Office of the Director

Office of the Associate Director for Policy

Wendy Heaps MPH, CHES.

Senior Advisor

Policy Research, Analysis, and Development Office

Office of the Associate Director for Policy

Office of the Director, CDC

wah9@cdc.gov

CDC State of Wellness

Promoting Health for a Nation

On ABCS, the USA gets an “F”

People at increased risk of CVD who are taking

Aspirin – 33%

People with hypertension who have adequately

controlled blood pressure –44%

People with high Cholesterol who have adequately

controlled hyperlipidemia – 29%

Smokers who try to quit and get help – 20%

Despite spending nearly $0.71/$1

on direct health care provision

3

Assuring the Conditions for Population Health

Commun-ities

Healthcare Delivery System

Employers & Businesses

The Media

Academia

Governmental Public HealthInfrastructure

Source: IOM. 2003. Assuring the Public’s Health in the 21st Century. Washington, D.C.: NAS; p. 30.

4

Employers

• 143 million full- and part- time workers

• Employees spend most of their day at the

workplace

• Employer based health insurance provided

coverage to 159 million Americans (63.4% of

those under age 65) in 2003

• Employers pay for 36% of the nation’s

healthcare expenditures

• Over half of employers with 500+ employees

offer some sort of wellness program

• Ongoing interventions: personalized HRA, health information, education, counseling and support

• Lifestyle interventions connecting personal health services with community-based services: obesity, smoking, YMCA-DPP, etc.

Counseling & Education

• Ongoing interventions: CVD prevention has greatest impact, A1C testing and reporting

• Medication adherence and personalized behavioral interventions

• Care coordination, particularly multiple chronic comordibities

Clinical Interventions

• One-time or infrequent interventions: immunizations, colonoscopy

• Smoking cessation

Long-Lasting Protective

Interventions

•Healthy air, water, food•Salt iodization•Water fluoridation• Essential HI benefits packages:

high value services

Changing Context To Make Individuals’ Default Decisions Healthy

•Poverty reduction

•Improved education

• Health insurance/access to care

Socioeconomic Factors

Source: Adapted from Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010;100(4):590-5.

Increasing

Individual

Effort

Required

Increasing

Population

Impact

Health Impact Pyramid

Key: Text in white

indicates OPTH target

Affordable Care Act: Pillars of Prevention

Key preventive services now covered without cost

sharing

Prevention and Public Health Fund

Public health policies and programs

National Prevention Council/National Prevention Strategy

More People Will Have Access to

Clinical Preventive Services

Key preventive services

now covered without cost

sharing

Focused on quality and

utilization of services

Established by the Affordable Care Act

A unique opportunity to prioritize and align

prevention activities

Chaired by the Surgeon General

Council members: 17 federal departments

Advisory Group: 25 non-federal members

The National Prevention Council

Ground activities in evidence-based practices

Set specific actions and timelines

Align and focus federal prevention and health promotion

activities

Align with existing strategies and initiatives, including:

Healthy People 2020

National Quality Strategy

First Lady’s “Let’s Move!” campaign

Surgeon General’s Vision for a Healthy and Fit Nation 2010

National HIV/AIDS Strategy

National Prevention Strategy

The National Prevention and Health Promotion Strategy

Ongoing leadership and coordination of federal

prevention activities

Annual status report

Key Deliverables

Work across sectors

Catalyze public and private partnerships

Federal, state, local, territorial, and tribal

Private, nonprofit, faith, community, labor

Focus on where people live, learn, work, and play

Community, worksite, institutions, etc.

Prioritize scalable activities

Approach

Strategic Interventions:

Focus on preventing leading causes of death and their

underlying risk factors

Prioritize high impact, evidence-based, scalable

interventions

Promote high value preventive care practices

Examples of National Prevention Strategy:

Guiding Principles

Maximize Impact:

Establish a cohesive federal response

Promote alignment between the public and private

sectors:

– Federal, state, local, territorial, and tribal

– Private, nonprofit, faith, community, labor

Obtain stakeholder input

Examples of National Prevention Strategy:

Guiding Principles

Active Lifestyles

Eliminate Health Disparities

Counter Alcohol/ Substance Misuse

Healthy Eating

Healthy Physical and Social Environment

High Impact Quality Clinical Preventive Services

Injury-Free Living

Mental and Emotional Wellbeing

Strong Public Health Infrastructure

Tobacco-Free Living

Draft Strategic Directions

Draft Strategic Directions: Purpose

Creates a structure from which to develop specific

recommendations and actions.

