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Race to the Healthiest Nation
How Our Families, Communities and Workplaces Can Help Make Us Fit
GlobalFit’s 3rd Annual Worksite Wellness Summit
May 14, 2009 Philadelphia, PA
L. Casey Chosewood, MD
Centers for Disease Control and Prevention
Disclaimer
• The mention of organizations and commercial entities and
products in this presentation is for illustrative purposes only
and does not represent an endorsement by CDC or the US
Department of Health and Human Services.
• The views herein represent those of the author and presenter
and not official cleared guidance from the Centers for
Disease Control and Prevention (CDC).
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Let’s Talk Health of the Nation
What does HEALTH mean to me?
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The U.S. Has a Critical Shortage of Health
The U.S. spends > $2 trillion every year on healthcare, more than any other country.
• Among industrialized countries, we rank no higher than 15th in health
status (disability-adjusted life expectancy)
• Among all countries of the world, the U.S. ranks:
• 35th in infant mortality prevention
• 30th in life expectancy at birth
“We spend less than four cents of every health care dollar on prevention and public health even
though eighty percent of the risk factors involved in the leading causes of death are behavior-related
and thus preventable.” – President Obama
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The U.S. Has a Critical Shortage of Health
• The US is one of the leading countries for cancer risk-- largely due to
tobacco
• Coronary heart disease rates are high, diabetes rates and risk factors
are increasing
• High levels of violence-related death are present
• Leading causes of premature death: tobacco, poor diet and physical
inactivity, alcohol, microbial agents, toxic agents, motor vehicle
crashes, firearm-related incidents, sexual behaviors, drugs
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Why Is The U.S. Not The Healthiest Nation?
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We are not getting the best value for what we are spending
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Health doesn’t happen in the doctor’s office or hospital
15 preventable medical conditions are responsible for nation’s health costs
increases
Health happens in our homes, schools, workplaces and communities
We do not invest enough in protecting health:
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Promoting good health
Preventing disease, injury, and disability
Preparing for new health threats
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Americans’ Views on Healthcare
Healthcare system satisfaction
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Rates “fair” or “poor”
Requires fundamental change or rebuilding
Satisfied with cost
Satisfied with quality
Republicans
Democrats
51%
77%
32%
58%
79%
93%
10%
20%
66%
43%
52%
80%
59%
68%
Worries
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Will have to pay more
Will lose insurance
Quality will get worse
Blendon RJ et al: Health Care in the 2008 Presidential Primaries. NEJM 358;4 2008
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LET’S TALK HEALTH EQUITY
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An Ethical Imperative: Social Determinants of Health
“Social injustice is killing people on a grand scale.”
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In the United States, from 1991-2000:
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176,633 lives were saved by modern medical advances
886,202 deaths would have been averted in this same time period if
mortality rates between white and African Americans had been
equalized.
The poorer you are, the worse your health outcomes
Source: WHO Commission on Social Determinants of Health - Final Report
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Urgent Realities
Preventable
diseases are an epidemic in America today.
Extreme chronic
diet
Extreme environment
Extreme aging
Extreme convenience
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Urgent Realities
• About 75 percent of the $2.2 trillion the United States spends on
healthcare goes toward treating chronic conditions like diabetes, heart
disease, and cancer.1
• That $2.2 trillion works out to $7,421 per person. Out-of-pocket costs
are $889 per American, a 5.3 percent increase over 2006 1
• One in 4 Americans has delayed medical care within the past 12
months because of cost
• Average cost for family health insurance coverage is $12,000 per year
Sources:
1 - Centers for Medicare and Medicaid Services
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Urgent Realities
• 133 million Americans, 45% of the total population, have at least one
chronic disease1
• It is projected that 388 million people will die worldwide from chronic
disease in the next 10 years.2
• An investment of $10 per person per year in proven community-based
programs to increase physical activity, improve nutrition, and prevent
smoking and other tobacco use could save the country more than $16
billion annually within five years.3
Sources:
1 - Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.
