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Wellness, Healthy Wellness, Healthy Eating and Active Living Eating and Active Living Prepared for: Michigan Legislature Prepared for: Michigan Legislature Health Committees Health Committees - - Joint Session Joint Session Presented by: Presented by: Amy Winterfeld, JD Amy Winterfeld, JD Program Principal Program Principal Health Program Health Program National Conference of State Legislatures National Conference of State Legislatures May 23, 2007 May 23, 2007

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Wellness, Healthy Wellness, Healthy Eating and Active LivingEating and Active LivingPrepared for: Michigan LegislaturePrepared for: Michigan LegislatureHealth Committees Health Committees -- Joint SessionJoint Session

Presented by: Presented by: Amy Winterfeld, JDAmy Winterfeld, JDProgram PrincipalProgram PrincipalHealth ProgramHealth ProgramNational Conference of State LegislaturesNational Conference of State Legislatures

May 23, 2007May 23, 2007

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Wellness Activities & Health CostsWellness Activities & Health Costs

Health cost driversHealth cost driversWellness programs Wellness programs can impact costscan impact costsState legislative State legislative actions on wellness, actions on wellness, healthy eating and healthy eating and active livingactive livingInsurance, state and Insurance, state and business wellness business wellness programsprogramsOther wellness, Other wellness, healthy eating and healthy eating and active living effortsactive living efforts

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Healthcare Cost DriversHealthcare Cost Drivers

Article in Article in Health AffairsHealth Affairs points to a points to a rise in number of people treated for rise in number of people treated for a handful of chronic conditions and a handful of chronic conditions and mental disorders as the primary mental disorders as the primary driver of increased healthcare costs.driver of increased healthcare costs.

Five of the most expensive medical Five of the most expensive medical conditions accounted for 1/3 of U.S. conditions accounted for 1/3 of U.S. health spending growth 1987health spending growth 1987--2000.2000.

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Most Costly Medical ConditionsMost Costly Medical Conditions

1.1. Heart DiseaseHeart Disease2.2. Pulmonary (lung) ConditionsPulmonary (lung) Conditions3.3. Mental DisordersMental Disorders4.4. CancerCancer5.5. Hypertension (high blood pressure)Hypertension (high blood pressure)7.7. Cerebrovascular Disease (stroke)Cerebrovascular Disease (stroke)8.8. ArthritisArthritis9.9. DiabetesDiabetes

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Leading Causes of Death,* 2000 Actual Causes of Death,† 2000

Kidney disease

0 5 10 15 20

Tobacco

Poor diet/Physical inactivity

Alcohol consumption

Microbial agents

Toxic agents

Firearms

Sexual behavior

Motor vehicles

Illicit drug use

Percentage (of all deaths)

Heart Disease

Cancer

Chronic lower respiratory disease

Unintentional Injuries

Pneumonia/influenza

Diabetes

Alzheimer’s disease

Stroke

Percentage (of all deaths)0 5 10 15 20 25 30 35

* Miniño AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-120.

† Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1246.

Causes of DeathCauses of DeathUnited States, 2000United States, 2000

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Predicted Likelihood of Developing Heart Predicted Likelihood of Developing Heart Disease, Stroke, or Diabetes by Age 65Disease, Stroke, or Diabetes by Age 65

SmokerSmokerOverweightOverweight

InactiveInactive RatioRatio

11%11% 58%58% 5.55.5

Source: Jones et al. Arch Intern Med 2002;162:2565–71

Non SmokerNon SmokerNormal WeightNormal Weight

ActiveActive

Men, Aged 50

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Wellness Efforts Can Address Wellness Efforts Can Address Modifiable Risk FactorsModifiable Risk Factors

Modifiable risk factors:Modifiable risk factors:•• NutritionNutrition•• Physical activityPhysical activity•• Tobacco useTobacco use

Examples of Wellness Efforts to Address Risk Examples of Wellness Efforts to Address Risk Factors:Factors:•• Tobacco cessationTobacco cessation•• Incentives for active living & healthy eatingIncentives for active living & healthy eating•• Alcohol and drug abuse treatmentAlcohol and drug abuse treatment•• Medically necessary treatment for obesityMedically necessary treatment for obesity

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Physical Activity BenefitsPhysical Activity BenefitsMillions of Americans suffer from illnesses that can Millions of Americans suffer from illnesses that can

be prevented or improved through regular be prevented or improved through regular physical activity. physical activity.

13.5 million people have coronary heart disease. 13.5 million people have coronary heart disease. 1.5 million people suffer from a heart attack in a 1.5 million people suffer from a heart attack in a given year. given year. 8 million people have adult8 million people have adult--onset diabetes. onset diabetes. 50 million people have high blood pressure. 50 million people have high blood pressure. Over 60 million people (a third of the population) Over 60 million people (a third of the population) are overweight. are overweight. 250,000 people suffer hip fractures annually.250,000 people suffer hip fractures annually.

