INTRODUCTION TO THE INDIAN
WORKSITE WELLNESS PROGRAM
Based on
Sentinel Surveillance for CVD in Indian Industrial Population-SSIIP
Prof K Srinath Reddy
President
Public Health Foundation of India &
Professor of Cardiology
All India Institute of Medical Sciences, New Delhi
Deaths In India (2005)
7%
CVD
2%
Chronic resp. ds.
29%
11%
Other chronic ds
Communicable ds,
perinatal, maternal
conditions & nutritional
deficiencies
Injuries
7%
36%
8%
Source : WHO
Cancer
Rising Chronic Disease Burdens
2007
2025
No. of Persons with
HYPERTENSION
125 Million
214 Million
No. of Persons with
DIABETES
41 Million
69 Million +
1 Million
2 Million +
No. of Persons
Dying from
TOBACCO
Worksite Survey: Study Settings

Ten large/ medium industries across India, employing 1500-5000
people (public & private) twinned to medical colleges (public &
private)

Employees and their family members

Surveillance of CVD risk factors

Age Group : 20-69 years (n=19973 for the questionnaire survey and
n= 10442 for biochemical investigations).
Worksite Wellness Programme
Age adjusted
prevalence
of risk factors
Graph
1: Age adjusted
prevalence
of CVD2002-2003
risk factors
Men
Women
Prevalence %
60
50
40
45.8
48.1
30
30.3
20
40.2
40.2
35.0
34.4
25.5
26.0
10
26.3
15.5
8.3 9.0
18.4
0
Overweight
Central
Obesity
Dyslipidemia
Diabetes
Hypertension Tobacco Use
Risk factors
KS Reddy et al WHO Bulletin 2006
Metabolic
Syndrome
COEXISTENCE OF MULTIPLE RISK FACTORS (SSIP 20-69 YRS)
120
97.8
Percentage
100
89.9
80
60.2
60
43.5
40
20
25.8
2.2
0
0
1
2
3
4
4 plus
No of risk factors
Age>50, Current regular use of tobacco, SBP>=120 to <140,
PG 100-125.9 mg/dl, Tg>150 mg/dl, Tc/HDl >=4.5, HDL <40 (m)/HDL<50 (f)
BMI>23, WC >80 (f), or WC>90 (m) and Family history of CVD
CVD Risk Factor Survey in 10 Industries
Risk Factors by Educational Status in Men
Risk Factors
ES I
(%)
OR
Tobacco Use
19.8
1
Smoking
15.2
1
Regular Physical
Activity
ES II
(%)
OR
ES III
(%)
OR
ES IV
(%)
OR
P for trend
40.2
2.7 (2.4-3.1)
77.3
13.8 (11.7-16.2)
<0.001
16.7
1.1 (0.9-1.3)
24.4
1.8 (1.5-2.1)
21.8
1.5 (1.3-1.8)
0.04
41.6
1
40.0
0.9 (0.8-1.1)
34.7
0.7 (0.6-0.8)
13.2
0.2 (0.18-0.25)
<0.001
Diabetes
8.4
1
10.4
1.2 (0.95-1.6)
13.3
1.6 (1.3-2.1)
7.6
0.9 (0.6-1.3)
0.056
Hypertension
27.2
1
29.9
1.1 (0.99-1.3)
28.6
1.1 (0.9-1.2)
32.6
1.3 (1.1-1.4)
0.05
26.5
1.4 (1.2-1.7)
Metabolic Syndrome
19.2
20.9
20.6
24.9
0.05
1
1.1 (0.9-1.4)
1.1 (0.9-1.3)
1.3 (1.1-1.7)
ES I: Post Graduate; ES II: Graduate; ES III: Secondary or High School; ES IV : Primary or Illiterate
(Ongoing Indian Industrial Surveillance Study; Baseline Survey in 2002-03)
YEARS OF LIFE LOST DUE TO CVD IN POPULATIONS
AGED 35-64 YEARS
17.9
India
9.2
10.5
China
6.7
3.2
Russia
3.3
PPYLL IN 2030
PPYLL IN 2000
2
USA
1.6
0.4
0.3
S. Africa
0.05
Portugual
0.04
0
2
4
6
8
10
12
14
16
18
20
NUMBER IN MILLIONS
PPYLL= Potentially Productive Years of Life Lost

Health Promotion Component
Health Interventions at other sites
Population approach: Pamphlets, posters, health talks, health
promos on visual medium, health melas, healthy cooking
competitions,
High Risk Approach: Individual counseling, group counseling,
referral to medical doctor for management of hypertension,
diabetes and dyslipidemia
Environmental changes: Provided healthier alternatives at
canteen, banned tobacco inside the premises etc
Interventions were targeted to






Create readiness to change
Influence aspiration to change and espouse new
behaviors
Improve engagement of the individuals and the
community-interaction, self-efficacy, relapses
Change environmental barriers( work-site,
educational inst., canteens, hotels, overcoming cost
factors, availability)
Eliminate environmental societal stimulants
Introduce behavioral supports
Worksite Wellness Programme
Intermediate changes (2004-2005)
Behavioral changes
% changes
Physical activity levels
↑ 17.1%
Fruits and vegetable consumption
↑36.3%
Conscious effort to decrease
oil/ghee/butter consumption
↑ 31.3%
Age adjusted prevalence of risk factors in
females
(before and after intervention)
60
50
48.1
40
30
28.5
30.3
17
20
Before
26.324.8
After
15.5
9
10
4.2
6
0
Overweight
Central
obesity
Tobacco use Hypertension
Diabetes
Trends in mean levels of variables in Men
(six centre data)
Variable
Baseline:2002
n=6428
First Annual
Surveillance: 2004
n=1236
Final survey: 2006
n=4698
SBP
128.4 (16.7)
127.1 (16.8)
123.4 (16.7)
DBP
79.9 (10.8)
78.4 (10.5)
74.7 (10.5)
Weight
62.2 (12.6)
61.8 (12.3)
61.7 (11.8)
WC
84.0 (11.1)
81.8 (11.0)
81.0 (10.3)
PG
92.1 (29.0)
n=2894
90.1 (30.5)
n=1207
83.6 (31.8)
n=4062
TC
176.5 (43.0)
173.1 (42.2)
165.7 (43.8)
TG
132.9 (76.1)
132.0 (80.1)
135.5 (80.9)
43.2 (11.6)
45.8 (11.5)
49.5 (10.3)
HDL
Proportion of individuals above the Framingham
10 year CVD risk of >=10%
40
Percentage %
35
30
Baseline
Final
34.7
34.1
26.8
25.4
25
20
15
10
5
0
Intervention
Control
PRIMARY PREVENTION OF CVD
Risk Detection + Risk Reduction in Individuals
People
EDUCATION
Professionals
Self -Referral
+
Opportunistic Screening
HBP, Overweight, Tobacco,
Physical Inactivity, Diet, Age,
Gender, Personal/Family History
GUIDELINES
Risk stratification (Step I)
(Diagnostic Algorithms)
Targeted Screening
Diabetes, Dyslipidemia,
Assessment for CVD
GUIDELINES
Risk Stratification (Step II)
(Management Algorithms)
Appropriate Therapy
Lifestyle Measures + Drugs