The impact of health promotion & cost effectiveness yvonne lewis
Health PromotioninThe Work PlaceModels of Workplace WellnessYvonne Lewis.Director Health Education Division
OBJECTIVESOBJECTIVESTo:•Explore the concept of Health Promotion•Explore the rationale for health promotion•Examine the relevance of the healthpromotion approach in the workplace setting
WHAT IS HEALTH PROMOTION?WHAT IS HEALTH PROMOTION?Health Promotion is based on a concept of healthas not merely the absence of disease, but completemental, physical, social and spiritual well-being(WHO)Health promotion is an approach that ‘enablespeople, (individually and collectively), to takeincrease control over and improve their health’(WHO, 1986)
Health as:A resource for living working,learning, loving, etc( A resource which gives people the ability to manageand change their surroundings)A positive conceptemphasizing social and personalskills and resources as well as physical capacities. (Physicalcapacities does not encompass key social and personal resources of people includingrelational, learning, coping capabilities)
Health is created and lived bypeople within the settings of theireveryday lives; where they live,learn, work, play and love
Health Promotion is oftenoperationalised in different settings.• School• Community• Workplace• Health• InstitutionsHealth Promotion in the workplace setting iscalled Workplace Health Promotion (WHP)WORKPLACE HEALTH PROMOTION (WHP)WORKPLACE HEALTH PROMOTION (WHP)
The Workplace Health Promotion approach will:1. Target organisation culture and practices. These willinclude changes in the organisational form as well as inthe quality of co-operation between executives andemployees (internal and external customers), and willinclude health promoting processes (health beneficialand health damaging processes)“A healthy workplace is one in which workers andmanagers collaborate to use a continual improvementprocess to protect and promote the health, safety andwell-being of all workers and the sustainability of theworkplace by considering the following, based on identified needs:- health and safety concerns in the physical work environment;-health, safety and well-being concerns in the psychosocial workenvironment including organization of work and workplace culture;-personal health resources in the workplace; and ways of participatingin the community to improve the health of workers, their families andother members of the community(PAHO/WHO).”
WHY Workplace Health Promotion?WHY Workplace Health Promotion?Health is created and lived by people within the settings oftheir everyday lives; where they live, learn, work, play andlove ….. This includes the workplaceHealth of the workplace impacts the health of employeesHealth of employees impacts the health of the workplaceWorkplace health promotion creates the potential tocombine productivity and health in the workplace
Some Approaches to WorkplaceHealth PromotionWHP as a component of Occupational Healthand Safety: Reduction and elimination ofphysical risk factors in the workplace.WHP as behavioural prevention in theworkplace: Widely practiced approach with afocus on health education and behaviourdirected prevention programs in the workplacePromotion & Education, Vol VI 1999/3
Some Approaches to WorkplaceHealth PromotionWHP as a component of organisationaldevelopment strategy: Modern managementconcepts eg. TQM approaches, emphasize thefunction of human resources in order to realiseeconomic aims. WHP creates the necessarypre-conditions for optimal creativity ofemployees and production by employeesPromotion & Education, Vol VI 1999/3
Other Approaches to promoting healthOther Approaches to promoting healthin workplace settingsin workplace settings• Employee Assistance Program (EAP)• Occupational Safety and Health (OSH)• Onsite Health Centre/Nurse• Gym and Wellness Centre• Health Insurance• Health Education• Work-life Balance Support• Health Fairs
Workplace Health PromotionWorkplace Health PromotionPolicyPolicyDecember 13th,Presented by: Yvonne LewisDirector Health EducationDivisionMinistry of Health
Health is: A resource for living (working, learning, loving, etc) A positive concept emphasizing social and personalskills and resources as well as physical capacities Not merely the absence of disease, but completemental, physical, social and spiritual well-being(WHO)What is Health Promotion?What is Health Promotion?Health promotion is an approach that ‘enables people,(individually and collectively), to take increased controlover and improve their health’ (WHO, 1986)Health Promotion is a strategic objective of theMinistry of Health , and an essential public health function
What is Workplace Health Promotion?What is Workplace Health Promotion?Health Promotion is often operationalised indifferent settings; School Community Workplace Health InstitutionsHealth Promotion in the workplace setting is calledWorkplace Health Promotion (WHP)
Why Workplace Health Promotion?Why Workplace Health Promotion? Health is created and lived by people withinthe settings of their everyday lives; where theylive, learn, work, play and love ….. Thisincludes the workplace Health of the workplace impacts the health ofemployees. Health of employees impacts thehealth of the workplace – Is the workplacesupportive of workers achieving andmaintaining optimal well-being and
Why Workplace Health Promotion?Why Workplace Health Promotion? Workplace health promoton creates the potentialto combine productivity and health in theworkplace• A healthy lifestyle reduces the risk of negativeeffects on the body.– It is a promotive factor which enables people toachieve optimal well-being, a resource for life– It is a protective factor against the developmentof negative health effects like chronic diseases.
