Preventing chronic disease at the worksite.
Nico Pronk, Ph.D., M.A., FACSM, FAWHP, is vice president of Health & Disease Management at HealthPartners health system in Minneapolis, Minnesota, with responsibility for health promotion, disease prevention and disease management programs for the health plan membership. He is also the Executive Director of the Health Behavior Group, a HealthPartners business unit that provides health promotion, disease prevention and disease self-management products and services to the local, national, and international wellness market. As a Senior Research Investigator at the HealthPartners Research Foundation, he conducts studies in the areas of behavior change, population health improvement and the impact of systems-level change on health-related outcomes. Dr. Ponk has published extensively in the areas of exercise and physical activity, behavior change, economic impact of health risk factors, and the integration of health risk management strategies in population health initiatives. He is currently an Associate Editor for the ACSM's Health & Fitness Journal®, a member of the International Editorial Board of Disease Management & Health Outcomes, and an Editorial Board member of the CDC e-journal Preventing Chronic Disease. He is a current Member of the Task Force on Community Preventive Services and the Clinical Obesity Research Panel (CORP) at the National Institutes of Health. Dr. Ponk received Fellow status for ACSM and the former Association for Worksite Health Promotion (AWHP).
Despite the fact that people in the United States recognize the seriousness of chronic diseases and identify chronic conditions and related risk factors that are strongly related to health problems, most have not changed their lifestyles sufficiently to reduce their risk for premature death or illness. More than 1.7 million people die of a chronic disease each year in the United States, accounting for approximately 70% of all deaths. More than two thirds of all annual deaths are caused by five chronic diseases-heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), and diabetes. Further, the working population is affected as approximately one third of the years of potential life lost before age 65 are due to chronic diseases.
Whereas the toll of chronic disease may be presented as the number of deaths every year, this does not convey the full picture of the associated burden. Disability and diminished quality of life affects those who live with chronic conditions-and there are many of them-as more than 125 million people in the United States have been diagnosed with chronic disease. Millions of new cases are diagnosed each year. Consider these statistics:
* Arthritis is the number one cause of disability, affecting one of every three adults in the United States.
* Stroke leaves more than one million people in the United States with disabilities, many of whom can no longer perform activities of daily living such as walking or bathing without the help of a caregiver.
* Diabetes is the leading cause of kidney failure and blindness in adults.
* Only half of the 50 million people in the United States with high blood pressure have the condition under control with lifestyle modifications and medication.
And then there is the financial burden. Chronic conditions account for nearly 75% of all health-care costs each year. In addition, several of the underlying risk factors contribute directly to both the direct (medical) and indirect (productivity) costs. Table 1 presents a brief overview of some numbers to consider.
Increasing the Use of Preventive Services
Access for employees and their families to preventive services has expanded significantly over the past decade as employers, health plans, and the government have promoted and covered such services. The Figure provides an overview of the proportion of employer- based preventive care services that are covered through the health plans they sponsor. Whereas cancer screenings, health maintenance exams, gynecological exams, and childhood immunizations tend to be well covered, other preventive health tests are covered at much lower rates, including smoking cessation and weight loss programs.
The value of preventive services to employers has been difficult to document. Many efforts to improve the adoption of preventive services are constrained by the difficulty in clearly articulating and communicating the return on investment (ROI) of such services. More information about the costs, ROI, and cost-benefit can support employers in making coverage decisions. In addition, emphasis on those preventive services that are proven to be effective is important. Such "high-value" preventive services should be highlighted, and employers should work closely with their health plans to ensure they are providing coverage for the most beneficial preventive services benefits package. According to the Partnership for Prevention (3, 4), the top 10 high-value preventive services for adults, based upon evidence of health protection and cost-benefit, include the following:
1. Tobacco cessation counseling.
2. Vision screening for those 65 years and older.
3. Cervical cancer screening.
4. Colorectal cancer screening.
5. Hypertension screening.
6. Influenza screening.
7. Chlamydia screening.
8. Cholesterol screening.
9. Problem drinking screening and counseling.
10. Pneumococcal vaccination for those 65 years and older.
Useful Links and Resources
It is not always easy to find credible and evidence-based resources to support employer-based decisions on preventive services coverage that will benefit employees and their families. Sometimes, the sources may have inherent conflicts of interest; other times, the information may be outdated. Several not-for-profit organizations provide resources that tend to be up-to-date, well researched, and comprehensive, in addition to providing proceedings of meetings and conferences that explicitly address the issue of preventive services (4, 5). Table 2 provides some resource organizations to consider.
Employers provide health insurance coverage to many U.S. individuals and thereby influence access for employees and their families to preventive services. As worksite health promotion practitioners, part of the job is to provide guidance, support, and credible information on how best to maintain health, prevent disease, and help detect disease early. Making sure that such information comes from credible sources is paramount. In addition, on behalf of the employees, the wellness coordinator should work with the Human Resources department to advocate, at a minimum, for the inclusion of the highest-value preventive services in the benefits package. Information on clinical preventive services can be packaged into ongoing, year-round communications to employees that ensure such services stay visible and end up being a highly consumed health service.
2. Partnership for Prevention/William M. Mercer National Survey of Employers, 2001.
3. Coffield, A. B., et al. Priorities among recommended clinical preventive services. American Journal of Preventive Medicine
4. Partnership for Prevention, 2002. Preventive Services: Helping employers expand coverage. Available at www.prevent.org
. Accessed September 21, 2005.