Why Wellness and What are We Doing to Improve It Lydia Makrides, PhD Atlantic Health Wellness Institute

1. Why Wellness and What are We Doing to Improve It?Lydia Makrides, PhDAtlantic Health & Wellness Institute Workplace Health Works! A Seminar on Innovative Workplace Health Practices Canadian Labour and Business Centre November 18-19th, 2003

2. Agenda Why wellness Project Impact WIN Future plans

3. The Business Case RETURN ON INVESTMENT (ROI) Data from over 20 years in the US, Europe and Canada have shown: Workplace health promotion programs can reduce absenteeism and employer costs and improve performance and productivity Workplaces are recognized as �the single most important channel to reach the adult population through health promotion programs� (WHO, 2001) A 1996 review of 10 major studies reported ROI ranging from $2 - 6 per $1 invested with two studies reporting as high as $10 - 20 per $1 invested.

4. The Business Case HEALTH CARE AND INSURANCE COSTS Bank of America reported an average of $164 lower insurance claims in retirees who participated in a health promotion program. In non-participants, costs increased by an average of $15 / retiree. Pacific Bell reported $300 / employee lower claims resulting in $700,000 savings in one year. Coca Cola reported reductions in health care claims of $500 / employee / year. Prudential Insurance reported a drop in the company�s major medical costs from $574 to $312 for each participant in its wellness program.

5. The Business Case ABSENTEEISM A 2-year study by the DuPont Corporation of its comprehensive health promotion program reported a 14% decline in disability days vs. 5.8% decline in the controls. They reported total of 11,726 fewer disability days. Pacific Bell reported 3.3 days less on STD for employees who participated in their health promotion program, resulting in savings of 4.7 million. A national manufacturing company reported that targeting of their wellness programs to high risk employees resulted in a 12.2% decrease in sick days.

6. The Business Case DATA FROM CANADA Canada Life (Toronto) reported ROI of $3.40 per dollar invested primarily due to reduced turnover, productivity gains and decreased medical claims. BC Hydro reported: $1.2 million in reduced sick leave $97,000 in reduced accident costs $35,000 in reduced WCB claims Productivity gains of $919,000 ROI of $2.74 per dollar invested. MDS Nordian reported: significant decreases in annual grievances decrease in absenteeism from 6 days in 1993 to 4 days in 1999 decrease in injuries per 100 person years from 2.5 to 0.5 in the same time frame. Husky Infection Molding System reported: reduction in sick days lost of 2.5 days/year/employee. reduction in drug costs of over 75% within 1 year after implementing comprehensive wellness program.

7. The Business Case THE PREVENTABLE COST BURDEN Established relationship between preventable risk factors such as smoking, inactivity and overweight that result in increased health claims. This increase in claims has been documented in the scientific literature:

8. The Business Case THE PREVENTABLE COST BURDEN Using this relationship the amount of preventable claims can be estimated and the �cost of doing nothing� can be calculated. Realistic goals for workplace wellness in reducing the Preventable Cost Burden on a company can also be predicted. With no wellness interventions as employees are aging and likely to move up the risk ladder there is an exponential increase for the company in the Preventable Cost Burden. So it is true that HEALTHY EMPLOYEES MAKE HEALTHY COMPANIES.

10. 1st Study of its kind in Canada - Randomized Clinical Trial. Study on the effects of employee Wellness programs on cardiovascular risk factors. Cardiovascular Disease: 36% of all deaths in 1997 (Rank #1). AHWI + Aventis Pharma + Atlantic Blue Cross Care + 8 local employers: Ocean Contractors NSLC NS Department of Education IWK Health Centre HRM MTT Nova Scotia Power Atlantic Blue Cross Care. Project Impact

11. Participant requirements: two or more modifiable risks 2,700 employees pre-screened - 1,656 (62%) with 2 or more risk factors. 556 employees randomly chosen to participate. Two groups: Intervention Group (Wellness program) Control Groups (no intervention). Intervention: education sessions, individual exercise programs, nutritional analysis and counselling, smoking cessation and stress management. Project Impact

12. To determine the impact of a 12-week primary prevention program on: Modifiable cardiovascular risk factors Cardiac and stroke risk Cost-effectiveness Program satisfaction. OBJECTIVES

