This document discusses strategies to promote population health in the United States. It provides data showing poor control of health conditions like high blood pressure and cholesterol. It also discusses how employers can play a key role in wellness since most Americans get health insurance through work. The document proposes several strategic directions for a National Prevention Strategy including promoting active lifestyles, healthy eating, strong public health infrastructure, and making clinical preventive services more accessible. It seeks input on draft strategic directions to guide federal prevention activities.

1. 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.gov
Office of the Director
Office of the Associate Director for Policy

2. Promoting Health for a Nation

3. 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

4. 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

5. 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

6. 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, colonoscopy
Increasing • Smoking cessation
Population
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.

7. 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

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

9. 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

10. 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

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

12. 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

13. Examples of National Prevention Strategy:
Guiding Principles
Strategic 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

14. Examples of National Prevention Strategy:
Guiding Principles
Maximize 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

15. 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

16. 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.

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

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

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

20. 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

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

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

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

24. Principal Targets
Pregnancy: pre-pregnant weight, weight gain, diabetes,
smoking
Reduce energy intake
Decrease high and increase low ED foods
Increase fruit and vegetable intake
Reduce sugar-sweetened beverages
Decrease television time
Breastfeeding
Increase energy expenditure
Increase daily physical activity

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

26. 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

27. 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


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

29. 29

31. Tobacco Cessation
31

32. 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.

33. 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

34. 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

35. 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.

36. 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

37. Smoking Shelter Becomes
Covered Bike Parking
37

38. 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

39. 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

40. CDC Workplace Tools and Resources

41. 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

42. Federal Initiatives
Let’s Move
Empower parents
Healthier foods in schools
Physical activity
Access to affordable healthy food
Childhood Obesity Task Force
HHS Healthy Weight Task Force
National Action Plan for Physical Activity
Dietary Guidelines for Americans
Communities Putting Prevention to Work (CPPW)
Child Nutrition Reauthorization
Surgeon General’s Call to Action on Breastfeeding
FTC Guidelines for Foods Marketed to Children
National Prevention, Health Promotion and Public Health Council

43. 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

44. 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

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