1. Bonfire Health Wellness Foundations

2. IGNITE YOUR HEALTH
“The United States is experiencing an unsustainable
disease burden – 130 million people today suffer from
chronic illnesses. We spend over $2 trillion a year – about
16 percent of our gross domestic product – on health
care. The vast majority of our health care dollars are spent
treating chronic disease.”
Dr. Richard H. Carmona, MD
17th Surgeon General of the United States
Almanac of Chronic Disease, 2008 Edition

3. If left unchecked, chronic diseases will cost our
economy over $4.1 trillion by the year 2023…
Projected costs associated with seven of the most common
chronic diseases*
$4,500
$4,000
Lost Economic Output
$3,500
Treatment Expenditures
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
09
12
21
03
06
15
18
20
20
20
20
20
20
20
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 3

4. …And could cost the U.S. almost $6 trillion in
lost economic output by 2050
Projected lost economic output associated with seven of the
most common chronic diseases*
6
5
4
$US Trillions
3
2
1
0
05
15
20
25
30
35
40
10
45
50
20
20
20
20
20
20
20
20
20
20
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 4

5. Workplace health promotion programs have been shown
to reduce health care costs, increase productivity and
reduce absenteeism
Average percent change in employers’ costs resulting from workplace health
promotion and wellness programs
Workers’ comp./ disability
Health management
Absenteeism
costs claims costs
-25
-26
Average Change
-27
-27%
-28
-28%
-29
-30
-30%
-31
Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).
5
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt

6. Wellness Foundations Series

7. IGNITE YOUR HEALTH
Wellness Series Objectives
•Information that empowers, inspires and equips
•Environment that promotes and rewards healthier choices
•Resources that make it easier to make healthier choices
•Community that supports a healthier lifestyle
•Specific team interests like weight-loss and stress reduction

8. IGNITE YOUR HEALTH
Bonfire Health Wellness Foundations Program
• Bonfire Wellness Foundations: $1200
(Single event 45 – 90 mins)
Recorded / DVD produced and provided for company lending library
• Complete Series: $3900
(Four events 60 - 90 mins)
Bonfire Wellness Foundations Seminar
Bonfire FUEL (how well people EAT)
Bonfire AIR (how well people MOVE)
Bonfire SPARK (how well people THINK)
Recorded / DVD produced and provided for company lending library

9. IGNITE YOUR HEALTH
“Overwhelming evidence from a variety of sources, including
epidemiological, prospective cohort, and intervention studies,
links most chronic diseases seen in the world today to
physical inactivity and inappropriate diet consumption.”
Roberts CK, et al. Effects of exercise & diet on chronic
disease. Journal Applied Physiology 2005; 98: 3-30
“You don’t GET sick… You DO sick.”

10. Chapter One: The Human Cost Today
Introduction:
Chronic diseases are a significant problem in the United States, accounting for many of the most prevalent
and costly illnesses that affect Americans. More than 133 million Americans, or 45 percent of the
population, have at least one chronic condition. These conditions include arthritis, asthma, cancer,
cardiovascular (heart) disease, depression and diabetes, though these are only a few of many chronic
illnesses that negatively impact the lives of Americans.
Many chronic diseases are caused or exacerbated by poor nutrition, lack of exercise, smoking and other
lifestyle choices. As a result of these factors, as well as a lack of emphasis on preventive care, incidence
rates of chronic disease have increased substantially over the last two decades. Risk factors like obesity are
also on the rise. Since 1980, obesity rates have increased 250 percent, now affecting 71 million Americans.
This has tremendous implications for future generations; for example, it is predicted that 1 in 3 children
born in 2000 will develop diabetes over the course of their lives, given current trends in overweight and
obesity.
Not surprisingly, chronic diseases have become the leading cause of death and disability in the United
States. Seven out of every 10 deaths are attributable to chronic disease, and illnesses like heart disease and
cancer top the list of most common causes of death. Minority populations are often disproportionately
impacted by chronic disease, with African Americans and Hispanics often 1.5 to 2 times more likely to
have a certain condition than their white counterparts.
10

11. States in the South and New England have the highest
rates of chronic diseases*
Top Quartile
Second
Third
Bottom Quartile
States in the top quartile have the lowest rates of seven common chronic diseases
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 11

