Food and the Bottom Line: Food and the Bottom Line: Decreasing Health Care Costs and Increasing Decreasing Health Care Costs and Increasing

Productivity by Upgrading the Corporate Food Productivity by Upgrading the Corporate Food EnvironmentEnvironment

Karrie E. Bergman, MPH Student

Walden University

PUBH-6165-4

Instructor: Dr. Stephen D. Arnold

Spring Quarter, 2010

What We Will CoverWhat We Will Cover

Overview of the Issue◦ The State or Our Health◦ The Cost of our “Health”◦ Costs to Employers◦ Can Changes Improve the Bottom Line?

Upgrading the Food Environment◦ Why Upgrade Food?◦ What is a Food Environment?◦ Ideas for Upgrading the Food Environment

Learning OutcomesLearning Outcomes

Why Employee Health Matters to your Profit Margin and Stakeholders

Why Food is Key to Employee HealthTypes of Upgrades

The State of Our HealthThe State of Our Health

The Health of Adults in the U.S.◦ 2005: 1 out of 2 adults had a chronic disease (CDC, 2009)◦ 2007-2008: 33.8% of adults overweight, 68.0% of adults were

overweight or obese (Flegal et al., 2010)◦ 2007: 23.5 million adults had diabetes (CDC, 2008)◦ 2003-2006: 20% of adults had hypertension (CDC, 2010)

Prevalence of Health Risk Factors (Food RDA)◦ In 2004 (CDC, n.d.)

Only 40% of people eat at least two daily servings of fruit Only 4% of people eat three daily servings of vegetables (with 1/3 being dark

green or orange) Only 13% of people have a daily sodium intake less than 2,400 mg

ReferencesCenters for Disease Control and Prevention. (n.d.). Focus Area 19: Nutrition and Overweight. Retrieved from ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/healthy_people/focus_areas/fa19_2.xls Centers for Disease Control and Prevention. (2008). 2007 National Diabetes Fact Sheet. Retrieved from http://www.cdc.gov/diabetes/pubs/estimates07.htm Centers for Disease Control and Prevention. (2009). Chronic Diseases and Health Promotion. Retrieved from http://www.cdc.gov/chronicdisease/overview/index.htm Centers for Disease Control and Prevention. (2010). Hypertension. Retrieved from http://www.cdc.gov/nchs/fastats/hyprtens.htm Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and Trends in Obesity Among US Adults, 1999-2008. The Journal of the American Medical Association, 303(3), pp. 235-241. doi:10.1001/jama.2009.2014.

The Cost of Our “Health”The Cost of Our “Health”

Cost of Health Care in the U.S.◦ 2007: Total Health Expenditures - $2.2 Trillion (NCHS, 2010)

◦ Expenditures have tripled since 1990 (CMS, 2008)

◦ 75% goes to treat chronic disease (Anderson, 2004)

ReferencesAnderson, G. (2004). Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins UniversityCenters for Medicare and Medicaid Services. (2008). National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent growth, by source of funds: selected calendar years 1960–2007. Retrieved from http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf National Center for Health Statistics. (2010). Health, United States, 2009: With Special Feature on Medical Technology. Retrieved from http://www.cdc.gov/nchs/data/hus/hus09.pdf#123

Costs to EmployersCosts to Employers

Employee Health Care Costs◦ 1999-2009: Insurance premiums for family coverage increased 131% (Kaiser/HRET,

2009) ◦ Being Overweight: Males $170 more/year; Females $495 more per/year (Peng, 2008)◦ 2005: Cost of health care added $1,110 to $1,500 to the cost of each of the 4.65

million vehicles sold (Appleby and Silke Carty, 2005)

ReferencesAppleby, J. & Silke Carty, S. (2005, June 24). Ailing GM looks to scale back generous health benefits. USA Today. Retrieved from http://www.usatoday.com/money/autos/2005-06-22-gm-healthcare-usat_x.htmPeng, T. (2008, August 15). Five Financial Costs of American Obesity. Newsweek. Retrieved from http://www.newsweek.com/id/153309 The Kaiser Family Foundation and Health Research & Educational Trust. (2009). Employer Health Benefits: 2009 Summary of Findings. Retrieved from http://ehbs.kff.org/pdf/2009/7937.pdf

Costs to Employers, Cont.Costs to Employers, Cont.

Lost of Productivity◦ 2003: Lost productivity from seven chronic diseases totaled $1.1 Trillion (DeVol and

Bedroussian, 2007) Loss of Productivity By Disease:

◦ Hypertenstion - $280 Billion◦ Cancers - $271 Billion◦ Mental Disorders - $171 Billion◦ Diabetes - $105 Billion◦ Heart Disease - $105 Bllion◦ Pulmonary Conditions - $94 Billion◦ Stroke - $22 Billion

◦ Absenteeism Obese workers may lose a week of work a year due to illnesses related to their weight (Peng,

2008).◦ Presenteeism

Results in a loss of productivity several times greater than absenteeism (DeVol and Bedroussian, 2007)

ReferencesDeVol, R. & Bedroussian, A. (2007, October). An Unhealthy America: The Economic Burden of Chronic Disease Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Milken Institute. Retrieved from http://www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf Peng, T. (2008, August 15). Five Financial Costs of American Obesity. Newsweek. Retrieved from http://www.newsweek.com/id/153309

Can Changes Improve the Bottom Line?Can Changes Improve the Bottom Line?

