1. Chris Bonnett, MHSc, PhD (Cand.) H3 Consulting, Guelph www.hthree.ca Managing Chronic Disease Can it work at work?

2. Three points in 15 minutes Review three prevalent and costly chronic diseases…among many others affecting the workplace. Consider the value of prevention. Presenting a good solution…made better.

3. A snapshot of chronic disease Cancer Lifetime prevalence is 40% for Canadian women and 45% for men. Cancer is now the leading cause of death. Eight of 12 new take-home cancer drugs had treatment costs of more than $30,000 annually. Cancer claims are ranked third in LTD plans, and present the longest average duration STD claims. Studies indicate 60 – 80% of employed cancer patients want to return to work after diagnosis and treatment, but need help to accommodate fatigue, poor concentration, and nausea. Sources: (1) Canadian Cancer Society, 2008, 2009. (2) Manulife Financial. (3) CancerBACUP 2005; Spelten 2002; Bouknight 2006.

4. A snapshot of chronic disease Mental health Mental illness is the leading cause of LTD claims and a major cause of STD claims. The cost to Canadian workplaces nearly $20 billion annually. Stigma and misunderstanding remain widespread, diagnosis and treatment are typically inadequate. There are at least seven different legal contexts for action against errant employers. Source: Mental Health Commission of Canada

5. A snapshot of chronic disease Metabolic Disorder Metabolic disorder incorporates illness and costs from heart disease, diabetes and obesity. Heart disease is the second-ranked cause of death: 17% of adults have undiagnosed hypertension. Among adults age 40–59, 22% are hypertensive. More Canadians are now overweight (37%) than ‘normal’ weight (36%). Life expectancy for type 1 diabetics is cut by up to 15 years, and by 5 – 10 years for type 2. Canadian adults with diabetes, on average, use 2.4 times more health resources. Sources: (1) Canadian Health Measures Survey, 2009-2011. (2) Canadian Community Health Survey, 2008. (3) Canadian Institute for Health Information.

6. The value of prevention at work High costs are correlated with more risk…by reducing risks, costs can be better controlled. Studies estimate that 40% – 70% of the cost of chronic disease can be avoided through lifestyle changes. Want to speak to executives? “Today’s reality is that health is a performance driver.” (Loepkke et al., 2010)

7. A better life and more of it Source: ICES, et al., 2012. Seven More Years: The impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy. To calculate your own life expectancy, go to: www.rrasp-phirn.ca/risktools.www.rrasp-phirn.ca/risktools The population health burdens of smoking and lack of physical activity were about the same. Years Gained SmokingAlcoholPhysical activityDietStressAll five risk factors Life expectancy gainHealth-adjusted life expectancy gain

8. Comprehensive Workplace Health Promotion A good solution…made better One temptation: Avoid wellness as ‘lifestyle correction done to employees’. Two perspectives: Personal, and organizational. Three words: Scope, intensity, and duration.

9. Comprehensive Workplace Health Promotion Key conclusion Properly designed, implemented and evaluated strategies are useful and important for Canadian employers, even though the evidence is mixed and the research flawed. “To be well, be wise.”

10. First understand the problem …then build a Solution Chronic diseases have high prevalence, are influenced by lifestyles, and are impacted by work environments. Chronic diseases create high personal, organizational, and societal costs in drugs, work absence, disability, distraction, and social services. Chronic disease rates, along with demographic and competitive pressures, mean a healthy and productive workforce is a strategic business issue worthy of executive attention. Solutions are at hand.