physical, Spiritual, Emotional,
Social, Intellectual, and Environmental components of their health, consistent
with the culture in which they reside.
R.C. Karch 1979
WHO Healthy Workplace Framework
Empowerment
Promotion of the abilities of people so that they can
form their social conditions and rule their own lives.
Their self-esteem is reinforced, their capabilities are
promoted. They are most likely to work together with
other people to achieve their goals.
R.C. Karch
Empowerment (Cont.)
In this approach even people with little ability or in extreme critical
situations are seen as having strengths and resources.
(Key Point)
Processes of empowerment can
not be produced only
promoted!
R.C. Karch
The Last What slide
- What is Driving Change?
• Unsustainable costs of health care
• The Patient Protection and Affordable Care Act
• The obesity epidemic*
• The increase in diabetes
• The overall relative decline in health
• The recognition that health is more than health care
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For Today
A Dual Task
We must attempt to Prevent Diseases
while
We Promote a Healthy and Self- Empowered Active Lifestyle!
A Big and Complex Challenge!!
Example -The Complexity in - Tackling Obesity
Complexity…
Health as an
outcome of a
multitude of
factors that
interact in a
highly
complex,
dynamic, and
inter-related
system
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Source: Vandenbroeck, Goossens, & Clemens. (2007). Foresight: Tackling Obesities: Future Choices –Obesity System Atlas.
WHO??
For today (this hour) it is just you and me!!!
But then - Everyone!!!
WHERE??
Key Settings – Touch Points
Government Agencies
Workplace Settings*
Workplace Health Associations (UNIDAS)*
Faith Based Organizations
Grocery Stores/ Pharmacies
Schools
Home
Everywhere!!!
(Do you know of a place where Health is not important??)
Where?
- A Choice to Think About -
The Doctor’s Office or The Workplace??
Total Non-sleep Hours
24 Hrs. Day ( – 8 Hrs. Sleep) = 16 Hrs. X 365 Day Year = 5840 Hours per year!!
Total working Hours
5 Days a week 8 hours a day = 40 Hours week X 50 weeks =2000 Hours year!!
Question? - How many hours a year do you spend with your Doctor???
(2hrs = a 1000 to 1 Ratio!!) & (Proximity Increases Success!! )
Just so you know - I love seeing my Doctor!!!!
The Worksite Setting
• Population access
• Significant reach into the population
(Again note Proximity)
• Significant frequency to intervention exposure
• Significant access to tools, vehicles, resources, etc. that may be mobilized
to increase awareness and PA behavior change
• Worksites can identify the population of interest
• Employees
• Employees and dependents
• Targeted subgroups of interest
• Interventions can be designed at various levels that interact with the
individuals receiving the intervention
• Individual - Inter-personal - Organizational & Environmental
The Worksite Setting
• Work matters for health
• Unemployment is a major determinant of health
• Worker health may be affected by the organization of work, the policies
at work, the relationships at work, etc.
• Health matters for work
• Chronic conditions may be exclusion criteria for job fit
• Fitness for duty tests as indicators of inclusion criteria
• Healthy workers and a healthy culture appear to be a good business
strategy
• Worksite health promotion also is a sound public health strategy and
fosters economic growth in the community
Employer recognize the need to:
•
•
•
•
•
•
•
•
•
Reduce healthcare spending
Reduce illness burden
Reduce the likelihood of becoming ill
Make healthy choices easy choices
Maintain or improve economic vitality
Reduce waste
Increase longevity
Enhance national security
Prepare communities for the workforce
Broader context
Opportunity and Responsibility
About one half of all of the people of the world are
Employees!!
A Karch Maxim
HE + HC1 + HC2 + HC3 = HW
If companies create Healthy Employees • Healthy employees will create Healthy Companies • Healthy Companies will then create Health Communities • Healthy communities will then create Healthy Countries • Healthy Countries will then create A Healthy World!!
Workplace Health Promotion:
a Win-Win-Win Scenario!!
Employers benefit:
Improved morale, higher productivity, enhanced recruitment and retention
( corporate image)
Employees benefit:
Improved quality of life through
better health, more control over
work, better balance of work and social life
Families and Communities Benefit
( But - Who is the First Winner??)
R.C. Karch
HOW?
Critical Elements for Successful Outcomes!!
Leadership & Culture!!
Essential Elements List
Guidance toward Integrated Health and Safety Programs
Organizational Culture and Leadership
1. Develop a “Human Centered Culture”
2. Demonstrate Leadership
3. Engage mid-level management
Program Design
4. Establish clear principles
5. Integrate relevant systems
6. Eliminate recognized occupational hazards
7. Be consistent
8. Promote employee participation
9. Tailor programs to the specific workplace
10. Consider incentives and rewards
11. Find and use the right tools
12. Adjust the program as needed
13. Make sure the program lasts
14. Ensure confidentiality
Program Implementation and
Resources
15. Be willing to start small and
scale up
16. Provide adequate resources
17. Build accountability
18. Communicate strategically
Program Evaluation
19. Measure and analyze
20. Learn from experience
TOTAL WORKER HEALTH™
Source: NIOSH Essential Elements List (see http://www.cdc.gov/niosh/TWH/essentials.html).