Establishes priorities that best prevent the leading

causes of death and disease.

Serves as a guide to assist policymakers, practitioners,

and communities in focusing prevention and wellness

activities.

To provide input, go to:

http://www.healthcare.gov/nationalpreventioncouncil

National Prevention Strategy:

We Welcome Your Continued Input.

Winnable Battles

Healthcare-associated infections (HAIs)

HIV

Motor vehicle injuries

Obesity/Nutrition/Physical Activity/Food Safety

Teen pregnancy

Tobacco

18

Obesity, Nutrition, Physical Activity & Safety

AD Policy Design Plan Brief to OI Imp Team Nov 17, 2009

19

Obesity, Nutrition, Physical Activity and Food Safety

Continue to support ••Let’s Move and the National

Plan to Prevent Obesity

Advance sodium and ••trans fat reduction strategies

Improve the ability to identify and reduce incidences

of ••Salmonella by implementing new identification

tests in public health labs

Develop and help promote national standards on

food marketing to children

20

Per Capita Expenses Due to Excess Weight

Finkelstein EA et al. J Occupational Environ Med 2010;52:971

Obesity Grade I II III

Men (total) $1,143 $2,491 $6,078

Medical $475 $824 $1,269

Absenteeism $277 $657 $1,026

Presenteeism $391 $1,010 $3,792

Women (total) $2,524 $4,112 $6,694

Medical $1,274 $2,532 $2,395

Absenteeism $407 $67 $1,262

Presenteeism $843 $1,513 $3,037

Costs of Obesity – 1998 vs 2008

1998 2008

Total costs $78.5 B/y $147 B/y

Medical costs 6.5% 9.1%

Finkelstein et al. Health Affairs 2009; 28:w822

1999

Obesity Trends Among U.S. AdultsBRFSS, 1990, 1999, 2009

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Principal Targets

Pregnancy: pre-pregnant weight, weight gain, diabetes,

smoking

Reduce energy intake

Decrease high and increase low ED foods

Increase fruit and vegetable intake

Reduce sugar-sweetened beverages

Decrease television time

Breastfeeding

Increase energy expenditure

Increase daily physical activity

Priority Strategies to Address Target Behaviors

Energy density

Apply nutrition standards in child care and schools

Promote menu labeling in states and communities

Increase retail food stores in underserved areas

Fruits and vegetables

Increase access through retail stores

Farm to where you are policies

Food policy councils

Sugar-sweetened beverages

Ensure access to safe and good tasting water

Limit access

Differential pricing strategies

Television viewing

Regulations to limit TV time in child care settings

Limit food advertising directed at children

Breastfeeding

Policies and environmental supports in maternity care

Policy and environmental supports in worksites

State and national coalitions to support breastfeeding

Physical activity

Community-wide campaigns

Increase access with informational outreach

Increase opportunities for PA in school settings

Resource: Breastfeeding Report Card,

http://www.cdc.gov/breastfeeding/data/reportcard.htm

Priority Strategies to Address Target Behaviors

Breastfeeding in the Workplace

Providing education for parents-to-be on the

importance of breastfeeding

Providing support to new mothers after delivery with

unlimited phone counseling with a lactation

consultant

Meeting the needs of mothers returning to work by

providing a return-to-work consultation and a

lactation room

Equipment at the worksite that will allow mothers to

continue supplying the important nutritional benefits

of breast milk

Settings for the Prevention and Treatment of Obesity

Industry

Child care

Medical Settings

School

Work Site

Community

29

Tobacco Cessation

31

About 438,000 U.S. Deaths per Year

Attributable to Cigarette Smoking*

*Average number of deaths, 1997-2001.

Source: MMWR 2005;54(25):625-8.

