State of Wellness - CDC

CDC State of Wellness Wendy Heaps MPH, CHES. Senior Advisor Policy Research, Analysis, and Development Office Office of the Associate Director for Policy Office of the Director, CDC wah9@cdc.govOffice of the DirectorOffice of the Associate Director for Policy

Promoting Health for a Nation

On ABCS, the USA gets an “F” People at increased risk of CVD who are taking Aspirin – 33% People with hypertension who have adequately controlled blood pressure –44% People with high Cholesterol who have adequately controlled hyperlipidemia – 29% Smokers who try to quit and get help – 20% Despite spending nearly $0.71/$1 on direct health care provision 3

Assuring the Conditions for Population Health Commun- ities Governmental Healthcare Public Health Delivery Infrastructure System Employers & Academia Businesses The Media Source: IOM. 2003. Assuring the Public’s Health in the 21st Century. Washington, D.C.: NAS; p. 30. 4

Employers• 143 million full- and part- time workers• Employees spend most of their day at the workplace• Employer based health insurance provided coverage to 159 million Americans (63.4% of those under age 65) in 2003• Employers pay for 36% of the nation’s healthcare expenditures• Over half of employers with 500+ employees offer some sort of wellness program

Key: Text in white indicates OPTH target Health Impact Pyramid Increasing Individual • Ongoing interventions: personalized HRA, health information, Counseling education, counseling and support Effort & Education • Lifestyle interventions connecting personal health services with Required community-based services: obesity, smoking, YMCA-DPP, etc. • Ongoing interventions: CVD prevention has greatest impact, A1C testing and reporting Clinical • Medication adherence and personalized behavioral Interventions interventions • Care coordination, particularly multiple chronic comordibities Long-Lasting • One-time or infrequent interventions: Protective immunizations, colonoscopyIncreasing • Smoking cessationPopulation Interventions Impact •Healthy air, water, food Changing Context To Make •Salt iodization Individuals’ Default •Water fluoridation • Essential HI benefits packages: Decisions Healthy high value services •Poverty reduction •Improved education Socioeconomic Factors • Health insurance/access to care Source: Adapted from Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010;100(4):590-5.

Affordable Care Act: Pillars of Prevention Key preventive services now covered without cost sharing Prevention and Public Health Fund Public health policies and programs National Prevention Council/National Prevention Strategy

More People Will Have Access to Clinical Preventive Services Key preventive services now covered without cost sharing Focused on quality and utilization of services

The National Prevention Council Established by the Affordable Care Act A unique opportunity to prioritize and align prevention activities Chaired by the Surgeon General Council members: 17 federal departments Advisory Group: 25 non-federal members

National Prevention Strategy Ground activities in evidence-based practices Set specific actions and timelines Align and focus federal prevention and health promotion activities Align with existing strategies and initiatives, including:  Healthy People 2020  National Quality Strategy  First Lady’s “Let’s Move!” campaign  Surgeon General’s Vision for a Healthy and Fit Nation 2010  National HIV/AIDS Strategy

Key Deliverables The National Prevention and Health Promotion Strategy Ongoing leadership and coordination of federal prevention activities Annual status report

Approach Work across sectors Catalyze public and private partnerships  Federal, state, local, territorial, and tribal  Private, nonprofit, faith, community, labor Focus on where people live, learn, work, and play  Community, worksite, institutions, etc. Prioritize scalable activities

Examples of National Prevention Strategy: Guiding PrinciplesStrategic Interventions: Focus on preventing leading causes of death and their underlying risk factors Prioritize high impact, evidence-based, scalable interventions Promote high value preventive care practices

Examples of National Prevention Strategy: Guiding PrinciplesMaximize Impact: Establish a cohesive federal response Promote alignment between the public and private sectors: – Federal, state, local, territorial, and tribal – Private, nonprofit, faith, community, labor Obtain stakeholder input

Draft Strategic Directions Active Lifestyles  High Impact Quality Clinical Preventive Eliminate Health Services Disparities  Injury-Free Living Counter Alcohol/ Substance Misuse  Mental and Emotional Wellbeing Healthy Eating  Strong Public Health Healthy Physical and Infrastructure Social Environment  Tobacco-Free Living

Draft Strategic Directions: Purpose Creates a structure from which to develop specific recommendations and actions. Establishes priorities that best prevent the leading causes of death and disease. Serves as a guide to assist policymakers, practitioners, and communities in focusing prevention and wellness activities.

