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CENTERS FOR
DISEASE CONTROL AND PREVENTION
Volume 17 • Number 1 • Fall 2004
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Health Department and Businesses Team Up to Fight Heart Disease and
Stroke
Businesses that spend wisely to promote the cardiovascular health of
their employees will reap huge returns on their investments. This is a vital
message that health departments need to be conveying to businesses,
according to Pamela Southers Wilson, RD, LD, Cardiovascular Health Director,
Georgia Department of Human Resources, Division of Public Health.
 Partnering with employers is a key strategy of the state’s new
Cardiovascular Health Initiative. Ms. Wilson meets with chamber of commerce
directors, human resources staff, and others across the state to share
information on how businesses can strengthen their wellness programs and
target the health problems that are most costly—cardiovascular disease, high
blood pressure, high cholesterol, obesity, and diabetes.
Businesses that have focused on people at high risk for cardiovascular
disease (CVD) have trimmed hundreds of thousands of dollars from their
health care costs each year (see employer profiles,
beginning in section 8).
Their employees are healthier, happier, and more productive on the job. And
best of all, many of these employers are extending their efforts to reach
not only employees, but also their families and the surrounding community.
Businesses Are Seeking Information
“Now is an ideal time for health departments to reach out to businesses
and other partners in the community,” said Ms. Wilson. Health care costs are
soaring, and CEOs are looking for unbiased, scientific guidance on the best
practices for reducing employees’ risk for heart disease and stroke.
“My role is to engage the communities so that they can see their
potential for partnering with others to provide health care focused on
prevention,” Ms. Wilson explained. In each community, important partners
include
- Hospitals, because
they realize that wellness is good for their bottom line and for community
outreach.
- Chambers of commerce, because they have a vested interest in any
business strategies that contribute to a vital, healthy economy.
- City and county governments, because they employ many people.
- Physicians who are willing to work with high-risk patients to help
them make lifestyle and behavior changes that will reduce their risk for
heart disease and stroke.
- Insurance companies, which must be willing to negotiate the plans they
offer businesses.
- The fitness community, for example, the Parks and Recreation
Department or the local YMCA, which can partner with local businesses to
ensure that employees have access to a place where they can exercise
safely.
- The local health department, which can provide communities with
training, expertise, and unbiased public health information to guide
wellness programs.
“Our state health department’s role is to be a consultant,” said Ms.
Wilson. “We offer training to hospitals and others wanting to provide work
site wellness programs. We direct work sites to lifestyle interventions. We
let them know that if the employee costs are to be reduced, the unhealthy
behaviors have to change.”
“When we go to a chamber of commerce to tell them about the successful
wellness programs at other work sites, their eyes light up,” Ms. Wilson
noted. “They say, ‘We have hospitals that are eager and ready to do this.
How can we work together?’ We’re finding that this is truly a grassroots
movement.”
Advice for Health Departments
State health departments should do their homework before approaching
businesses. Ms. Wilson offers these tips:
- Speak in business terms. During meetings and workshops with
businesspeople, “talk to them in language they can understand—in business
language, not in public health terms,” noted Ms. Wilson. Talk about the
economic incentives for promoting the cardiovascular health of employees.
Link wellness to the company’s bottom line.
- Share success stories. Success stories are an effective way to
convey the nuts and bolts of a wellness program, and health departments
can share these stories with businesses in an unbiased way. The Georgia
Department of Human Resources uses a slide presentation that describes
businesses with successful wellness programs and details the companies’
cost savings and returns on investment.
- Provide advice that is based on sound evidence. “The public
health agency’s role is to provide research-based information for the
community,” Ms. Wilson advised. “For example, when consulting with work
sites, we promote the DASH (Dietary Approaches to Stop Hypertension)
eating plan as opposed to some of the more popular fad diets now on the
market, because the DASH diet is clinically proven to reduce high blood
pressure,” she explained. “We also recommend that work sites do fasting
lipid tests,” which are proven to provide more accurate test results than
nonfasting tests. In addition, the state health department urges employers
to get their health information from credible sources such as the American
Heart Association and American Cancer Society rather than any source whose
motivation is to make money or who may have a hidden agenda.
