Presentation on theme: "2013 UNIDAS Congress Health Promotion Programs (A Perspective)"— Presentation transcript:
12013 UNIDAS Congress Health Promotion Programs (A Perspective) Presented byProfessor Robert C. Karch, Ed.D.American UniversitySchool of Education, Teaching, and HealthWashington, DC, USA.
2College of Arts and Sciences School of Education, Teaching and Health AMERICAN UNIVERSITYCollege of Arts and SciencesSchool of Education, Teaching and HealthBS in Health Promotion (18 Years)MS in Health Promotion Management (33 Years)National Center for Health and Fitness33 Years and 30 Million Dollars in External Research/Contract Activity
4Some Facts Based in Washington, DC at American University Unique global forum of established Health Promotion Professionals and prestigious institutionsPersonal and institutional links in 60+ countriesGlobal communication network with interdisciplinary partnershipsCurrently establishing Regional Coordinating Centers - ( IIHP-RCC)33 Years of experience in Health Promotion EducationDeveloping On-line Executive/Professional Education Programs
7The WHY? Humanistic/Civil Issues Business/Competitive Issues Cost - $/Savings/ROIProductivitySustainabilityCompetitiveness (National/Global)Recruitment - RetentionGrowthCost - Not just $ - OtherThe Human ConditionCivil SocietyHumanistic ConcernsSpiritual ConcernsThe right thing to do!!!
8Unsustainable Cost Pressure Source: 2011 Milliman Medical Index
9Or to look at it another way… Source: Alliance of Community Health Plans
10Or to look at it a third way… Income: $59,858Source: Alliance of Community Health Plans
11Health is more than health care Drivers of healthWhere money spentHealth is more than health careSocial and economic factorsPhysical environmentHealthy behaviors30%10%40%Medical services20%Medical services8% Other4%Healthy behaviors88%Where do U.S. health care dollars actually go?INTRODUCE BUSINESS CASECurrent 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)
12Why You?? Why Me?? Why US?? and Why UNIDAS & Why Self Insure?? My Answer!!!
13Shorter 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.
14This Fact Drives Me!! My “WHY” Punch Line It is a sobering (sickening) thought; we might live longerthan 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!!
15The WHAT? What is Health Promotion?? What can/does it mean for a company? (Owners, Management, Employees, Dependents, Customers, Competitors)What is Health Promotion ?
16LANGUAGE “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.” ConfuciusR.C. Karch
17Prevention vs. Promotion To Prevent or Prevention Pre - Coming beforeVent – Letting/Getting outTo Promote or PromotionPro - For and/or in support ofMotion – Action - Movement - Advocate
18Promotion and Prevention “To start”Pre – vention“To stop”R.C. Karch
19World 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. Karch11
20Mental HealthWHO 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
21Positive HealthState 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
22Total HealthA 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 anindividually, socially, and economically productive life.R.C. Karch
23Health Continuum Wellness Illness Premature Death Disability Signs AttitudesHealthBehaviorsPrematureDeathSymptomsKnowledgeHealth PromotionTraditional MedicineNo discernible illness or wellnessWellnessIllnessSource: Michael O’Donnell - Definition of Health PromotionAmerican Journal of Health Promotion Summer, 1986R.C. Karch
24A model of health promotion; Downie, Fyfe, & Tannahill, 1992 Health EducationHealth ProtectionPreventionA model of health promotion; Downie, Fyfe, & Tannahill, 1992R.C. Karch
25The American University’s Optimal WellnessThe American University’sNational Center for Health Fitness Optimal Wellness ModelTo 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
28EmpowermentPromotion 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
29Processes 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
30The Last What slide - What is Driving Change? Unsustainable costs of health careThe Patient Protection and Affordable Care ActThe obesity epidemic*The increase in diabetesThe overall relative decline in healthThe recognition that health is more than health care
31For TodayA Dual TaskWe must attempt to Prevent DiseaseswhileWe Promote a Healthy and Self- Empowered Active Lifestyle!A Big and Complex Challenge!!
32Example -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 systemSource: Vandenbroeck, Goossens, & Clemens. (2007). Foresight: Tackling Obesities: Future Choices –Obesity System Atlas.
34WHO??For today (this hour) it is just you and me!!! But then - Everyone!!!
35Key Settings – Touch Points WHERE??Key Settings – Touch PointsGovernment AgenciesWorkplace Settings*Workplace Health Associations (UNIDAS)*Faith Based OrganizationsGrocery Stores/ PharmaciesSchoolsHomeEverywhere!!!(Do you know of a place where Health is not important??)
36Where? - A Choice to Think About - The Doctor’s Office or The Workplace??Total Non-sleep Hours24 Hrs. Day ( – 8 Hrs. Sleep) = 16 Hrs. X 365 Day Year = Hours per year!!Total working Hours5 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!!!!