Why Workplace Health Promotion?Why Workplace Health Promotion?– It can help persons with illnessesmanage their disease and achieveoptimal well-being– Workplace health promotion is acomponent of occupational health andresponds to the MOH OSH PolicyPart 1-B (m)“Promote good health and be concernedwith the prevention of occupational andnon-occupational disorders and diseasesthrough health counseling and education”
Context cont.’Context cont.’ Chronic Non-Communicable Diseases threaten both thequality of life of individuals, the productivity of thepopulation and the economic viability of the nation. Over the last twenty years, chronic diseases (heartdisease, cerebro-vascular diseases, diabetes, cancer) havebeen the top four leading causes of deaths in Trinidadand Tobago. Together, they account for over 60% of alldeaths.
RankRank Cause of DeathCause of Death No.No. % of Total% of TotalDeathsDeathsRate perRate per100,000100,0001 Heart Diseases 2,425 23.8 189.12 Diabetes Mellitus 1,427 14.0 111.33 Malignant Neoplasms 1,324 13.0 103.24 Cerebrovascular Disease 1,022 10.0 79.75 Accidents & Injuries 835 8.2 65.16 Respiratory Diseases 587 5.8 45.87 AIDS / HIV Disease 410 4.0 32.08 Digestive SystemDiseases333 3.3 26.09 Perinatal PeriodConditions286 2.8 22.310 GenitourinaryDiseases243 2.4 18.9Total All Causes 10,206 100Fig 1: Deaths and Death Rates for the Ten Leading causes by Rankand % of Total Deaths, T&T, 2003
• Actions on the modifiable riskfactors and determinants ofNCDs– behavioral risk factors– Biological determinants– environmental determinants andglobal influences.
The Goal Of The Workplace Health PromotionThe Goal Of The Workplace Health PromotionPolicy IsPolicy Is• To develop a comprehensive, integratedset of actions which enhances the healthof public sector employees, by creating asupportive social and physicalenvironment in the workplace which makehealth promoting behaviours and choicesrelating to healthy eating and physicalactivity, easier choices and promoteprimary prevention of chronic diseases byimpacting on these two risk factors.
ObjectivesObjectives To assist in the development of supportive workplaceenvironments and services which promote and enhancethe health and productivity of staff To build personal health skills of employees and supportthem to adopt health promoting behaviours withemphasis on healthy eating, physical activity andsmoking cessation To standardize guidelines for healthy eating at worksites
Policy GuidelinesPolicy GuidelinesHealthy EatingMonitoring &EvaluationPhysical ActivityMechanisms to supportImplementation
Healthy Eating in the WorkplaceHealthy Eating in the WorkplacePolicy Guidelines: Certified food handlers and food premise licensed No food for meetings shorter than two (2) hours ormeetings held after lunch, or after supper hours. Minimal amount of added fats and oils, low sodiumentrees, sauces and condiments Safe, potable water made availabe to workers close totheir work stationsNutritious and safe food and beverage choices should be providedat all meetings, workshops, and other functionssponsored by Government Ministries, Statutory bodies and agencie
Physical Activity in the WorkplacePhysical Activity in the WorkplaceThe ministry/agency shall create anenabling environment that promotes andencourages employee participation in regular,moderate physical activity
Physical Activity in the Workplace con’t…Physical Activity in the Workplace con’t… One or more active breaks shall be included inmeetings greater than two hours in length. Each Ministry shall develop workplace based physicalactivity programmes including, ‘Take the Stairs’campaign, walking/hiking clubs, and recreationalsports. Each Ministry/agency shall develop a workplacewellness centre management Health education material on nutrition, physicalactivity and health shall be provided for all staff on anongoing basis, and health education seminars andworkshops shall be conducted at least once per quarter
Prepared by Yvonne Lewis. Director Health Education Division, Ministry of Health.Trinidad and Tobago. May 2012HealthyLifestylePassportCheckYourself… KnowyourNumbers
Blood Glucose Summary Profile:Approximately thirty percent(30.3%), had blood glucoselevels within the range of120-179mg/dLwhich is within theacceptable range forpostprandial screens (CHRC2011).However, just over thirteenpercent (13.4%) had levels≥180 mg/dl indicating highrisk of being either pre-diabetic or diabetic.(Results detailed in Fig 2)
5%27.97% 30.51%33.05%3%No.ofpeopleB.M.ILevelsTotal PercentageBMI Levels of both MalesandFemalesBothMale andFemaleBody Mass Index SummaryProfile:Approximately twenty-eightpercent (27.97%) of theindividuals screened had ahealthy weight which was a B.M.Iwithin the range of 18.5 to 24.9Five percent (5%) of theindividuals screened had B.M.ILevels which were in theunderweight range of less than18.5.Approximately two thirds of staff,(66.6%) were overweight orobese, with BMI levelsabove 25, as detailed in Fig 3.
