Presentation from meetings with employers on workforce health and links to productivity

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Health, productivity and
employers:
public health approaches bring
competitive workforces
Jim McManus, CPsychol, CSci, AFBPsS, FFPH,
FRSPH, MCIPD
Director of Public Health

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The Problem
• Increasing non-communicable disease
– Smoking, obesity
• Increasing mental ill health
• Increasing sickness absence
• Increasing loss to business productivity and
performance from sick pay
• Avoidable cost of managing and replacing sick
and absent staff

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Where’s the evidence?
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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What is the root issue?
• There is a flow from low risk to high risk to
disease for the working age population
• This leads to:
• Diseases of lifestyle
• More risk, more absence
• Compound risk, compound absence
• Low productivity

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What does this mean for you as
employers?
• 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/m2) Obesity (BMI ≥ 30 kg/m2)
– Inactivity Smoking
– Stress Elevated blood pressure
– Elevated cholesterol High blood sugar
– Alcohol
• Places an increasing burden on employers: decreased productivity,
increased absenteeism, increased health and worker’s
compensation claims.

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The upshot of this unless we do something is that
2/3 of people will be in chronic ill health or disability
before age 68, the new retirement age

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And Hertfordshire shows the same pattern!

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Why should you care?
• You’re paying for it
• The do-nothing strategy of waiting for sickness and then
paying for treatment isn’t cost neutral – it costs you
• 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.
• Now I’m going to prove it….

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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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Absenteeism Increases with Number of Health Risks
Number of Health Risks
(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))
Base work
loss days/yr
Excess
Work Loss
days/yr
work loss
days/yr

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Work done for Herts by
economists at
Example: Smoking costs in Herts
• total annual cost in Hertfordshire £45,972,899
– NHS Treatment and Care costs: £32,429,375
– Costs to businesses (productivity
losses): £12,931,914
– Passive smoking costs: £598,947 (adults: £425,607;
children: £173,340)

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Root causes
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).

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What can be done
• 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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NICE Business Case 1: Gross Savings
• Worked example - for a company with 300
employees earning average £8.20/hr
Average no. of
days sickness
absence
Total no. of
days sickness
absence Hours per day
Total annual
cost
£
% reduction in
sickness
absence
Total annual
savings
£
8.4 2520 7.5 154,980 20% -30,996
On average, sickness absence costs employers 8.4 working days per employee
per year (Chartered Institute of Personal Development 2007a).
Physical activity programmes at work have been found to reduce absenteeism
by up to 20%; physically active workers take 27% fewer sick days (Health, Work
and Wellbeing Programme 2008).

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Nice Business Case 2: Interventions
Examples of Interventions
Cost per
employee
£
% of
employees
taking part
Total Cost
£
Health champion/coordinator NA 100% 3,000
Health check 35 100% 10,500
Pedometer challenge 20 50% 3,000
Lunchtime walks 10 50% 1,500
Workplace travel plans 10 100% 3,000
Activity classes 50 30% 4,500
Social events 100 30% 9,000
Discounted local gym membership 100 30% 9,000
Team days - estimated 20 100% 6,000
Signs and posters NA 100% 200
Booklets, leaflets and promotional material 2 100% 600
Total Cost
£50,300

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NICE Business Case 3: Net Savings
Total quantifiable benefits -45,024
Total costs 50,300
Total costs 5,277

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Interventions with Gold Standard
Evidence (Systematic Reviews)
• Musculoskeletal disorders
– education about stress management, principles of ergonomics,
anatomy, musculoskeletal disorders, and the importance of
physical activity.
– 'pause gymnastics', how to use a relaxed work posture, proper
positioning, the importance of rest breaks, and strategies to
improve relaxation.
– Some studies also included how to modify work tasks, work
load, working techniques, working positions, and working
hours.
– adjustments and recommended alternatives to the existing
furniture and equipment at the workplace.

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Interventions with Gold Standard
Evidence (Systematic Reviews)
• Standing workers and vein problems
• flexible working interventions that increase worker
control and choice (such as self-scheduling or
gradual/partial retirement) are likely to have a positive
effect on health outcomes
• Smoking Cessation
• Healthy weight management
• Stopping movement from low – high risk -
disease

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Healthy Herts
• County Council Programme
• Reduced Sickness Absence
• Increased Health Offer including smoking
cessation, gym, physical activity, emotional
wellbeing, roll out of alternatives to Lifts
• Nominated for two awards
• Will be rolled out further

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Coming soon
• Hertfordshire workplace health offer for
employers
• Online tools for behaviour change and mental
wellbeing
• First six Herts major commercial Employers
already engaged
• Working closely with Business in the
Community as key partner

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2011 Census – Hertfordshire Projected Population Change

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Hertfordshire percentage projected population change
2010 to 2035
Age Group Percentage Change
All persons - 0-4 6.89
All persons - 5-9 21.27 21.27
All persons - 10-14 24.04
All persons - 15-19 18.36
All persons - 20-24 13.32
All persons - 25-29 13.56
All persons - 30-34 11.68
All persons - 35-39 8.35
All persons - 40-44 9.49
All persons - 45-49 11.91
All persons - 50-54 20.83
All persons - 55-59 25.24
All persons - 60-64 20.16
All persons - 65-69 59.04
All persons - 70-74 69.54
All persons - 75-79 51.01
All persons - 80-84 53.82
All persons - 85-89 102.96
All persons - 90+ 231.33

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Thank you!
Jim.McManus@hertfordshire.gov.uk