Leadership and Strategy
• Organizational commitment
• Shared program ownership
• Identified wellness champions
• Program connected to business
objectives
• Supportive policy, physical, and
cultural environment
Operations
• Clearly defined operations plan
• Effective communications
• Scalable, sustainable, and accessible
programs
• Assessment, screening, and triage
• Effective interventions
• Meaningful participation incentives
Program Best Practices
Policy Development and Enforcement
(Benevolent Policies)
Evaluation
• Program measurement and evaluation
Integration and Data Practices
• Integration of program components at the
point of implementation
• Integration across multiple organizational
functions and departments
• Integrated data systems
• Efficient and effective data practices
• Data privacy and confidentiality
Five Guiding Principles for a Healthy Workplace!
Meet the needs of all employees, regardless of their current level of
health; (Do not forget the Dependents!!)
Recognize the needs, preferences and attitudes of different groups of
participants;
Recognize that an individual’s “lifestyle” is made up of an
interdependent set of health habits;
Adapt to the special features of each workplace environment; and
Support the development of a strong overall health policy in the
workplace.
(Health Canada)
R.C. Karch
Value through design
Companies across a variety of industries report benefits:
• Lower health care costs
• Greater productivity
• Higher morale
ROI can be as high as 6:1 (Note ?)
Six Essential Pillars for Successful Programs:
1.Engaged leadership at multiple levels
2.Strategic alignment with the company’s identity and aspirations
3.A design that is broad in scope and high in relevance and quality
4.Broad accessibility
5.Internal and external partnerships
6.Effective communications
The value of Health-Dollars and Sense
ROI Literature Review
Systematic review and meta-analysis
Conclusion:
Worksite Health Promotion programs can
generate positive ROI for medical- and
absenteeism-related savings:
Medical: 3.27 : 1
Absenteeism: 2.73 : 1
Drivers of health
20%
Facing the
challenges
in health
care
Where money spent
Medical
services
Healthy
30% behaviors
Social and
40% economic
factors
88% Medical
services
Where do
U.S. health
care dollars
actually go?
4% Healthy behaviors
Physical
10% environment
8%
Other
Evaluation
Determining the Degree of Success
Some Factors to Consider
1. What to measure?
(Clinical Outcomes, Financial Savings, Productivity, etc.?)
2. When to Measure ?
( every day, week, month, quarter, year?)
3. How to measure?
(Self report, data driven, cost saving, ROI?)
4. Who to measure?
(Everyone, Employees, dependents a sample?)
5. Other Factors?
(effect of incentives, rewards, time of exposure, increased rentention,
and/or profits, etc., etc.)
Risk transitions
based on HAderived risk
levels among
employees over
2 years
(N=1,087)
21%
66%
Got
Better
Without health
and well-being
programs, the
net employee
population’s
health may get
worse by 7% per
year
13%
Got
Worse
Stayed the
Same
Baseline 44%
Low Risk
36.3%
14.4%
Baseline 24%
13.2%
15.1%
Moderate
Risk
33.5%
Soource
Baseline
24%
2.5%
0.2%
0.8%
High Risk
4.5%
This 2-year
health and wellbeing program
was associated
with a ROI of 3:1
Source: HealthPartners
Health Assessment Database, 2011
Baseline 7%
Disease:
Well
Managed
25.0%
1.3%
Baseline 1%
Disease:
Poorly
Managed
Net population
health
improvement of
8%.
87% did not get
worse
Integrated Worker Health
Protection and Promotion
TOTAL WORKER HEALTH™
Integrated (Synergistic) Approach
Building Healthier and Safer Workplaces
• Traditionally, workplace health protection and
promotion programs have operated independently
• The “silo” approach has limited overall effectiveness
in optimizing worker health and safety
• Integration of health promotion, safety, and
environmental programs, policies, protocols, and
processes will allow for synergy in improving worker
health and safety
• A safer workforce is a healthier workforce and vice
versa
Moving Beyond Available Evidence
“Well, I can see that it works in practice, but does it work in theory?”
—Garret Fitzgerald
• Evidence of what works needs to be applied in the context of
the workplace environment
• Inflexible focus on program fidelity may limit adoption of
programs with sustained success
• Practice-based evidence can only be generated if solutions are
successfully implemented
• Worksite health promotion programs will only deliver on their
promise when supported as a business strategy with
leadership support and accountability!!!!!
Thank You Very Much For this
Opportunity!
&
Questions and/or Comments
Bob Karch
can be reached Phone 202-297-1219
[email protected]
[email protected]