Atlantic Health and Wellness Institute, Research Affiliate
The Business Case of
Comprehensive Workplace Health
Lydia Makrides, PhD
President, Creative Wellness Solutions
Editor-in-Chief, International Journal of Workplace Health Management
ECOSH/ROWER Conference
September 17-18, 2009
Amsterdam
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Atlantic Health and Wellness Institute, Research Affiliate
Greetings from Halifax
Nova Scotia!

Atlantic Health and Wellness Institute, Research Affiliate
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Health Risks for Chronic Disease
Atlantic Health and Wellness Institute, Research Affiliate
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Health Risks for Chronic Disease
Atlantic Health and Wellness Institute, Research Affiliate
• Chronic disease related deaths account for 56% of all deaths in the working-age population in the world
(World Health Organization).
• High prevalence of major modifiable health risks contributes to the epidemic of chronic disease.
Elevated BMI (BMI ≥25kg/m 2 )
Obesity (BMI ≥ 30 kg/m 2 )
Inactivity Smoking
Stress
Elevated cholesterol
Alcohol
Elevated blood pressure
High blood sugar
• Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and worker’s compensation claims.
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Health Risks for Chronic Disease:
Profile of Atlantic Canadian Employees
Atlantic Health and Wellness Institute, Research Affiliate
• N=6067: 2665 Males & 3402 Females
• 51 Organizations: Private companies (N=2859). Pulblic
Companies (N=1425), Health Care Facilities (N=1783)
• Average age 41.3 years
• 70% overweight (BMI ≥ 25)
- 31% obese (BMI ≥ 30)
• 49% inactive (less than 3 times per week)
• 38% elevated cholesterol (greater than 5.2 mmol/L)
• 20% daily cigarette smokers
• 16% elevated blood pressure (greater than 140/90 mmHG)
• 18% elevated stress scores
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Health Risks for Chronic Disease:
Profile of Atlantic Canadian Employees
Atlantic Health and Wellness Institute, Research Affiliate
• Multiple health risks compounding the health issues
• Average 2.4 health risks/employee
• Average Wellness Score - 46%
• Need to improve Wellness Score - 72% (scored
49% or lower)
• Chronological age - 41.3 yrs
• Achievable Health Age - 35.8 yrs
• Coronary risk moderate to high - 46%
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Health Risks for Chronic Disease:
Profile of Atlantic Canadian Employees*
Atlantic Health and Wellness Institute, Research Affiliate
50
40
30
20
16
21
37
Atlantic Canadian Employees
AHWI data (n=6067)
18
7
10
0
0 1 2 to 3 4 to 5 6+
Number of Risk Factors**
* AHWI Database
**Inactivity, overweight, elevated cholesterol, blood pressure, smoking, high stress, illness days, alcohol use, life satisfaction, existing medical condition.
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Atlantic Canadian vs.
Healthy Company Profile
Atlantic Health and Wellness Institute, Research Affiliate
Shift in risk factors after 4 years of workplace wellness program
50
40
43
37
Atlantic Canadian Employees
AHWI Data (n = 6,067)
Healthy Company*
30
21
25
24
20
18
16
7
10 7
1
0
0 1 2 to 3
Number of Risk Factors
4 to 5 6+
*(Steelcase study: Amer. J. of Health Promotion, Vol. 6, No. 1:46-54, 1991)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
1. The do-nothing strategy of waiting for sickness and then paying for treatment is a failed strategy.
2. Lifestyle related risk factors and behaviours of employees as well as unhealthy work environments and practices drive costs.
• High risk employees incur high costs whatever the outcome measure: pharmaceutical, absenteeism, compensation costs or productivity.
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
Productivity Decreases with Number of Health Risks
Excess
Productivity
Loss
Productivity Loss (%)
Base Cost
Number of Health Risks
(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
Absenteeism Increases with Number of Health Risks
Excess
Work Loss Days /
Year
Work Loss Days (#/yr)
Base Work Loss
Days / Year
Number of Health Risks
( Summary of 10 Mid-sized U.S. Corporations (n=5,142 employees))
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
Healthcare Costs Rise with Number of Health Risks
Excess
Cost
Health Claims (RR)
Base Cost
Number of Health Risks
( University of Michigan Study (n = 205,216)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
3. One of the root causes of unsustainable increases in costs is natural flow of individuals from low risk → high risk →disease →higher employer costs – natural flow estimated at 2% - 4% per year.