2 - PricewaterhouseCoopers, Working Towards Wellness. Feb 2007 Report
3 - Trust for America’s Health
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Is the “Care” in Healthcare Over-Emphasized?
Expensive Care – costs extraordinarily high -16% of annual gross domestic product (GDP) or about
$6,400 per person
Access to Care – 45-47 million Americans are uninsured;
geographic and other barriers to access; loss of primary
care homes and emphasis; provider shortages; pre-existing
conditions
Quality of Care – over- and under-utilization of services; medical errors
Quick Quiz:
Compared to one generation ago, how much would a
dozen eggs cost today if they had risen in price at the
same rate as healthcare?
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Quick Quiz Answer
$80.25
(that’s $6.69 per egg)
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PolyPill: Miracle or Myth?
• “…proponents say could reduce blood pressure and cholesterol levels -- two well-known
heart disease risk factors -- significantly for some, according to research presented today at
the American College of Cardiology's 58th annual scientific session in Orlando.” 1
• Combines multiple drugs into a single pill taken once per day
• 3 blood-pressure lowering drugs
• 1 cholesterol-lowering “statin” drug
• aspirin
• Concerns:
• Balance Sheet Dieting – “I’ll have a cheeseburger, diet soda, and polypill, please…”
• Potential paradigm shift from treating individuals to generalized risk groups
• “the number of medications included in the pill makes tailored treatment impossible...”2
• Loss of personal responsibility?
1.
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Dan Childs, ABC News, 30 MAR 09
Dr. Robert Bonow, past president of the American Heart Association
Isn’t Behavioral Change Enough?
Sir Michael Marmot
“ It is unreasonable to expect people to change their
behavior when the social, cultural and physical environments
around them fully conspire against them….”
Adapted from M. Marmot/Institute of Medicine Report
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It’s Time to Think and Act Differently About Health
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Shift the focus from healthcare to well-being
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Join forces at local, state, national levels to work together for health
Encourage grassroots action and empower people to demand change
Provide specific action ideas for creating the healthiest home, healthiest city, etc.
Create physical, social, and economic conditions that promote health and embrace
prevention
Change how we define a successful health system –track measures of health
rather than disease
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Let’s Talk Health of the Nation
Can we be the HEALTHIEST nation?
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Becoming “Choice Architects”
Choice-making is never neutral
Directing default options toward health can be
powerful
Subtle “nudges” toward healthier choices can
better outcomes
Policy interventions provide the basis for better
choices
Incentives and spotlights can motivate
Provide structure around complex choices
Themes from Thaler R, Sunstein, C: Nudge Improving Decisions About Health, Wealth, and
Happiness, 2008.
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New for 2008!
Physical Activity Guidelines for Americans Toolkit
Be Active, Healthy, and Happy!
• www.health.gov/PAguidelines
• Be Active Your Way: Fact Sheet and Guide for Adults
• PA Guidelines for Americans Toolkit User’s Guide
o At-A-glance: A Fact Sheet for Professionals
o FAQs
o Federal Resources for More Information and Ideas
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Are you Meeting the New 2008
Physical Activity Recommendations
for Adults and Children?
•Adults
• At least 2 and ½ hours a week of moderate intensity aerobic physical activity
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Or 1hour and 15 minutes of vigorous physical activity
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Increase to 5 hours a week moderate or 2 and ½ hours weekly of vigorous physical activity
•Older Adults
• Older adults should follow same adult guidelines as ability and condition allows
• Concentrate on exercises that maintain or improve balance if needed
•Children and Adolescents
• At least 1 hour or more of moderate/vigorous aerobic physical activity everyday
• Vigorous intensity activity at least 3 days a week
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Are you Meeting the New 2008
Physical Activity Recommendations
for Special Populations
•Women during Pregnancy
• Healthy women should get at least two and ½ hours of moderate-intensity aerobic activity a week
• Vigorous activity allowed if active before pregnancy and under guidance of healthcare provider
•Adults with Disabilities
• Should follow same adult guidelines as ability allows
• Incorporate muscle-strengthening activities two or more days a week
•People with Chronic Medical Conditions
• Should follow same adult guidelines as ability allows
• Should do so with the guidance of a health care provider
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A Health System for A Healthiest Nation:
Health Protection for Life!