The Cost of Chronic DiseaseThe Cost of Chronic Diseaseis Mountingis Mounting• In 2004 the public expenditure on drugs for thetreatment of cardiovascular disease, diabetes, cancer,hypertension was 34 million TTD (USD 5.4 million).In 2009, that figure has more than tripled to 121.8million TTD or 19.3 million USD.• Over a six year period (2004-2009), publicexpenditure on drugs for treatment of the followingCNCDs: cardiovascular disease, diabetes, cancer,hypertension, increased by over 250%.
The Cost of Chronic Disease isThe Cost of Chronic Disease isMountingMounting• Graph 1: Shows the Total Public Expenditure ondrugs for CNCDs (US$)TOTAL PUBLIC EXPENDITURE ON DRUGS FOR CNCDS (US$$)$5.4$8.3$9.2$13.0$17.7$19.3$0.0$5.0$10.0$15.0$20.0$25.02004 2005 2006 2007 2008 2009YearsUSDollars
Some Major HealthSome Major HealthIssues Impacting theIssues Impacting theHealth of theHealth of thePopulation in TrinidadPopulation in Trinidadand Tobagoand Tobago
THE CHRONIC DISEASETHE CHRONIC DISEASECHALLENGE:CHALLENGE:The five (5) leading causes of death in Trinidad andThe five (5) leading causes of death in Trinidad andTobagopercentage distribution, 2000 – 2006 (CentralTobagopercentage distribution, 2000 – 2006 (CentralStatistical Office)Statistical Office)Rank 1980 1990 2000 20051 Heart disease Heart disease Heart disease Heart disease2 CerebrovasculardiseaseMalignantneoplasmMalignantneoplasmMalignantneoplasm3 MalignantneoplasmDiabetes mellitus DiabetesmellitusDiabetesmellitus4 RespiratorydiseasesCerebrovasculardiseaseCerebrovasculardiseaseAccidents &Injuries5 Accidents/InjuriesAccidents&InjuriesAccidents &InjuriesCerebrovasculardisease
THE CHRONIC DISEASETHE CHRONIC DISEASECHALLENGE:CHALLENGE:The five (5) leading causes of death in Trinidad andThe five (5) leading causes of death in Trinidad andTobago percentage distribution, 2000 – 2006 (CentralTobago percentage distribution, 2000 – 2006 (CentralStatistical Office)Statistical Office)Causes of Death 2000 2001 2002 2003 2004 2005 2006Heart Disease 25.3 23.6 25.1 23.8 24.8 24.2 24.6Malignant Neoplasms(Cancers)12.7 12.4 13.0 13.0 13.8 13.8 13.8Diabetes 13.6 13.7 13.0 14.0 13.9 14.1 13.6Cerebrovascular Disease(Stroke)10.1 10.0 10.4 10.0 9.6 9.1 9.0Injuries and Accident 7.1 8.2 7.4 8.2 9.2 10.0 10.6
Trinidad and Tobago has one on the highestTrinidad and Tobago has one on the highestmortality rates for Diabetes in the Caribbeanmortality rates for Diabetes in the CaribbeanPAHO Basic Health Indicators 2009DM - diabetes; IHD – Heart disease; CVA - strokeAdjusted Mortality Rates /100,000, Selected CARICOM countriesvs. Canada 2003 - 2005020406080100120140160Trinidad & Tobago Guyana Suriname Bahamas CanadaDM IHD CVA
From the Office of Yvonne Lewis.Director Health Education Division0102030405060Prevalence(%)1970s 1980s 1990sYEARSTrends in Adult Overweight/Obesityin the CaribbeanMaleFemale
From the Office of Yvonne Lewis.Director Health Education DivisionLeading Causes of Death in CARICOMCountries by Sex, 20041. Heart Disease2. Cancers3. Injuries and violence4. Stroke5. Diabetes6. HIV/AIDS7. Hypertension8. Influenza/pneumonia1. Heart Disease2. Cancers3. Diabetes4. Stroke5. Hypertension6. HIV/AIDS7. Influenza/pneumonia8. Injuries and violenceMALES FEMALES(Source: CAREC, based on country mortality reports)
The Top five Causes ofThe Top five Causes ofMortality in Trinidad andMortality in Trinidad andTobago (2009)Tobago (2009)• Cardiovascular disease (CVD)• Cancer• Diabetes• Accidents and Injuries• Cerbrovascular disease
The Chronic DiseaseThe Chronic DiseaseChallengeChallenge• Heart disease is the #1 cause of death in Trinidad andTobago accounting for a quarter (25%) of all deaths.• The diabetes prevalence rate is approximately 12%-13%• Taken together, heart disease, cancer, diabetes andcerebrovascular disease, account for over 60% of alldeaths
THE DECLARATION OF PORT OF SPAINTHE DECLARATION OF PORT OF SPAINCALLED FOR CRITICAL ACTIONS ON THECALLED FOR CRITICAL ACTIONS ON THERISK FACTORS OF CNCDsRISK FACTORS OF CNCDs• Actions on the modifiable risk factorsand determinants of NCDs– behavioral risk factors– Biological determinants– environmental determinants and globalinfluences.