12. Chapter Two: The Economic Cost
Today
Introduction
Chronic diseases are at the root of a significant portion of rising health care costs. About
two-thirds of the rise in health care spending over the last two decades is due to the rise in
treated rates of chronic disease. In addition, the vast majority of current spending is for
treatment of Americans with one or more chronic conditions. Indeed, more than 75 percent
of the approximately $2 trillion Americans spend each year on health care is spent on chronic
diseases, and public health programs like Medicare and Medicaid are seeing sizable portions
of their budget devoted to treatment of chronic diseases and complications from those
conditions.
But direct health care costs represent only a quarter of the total cost of chronic diseases.
Indirect costs such as absenteeism and presenteeism* cost businesses – and our economy --
$1 trillion a year. Every year, millions of work days are missed because employees are
suffering themselves from a chronic disease, or they have to care for a loved one who is ill.
*Presenteeism is defined as lost productivity that occurs when employees come to work but
perform below par due to any kind of illness.
12

13. Three in four dollars spent on health care in the U.S. are for
patients with one or more chronic conditions
Total U.S. health spending in 2006 = $2.1 trillion
25%
Health care costs
associated with
patients with one or
75% more chronic
diseases =
~$1.58 trillion
Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at:
http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007. 13

14. Within public health problems, patients with chronic
diseases represent an even higher percentage of spending
More than 96 cents of every dollar …and 83 cents of every dollar
spent in Medicare… spent in Medicaid
Share spent on patients with chronic diseases
Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004 Update. Available at:
http://www.rwjf.org/files/research/Chronic%20Conditions%20Chartbook%209-2004.ppt. Accessed on April 17, 2007. 14

15. Increases in the prevalence and treatment intensity of
chronic disease are responsible for about two-thirds of the
increase in health care costs over the past two decades
$700
Level of health spending among the
noninstitutionalized U.S. population, 1987–2000 $627.9
$600 (in billions of nominal dollars)
= Increase
attributable
$500 to rise in
prevalence
$400 of treated
$313.5 ~$211 billion chronic
disease
$300
$200
$100
$0
'87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00
Years
Source: Thorpe K. The Rise In Health Care Spending And What To Do About It. Health Affairs. 2005;6:1436-1445. Also, Thorpe K,
Florence CS, Joski P. Which Medical Conditions Account For The Rise In Health Care Spending? 15

16. The doubling of obesity is responsible for about one-third
of the rise in health care costs since the mid-1980s
Percent of U.S. adults who are obese*
1985 2005
No data <10% 10%-14% No data <10% 10%-14% 15%-19% 20%-24% 25%-29% >30%
*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person
Source: Thorpe K, Florence, C, Howard, D, Joski, P. The Impact of Obesity in Rising Medical Spending. Health Affairs. 2004. Also, Centers for Disease
Control and Prevention. U.S. Obesity Trends 1985-2000. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/trend.maps 16

17. Health care spending related to chronic diseases is
dwarfed by the indirect costs of these health problems
Total cost burden in 2003 for seven common chronic diseases*
Direct costs represent
about a fifth of the
total cost burden of $277 billion
chronic diseases 21% Indirect costs
amount to four-
fifths of the total
$1.0 trillion burden
79%
Direct costs = Health care costs associated with treatment of chronic disease
Indirect costs = Productivity losses such as absenteeism and presenteeism associated with people with
chronic diseases
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 17

18. Cancer and hypertension are among the most costly chronic
conditions, accounting for over $500 billion annually in
treatment expenditures and lost economic output
Treatment expenditures and lost economic output (in billions)
per chronic condition*
Stroke $22
Diabetes $27 $105
Pulmonary Conditions $45 $94
Heart Disease $65 $105
Mental Disorders $46 $171
Hypertension $33 $280
Cancers $48 $271
$0 $50 $100 $150 $200 $250 $300 $350 $400
Treatment Expenditures Lost Economic Output
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 18

19. Presenteeism is responsible for the largest share of lost
economic output associated with chronic health problems
Cost of chronic diseases by category, 2003
Total = Lost Workdays
Presenteeism is
Individual,
~$1 trillion
$127 billion defined as lost
productivity that
Presenteesism
Caregiver,
occurs when
$80 billion employees come
to work but
perform below par
Lost Workdays due to any kind of
Presenteesism Caregiver, illness.
Individual, $11 billion
$828 billion
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 19