(Edington et al, 2009).
3. The Health Risk Assessment (HRA) is the tool used in
Comprehensive Workplace Wellness to raise awareness and determine employee health risk status.
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
5. An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk.
• Employers costs go up as people age, regardless of their health risk status and as health risk status gets worse, costs go up regardless of age.
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
6. Risk clusters likely to be associated with high healthcare costs within a 2-3 year period:
• Metabolic syndrome: combinations of high blood pressure cholesterol, blood glucose and waist circumference/ BMI associated with higher risk for diabetes or heart disease.
• Pre-metabolic syndrome: combinations of one or two risk factors.
( Edington, 2009)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
Relationship of Biometric Cluster to Diabetes and Heart Disease
Risks: Waist
Circumference,
Hypertension,
Glucose
Intolerance,
Cholesterol
Pre-
Metabolic
Syndrome
Metabolic
Syndrome
Diabetes
Retinopathy
Neuropathy
Nephropathy
Heart
Disease
Costs to Employers:
Health Care Costs
Productivity Costs
( Edington, Zero Trends, 2009)
Cost to Individual:
Quality of Life
Morbidity
Mortality
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
7. Changes in healthcare costs follow changes in health risk:
• As number of risks goes up, costs go up.
• As number of risks goes down, costs go down.
(Wright et al, 2002)
8. Established relationship between lifestyle related risk factors (smoking, inactivity, obesity) and productivity absenteeism and health claims.
(Buron et al,2005, Wellsource, 2006 & University of Michigan, 2006)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
Absenteeism, Productivity Loss, Health Claims and
Number of Risk Factors
Number of
Risks
0 Risks
1 Risk
2 Risks
3 Risks
4 Risks
5 Risks
6+ Risks
Excess work loss days (%)
0
0.6
1.2
1.9
2.2
2.5
3.1+
Excess
Productivity
Loss (%)
0
Increase Health
Claims Cost
0
1.9
4.4
0.317
0.667
7.5
9.1
13
14.5+
1.032
1.498
1.956
2.520+
(Buron et al, 2005, Wellsource, 2006 & University of Michigan, 2006)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
9. Inverse relationship between health care costs and wellness score.
Relationship between Health Costs and Wellness Score
(Yen et al, 2005)
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10 Compelling Reasons
Atlantic Health and Wellness Institute, Research Affiliate
10. Changes in employer costs follow participation in HRA and Workplace Wellness activities.
• Employees who participate in Health Risk Assessment at least twice have annual cost increases of 4.2% while employees who never participated or took HRA only once have annual increases of 12.6%.
( Edington, 2009)
• Participation in Workplace Wellness resulted in decreased annual absenteeism of 2.4% for participants vs 3.6% for nonparticipants.
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Return on Investment
Atlantic Health and Wellness Institute, Research Affiliate
From a review of 73 published studies:
• Average $3.50 saved per $1 invested in reduced absenteeism and health care costs.
From a meta review of 42 published studies:
• Average 28% reduction in sick leave
• Average 26% reduction in health costs
• Average 30% reduction in WCB and disability claims
• Average $5.93 saved per dollar invested
(The Art of Health Promotion, 2003)
Comprehensive Workplace Health Program at Citibank:
• $4.56 – 4.73 saved per $1 invested in reduced health care costs
(Amer. Journal Health Promotion, 1999)
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Return on Investment
Atlantic Health and Wellness Institute, Research Affiliate
Organization
Bank of America
PacBell
Wisconsin School District Insurance Group
Prudential Insurance U.S.
Bank of America
General Mills
DuPont
Citibank
BC Hydro
Review of 13 studies
Dollars Saved/ Dollars Spent
$5.95/ $1
$3.10/ $1
$4.47/ $1
$2.90/ $1
$4.73/ $1
$3.50/ $1
$2.05/ $1
$4.56-4.73/$1
$2.74/ $1
$3.45-$5.82/$1
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(Chapman L., 1996.; Wellness Councils of America, May 1995.; Blair S., Pacific Bell 1996) .

Atlantic Health and Wellness Institute, Research Affiliate
Atlantic Health and Wellness Institute, Research Affiliate