Symposium 2004 Keynote Speech

"Call to Action: Why STEPS to a Healthier Workforce?" 

Good afternoon, ladies and gentlemen!

On behalf of the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health, and on behalf of each of our co-sponsors and supporters, it is my pleasure to welcome each of you to the STEPS to a Healthier US Workforce Symposium!

Our Symposium is the first event in a multi-year Initiative that the Institute is launching in collaboration with its co-sponsors and supporters to bring a new, more coordinated approach to achieving the goal of healthier, safer American workers. Our worker-centered efforts are synergistic, as you have already heard from CAPT Penelope Royall, with the Department of Health and Human Services' STEPS to a Healthier US Initiative.

A Chinese proverb tells us that a journey of a thousand miles must begin with a single step. We take that first step today. In taking our first step toward a healthier US workforce, we are affirming that o ur Nation's most valuable asset is its people and the healthier its people are the healthier is the Nation.

And, health is not only a foundational prerequisite for our nation's viability, but health allows us to experience greater personal well-being and to accomplish productive work as well.

In recognizing the value of health to personal and national well-being, we also recognize that unsafe and unhealthy working environments can present risks to a worker's physical and psychosocial well-being as well as risks to an employer's economic viability.

For those of us--like those of us from NIOSH--who are from the occupational health and safety protection community, our efforts are aimed chiefly at ensuring that employers can, and do, provide working conditions that are safe and healthful for workers. We often say that our jobs are to ensure that workers leave work at the end of the day as healthy as they came to work. But in saying that, we have made the assumption that workers are just as healthy as they can be when they come to work.

For those from the health promotion and education communities, efforts are chiefly aimed at fostering lifestyle choices that enhance health for everyone, including those who leave their homes everyday to go to work--or, increasingly, stay in their homes to "do work." It is true that our protection and promotion efforts are often complementary, and occasionally they occur at the same time in the same place, but any degree of programmatic coordination between the two is often more the result of coincidence than intention.

Thus, in taking our first step to a healthier US workforce, we also recognize that the health protection and promotion communities need to be more effectively coordinated than they are now.

Today, we take our first step toward building a partnership between health protection and health promotion to effectuate comprehensive risk reduction.

Our partnership should be a synergy of prevention strategies whose objectives are more than achieving zero adverse work-related outcomes, but rather a holism where work is self-defining in the most enhancing way possible, where a worker can enjoy any retirement years with intact health, and where health-enhancing behaviors are valued and promoted in the workplace along with safety and health protection.

It is timely that we do this, because working Americans of the 21st century need more from us than the health and safety protection and promotion duopoly we gave them in the 20th century. It is no longer enough for us to say that our job is to ensure that workers go home from work as healthy as they came to work. We need to ensure that workers return to work the next day as safe and healthy as they can be.

Our human resources are the Nation's most valuable resource and health protection and health promotion are two sides of the human investment coin.

As Congress stated in 1970, the purpose of the Occupational Safety and Health Act was to "assure so far as possible every working man and woman in the Nation safe and healthful working conditions," but the Congress also said that the Act's purpose was to "preserve our [Nation's] human resources."¹

Protecting the human resource in an coordinated manner involves not only ensuring the health and safety of the worker, but it also requires coordination of our worker protection efforts with efforts to promote safety on the highway, safety while recreating, safety in the home, and with efforts to educate workers about how to make health-enhancing lifestyle choices--nutritional choices, physical activity choices, substance use avoidance choices, stress reduction choices and other positive lifestyle choices.

For too long there has been a disconnect within our prevention communities--between those interested in control of risks from work and those focused on risk reduction outside the workplace. In the 21st century, we can ill afford to continue the separation of occupational safety and health protection from health promotion--continued fragmentation of effort must be converted to coordination of effort.

Yet, even as we take on the challenge of coordinating our efforts, we must be mindful of the challenges that loom large in front of us. Our task is made all the more difficult by different systems of payment for the medical costs of injury and disease that have contributed to our duopoly: conditions caused or significantly exacerbated by workplace exposures are covered through workers’ compensation insurance schemes that are separate--at least conceptually separate--from any health insurance benefits paying for care for the diseases and injuries “of everyday life.” But, the continued separation of focus on at-work and off-work risks is artificial and is not serving workers or their employers optimally.

