1. Safe, Healthy, and Engaged
How Protecting and Promoting the Health
of Your Employees Can Build a Culture of Wellness
Webinar with HPCareer.net
June 10, 2011
L. Casey Chosewood, MD – Sr. Medical Officer, Total Worker Health
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
1

2. Disclaimer
• The mention of organizations and commercial entities and
products in this presentation is for illustrative purposes only
and does not represent an endorsement by CDC or the US
Department of Health and Human Services.
• The views herein represent those of the authors and
presenter. For official guidance from the Centers for Disease
Control and Prevention, visit www.cdc.gov.
2

3. The U.S. Has a Critical Shortage of Health
The U.S. spends > $2 trillion every year on healthcare…
more than any other country.
• Yet, among all countries of the world, the U.S. ranks:
• 35th in infant mortality prevention
• 30th in life expectancy at birth
3

4. The U.S. Has a Critical Shortage of Health
• The US is one of the leading countries for cancer risk-- largely due to
tobacco
• Coronary heart disease rates are high, diabetes rates and risk factors
are increasing
• High levels of violence-related death are present
• Leading causes of premature death: tobacco, poor diet and physical
inactivity, alcohol, microbial agents, toxic agents, motor vehicle
crashes, firearm-related incidents, sexual behaviors, drugs
4

5. “We spend less than four cents of every health
care dollar on prevention and public health
even though eighty percent of the risk
factors involved in the leading causes of
death are behavior-related and thus
preventable.”
President Barack Obama
5

6. What’s Driving Up the
Cost of Healthcare?
• Increasing prevalence of disease
Especially obesity, diabetes, and heart disease
• Continuing technological innovations
• Increasing treatment intensity and duration
• Delivery system inefficiencies
• Over- and under-utilization
6

7. Between 1987 to 2005, healthcare utilization
increased significantly
• Mental Health Conditions 242%
• Elevated Lipids 860%
• High Blood Pressure 62%
• Diabetes 100%
• Pulmonary Disease 94%
• Back Pain 180%
7

8. Quick Quiz Question
Compared to one generation ago, how much
would a dozen eggs cost today if they had risen
in price at the same rate as healthcare?
8

9. Quick Quiz Answer
$80.25
(that’s $6.69 per egg)
9

10. The Deadliest Threats Facing CDC
Cardiovascular
Disease
Cancer
Extreme diet
Extreme environment
Diabetes
Preventable Injury
Extreme convenience
Extreme aging
10

11. Obesity Trends* Among U.S. Adults, 1990
(*BMI 30, or about 30 lbs overweight for 5’4” person)
No Data <10% 10%-14% 15%-19 20%-24% 25%
Source: Behavioral Risk Factor Surveillance System, CDC 11

12. Obesity Trends* Among U.S. Adults, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
(*BMI 30, or about 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC 12

13. 13

14. 14

15. Isn’t Behavior Change Enough?
Sir Michael Marmot
― It is unreasonable to expect people to change their
behavior when the social, cultural and physical environments
around them fully conspire against them….‖
Adapted from M. Marmot/Institute of Medicine Report
15

16. What is health?
Am I healthy?
Do I care if others in my life are healthy?
What influences my health?
Does this job help make me healthier?
How can my workplace help me change my health?
Does my boss care if I am healthy?
16

17. A comprehensive worksite health promotion program
contains…
o Strong senior leadership commitment
o Worker protection and respect as the primary cornerstone
o High quality occupational health and safety programming
o Adequate social, technical and programmatic support
o A variety of opportunities for health enhancement for persons at all
ages, interests, abilities, and health and fitness levels
o Frequent, clear communication, marketing, and branding
o Strong evaluation and process improvement process
o See all 20 at http://www.cdc.gov/niosh/docs/2010-140
17

18. Does Your Company Have These Policies to
Support Health?
• Tobacco-free campus
• Flexible work/schedule policies
o Leave, telework, job share, parental/dependent care
• Nutritious foods-at-meetings policy
• Healthy transportation policies
• Smoke-free meetings policy
• Time during work hours for wellness activities
o Training or educational opportunities, health fairs, events
o Screenings, health coaching, EAP
o Physical Activity (efforts in progress)
18

19. 19

20. Key Work-Life Balance Truths
• Workers Want, Need and Will Seek Out More Flexibility
• Organizing Work around People Works Better than
Organizing People around Work
• Every workplace policy will have some effect on the health
and wellbeing of workers—take steps to make sure it is a
positive one
• View every workplace decision through the lens of ―the
health and wellbeing of the worker‖
20

21. Work and Life: Acknowledge
the Balancing Act
Provide links to your community’s parenting
and adult care resources: referrals, articles,
podcasts, webinars, forums, list servs, blogs
• Develop specific resource kits
around critical topics
o Autism Information and Resources
o Prenatal period
o Parenting Teens
o Lactation
o Family Wellness, Nutrition and
o A New Parents Return to Work
o Adult Care-giving
o Child Safety
o Grief and Loss
o College: Decision support and
Financing o Others from your own experiences
o Children with ADHD

22. Designing Healthier Workplaces
Can You Become a “Choice Architect”?
• Choice-making is never neutral
• Directing default options toward health can be powerful
• Subtle ―nudges‖ toward healthier choices can improve
health outcomes
• Policy interventions provide a strong basis for better
choices
• Incentives and spotlights can motivate
• Providing structure around complex choices helps
Themes from Thaler R, Sunstein, C: Nudge Improving Decisions About Health, Wealth, and
Happiness, 2008.
22