National Prevention Strategy: We Welcome Your Continued Input. To provide input, go to:http://www.healthcare.gov/nationalpreventioncouncil

Winnable Battles Healthcare-associated infections (HAIs) HIV Motor vehicle injuries Obesity/Nutrition/Physical Activity/Food Safety Teen pregnancy Tobacco 18

Obesity, Nutrition, Physical Activity & Safety AD Policy Design Plan Brief to OI Imp Team Nov 17, 2009 19

Obesity, Nutrition, Physical Activity and Food Safety Continue to support ••Let’s Move and the National Plan to Prevent Obesity Advance sodium and ••trans fat reduction strategies Improve the ability to identify and reduce incidences of ••Salmonella by implementing new identification tests in public health labs Develop and help promote national standards on food marketing to children 20

Per Capita Expenses Due to Excess Weight Obesity Grade I II IIIMen (total) $1,143 $2,491 $6,078Medical $475 $824 $1,269Absenteeism $277 $657 $1,026Presenteeism $391 $1,010 $3,792Women (total) $2,524 $4,112 $6,694Medical $1,274 $2,532 $2,395Absenteeism $407 $67 $1,262Presenteeism $843 $1,513 $3,037 Finkelstein EA et al. J Occupational Environ Med 2010;52:971

Costs of Obesity – 1998 vs 2008 1998 2008Total costs $78.5 B/y $147 B/yMedical costs 6.5% 9.1%Finkelstein et al. Health Affairs 2009; 28:w822

Obesity Trends Among U.S. Adults BRFSS, 1990, 1999, 2009 1990 1999 2009No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Principal TargetsPregnancy: pre-pregnant weight, weight gain, diabetes, smokingReduce energy intake Decrease high and increase low ED foods Increase fruit and vegetable intake Reduce sugar-sweetened beverages Decrease television timeBreastfeedingIncrease energy expenditure Increase daily physical activity

Priority Strategies to Address Target BehaviorsEnergy density Apply nutrition standards in child care and schools Promote menu labeling in states and communities Increase retail food stores in underserved areasFruits and vegetables Increase access through retail stores Farm to where you are policies Food policy councilsSugar-sweetened beverages Ensure access to safe and good tasting water Limit access Differential pricing strategies

Priority Strategies to Address Target Behaviors Television viewing Regulations to limit TV time in child care settings Limit food advertising directed at children Breastfeeding Policies and environmental supports in maternity care Policy and environmental supports in worksites State and national coalitions to support breastfeeding Physical activity Community-wide campaigns Increase access with informational outreach Increase opportunities for PA in school settings Resource: Breastfeeding Report Card, http://www.cdc.gov/breastfeeding/data/reportcard.htm

Breastfeeding in the Workplace Providing education for parents-to-be on the importance of breastfeeding Providing support to new mothers after delivery with unlimited phone counseling with a lactation consultant Meeting the needs of mothers returning to work by providing a return-to-work consultation and a lactation room Equipment at the worksite that will allow mothers to continue supplying the important nutritional benefits of breast milk 

Settings for the Prevention and Treatment of Obesity Industry Child care Medical Settings School Work Site Community

Tobacco Cessation 31

About 438,000 U.S. Deaths per Year Attributable to Cigarette Smoking* Stroke Other cancers 17,400 34,700 Other diagnoses 84,600 Lung cancer 123,800 Chronic lung disease 90,600 Coronary heart disease 84,600*Average number of deaths, 1997-2001.Source: MMWR 2005;54(25):625-8.