37The Worksite Setting Population access Significant reach into the population (Again note Proximity)Significant frequency to intervention exposureSignificant access to tools, vehicles, resources, etc. that may be mobilized to increase awareness and PA behavior changeWorksites can identify the population of interestEmployeesEmployees and dependentsTargeted subgroups of interestInterventions can be designed at various levels that interact with the individuals receiving the interventionIndividual - Inter-personal - Organizational & Environmental
38The Worksite Setting Work matters for health Unemployment is a major determinant of healthWorker health may be affected by the organization of work, the policies at work, the relationships at work, etc.Health matters for workChronic conditions may be exclusion criteria for job fitFitness for duty tests as indicators of inclusion criteriaHealthy workers and a healthy culture appear to be a good business strategyWorksite health promotion also is a sound public health strategy and fosters economic growth in the community
39Broader context Employer recognize the need to: Reduce healthcare spendingReduce illness burdenReduce the likelihood of becoming illMake healthy choices easy choicesMaintain or improve economic vitalityReduce wasteIncrease longevityEnhance national securityPrepare communities for the workforce
40Opportunity and Responsibility About one half of all of the people of the world are Employees!! A Karch Maxim HE + HC1 + HC2 + HC3 = HWIf 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!!
41Workplace 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 throughbetter health, more control overwork, better balance of work and social lifeFamilies and Communities Benefit( But - Who is the First Winner??)R.C. Karch
44Essential Elements List Guidance toward Integrated Health and Safety Programs Organizational Culture and LeadershipDevelop a “Human Centered Culture”Demonstrate LeadershipEngage mid-level managementProgram DesignEstablish clear principlesIntegrate relevant systemsEliminate recognized occupational hazardsBe consistentPromote employee participationTailor programs to the specific workplaceConsider incentives and rewardsFind and use the right toolsAdjust the program as neededMake sure the program lastsEnsure confidentialityProgram Implementation and ResourcesBe willing to start small and scale upProvide adequate resourcesBuild accountabilityCommunicate strategicallyProgram EvaluationMeasure and analyzeLearn from experienceTOTAL WORKER HEALTH™Source: NIOSH Essential Elements List (see
45Program Best Practices Leadership and StrategyOrganizational commitmentShared program ownershipIdentified wellness championsProgram connected to business objectivesSupportive policy, physical, and cultural environmentPolicy Development and Enforcement(Benevolent Policies)EvaluationProgram measurement and evaluationOperationsClearly defined operations planEffective communicationsScalable, sustainable, and accessible programsAssessment, screening, and triageEffective interventionsMeaningful participation incentivesIntegration and Data PracticesIntegration of program components at the point of implementationIntegration across multiple organizational functions and departmentsIntegrated data systemsEfficient and effective data practicesData privacy and confidentiality
46Five 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; andSupport the development of a strong overall health policy in the workplace.(Health Canada)R.C. Karch
51Value through designCompanies across a variety of industries report benefits:Lower health care costsGreater productivityHigher moraleROI can be as high as 6:1 (Note ?)Six Essential Pillars for Successful Programs:Engaged leadership at multiple levelsStrategic alignment with the company’s identity and aspirationsA design that is broad in scope and high in relevance and qualityBroad accessibilityInternal and external partnershipsEffective communications
52The 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
53Facing the challenges in health care Drivers of healthWhere money spentFacing the challenges in health careSocial and economic factorsPhysical environmentHealthy behaviors30%10%40%Medical services20%Medical services8% Other4%Healthy behaviors88%Where do U.S. health care dollars actually go?INTRODUCE BUSINESS CASECurrent 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)
54Evaluation Determining the Degree of Success Some Factors to ConsiderWhat 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.)
55Net population health improvement of 8%. SoourceRisk 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 yearGotBetterStayed theSameGot WorseBaseline 44%Low Risk36.3%14.4%Baseline 24%ModerateRisk13.2%15.1%33.5%2.5%0.2%Baseline 24%High Risk0.8%4.5%Baseline 7%Disease:WellManagedThis 2-year health and well-being program was associated with a ROI of 3:1Net population health improvement of 8%.87% did not get worse25.0%1.3%Baseline 1%Disease:PoorlyManagedSource: HealthPartnersHealth Assessment Database, 2011
56Integrated Worker Health Protection and Promotion TOTAL WORKER HEALTH™
57Integrated (Synergistic) Approach Building Healthier and Safer Workplaces Traditionally, workplace health protection and promotion programs have operated independentlyThe “silo” approach has limited overall effectiveness in optimizing worker health and safetyIntegration of health promotion, safety, and environmental programs, policies, protocols, and processes will allow for synergy in improving worker health and safetyA safer workforce is a healthier workforce and vice versa
58Moving Beyond Available Evidence “Well, I can see that it works in practice, but does it work in theory?”—Garret FitzgeraldEvidence of what works needs to be applied in the context of the workplace environmentInflexible focus on program fidelity may limit adoption of programs with sustained successPractice-based evidence can only be generated if solutions are successfully implementedWorksite health promotion programs will only deliver on their promise when supported as a business strategy with leadership support and accountability!!!!!
59Thank You Very Much For this Opportunity! & Questions and/or Comments