Other cancers

34,700

Chronic lung disease90,600

Lung cancer

123,800

Stroke

17,400

Other diagnoses

84,600

Coronary heart disease

84,600

• Smokers incur higher costs related to disability, lost

productivity, and absenteeism

• Smoking costs about $92 billion per year in lost

productivity due to premature death

• Men incur nearly $16,000 and women nearly $17,000

more in lifetime medical expenses than nonsmokers

• Smokers: 1-2 more years of disability than nonsmokers

• Sick days: Men use four more, women use two more than

nonsmokers

Productivity, Absenteeism, Disability, Cost

Tobacco

Implement and evaluate tobacco control programs

funded through the American Recovery and

Reinvestment Act

Promote anti-tobacco education campaigns•

Continue progress on smoke-free laws and price

increases

Support the implementation of the Family Smoking

Prevention and Tobacco Control Act

Promote new cessation services through health

reform

34

Federal Employee Health

Benefits 2011

• Cover all seven FDA-approved cessation medications

and individual, group, and telephone counseling -- the

treatments found to be effective in the 2008 update of

the Clinical Practice Guideline on Treating Tobacco

Use and Dependence.

• No copayments or coinsurance and not subject to

deductibles or annual/lifetime dollar limits.

36

Case Study: CDC’s Tobacco Free

Campus Initiative

• Significant policy change in 2005

• Completely smoke free

campuses, indoors and out

• Collaboration of health promotion,

clinical, EAP staff and “quit-lines”

• Personal quit plan, free nicotine

replacement

• Support for multiple quit attempts

• Link annually with the Great

American Smokeout®

Smoking Shelter Becomes

Covered Bike Parking

37

Policy Horizons: Does Your Organization Have These in Place?

Tobacco-free campus or worksite

Flexible work/schedule policies

parental/dependent care

Nutritious foods-at-meetings policy

Healthy transportation policies

Smoke-free meetings policy

Time during work hours for wellness activities

Physical activity

Training or educational opportunities, health fairs,

events

Screenings, health coaching, EAP

Does Your Built Environment Allow Health to Thrive?

Safe, hazard-free workplace

Welcoming, user-friendly workspaces

Stairs, walkways, paths, trails that are safe and

inviting

Onsite food choices that make eating healthier easy

Lactation rooms

Transportation and parking options that enhance

health

Onsite or nearby health clinic or access to

healthcare providers

Fitness facilities or opportunities for physical

activity

39

CDC Workplace Tools and Resources

41

Lean Works

• Leading Employees to Activity and Nutrition

– CDC LEAN Works! is a FREE website that offers a

comprehensive, one-stop resource for planning,

designing, building, promoting, and assessing worksite

obesity management programs

41

Federal InitiativesLet’s Move

Empower parents

Healthier foods in schools

Physical activity

Access to affordable healthy food

Childhood Obesity Task Force

HHS Healthy Weight Task Force

National Action Plan for Physical Activity

Dietary Guidelines for Americans

Communities Putting Prevention to Work (CPPW)

Child Nutrition Reauthorization

Surgeon General’s Call to Action on Breastfeeding

FTC Guidelines for Foods Marketed to Children

National Prevention, Health Promotion and Public Health Council

Resources

www.cdc.gov/workplacehealthpromotion

www.cdc.gov/workplacehealthpromotion/healthtopic

s/index.html

Webber A, Mercure S. Improving population health:

the business community imperative. Prev Chronic

Dis 2010;7(6).

www.cdc.gov/pcd/issues/2010/nov/10_0086.htm.

www.cdc.gov/communitiesputtingpreventiontowork

http://www.healthcare.gov/nationalpreventioncouncil

Acknowledgements

Pam Allweiss , National Center for Chronic Disease

Prevention and Health Promotion , CDC

Casey Chosewood National Institute for

Occupational Safety and Health CDC

Jason Lang, National Center for Chronic Disease

Prevention and Health Promotion , CDC

Lydia Ogden, Office of Prevention Through

Healthcare, CDC

Abby Rosenthal, National Center for Chornic

Disease Prevention and Health Promotion , CDC

Thank You!

Questions?

Comments?

Contact information :

WHeaps@CDC.Gov