Adoption of healthy lifestyles is not only dependenton an individual’s choice… but on the capacity ofthat person to make and implement that choice.Behaviour and lifestyle are embedded in the socialand economic context in which people live.Health promotion recognizes that the determinantsof health are varied. They go beyond lifestyles anddisease prevention and include peace, shelter,education,food, income, equity, sustainableresources.
HEALTHPROMOTIONACTIONCARIBBEAN CHARTER FOR HEALTHCARIBBEAN CHARTER FOR HEALTHPROMOTION STRATEGIESPROMOTION STRATEGIESREORIENTINGHEALTHSERVICESFORMULATING HEALTHYPUBLIC POLICYCREATINGSUPPORTIVEENVIRONMENTSEMPOWERINGCOMMUNITIES TOACHIEVE WELLBEINGDEVELOPING ANDINCREASINGPERSONAL HEALTHSKILLSBUILDING ALLIANCESWITH SPECIALEMPHASIS ON THEMEDIA
Examples of:Examples of: Primary preventionPrimary prevention,,Secondary preventionSecondary prevention, and, and Tertiary careTertiary care activitiesactivitiesin a worksite setting.in a worksite setting.PhysicalexamsHealth fairHealtheducationFitnessactivitiesHealthscreeningsImmunizationSafetyPrecautionsHealth riskappraisalEnvironmentalinterventionsCasemanagementRehabilitationEmergency responsesSource: Evaluating Worksite Health Promotion 2002, by David Chenoweth
Taken from Planning Health Promotion at the Worksite by D. Chenoweth, 1991, Dubique, IA: Brown andHuman ResourcesHealth ServicesMedical CenterExternal ServicesPsychologicalServicesExternal ServicesReferrals ReferralsReferralsReferralsReferrals“Alcohol:Everybody’sBusiness”Stress managementReferralsPhysical FitnessWellness CenterWeight controlSmoking CessationNutritionEvaluationReferralsThe Integrated Health Management Framework used atthe Adolph Coors Company
HEALTHFULWORKPLACE/HEALTHFULCORPORATE POLICIESShort-term benefitsImproved well-beingImproved risk profileJOHNSON & JOHNSONEMPLOYEESSlower increase in corporatehealth benefit costsDecrease inabsenteeismImproved motivation, attitudes, and behaviourModerate risk reductionSmall decrease in health careutilizationImproved corporate commitmentLong-term benefitsImproved corporate commitmentHEALTH RISKAPPRAISAL ANDLIFESTYLE EDUCATIONOTHER HEALTH PROMOTIONPROGRAMMINGThe LIVE FOR LIFE Conceptualization of Program EffectsTaken from Worksite Health Promotion by Dr. David Chenoweth, 1998
Note. From “Control Data’s Staywell Program: A Health Cost Management Strategy” by W.S. Jose and D.R. AndersonPerspectives in Behavioural Medicine: Health at Work by S.M. Weiss, J.E. Fielding, and A. Baum (Eds.), 1991HEALTH PROGRAMCOMPONENTSSUPPORTIVEENVIRONMENT•WORK•HOMEPROGRAMPROMOTIONLOWERRISKFACTORSLOWERMORBIDITYANDMORTALITYBEHAVIOURCHANGEHEALTHKNOWLEDGEACQUISITIONEMPLOYEEBENEFITS:• Reduced personalhealth costs• Improved quality oflife• More energy andvitalityHEALTHATTITUDECHANGEHEALTHSKILLSACQUISITIONEMPLOYERBENEFITS:• Reduced health carecosts• Reduced disabilitycosts• Reduced absenteeism• Reduced turnover• Increases productivityThe Staywell process model
RISK FACTORS ANDRISK FACTORS ANDDETERMINANTS OF CNCDsDETERMINANTS OF CNCDsModifiableBehavioral RiskFactorsModifiableBiological RiskFactorsEnvironmentalDeterminantsGlobalInfluencesTobacco useUnhealthy dietPhysicalinactivityAlcohol abuseOverweight &obesityHigh cholesterollevelsHigh blood sugarHigh bloodpressurePolitical, Social,Economic, andconditionsPhysicalInfrastructureEducationEnvironmentAccess to healthServices andEssential medicinesGlobalizationUrbanizationTechnologyMigration