20. When it comes to presenteeism, arthritis, hypertension,
and depression are among the most costly conditions
Estimated average annual cost of presenteeism per employee with condition
$300
Cost per Employee with Condition
$252 $247 $246
$222
$200 $189
$159
$100 $76 $72 $71
$33
$0 Arthritis
A rth riti s
Hypertension
H y e rte n sio n M ig ra in /H e a d a c h e
p
Depression/
D e p re ssio n /S a d n e ss/Me n ta l Illn e ss
Allergy
A lle rg y
Migraine/
M ig ra in e /H e a d a c h e
Diabetes
D ia b e te s
Any
A n yC a n c e r
Asthma
A sth ma
Heart
H e a rt D i se a se
Respiratory
R e sp ira to ry D i so rd e rs
Sadness/ Headache Cancer Disease Disorders
Mental Illness
Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S.
Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt 20

21. Depression and stress are the most common causes of
absenteeism
Number of days absent per affected individual per year due to
10 conditions, 1997-1999
60
50
Days per Year Absent
(Low, Average, High)
40
30
25.6
20
16.9
14.7
12.0 10.7
10 8.2 6.8 5.9
2.0 0.9
0
Depression/S Any Respiratory Asthma Migraine/ Allergy Heart Arthritis Diabetes Hypertension
adness/ Cancer Disorders Headache Disease
Mental
Illness
Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S.
Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.
21
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt

22. … And mental illnesses, when comorbid* with other
chronic diseases, significantly decrease work productivity
Number of 30-day role impairment days associated with pure and comorbid*
chronic illnesses
4 (Role impairment = sickness absence days plus work cut-back days)
Average Number of Impaired Days per
3
Month
2
1
0
Hypertension Arthritis Asthma Ulcers
Chronic Disease
Chronic Disease and Mental Illness
*Cormorbidity is the condition of having two or more diseases at the same time.
Source: Kessler, RC, Ormel, J, Demler, O, et al. Comorbid Mental Disorders Account for the Role Impairment of Commonly Occurring Chronic
Physical Disorders: Results From the National Comorbidity Survey. Journal of Occupational & Environmental Medicine. 45(12):1257-1266,
December 2003. 22

23. Chapter Three: The Cost Tomorrow
Introduction:
While chronic diseases exact a huge toll on Americans today, the future is even more
troubling. Over the next 15 years, the prevalence of chronic conditions in the U.S. is
expected to rise dramatically. According to a study by the Milken Institute, there will be 230
million reported cases of chronic disease in 2023, an increase of 42 percent from 2003. Cases
of cancer, diabetes and mental disorders are expected to rise most substantially, by 53 to 60
percent per illness. In addition, the number of obese Americans, currently one third of the
total population, is also projected to increase. By the year 2015, it is predicted that 75
percent of Americans will be obese, significantly contributing to the rise in chronic illnesses.
Indeed, if current U.S. health trends continue, the results could be catastrophic for future
generations, the health care system and the economy. Without immediate focus on
prevention, the direct and indirect costs of chronic diseases are predicted to grow
exponentially. Research has shown that, if left unchecked, chronic conditions will cost the
U.S. economy over $4.1 trillion annually in treatment expenditures and lost economic output
by the year 2023. Certain diseases, like heart disease and cancers, will be the most costly.
23

24. By the year 2023, the incidence of chronic disease is
expected to rise dramatically
100% Projected rise in cases of seven of the most common chronic
diseases, 2003-2023*
80%
62
60% 54 53
41 39
40% 31 29
20%
0%
rs
e
es
e
ns
s
on
k
as
er
e
et
ro
o
i
rd
c
ns
e
it i
b
St
an
is
o
ia
e
d
is
tD
C
rt
on
D
D
e
r
C
yp
ea
l
ta
y
H
H
en
ar
on
M
lm
Pu
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report available at: www.chronicdiseaseimpact.com. Note: Statistics only include data for top seven chronic diseases 24

25. The rate of obesity is also expected to increase, and
contribute to rising rates of chronic diseases
By 2015, it is predicted that 41 percent of Americans will be obese
100%
By 2015 without major changes, researchers predict 75 percent of
adults and 24 percent of children will be overweight or obese
80%
60%
41
40% 32
20% 13
0%
1960 2004 2015
Year
Source: Wang, Y and Beydoun, M. The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic
Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiologic Review. 2007 29(1):6-28; doi:10.1093/epirev/mxm007 25

26. If left unchecked, chronic diseases will cost our
economy over $4.1 trillion by the year 2023…
Projected costs associated with seven of the most common
chronic diseases*
$4,500
$4,000
Lost Economic Output
$3,500
Treatment Expenditures
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
09
12
21
03
06
15
18
20
20
20
20
20
20
20
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 26