13. Awareness: 80% did not know their cholesterol and 45% did not know their blood pressure. 61% of participants had at least 2 cardiovascular risk factors (smoking, obesity, high cholesterol, high blood pressure and lack of physical activity). More than half were moderately overweight or obese. 10 out of the 556 had serious medical problems (some resulting in surgery). Initial Findings

14. All major risk factors decreased significantly. 40% of all smokers quit smoking. Control group also reduced their risk factors�showing importance of awareness and prescreening. Number of events avoided over a 10 year period: 1 cardiac event avoided for every 100 participants 1 stroke event avoided for every 500 participants Results

15. Overall cost benefit analysis: return of $1.64 per $1 spent. Participants with 3-5 risk factors: $2.04 per $1. Participants who are blue collar workers: $3.98 per $1. Cost Benefit Analysis

16. 3-month primary prevention program, consisting of structured education and counseling, healthy eating, weight management, cessation of smoking and individual exercise prescription, is effective in decreasing major modifiable cardiovascular risk factors such as: Obesity / overweight Physical inactivity Smoking These improvements lead to a decrease in projected cardiac and stroke risk factors based on 5-year Framingham risk estimates. Conclusion

17. Joint task force throughout Atlantic Canada. Partner organizations with the AHWI Nova Scotia Heart and Stroke Foundation Abbott Laboratories Aventis Pharma Luedey Consultants Inc. Departments of Health Heart and Stroke Foundations Chambers of Commerce WIN - Phase I: Perceptions of Workplace Wellness in Atlantic Canada.

18. Gain understanding of organizations perceptions and current involvement in wellness and dissemination of information.

19. FOCUS GROUPS Five in Atlantic Canada: St. John�s, Charlottetown, Halifax, Moncton, Sydney. ORGANIZATIONAL CHARACTERISTICS Generally larger with 200 + employees Both public and private sectors Unionized and non-unionized workplaces Human resource staff Engaged in wellness. Methods

20. MEANING OF WORKPLACE WELLNESS Healthy Organizational Culture (valuing employees, job satisfaction, a balance of worksite demands vs. control, participatory approaches, supportive psychosocial environment) Connection to family health Individual health Safe and supportive physical environment

21. BENEFITS OF A HEALTHY WORKPLACE Increased productivity and quality of service. Increased employee morale. Decreased absenteeism. Happier employees. A spirited, vibrant workplace. Improved retention and decreased turnover. Decreased sick time and disability. Decreased level of risk factors. Increased autonomy among employees.

22. CURRENT WORKPLACE HEALTH ISSUES Stress due to increasing workloads. The aging workforce. Repetitive work. Safety issues. Level of education. The need for greater autonomy.

23. CURRENT WORKPLACE HEALTH INITIATIVES Lifestyle initiatives. Needs and interest assessments. Workplace health committees. Occupational health and safety. Organizational health.

24. RESPONSIBILITIES Shared between the employer and employee Support from stakeholders: Government (provincial and municipal) Health care sector Business sector

25. CHALLENGES Lack of access and coordination of resources. Lack of financial resources. Lack of management support. Lack of employee interest and time. Assuring and maintaining confidentiality.

26. SUPPORTING EMPLOYERS How-to guides and best practice models. Resources to build awareness and commitment. Information on how to motivate employees. Resources to make the business case (ROI). Sharing / networking. Incentives and recognition. Build awareness, understanding and commitment.

27. SUPPORTING EMPLOYEES Onsite programs and convenient times. Incentives. Recognition. Management support and participation. Charging nominal fee to ensure commitment.

28. IMPLICATIONS Exploratory research. Perspective of large organizations. Seek small business perspective. Did not get complete picture - would require comprehensive survey. Interest and readiness in the business community. Need to network for sharing, building awareness and commitment.

29. WIN PHASE II Comprehensive written survey. Report on Healthy Workplace services, resources, websites etc. Annual symposium and establishment of WIN as a sustainable network to share and learn. Further research on issues related to the established relationship between modifiable (lifestyle) risk factors and associated health costs and claims.

30. THANK YOU! Lydia Makrides, PhD Director Atlantic Health & Wellness Institute 6960 Mumford Road West End Mall Suite 14 Halifax Nova Scotia B3L 4P1 CANADA Telephone: (902) 482 2494 Fax: (902) 482 2501 Cell: (902) 452 7181