- Assess each work site’s unique needs. When meeting with
employers, the Georgia Department of Human Resources asks each participant
to complete an assessment sheet describing their work site so that the
health department staff can identify the greatest health risks and
barriers facing employees. “We then give them a demographic report on
their work site and suggest where they might be able to focus their
prevention efforts,” Ms. Wilson said. To see how employers are
progressing, the state health department follows up with the work sites
through a contract arrangement with Health Navigators, LLC, where
contractors are experienced in health promotion, health benefits, and
preventive medicine.
Everybody Wins
“Targeting cardiovascular disease at work sites will help not only
companies but also the employees, their families, and society,” advised
Peter A. Townsley of Health Navigators, LLC. “This is a breakthrough for
health departments because they can work with businesses toward common
goals,” he said. “It’s a breakthrough for businesses because people have
been selling them a variety of work site wellness services, and very few of
them have been evidence-based.”
“Businesses that do this correctly get their investment back at several
levels,” he said. “First, they identify people with the greatest need and
target their health problems before they become more costly. For example,
switching to a healthy diet today can avert later use of costly prescription
medications, angioplasty, or bypass surgery.”
“A second benefit is that the overall health of the company’s employee
population improves,” Mr. Townsley explained. People at risk for heart
disease and stroke are greater users of the health care system than others.
But when they change their lifestyles and adopt healthier behaviors, they
are no longer in this high-risk group. Thus, the company’s health care costs
decline.
Some companies take the money they save and invest it back into their
wellness programs to target other chronic diseases. “If employees are no
longer obese, their blood pressure is under control, and they’re not having
heart attacks or needing bypass surgery, the company is saving money, enough
to do screening in other areas—for example, cancer screening,” Ms. Wilson
said.
“Health care costs are skyrocketing for businesses, and the focus has
been on cost management, not prevention,” noted Charles H. Taylor, MD, of
Health Navigators, LLC. That is because few companies are aware that
prevention can be extremely cost-effective.
“Employers have no public health perspective, but when they hear from
health departments, ‘This is how it works. Here are standards based on
credible scientific evidence,’ they listen,” added William R. “Robbie”
Burlas, Consultant, Health Navigators, LLC.
“Public health partnerships with businesses are the best start to a
healthier society. Everybody wins— the state health department, the
community, the employer, and the employees,” said Dr. Taylor. “And if our
public health messages get to employees and they take them home to their
families and communities, it’s a chance to change the world,” Mr. Townsley
added.
Editor’s Note: Georgia’s Cardiovascular Health Initiative was
showcased in June at the 5th International Heart Health Conference in Milan,
Italy, where cardiovascular health officials from around the world gathered
to network and share information.
What Do Successful Work Site Programs Have in Common?
“And if our public health messages get to employees and they take them
home to their families and communities, it’s a chance to change the
world.”
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Businesses with successful wellness programs share several common
qualities. These are elements shared by companies large and small, in both
rural and metropolitan areas.
- Target cardiovascular disease and other chronic diseases that pose
the greatest health risk to employees and are most costly to the business.
The most successful programs “take their health promotion dollars and
spend them on high-risk populations—employees who are overweight or who
have high blood pressure, high cholesterol levels, or diabetes,” explained
Pamela Southers Wilson, RD, LD, Cardiovascular Health Director, Georgia
Department of Human Resources, Division of Public Health.
- Offer employees regular health screenings and risk assessments as
part of the company’s benefits plan. The wellness staffers use the
clinical findings from these tests to stratify employees into different
health risk categories. “Employees in the high-risk category can then be
directed to interventions that will lower their risk factors,” such as
high cholesterol, Ms. Wilson said.
- Follow evidence-based standards. “Companies that have the most
successful wellness programs follow medical standards that have been
researched and proven effective in promoting health or preventing
disease,” explained Ms. Wilson.
- Integrate health promotion and health benefits into the company’s
core business plan. This integration will ensure that health promotion is a high priority among managers and will link health
promotion and health benefits with the company’s overall goals and mission.
The health benefits plan is a substantial cost to the business and must be a
part of the company’s overall plan for success. “General Motors currently
spends more on health benefits than steel,” Ms. Wilson noted. This means
health benefits must be scrutinized in the same way other business decisions
are made.
