1. 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.

2. College of Arts and Sciences School of Education, Teaching and Health
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

4. Some Facts Based in Washington, DC at American University
Unique global forum of established Health Promotion Professionals and prestigious institutions
Personal and institutional links in 60+ countries
Global communication network with interdisciplinary partnerships
Currently establishing Regional Coordinating Centers - ( IIHP-RCC)
33 Years of experience in Health Promotion Education
Developing On-line Executive/Professional Education Programs

5. Health Promotion Programs
Why?
What?
Who?
Where?
How?

6. WHY?
Why Health Promotion? Why now? Why Your/My/Every Country? Why UNIDAS Nacional? Why You? – Why Me?

7. The WHY? Humanistic/Civil Issues Business/Competitive Issues
Cost - $/Savings/ROI
Productivity
Sustainability
Competitiveness (National/Global)
Recruitment - Retention
Growth
Cost - Not just $ - Other
The Human Condition
Civil Society
Humanistic Concerns
Spiritual Concerns
The right thing to do!!!

8. Unsustainable Cost Pressure
Source: 2011 Milliman Medical Index

9. Or to look at it another way…
Source: Alliance of Community Health Plans

10. Or to look at it a third way…
Income: $59,858
Source: Alliance of Community Health Plans

11. Health is more than health care
Drivers of health
Where money spent
Health is more than health care
Social and economic factors
Physical environment
Healthy behaviors
30%
10%
40%
Medical services
20%
Medical services
8% Other 4%
Healthy behaviors
88%
Where do U.S. health care dollars actually go?
INTRODUCE BUSINESS CASE
Current challenges in health care This diagram illustrates how far removed we are in the current state from where our focus needs to be – both as individuals and within the system.
When we look at what drives an individual’s health, according to David Kindig, a University of Wisconsin population health expert, who argues that there are multiple determinants of health outcomes, we see that Medical services only contribute 20% of actual health care spend. Healthy behaviors account for 30 percent, and in fact, where you live, your access to education, safety, and a healthy environment contribute a whopping 40%.
[CLICK]
Now, where do you think we, in the U.S. as a whole, actually spend our dollars on health care?
That’s right. 88% of our total spend is on medical services.
As a system, we need to align our spending with the elements that actually determine health.
[NEXT SLIDE)

12. Why You?? Why Me?? Why US?? and Why UNIDAS & Why Self Insure?? My Answer!!!

13. 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.

14. This Fact Drives Me!! 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!!

15. The WHAT? What is Health Promotion?? What can/does it mean for a company? (Owners, Management, Employees, Dependents, Customers, Competitors)
What is Health Promotion ?

16. 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

17. 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

18. Promotion and Prevention
“To start”
Pre – vention
“To stop”
R.C. Karch

19. 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 11

20. 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

21. 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

22. 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

23. Health Continuum Wellness Illness Premature Death Disability Signs
Attitudes
Health
Behaviors
Premature
Death
Symptoms
Knowledge
Health Promotion
Traditional Medicine
No discernible illness or wellness
Wellness
Illness
Source: Michael O’Donnell - Definition of Health Promotion
American Journal of Health Promotion Summer, 1986
R.C. Karch

24. A model of health promotion; Downie, Fyfe, & Tannahill, 1992
Health Education
Health Protection
Prevention
A model of health promotion; Downie, Fyfe, & Tannahill, 1992
R.C. Karch

25. The American University’s
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

27. WHO Healthy Workplace Framework

28. 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

29. Processes of empowerment can not be produced only promoted!
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

30. 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

31. 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!!

32. 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
Source: Vandenbroeck, Goossens, & Clemens. (2007). Foresight: Tackling Obesities: Future Choices –Obesity System Atlas.

34. WHO??
For today (this hour) it is just you and me!!! But then - Everyone!!!

35. Key Settings – Touch Points
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??)

36. 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 = 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!!!!

37. 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

38. 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

39. Broader context 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

40. 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!!

41. 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

42. HOW?
Critical Elements for Successful Outcomes!!

43. Leadership & Culture!!

44. Essential Elements List Guidance toward Integrated Health and Safety Programs
Organizational Culture and Leadership
Develop a “Human Centered Culture”
Demonstrate Leadership
Engage mid-level management
Program Design
Establish clear principles
Integrate relevant systems
Eliminate recognized occupational hazards
Be consistent
Promote employee participation
Tailor programs to the specific workplace
Consider incentives and rewards
Find and use the right tools
Adjust the program as needed
Make sure the program lasts
Ensure confidentiality
Program Implementation and Resources
Be willing to start small and scale up
Provide adequate resources
Build accountability
Communicate strategically
Program Evaluation
Measure and analyze
Learn from experience
TOTAL WORKER HEALTH™
Source: NIOSH Essential Elements List (see

45. Program Best Practices
Leadership and Strategy
Organizational commitment
Shared program ownership
Identified wellness champions
Program connected to business objectives
Supportive policy, physical, and cultural environment
Policy Development and Enforcement
(Benevolent Policies)
Evaluation
Program measurement and evaluation
Operations
Clearly defined operations plan
Effective communications
Scalable, sustainable, and accessible programs
Assessment, screening, and triage
Effective interventions
Meaningful participation incentives
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

46. 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

51. 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:
Engaged leadership at multiple levels
Strategic alignment with the company’s identity and aspirations
A design that is broad in scope and high in relevance and quality
Broad accessibility
Internal and external partnerships
Effective communications

52. 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

53. Facing the challenges in health care
Drivers of health
Where money spent
Facing the challenges in health care
Social and economic factors
Physical environment
Healthy behaviors
30%
10%
40%
Medical services
20%
Medical services
8% Other 4%
Healthy behaviors
88%
Where do U.S. health care dollars actually go?
INTRODUCE BUSINESS CASE
Current challenges in health care This diagram illustrates how far removed we are in the current state from where our focus needs to be – both as individuals and within the system.
When we look at what drives an individual’s health, according to David Kindig, a University of Wisconsin population health expert, who argues that there are multiple determinants of health outcomes, we see that Medical services only contribute 20% of actual health care spend. Healthy behaviors account for 30 percent, and in fact, where you live, your access to education, safety, and a healthy environment contribute a whopping 40%.
[CLICK]
Now, where do you think we, in the U.S. as a whole, actually spend our dollars on health care?
That’s right. 88% of our total spend is on medical services.
As a system, we need to align our spending with the elements that actually determine health.
[NEXT SLIDE)

54. Evaluation Determining the Degree of Success
Some Factors to Consider
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.)

55. Net population health improvement of 8%.
Soource
Risk transitions based on HA-derived risk levels among employees over 2 years
(N=1,087)
21%
66%
13%
Without health and well-being programs, the net employee population’s health may get worse by 7% per year
Got
Better
Stayed the
Same
Got Worse
Baseline 44%
Low Risk
36.3%
14.4%
Baseline 24%
Moderate
Risk
13.2%
15.1%
33.5%
2.5%
0.2%
Baseline 24%
High Risk
0.8%
4.5%
Baseline 7%
Disease:
Well
Managed
This 2-year health and well-being program was associated with a ROI of 3:1
Net population health improvement of 8%.
87% did not get worse
25.0%
1.3%
Baseline 1%
Disease:
Poorly
Managed
Source: HealthPartners
Health Assessment Database, 2011

56. Integrated Worker Health Protection and Promotion
TOTAL WORKER HEALTH™

57. 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

58. 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!!!!!

59. Thank You Very Much For this Opportunity! & Questions and/or Comments

60. Bob Karch can be reached -
Phone