Productivity, Absenteeism, Disability, Cost• Smokers incur higher costs related to disability, lost productivity, and absenteeism• Smoking costs about $92 billion per year in lost productivity due to premature death• Men incur nearly $16,000 and women nearly $17,000 more in lifetime medical expenses than nonsmokers• Smokers: 1-2 more years of disability than nonsmokers• Sick days: Men use four more, women use two more than nonsmokers

Tobacco Implement and evaluate tobacco control programs funded through the American Recovery and Reinvestment Act Promote anti-tobacco education campaigns• Continue progress on smoke-free laws and price increases Support the implementation of the Family Smoking Prevention and Tobacco Control Act Promote new cessation services through health reform 34

Federal Employee Health Benefits 2011• Cover all seven FDA-approved cessation medications and individual, group, and telephone counseling -- the treatments found to be effective in the 2008 update of the Clinical Practice Guideline on Treating Tobacco Use and Dependence.• No copayments or coinsurance and not subject to deductibles or annual/lifetime dollar limits.

Case Study: CDC’s Tobacco Free Campus Initiative• Significant policy change in 2005 • Completely smoke free campuses, indoors and out• Collaboration of health promotion, clinical, EAP staff and “quit-lines”• Personal quit plan, free nicotine replacement• Support for multiple quit attempts• Link annually with the Great American Smokeout® 36

Smoking Shelter Becomes Covered Bike Parking 37

Policy Horizons: Does Your Organization Have These in Place? Tobacco-free campus or worksite Flexible work/schedule policies  parental/dependent care Nutritious foods-at-meetings policy Healthy transportation policies Smoke-free meetings policy Time during work hours for wellness activities  Physical activity  Training or educational opportunities, health fairs, events  Screenings, health coaching, EAP

Does Your Built Environment Allow Health to Thrive? Safe, hazard-free workplace Welcoming, user-friendly workspaces Stairs, walkways, paths, trails that are safe and inviting Onsite food choices that make eating healthier easy Lactation rooms Transportation and parking options that enhance health Onsite or nearby health clinic or access to healthcare providers Fitness facilities or opportunities for physical activity 39

CDC Workplace Tools and Resources

Lean Works• Leading Employees to Activity and Nutrition – CDC LEAN Works! is a FREE website that offers a comprehensive, one-stop resource for planning, designing, building, promoting, and assessing worksite obesity management programs 41 41

Federal InitiativesLet’s Move Empower parents Healthier foods in schools Physical activity Access to affordable healthy foodChildhood Obesity Task ForceHHS Healthy Weight Task ForceNational Action Plan for Physical ActivityDietary Guidelines for AmericansCommunities Putting Prevention to Work (CPPW)Child Nutrition ReauthorizationSurgeon General’s Call to Action on BreastfeedingFTC Guidelines for Foods Marketed to ChildrenNational Prevention, Health Promotion and Public Health Council

Resources www.cdc.gov/workplacehealthpromotion www.cdc.gov/workplacehealthpromotion/healthtopic s/index.html Webber A, Mercure S. Improving population health: the business community imperative. Prev Chronic Dis 2010;7(6). www.cdc.gov/pcd/issues/2010/nov/10_0086.htm. www.cdc.gov/communitiesputtingpreventiontowork http://www.healthcare.gov/nationalpreventioncouncil

Acknowledgements Pam Allweiss , National Center for Chronic Disease Prevention and Health Promotion , CDC Casey Chosewood National Institute for Occupational Safety and Health CDC Jason Lang, National Center for Chronic Disease Prevention and Health Promotion , CDC Lydia Ogden, Office of Prevention Through Healthcare, CDC Abby Rosenthal, National Center for Chornic Disease Prevention and Health Promotion , CDC

Thank You! Questions? Comments?Contact information : WHeaps@CDC.Gov

State of Wellness - CDC

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