Wellness Concepts, Programs, & Practices 2011

Lona Sandon, MEd, RD, LD

The function of protecting and developing health must rank even above that of restoring it when it is impaired.

—Hippocrates

Objectives

Define the terms wellness and health promotion.

Restate reasons for implementing wellness and health promotion program.

Explain how wellness and health promotion programs improve health and reduce health care costs.

Review examples of health promotion and wellness initiatives.

Discuss best practices in wellness programming.

View Video

The effects of health care costs on U.S. businesses

http://www.cdc.gov/leanworks/index.html

Discussion Starter

What do you think a dietitian who works in wellness/health promotion does?

What does health mean to you?

What determines health?

Biology Lifestyle

Working/living/social conditions

Community conditions

Background conditions

Sex, race, age, hereditary factors

Physical activity, diet, hobbies, leisure time, use of any type of drugs, safety practices, medical self-care, stress management

Housing, education, occupation, income, employment status, social networks, socioeconomic status, race/ethnic health disparities

Climate, geography, water supply, availability of hospitals, clinics, medical services, social services, industries, government structure, grocery stores, recreation, transportation

Nutrition policy, minimum wage, cultural beliefs, values, & attitudes, advertising, media messages, food distribution systems

Table 1-1, Boyle & Holben, 2010

Match the Definition

A. Wellness

B. Health Promotion

___ Includes positive emotions, relationships, physical & mental traits, engagement, & satisfaction

___ Intends to reduce or control risk factors for disease by empowering people to take control of their health

A

B

What is Wellness?

“Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.” - National Wellness Institute (NWI)

http://www.nationalwellness.org/index.php?id_tier=2&id_c=26

6 Dimensions of Wellness

Developed by Dr. Bill Hettler, NWI

Physical

Spiritual

Inte

llectu

al

Soci

al

Occ

upati

onal

Em

otio

nal

http://www.nationalwellness.org/index.php?id_tier=2&id_c=25

What is health promotion?

Health Promotion – process of enabling people to increase control over, and to improve their health

Typically focused on reducing, eliminating or controlling health risk factors

Health Promotion …

Dynamic balance of: physical,

emotional, social, spiritual, & intellectual health

O’Donnell MP. Definition of health promotion 2.0: embracing passion, enhancing motivation, recognizing dynamic balance, and creating opportunities. Am J Health

Promot. 2009 Sept-Oct;24(1):iv.

Health Promotion…

Motivates & supports lifestyle toward optimal health using health education & behavior change theory

Am J Health Promot. 2009 Sept-Oct;24(1):iv.

American Journal of Health Promotion

Physical Fitness.  Nutrition.  Medical self-care.  Control of substance abuse.

Emotional Care for emotional crisis.  Stress Management

Social Communities.  Families.  Friends

Intellectual

Educational.  Achievement.  Career development

Spiritual Love.  Hope.  Charity.http://www.healthpromotionjournal.com/

HP Occurs at All Levels

Boyle & Holben, 2010 p. 9 Fig. 1-2

Current Health Care Systems Individual is responsible

for their own prevention Downstream health care

system Majority $ are spent on

curative care Designed to respond to

crisis intervention Are people’s

expectations of a cure to high?

Why do we need health promotion?

Advances in the 20th century = people living longer with chronic disease

Progress is now trending in the wrong direction

Health disparities due to race, income, geography are significant

Rising obesity in youths

Why do we need health promotion?

Self-induced chronic disease

Struggling public health infrastructure

Rising cost of health care/insurance

Concern with access to care

Leading Causes of Death in U.S.

Nutrition & lifestyle related 1 Heart disease - $318 B 2 Some cancers - $89 B 3 Stroke 5 Diabetes - $116 B 9 Kidney disease

Key risk factors: obesity ($61 B), physical inactivity, smoking, poor diet

CDC http://www.cdc.gov/chronicdisease/overview/index.htm

Health Statistics

7 out of 10 deaths due to chronic disease

133 million have at least 1 chronic disease

Arthritis most common cause of disability

Diabetes leading cause of kidney failure, amputations, & blindness

> 1/3 adults do not exercise regularly CDC

http://www.cdc.gov/chronicdisease/overview/index.htm

Health Statistics

< 25% eat enough fruit/veggies 1 in 5 smoke Avg. medical costs $7000/person/yr

(2006 estimate) 75% of health care $ spent on

chronic disease

CDC http://www.cdc.gov/chronicdisease/overview/index.htm

Healthy People 2020 - DHHS

Nations health improvement agenda Vision, mission, & goals

http://www.healthypeople.gov/2020/about/default.aspx

Align goals/objectives with nutrition program planning

Fell short of meeting 2010 goals

http://www.healthypeople.gov/2020/default.aspx

Healthy People 2010/2020

Improved but didnot meet goal.

Healthy People 2010

Base

line

1988

-94

2010

obj

ectiv

e0

102030405060

HP 2010 obj.: 60% healthy weight

Perc

en

t of

Pop

ula

tion

Base

line

1988

-94

Curen

t est

imat

e (o

besity

)

2010

Obj

ectiv

e0

10

20

30

HP 2010 obj: 15% obesity

Perc

en

t o f

Pop

ula

tion

Healthy People 2020 Goals

1. Eliminate preventable disease, disability, injury, & premature death

2. Achieve health equity, eliminate disparities, & improve health in all groups

3. Create social & physical environments that promote good health for all

4. Promote healthy development & healthy behaviors across every stage of life

Boyle & Holben, 2010 p. 16

Match the Definition

A. Primary Prevention

B. Secondary Prevention

C. Tertiary Prevention

____ treatment to prevent further complications

____ awareness & environmental/policy influence on health

____ screening & reducing risk

A

B

C

Showing a group of teenagers how to eat healthier using the MyPlate web site is what level of prevention?