A Health System for A Healthiest Nation:
Health Protection for Life!
Public Health Network
Health Protection: Health Promotion,
Prevention, and Preparedness
Healthcare Delivery System
Disease Care
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Workplace Health Investments in Prevention
$$$ to the Bottom Line
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Worksite health promotion programs yield an average return on investment of nearly $4 for
each $1 spent on direct health care costs(1)
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Reduce the cost of absenteeism by $5 for every $1 spent(1)
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A review of 42 published studies of worksite health promotion programs shows:
• Average 28% reduction in sick leave absenteeism
• Average 26% reduction in health costs
• Average 30% reduction in workers compensation and disability management claims
costs
• Average savings of $5.93 for every $1 spent(2)
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Common Flu causes - 70 million missed work days(3) per year
Sources:
1.
Anderson, E. Wellness Councils of America, 2002
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Aldana SG. Financial impact of health promotion programs: a comprehensive review of the literature. Am J Health Promotion.
2001;15(5):296-320
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Challenger, Gray & Christmas Inc.
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GlobalFitTM and CDC Partnership
• Working together for more than 5
years
• Complements our onsite fitness
programming
• Benefit extends to families and
contractors
• With GlobalFit we provide more
than 98% of CDC employees
access to free or low-cost fitness
facilities
• No-cost contract mechanism
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Go Green! Get Healthy!
• Launched in 2007
• Combines personal health promotion
and environmental awareness efforts
• Improve
• workplace morale
• staff and agency resiliency
• care for employees
• Leadership role modeling
• environmental responsibility
• corporate citizenship
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Family/workplace interventions
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Summary
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The health and healthcare challenges we face are daunting
The solution requires a paradigm shift from merely treating disease
to promoting health and well-being before disease begins
Greater investments in health protection are necessary
Success comes from empowered individuals and organizations
dedicated to true health system transformation
Policy and equity interventions combined with meaningful measures
of health are critical
It’s time to act now—together we can accomplish more
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…In support of Healthiest Nation
Resources
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Healthy People 2010 – Healthy People 2020
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• www.healthypeople.gov/
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GlobalFitTM
• http://www.globalfit.com/corp/
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Guide to Community Preventive Services
• www.healthiestnation.org
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Go Green! Get Healthy!
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NIOSH WorkLife Initiative
• http://www.cdc.gov/niosh/worklife/
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HHS Physical Activity Toolkit:
Community Toolbox
• http://ctb.ku.edu/en/
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• http://www.cdc.gov/about/stateofcdc/html/200
8/About05Green.htm
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Smallstep
• http://www.smallstep.gov/
• http://www.thecommunityguide.org/
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Alliance to Make US Healthiest
CDC’s Healthiest Nation Efforts
• http://www.cdc.gov/about/Nation/healthiestNatio
n.htm
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APHA - Healthiest Nation in 1 Generation
• http://www.generationpublichealth.org/
http://www.health.gov/PAGuidelines/toolkit.aspx
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One Model for a Healthier US
Means
Ways
Research
Faith-based Orgs
Public Figures
Business
Public Health
Youth Movements
Private
Unions/Labor
Civic/Social Groups
• Community and Workplace
Health Indexes
• Cultural Change
ASTHO
A Nation Invested in
Prevention and Health
Promotion
• Social Networking
and Technology
• Partnerships
Education
CDC
End
POLICY
NGOs
NACCHO
• Social
Networking
COMMUNICATIONS
& MARKETING
People
TARGETED INTERVENTIONS
Philanthropic/
Foundations
Academia
• Individual Actions
Media/Entertainment
Legislators
Healthcare
Non-profits
Advocacy Orgs
Government
• Health in All Policies
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Alliance to Make US Healthiest
Join now at www.healthiestnation.org
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QUESTIONS?
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