2013 UNIDAS Congress Health Promotion Programs (A Perspective) Presented by Professor Robert C. Karch, Ed.D. American University School of Education, Teaching,

2013 UNIDAS Congress

Health Promotion Programs(A Perspective)

Presented by

Professor Robert C. Karch, Ed.D.American University

School of Education, Teaching, and HealthWashington, DC, USA.

AMERICAN UNIVERSITYCollege 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

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

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

$9,235(2002)

$10,168 $11,192

$12,214 $13,382

$14,500 $15,609

$16,771 $18,074

$19,393(2011)

$20,944 $22,620

$24,430 $26,384

$28,496 $30,774

$33,236

$35,895

$38,767

$41,868(2021)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Health care expenses for U.S. families:2002-2021 (projected at present growth rate)

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

Where do U.S.

health care

dollars actually

go?

Health is more than health care Social and

economic factors

Physical environment

Healthy behaviors30%

10%

40%

Medicalservices20%

Medical services

8% Other

4% Healthy behaviors

88%

Where money spent

Drivers of health

Why You?? Why Me?? Why US?? and Why UNIDAS & Why Self Insure??

My Answer!!!

Shorter Lives, Poorer Health

13

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.

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.”

- ConfuciusR.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 OrganizationPAHO

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 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 an individually, socially, and economically productive life.

R.C. Karch

Health Continuum

PrematureDeath

Disability Signs Attitudes

SymptomsHealthBehaviorsKnowledge

Traditional MedicineHealth Promotion

Illness WellnessNo discernible illness or wellness

Source: Michael O’Donnell - Definition of Health PromotionAmerican Journal of Health Promotion Summer, 1986 R.C. Karch

Health Education

HealthProtection

Prevention

A model of health promotion; Downie, Fyfe, & Tannahill, 1992R.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

30

For Today A Dual Task

We must attempt to Prevent Diseaseswhile

We Promote a Healthy and Self- Empowered Active Lifestyle!

A Big and Complex Challenge!!

Example -The Complexity in - Tackling Obesity

32

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.

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

Broader contextEmployer 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

Opportunity and ResponsibilityAbout 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 lifeFamilies and Communities Benefit

( But - Who is the First Winner??)R.C. Karch

HOW? Critical Elements for Successful Outcomes!!

Leadership & Culture!!

Essential Elements ListGuidance toward Integrated Health and Safety ProgramsOrganizational 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).

Program Best PracticesLeadership 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

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 designCompanies across a variety of industries report benefits:• Lower health care costs• Greater productivity• Higher moraleROI can be as high as 6:1 (Note ?)

Six Essential Pillars for Successful Programs:1.Engaged leadership at multiple levels2.Strategic alignment with the company’s identity and aspirations3.A design that is broad in scope and high in relevance and quality4.Broad accessibility5.Internal and external partnerships6.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 : 1Absenteeism: 2.73 : 1

Where do U.S.

health care

dollars actually

go?

Facing the challenges in health care Social and

economic factors

Physical environment

Healthy behaviors30%

10%

40%

Medicalservices20%

Medical services

8% Other

4% Healthy behaviors

88%

Where money spent

Drivers of health

EvaluationDetermining 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.)

Soource

Low Risk

ModerateRisk

High Risk

Disease:Well

Managed

Disease:Poorly

Managed

Baseline 44%

Baseline 24%

Baseline 24%

Baseline 7%

Baseline 1%

15.1%

0.8%

4.5%

1.3%

14.4%

2.5% 0.2%

36.3%

33.5%

13.2%

25.0%

Risk transitions based on HA-derived risk

levels among employees over

2 years(N=1,087)

21% 66% 13%

Net population health

improvement of 8%.

87% did not get worse

GotBetter

Stayed theSame

Got Worse

Without health and well-being programs, the net employee population’s

health may get worse by 7% per

year

This 2-year health and well-being program was associated

with a ROI of 3:1

Source: HealthPartners Health Assessment Database, 2011

Integrated Worker Health Protection and Promotion

TOTAL WORKER HEALTH™

Integrated (Synergistic) ApproachBuilding 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

• 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!!!!!

“Well, I can see that it works in practice, but does it work in theory?”—Garret Fitzgerald

Thank You Very Much For this Opportunity!

& Questions and/or Comments

Bob Karchcan be reached -

Phone 202-297-1219 [email protected] [email protected]