27. …And could cost the U.S. almost $6 trillion in
lost economic output by 2050
Projected lost economic output associated with seven of the
most common chronic diseases*
6
5
4
$US Trillions
3
2
1
0
05
15
20
25
30
35
40
10
45
50
20
20
20
20
20
20
20
20
20
20
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 27

28. Chapter Four: Opportunity for Improvement
Introduction:
Right now, far too little is being invested in improving Americans’ health
and effectively preventing and managing common and costly chronic
health problems. In an average year, the U.S. spends less than $10 per
person on prevention -- about the same amount of money as a single
movie ticket costs in many places in the U.S.!
Improvements in personal health behaviors, investment by business and
the health care system in population health improvement could save
millions of lives, and trillions of dollars. By the year 2023, the U.S. could
save over $1 trillion through investing in prevention, mostly by reducing
indirect costs of chronic health problems, such as absenteeism and
presenteeism.
28

29. But simple changes in behaviors could lead to significant
decreases in cases of common and costly chronic diseases
The Centers for Disease Control and Prevention (CDC) estimates up to…
80% of
heart
80% of type 2 disease and
diabetes 40% of cancer stroke
…could be prevented if only Americans were to do three things:
 Stop smoking
 Start eating healthy
 Get in shape
Source: Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health Webinar. May 23, 2006.
Available at: http://www.businessgrouphealth.org/opportunities/webinar052306chronicdiseases.pdf. Accessed April 17, 2007. 29

30. Workplace health promotion programs have been shown
to reduce health care costs, increase productivity and
reduce absenteeism
Average percent change in employers’ costs resulting from workplace health
promotion and wellness programs
Workers’ comp./ disability
Health management
Absenteeism
costs claims costs
-25
-26
Average Change
-27
-27%
-28
-28%
-29
-30
-30%
-31
Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).
30
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt

31. By the year 2023, the U.S. can save over $1 trillion
through investing in prevention, mostly in indirect costs*
$1,200
Lost economic output (indirect)
$1,000 Treatment expenditures (direct)
$800
$600
$400
$200
$0
04
06
08
10
12
14
16
18
20
22
20
20
20
20
20
20
20
20
20
20
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension,
mental disorders, pulmonary conditions, and stroke. Alternative assumptions on the future path of chronic-disease incidence, prevalence and
cost were developed based on best practices in prevention, early detection and new innovations in disease treatment and management.
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007.
Full report and methodology available at: www.chronicdiseaseimpact.com. 31

32. Investing in prevention will save the U.S. billions of
dollars in direct and indirect health costs
Costs of chronic disease (in billions) in 2023 due to treatment expenditures and lost
economic output
Stroke $74 $24
Pulmonary Conditions $310 $73
Diabetes $340 $90
Heart Disease $292 $213
Mental Disorders $587 $116
Hypertension $731 $196
Cancers $696 $410
$0 $400 $800 $1200
Billions
Alternate future Costs that could be avoided through prevention
Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. 32
Full report and methodology available at: www.chronicdiseaseimpact.com.

33. … and that the U.S. should invest more in prevention
Four out of five Americans prefer health care dollars to be spent on
preventive measures as opposed to treating diseases after the fact.
81 percent of adults interviewed believe the U.S. should prioritize our
health care dollars to “invest in preventive measures”
Survey by the Partnership to Fight Chronic Disease: Conducted by APCO Insight, April 27-29, 2007 and based on telephone interviews with a
national adult sample of 1,001. 33

34. Resources
PFCD Resources
• PFCD Policy Platform:
http://www.fightchronicdisease.com/advocate/platform/index.cfm
• PFCD “Unhealthy Truth” Presentation:
http://www.fightchronicdisease.com/resources/national.cfm
• Chronic Care “Chartbook”:
http://www.fightchronicdisease.com/crisis/index.cfm
Partner Resources
• Alliance for Aging Research Silver Book: http://www.silverbook.org/
• American Cancer Society Cancer Facts & Figures 2007:
http://www.cancer.org/docroot/STT/content/stt_1x_cancer_facts__figures_2007.asp
• American Hospital Association Trendwatch Reports:
http://www.aha.org/aha_app/trendwatch/archive.jsp
• Milken Institute “An Unhealthy America” Report:
http://www.chronicdiseaseimpact.com/
• Partnership for Prevention
34

35. IGNITE YOUR HEALTH
contact@bonfirehealth.com