23. Does Your Workplace’s Built Environment
Allow Health to Thrive?
• Safe, hazard-free workplace
• Welcoming, user-friendly, ergo-appropriate workspaces
• Commitment to employee respect, engagement, and input
• Stairs, walkways, paths, trails that are safe and inviting
• Onsite food choices that make eating healthier easy
• Transportation and parking options that enhance health
• Onsite or nearby health clinic or access to healthcare
providers
• Fitness facilities or opportunities for physical activity
23

24. Does Stress Affect Your Workplace?
On the average workday in the
US, how many employees are
absent due to stress?
24

25. Address the Stress
• An estimated 1 million workers are absent every day due to
stress. 1
• Job stress costs U.S. businesses of over $300 billion yearly
due to absenteeism; employee turnover; diminished
productivity; medical, legal and insurance expenses; and
Workers' Compensation payments. 1
• Work stress vs home stress?
o Craft a less-stressful workplace first
o Build resilient workers second
• Find out more at www.cdc.gov/niosh/topics/stress
Source: 1. American Institute of Stress 25

26. 26

27. StairWELL Project
Simple changes to dreary stairwells
increase usage
• Painting
• Carpeting
• Framed artwork
• Motivational signs
• Music
Low-cost, high-impact
27

28. 28

29. 29

30. 30

34. 34

35. 35

36. The Guide to Community Preventive Services
(The Community Guide)
• Summarizes what is known about the effectiveness,
economic efficiency, and feasibility of interventions to
promote health and prevent disease
• www.thecommunityguide.org
36

37. Community Guide Worksite Reviews
Physical Activity and Obesity Prevention
Promoting Physical Activity and Obesity Prevention
o Worksite programs to control overweight and obesity
(Recommended)
o Point-of-decision prompts to encourage use of stairs
(Recommended)
o Creation of or enhanced access to places for physical activity
combined with informational outreach activities (Recommended)
37

38. Community Guide Worksite Reviews
Assessment of Health Risks with Feedback
to Change Employees’ Health Behaviors
Assessment of Health Risks with Feedback (AHRF)
o AHRF used alone
o Insufficient Evidence
o AHRF plus health education with or without other interventions
o Recommended
38

39. Community Guide Worksite Reviews
Decreasing Employee Tobacco Use
Incentives and Competitions to Increase Smoking Cessation
o Incentives and competitions when combined with additional interventions
o Recommended, based on sufficient evidence of effectiveness in reducing tobacco use
among workers
o Incentives and competitions when used alone
o Insufficient evidence was found to determine whether or not worksite-based incentives
and competitions alone work to reduce tobacco use among workers
Smoke-free policies to reduce tobacco use among workers
o Recommended, based on sufficient evidence of effectiveness in reducing tobacco use
among workers
Soler, et al. American Journal of Preventive Medicine, February 2010
39

40. CDC LEANWorks!
www.cdc.gov/leanworks
40

41. CDC Workplace Tools and Resources
41

42. Total Worker Health
• NIOSH is dedicated to the preserving and
enhancing the Total Health of Workers
• Total Worker Health is a comprehensive
organizational strategy that integrates traditional
occupational safety and health protection efforts
with health promotion and other workplace activities
to prevent illness and injury, regardless of cause, so
that all workers have opportunities to achieve
optimal levels of health and well-being.
www.cdc.gov/niosh/TWH
42

43. Total Worker Health
Examples of Integrated Programs
o Respiratory protection programs that comprehensively address tobacco abuse
o Ergonomic consultations that also discuss arthritis management strategies
o Stress management efforts that first seek to diminish workplace stressors, and
only then work on building worker resiliency
o Integrated training and prevention programs (falls, motor vehicle safety, first aid,
hearing conservation, stretching, flexibility and lifting programs)
o Comprehensive screenings for work and non-work risks
o Occupational health combined with a workplace primary care home model
o Full integration of: clinics, behavioral health, traditional safety, health promotion
programs, coaching, EAP, nutrition, disability and workers compensation.

44. Total Worker Health
• WorkLife National Centers of Excellence
o University of Iowa Healthier Workforce Center for Excellence
o Center for the Promotion of Health in the New England
Workplace
• University of Massachusetts, Lowell
• University of Connecticut
o Harvard School of Public Health Center for Work, Health and Wellbeing
• Research partnerships and advisories with Veterans
Administration, Office of Personnel Management, and other
federal, labor and private sectors partners

45. Resources
• Centers for Disease Control and Prevention • NIOSH: Worker Health and Safety
www.cdc.gov www.cdc.gov/niosh
• NIOSH WorkLife Initiative • Alliance to Make US Healthiest
http://www.cdc.gov/niosh/worklife www.healthiestnation.org
• Essential Elements of Effective Workplace • CDC’s Division of Nutrition, Physical
Programs and Policies for Improving Worker Activity & Obesity
Health and Well-Being http://www.cdc.gov/nccdphp/dnpao
www.cdc.gov/niosh/worklife/essentials.html
• Smallstep
• HHS Physical Activity Toolkit http://www.smallstep.gov
http://www.health.gov/PAGuidelines/toolkit.aspx. • Community Toolbox
• CDC Healthier Worksite Initiative http://ctb.ku.edu/en
http://www.cdc.gov/hwi • APHA - Healthiest Nation in 1 Generation
• OPM’s Site for Workplace Resources http://www.generationpublichealth.org
www.opm.gov/Employment_and_Benefits/WorkLife/He • CDC LeanWorks!
althWellness/wellnessresources
http://www.cdc.gov/leanworks
45