Changes in Prevention and Treatment (DeVol and Bedroussian, 2007)

◦ Avoid 40 million chronic disease cases◦ Reduce disease impact by 27% or $1.1 billion/year◦ Lower obesity rate could mean productivity gains of

$254 billion/year

ReferencesDeVol, R. & Bedroussian, A. (2007, October). An Unhealthy America: The Economic Burden of Chronic Disease Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Milken Institute. Retrieved from http://www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf

Why Upgrade Food?Why Upgrade Food?

Foods Affect on Health◦ Cardiovascular Disease and Diet

Study of Low-fat Plant Diet (Esselstyn, 1999)◦ Prior to study total cholesterol was 237mg/dl◦ At 5 years total cholesterol was 137mg/dl ◦ At 10 years total cholesterol was 145 mg/dl

◦ Hypertension and Diet Dietary Approaches to Stop Hypertension (DASH) Trial (Svetkey et

al., 2001)◦ Diet low in fat, sodium and full of fruits and veggies◦ In 3 weeks:

Hypertensive patients – Decrease of 11.6/5.3 mm Hg Normotensive patients – Decrease of 3.5/2.2 mm Hg

ReferencesEsselstyn, C. B. (1999, August 1). Updating a 12-Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology). The American Journal of Cardiology, 84, 339-341Svetkey, L. P., Simons-Morton, D., Vollmer, W. M., Appel, L. J., Conlin, P.R., Ryan, D. H.,... Kennedy, B.M. (1999, February 8). Effects of Dietary Patterns on Blood Pressure. Archives of Internal Medicine, 159, pp. 285-293

Why Upgrade Food, cont.Why Upgrade Food, cont.

You Determine Availability and Access◦Cafeterias◦Vending Machines◦Restaurants◦Pricing

What is a Food Environment?What is a Food Environment?

Vending Machines◦What is in the vending machines?

Cafeterias or Restaurants◦What types of food are they selling?

Refrigerators◦Is there sufficient space for people to bring

food?Catering

◦Are you getting what you pay for?

Upgrade IdeasUpgrade Ideas

Upgrading the Food◦Upgrading Ingredients

Ex: Pasture Fed Beef vs. Feedlot-Fed Beef Ex: Switching to Whole Grains

◦Upgrading the Menu Ex: No Fried Items Ex: Lots of fruits and vegetables – fresh or cooked

without oils Make it Delicious

Upgrade Ideas, cont.Upgrade Ideas, cont.

Make Healthy Food as Easy (or easier) to Access as Unhealthy Food◦Physical Access◦Pricing◦Make it Easier to Bring Food From Home◦Vending Machines◦Creative Programs ex: Farmer’s Market On Site

Upgrade Ideas, cont.Upgrade Ideas, cont.

Education and Wellness Programs◦Provide Nutritional Information◦Wellness Programs

Pamphlets and Newsletters Personal Lifestyle Change Classes Nutrition Classes

◦Cooking Classes Moral Events

Let’s ReviewLet’s Review

State of our “Health”The Cost of “Health”Food and HealthUpgrading the Food Environment

ReferencesReferences

American Dietetic Association. (n.d.). Boost Your Nutrition with Beans. Retrieved from http://www.eatright.org/Public/content.aspx?id=6442452093&terms=beans+and+legumes

Anderson, G. (2004). Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University Appleby, J. & Silke Carty, S. (2005, June 24). Ailing GM looks to scale back generous health benefits. USAToday. Retrieved from http://www.usatoday.com/money/autos/2005-06-22-gm-healthcare-usat_x.htm Centers for Disease Control and Prevention. (n.d.). Focus Area 19: Nutrition and Overweight. Retrieved from ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/healthy_people/focus_areas/fa19_2.xls Centers for Disease Control and Prevention. (2008). 2007 National Diabetes Fact Sheet Retrieved fromhttp://www.cdc.gov/diabetes/pubs/estimates07.htm Centers for Disease Control and Prevention. (2009). Chronic Diseases and Health Promotion. Retrievedfrom http://www.cdc.gov/chronicdisease/overview/index.htm Centers for Disease Control and Prevention. (2010). Hypertension. Retrieved fromhttp://www.cdc.gov/nchs/fastats/hyprtens.htm Centers for Medicare and Medicaid Services. (2008). National health expenditures aggregate, per capitaamounts, percent distribution, and average annual percent growth, by source of funds: selected calendar years 1960–2007.

Retrieved from http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf Center for Science in the Public Interest. (2004, May). Dispensing Junk: How School Vending Undermines Efforts to Feed Children Well. Retrieved from http://www.cspinet.org/dispensing_junk.pdf DeVol, R. & Bedroussian, A. (2007, October). An Unhealthy America: The Economic Burden of ChronicDisease Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Milken Institute. Retrieved

from http://www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf Esselstyn, C. B. (1999, August 1). Updating a 12-Year Experience With Arrest and Reversal Therapy forCoronary Heart Disease (An Overdue Requiem for Palliative Cardiology). The American Journal of Cardiology, 84, 339-341

References, cont.References, cont.

Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and Trends in Obesity AmongUS Adults, 1999-2008. The Journal of the American Medical Association, 303(3), pp. 235-241. doi:10.1001/jama.2009.2014 Jeffery, R. W., French, S. A., Raether, C., & Baxter, J. E. (1994, November). An environmental intervention to increase fruit and salad purchases in a cafeteria. Preventive Medicine, 23(6), 788-792 Mayo Clinic. (2008, May 23). Three main sources of sodium. Retrieved fromhttp://www.mayoclinic.com/health/sodium/NU00284/NSECTIONGROUP Mayo Clinic. (2008, May 31). Top 5 lifestyle changes to reduce cholesterol. Retrieved from

http://www.mayoclinic.com/health/reduce-cholesterol/CL00012 Mayo Clinic. (2008, August 7). High blood pressure (hypertension). Retrieved fromhttp://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=risk-factors Mayo Clinic. (2009, November 19). Dietary fiber: Essential for a healthy diet. Retrieved from http://www.mayoclinic.com/health/fiber/NU00033 Mikkelson, L., Erickson, C. S., & Nestle, M. (2007). Creating Healthy Food Environments and PreventingChronic Disease. In L. Cohen, V. Chávez, & S. Chehimi (Eds.), Prevention is Primary (pp. 287-311). San Francisco: Jossey-Bass National Center for Health Statistics. (2010). Health, United States, 2009: With Special Feature onMedical Technology. Retrieved from http://www.cdc.gov/nchs/data/hus/hus09.pdf#123 Occupational Health Management. (2008, August). An Apple a day: Workers eat healthy to stay healthy. Occupational Health Management, 90-91 Park, M. (2009, June 3). Farmers markets bloom at hospitals. Retrieved from http://www.cnn.com/2009/HEALTH/06/03/farmers.markets.hospitals/index.html Peng, T. (2008, August 15). Five Financial Costs of American Obesity. Newsweek. Retrieved fromhttp://www.newsweek.com/id/153309

References, cont.References, cont.

Svetkey, L. P., Simons-Morton, D., Vollmer, W. M., Appel, L. J., Conlin, P.R., Ryan, D. H.,... Kennedy, B.M.(1999, February 8). Effects of Dietary Patterns on Blood Pressure. Archives of Internal Medicine, 159, pp. 285-293 The Kaiser Family Foundation and Health Research & Educational Trust. (2009). Employer HealthBenefits: 2009 Summary of Findings. Retrieved from http://ehbs.kff.org/pdf/2009/7937.pdf Time. (2006, June 11). The Grass-Fed Revolution. Retrieved fromhttp://www.time.com/time/magazine/article/0,9171,1200759,00.html United States Department of Agriculture. (2005). Dietary Guidelines for Americans 2005. Retrieved fromhttp://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf United States Department of Agriculture. (2009, October 1). Why is it important to eat grains, especially whole grains?. Retrieved from http://www.mypyramid.gov/pyramid/grains_why.html United States Department of Agriculture. (2009, October 1). Why is it important to eat vegetables? Retrieved from http://www.mypyramid.gov/pyramid/vegetables_why.html United States Department of Agriculture. (2009, October 1). Why is it important to eat fruit? Retrieved from http://www.mypyramid.gov/pyramid/fruits_why.html Washington State Department of Health. (2006, August). Worksite Wellness and Chronic Disease Prevention Resource Kit: An Investment in Good Health, Improved Productivity and Lower Healthcare Costs. Retrieved from http://

www.doh.wa.gov/cfh/NutritionPA/our_work_sites/worksite_data/Worksite_wellness_toolkit.htm Zank, D. and Friedsam, D. (2005, September). Employee Health Promotion Programs: What is the Return on Investment?. Wisconsin Public Health & Health Policy Institute Issue Brief, 6(5) World Health Organization. (n.d.). Cardiovascular disease: prevention and control. Retrieved from http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/ World Health Organization. (2006, September). Obesity and overweight. Retrieved fromhttp://www.who.int/mediacentre/factsheets/fs311/en/index.html Zeratsky, K. (2010, February 11). Junk food blues: Are depression and diet related?. Retrieved from http://www.mayoclinic.com/health/depression-and-diet/AN02057

Additional ResourcesAdditional Resources

http://www.fruitsandveggiesmatter.gov/ - A web site from the CDC promoting the increased intake of fruit and vegetables

http://www.mypyramid.gov/ - USDA’s Food Pyramid web site http://www.cdc.gov/chronicdisease - CDC web site with

information on chronic disease http://www.cdc.gov/obesity/ - CDC web site with information on

overweight and obesity http://www.eatright.org/ - Home Page of the American Dietetic

Association where you can find registered dietitians http://www.doh.wa.gov/cfh/NutritionPA/Documents/WA_Worksite_

Wellness_Toolkit.doc - Worksite Wellness and Chronic Disease Prevention Resource Kit

Questions?Questions?