A. PrimaryB. SecondaryC. Tertiary

Power of Prevention

3 elements Health promotion (10) Early detection (20) Management of

existing disease (30)

Power of Prevention

Quitting smoking ’s CVD risk by ½ in 1 yr. & ’s death from lung cancer risk by ½ in 10 yr.

5-7% in weight can prevent or delay type 2 diabetes

in BP & total Chol ’s CVD risk

Power of Prevention in the Workplace

Adults spend most their time at work

Most chronic illness develops during the working years, 20-40 yrs.

Employers can control the environment & policies that promote health

Healthier workers = Improved

productivity Less absenteeism Lower health care

costs Improved morale &

loyalty

Methods of Health Promotion:

Enhance awareness Increase motivation Build skills Create opportunities &

environments that make positive health practices the easiest choice

O’Donnell MP. Definition of health promotion 2.0: embracing passion, enhancing motivation, recognizing dynamic balance, and creating opportunities. Am J Health

Promot. 2009 Sept-Oct;24(1):iv.

Health screenings/HRA’s

Smoking cessation Health fairs* Brown-bag seminars* Weight loss programs* Fitness programs Nutrition

assessments* Injury prevention

Poster boards* Health Newsletters* Healthy cooking

demos/taste tests* Stress reduction

programs Individual

counseling* Vending/cafeteria

policies*

Examples of HP Activities

* Expertise of RD importantWhat is

the problem with

most o

f these

types of stra

tegies?

Motivators to Participate in HP

Concerns for one’s health

Monetary incentives Free to participate During work hours Social interaction Reduced insurance

premiums Health provider

recommended Competition Leadership support

Barriers to Participate in HP

Lack of time Cost Competing

interests/programs Kids got soccer

practice Lack of interest Lack of support

from friends, family, co-workers, leadership

Best Practices in Workplace HP Leadership buy-in Identify a leader Determine interest

& assess needs Health

screenings/HRA’s Physical activity

incentive campaigns

Lunch-n-learns Wellness library Quarterly wellness

newsletter Health policies Leverage

community resources

Hunnicutt, D. Big steps for small businesses. Absolute Advantage, 7(3);2-48, 2008. Wellness Council of America www.welcoa.org

CDC’s LEANWorks!

Leading Employees to Activity & Nutrition

View Dr. William Dietz video http://www.cdc.gov/leanworks/why/in

dex.html

Workplace obesity prevention initiative

Case studies: http://www.cdc.gov/leanworks/why/casestudies.html

CDC’s LEANWorks!

Obesity – Impacts productivity Increases employer health care costs Increases absenteeism Strong association with chronic disease

CHIP Wellness Program

Coronary Health Improvement Project

” affordable, lifestyle enrichment program designed to reduce disease risk factors through the adoption of better health habits and appropriate lifestyle modifications”http://www.chiphealth.com/index.php

CHIP Wellness Program

Goals are to lower: blood cholesterol, triglycerides, blood sugar levels, & high blood pressure by reducing excess

weight, enhancing daily exercise, & improving dietary choices

And to eliminate smoking

CHIP Wellness Program

Components Health risk assessment Lifestyle Education program▪ four times a week for four weeks, or▪ three times a week for five weeks, or▪ twice a week for eight weeks

Train the trainer approach▪ Implements video lessons

http://www.chiphealth.com/about_chip/course_content.php

Washoe County School District Mission Statement

http://www.washoe.k12.nv.us/staff/wellness-program/about-contact

Framework – HP 2010 goals & Healthier US initiatives

Create environments that: Increase awareness Promote positive lifestyles Lower disease risk Improve quality of life

Washoe County School District

Incentive driven: $40 per mos. Good Health Incentive

Contribution paid by all employees Price is lowered potentially to $0 if:▪ Employees participate in screening - $30▪ No health problems found - $0 ▪ Found at risk & participate in education

programs 91-93% participation rates!!!http://www.washoecountyschools.org/staff/wellness-program

Washoe County School District

Variety of activities Picture gallery

http://www.washoecountyschools.org/staff/wellness-program

Oregon.gov

Wellness at Work Toolkithttps://

dwp1.dhs.oregon.gov/WellnessAtWork/

Call To Action

Harness collective power of Communities Health care professionals Volunteer groups Government agencies Academic institutions

http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Call To Action – Key Areas

Well-being – help people take charge of their health School education Workplace wellness Faith-based communities Community based lifestyle interventions

http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Call To Action – Key Areas

Policy promotion Environmental

changes that support healthy living – mixed use communities

Public transportation Fresh fruit & veggie

access in all neighborhoods

Phys ed requirements in schools

http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Call To Action – Key Areas Health equity

Target social determinants of health▪ Race, ethnicity, income,

education Equitable access to

health screenings Coverage for

prevention Access to healthy food

Research translation Communicate

effectively what we know works

Design and test effective strategies

Spread the word quickly

Call To Action – Key Areas

Workforce development State funded chronic

disease prevention program workforce

Community prevention & self-management programs

Worksite wellness program

Call To Action – Key Areas

What is the RD’s Role?

Assess, develop, implement,manage programs

Evaluate effectiveness

Act as Health & Wellness coach

Needs Assessment

Plan

ImplementMonitor

Evaluation

Summary

Wellness & health promotion aim to improve quality of life & reduce disease risk

Health is more than just biology and individual choices

Wellness programs lower health care costs

RD’s do more than tell people what to eat – program planning & implementation

Breslow’s 7 (2004) Keys for HP

No smoking Moderate alcohol or none Regular exercise Regular sleep Regular meals Moderate weight Eat breakfast

Healey & Zimmerman, Jr., 2010