- Win the long-term support of company leaders. “You’ve got to
have management’s support because you might not see a return on your
investment for several years,” advised Denise Ivester, Group Insurance
Manager, Fieldale Farms, a large poultry company based in Baldwin,
Georgia. Managers were willing to wait 6–8 years to show a return on
investment, even though it took Fieldale Farms only half that time. “We’re
committed to our wellness program, and my managers have given me every
resource I need to offer this program,” she said.
- Remove the barriers that make it difficult for employees to lead a
healthy lifestyle. King and Prince Seafood in Brunswick, Georgia, is a
good example. The company has 464 employees who pack seafood and ship it
to commercial enterprises. In the early 1990s, the company assessed its
needs and discovered why employees were not getting regular medical care
for their high blood pressure. Employees said they could not afford to
take off from work to visit the doctor, because that would mean lost
wages. They also said they were embarrassed to leave work and go directly
to a doctor’s office because they smelled like fish.
These findings prompted the company to open a clinic on-site. “Employees
are now much more likely to get the preventive care they need, not only for
high blood pressure but also for other much-needed services, such as
prenatal care,” said Ms. Wilson. “King and Prince is saving enough money
that every year, during November and December, employees do not pay their
health plan benefits. That’s a bonus to the employees.”
- Encourage employees to participate. “Some companies offer extra
benefits to employees who are willing to be screened and participate in
risk-reduction programs,” Ms. Wilson suggested. Or they require employees to
be screened and to participate in follow-up programs if they are identified
as being in the high-risk category; otherwise, they cannot subscribe to the
health benefits plan.
“When offering gifts as incentives, companies must make sure the gifts
are culturally appropriate and items that employees really want,” Ms. Wilson
advised. For example, a service or high-tech industry might offer vacations
or gift certificates for dinner as incentives. At Fieldale Farms, employees
receive a $10 gift certificate to a local discount store when they
participate in the cardiac profile screening. The company has a drawing for
a $300 gift certificate for department supervisors whose employees’
participation in the screenings is high. “For those who are at high risk and
participate in the dietitian sessions or the fitness programs, periodically
throughout the year we give incentives such as jump ropes, T-shirts,
measuring cups and spoons, cookbooks, Crock-Pots, and grills,” Ms. Ivester
noted. “We put our company logo on all the incentives.”
To further encourage participation, Fieldale Farms allows employees to
leave the production lines for screening without clocking out. In addition,
employees are paid for time spent visiting the company nurse and dietitian
for follow-up sessions.
- Create a healthy environment. Companies with successful wellness
programs do more than just offer assessments and services. “Health and
wellness must be part of the culture,” emphasized Laura Hanson, Manager,
Learning and Development, Highsmith Inc., Fort Atkinson, Wisconsin.
“Wellness must be more than just a stand-alone program. Companies need to
provide a culture and environment that supports healthy lifestyle choices,”
she said.
Highsmith works with a local vendor to provide healthier snacks in the
company’s vending machines. “We subsidize the cost of healthier items and
add that cost to the less healthy snacks,” Ms. Hanson explained. “For
example, pretzels cost 25 cents, but potato chips cost 75 cents. This is one
example of small, inexpensive changes an organization can make to impact the
overall health and well-being of its employees.”
- Develop partnerships with local health departments, hospitals,
fitness centers, and physicians willing to work with patients on lifestyle
interventions. For example, Summit HealthCare System in Newnan, Georgia,
has a full-service YMCA on-site. “Summit’s wellness program refers cardiac
and any patients needing rehabilitation to the on-site Y,” Ms. Wilson
explained. “Hospital staff, their families, and people in the community can
all go to this Y. It’s a seamless attempt to bring doctors to the work site
and to bring the community and hospital together.”
At Fieldale Farms, employees who need to reduce their risk for heart
disease and stroke are offered free memberships to a local gym, but there is
a catch. Employees must go to the gym at least six times a month for
Fieldale Farms to pay.
These are just some of the successful strategies that businesses are
using to promote the cardiovascular health of employees. For additional
approaches, see the profiles of four work site
wellness programs, beginning in section 8. |
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