And organizationally, professionals who administer health promotion programs often are separated from professionals who administer health protection programs, making effective communication and coordination difficult.

A new emphasis on the "people asset" of any enterprise suggests that productivity should be related to a more holistic view of health than our current occupational vs. non-occupational paradigm. For example, the current interest in health productivity management can be used to facilitate our efforts to both protect and promote the health of the American worker. One hopes that holistic approaches to worker health will also contribute to creating a sustainable future for the American medical care system.

This objective is critical as most observers agree that our current medical care expenditure trends are unsustainable.

Of the one and one-half trillion dollars expended each year in the American medical care system, about 80% of those dollars are spent for medical care for chronic diseases and chronic disabling injuries. Many of these chronic conditions are preventable through adoption of health-conscious lifestyle changes or can be better managed by adopting health-enhancing behaviors. Likewise, many may be prevented or reduced in severity by the application of occupational safety and health protection programs, thus creating a natural synergy between health protection and health promotion. Escalating chronic disease and injury care continue to exert pressure on the cost of medical care. Family premiums in employer-sponsored plans increased 11.2 percent in 2004, the fourth year of double-digit growth.²

These cost increases--especially the increasing costs to covered workers—through benefit reductions, more out-of-pocket charges and less health plan choice—will ultimately transform a covered worker from a fairly indifferent health care "user" to a more health-conscious "consumer" and will create opportunities for a coordinated health protection and health promotion effort.

In addition, the transformation of workers to health-conscious consumers may be even sharper for workers who lack medical care coverage. And the number of workers lacking health care coverage is larger than ever—the Bureau of Labor Statistics reports that the percentage of private sector workers participating in employer-provided medical care plans continues to decline—from a high of 63% in 1992 to 45% of the workforce in 2003.³

Is there a role for coordinated programs of health protection and health promotion in ensuring medical care cost sustainability?

If we can transform our singular efforts into coordinated efforts, I believe that the answer is "yes," we can have a greater impact on the health and safety profile of the American worker.

As has been seen with smoking cessation programs aimed at blue-collar workers—those workers with the greatest need for such interventions—worksite smoking cessation programs are most successful when they are a part of a comprehensive program which includes both worker health protection and health promotion.⁴

Thus, it seems that the success of workplace health promotion is linked to the simultaneous presence of a robust health protection program.

• Working together, we can carefully examine, in a scientific way, the existing anecdotal organizational and economic evidence that attention to comprehensive worker safety and health protection and promotion leads to an increase in personal and business productivity.
  
  
• Working together, we can generate an agenda for research into health productivity management issues and charter centers of excellence to address our research agenda and to produce evidence-based solutions.
  
  
• Working together, we can develop, evaluate and disseminate to small and medium-sized employers the most effective "best practices" for health productivity management through demonstration and evaluation projects.
  
  
• Working together, we can incorporate into our "best practices" those international "best practices" that may translate well into American health protection and promotion systems.
  
  
• And, working together, we can drive policy changes that can help achieve our common goal of improving the health of the American workforce and, in doing so, improving the Nation's health as well.

So, let us strive to coordinate our health protection and health promotion efforts by taking our first step together today. And, let us not forget that we share a common goal as we take the many STEPS to a Healthier US Workforce that lie ahead of us.

Thank you for taking time from your very busy schedules to attend the STEPS Symposium. But, I urge you to do much more than attend, please participate!

Speak up, engage the presenters, and remember that you are now a part of a large partnership now--STEPS to a Healthier US Workforce.

Thank you and I wish each of you a safe, healthful and secure workplace.

¹29 USC Section 651(b).

²"Health Care Premiums Jump 11.2 Percent," Associated Press, Sept. 9, 2004, referencing Kaiser Family Foundation, Employer Health Benefits: 2004 Summary of Findings, Exhibit A (Increases in Health Insurance Premiums Compared to Other Indicators, 1988-2004)., p.1.

³William Wiatrowski, "Medical and Retirement Plan Coverage: Exploring the Decline in Recent Years," Monthly Labor Review, August 2004, p. 29-36.

⁴Sorenson G et al., Worksite-based cancer prevention: Primary results from the Working Well Trial. Am J Public Health 86(7):939-947(1996).