Source: Centers for Disease Control and Prevention, 2006Source: Centers for Disease Control and Prevention, 2006

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Role of Good NutritionRole of Good NutritionResearch shows that good nutrition can help to lower people’s Research shows that good nutrition can help to lower people’s

risk for many chronic diseases, including risk for many chronic diseases, including heart disease, heart disease, stroke, stroke, some cancers, some cancers, diabetes, diabetes, and osteoporosis. and osteoporosis.

A large gap remains between healthy dietary patterns and A large gap remains between healthy dietary patterns and what Americans actually eat. what Americans actually eat.

In 2005, only oneIn 2005, only one--fourth of U.S. adults ate five or more fourth of U.S. adults ate five or more servings of fruits and vegetables each day. servings of fruits and vegetables each day.

U.S. Department of Agriculture publishes U.S. Department of Agriculture publishes Dietary Guidelines Dietary Guidelines for Americansfor Americans (available online at (available online at http://http://www.healthierus.gov/dietaryguidelineswww.healthierus.gov/dietaryguidelines).).

1010

State Legislative Approaches to State Legislative Approaches to Wellness, Healthy Eating and Wellness, Healthy Eating and

Active LivingActive LivingInsurance and fiscal incentivesInsurance and fiscal incentivesInsurance benefit requirementsInsurance benefit requirementsState employee wellness programs State employee wellness programs Employer/worksite wellness programsEmployer/worksite wellness programsStudies and task forcesStudies and task forcesSchool wellness, nutrition & physical School wellness, nutrition & physical activityactivityCommunity design, access to healthy foodCommunity design, access to healthy food

Many are low cost to state government.Many are low cost to state government.

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Insurance and Fiscal Incentives Insurance and Fiscal Incentives

Three Types of Wellness Incentives:Three Types of Wellness Incentives:

•• Insurance Premium Discounts or Rebates for Insurance Premium Discounts or Rebates for InsuredsInsureds’ Participation in Wellness Programs’ Participation in Wellness Programs

•• Insurance Premium Rating Factors to Discount Insurance Premium Rating Factors to Discount Group Premium RatesGroup Premium Rates

•• Tax Credits Tax Credits -- Especially for small businesses Especially for small businesses (7 states proposed in 2006 (7 states proposed in 2006 -- HI, IA, MS, NJ, NY, HI, IA, MS, NJ, NY,

RI, WI)RI, WI)

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Insurance Incentives Insurance Incentives -- Sample of Sample of Bills EnactedBills Enacted

•• MI SB 848 (2006, enacted)MI SB 848 (2006, enacted)-- Requires insurers providing group Requires insurers providing group expenseexpense--incurred hospital, medical or surgical certificates and incurred hospital, medical or surgical certificates and HMOs offering group wellness coverage to rebate premiums if HMOs offering group wellness coverage to rebate premiums if a majority of employees enroll and maintain participation in a majority of employees enroll and maintain participation in wellness programs.wellness programs.

•• MI SB 848 (2006, enacted)MI SB 848 (2006, enacted)-- Requires health care corporations Requires health care corporations to offer nonto offer non--group wellness coverage with a premium rebate if group wellness coverage with a premium rebate if an individual or family enroll and maintain participation in an individual or family enroll and maintain participation in wellness programs.wellness programs.

•• IN HB 1420 (2006, enacted) IN HB 1420 (2006, enacted) -- Allows an employer to Allows an employer to implement financial incentives related to employer provided implement financial incentives related to employer provided health benefits in order to reduce employee tobacco use. health benefits in order to reduce employee tobacco use.

•• NH HB 652 (2004, enacted) NH HB 652 (2004, enacted) -- Permits small group and Permits small group and individual insurers to use a rating factor to discount premium individual insurers to use a rating factor to discount premium rates for plans giving fiscal incentives for participants in rates for plans giving fiscal incentives for participants in wellness or disease management programs.wellness or disease management programs.

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Insurance Incentives Insurance Incentives -- Sample of Sample of Bills ProposedBills Proposed

•• MD HB 312MD HB 312-- Health insurance premium Health insurance premium discount for wellness activities discount for wellness activities ––(proposed 2004)(proposed 2004)

•• NY AB 3344 NY AB 3344 --Actuarially appropriate Actuarially appropriate premium discounts for wellness premium discounts for wellness program participation (proposed 2004)program participation (proposed 2004)

•• FL HB 1629 FL HB 1629 –– Proposed premium rebate Proposed premium rebate for participation in wellness programs for participation in wellness programs (proposed 2004)(proposed 2004)

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Insurance Benefit Requirements Insurance Benefit Requirements --Number of States Requiring Number of States Requiring

Alcoholism Treatment Alcoholism Treatment –– 44* 44* Blood Lead Screening Blood Lead Screening -- 77Bone Density Bone Density Screening Screening –– 1616Cervical Cancer Cervical Cancer Screening Screening -- 2929Colorectal Screening Colorectal Screening ––2525

Diabetic Diabetic Supply/Education Supply/Education ––47*47*Mammography Mammography Screening Screening –– 50*50*Morbid Obesity Care Morbid Obesity Care ––44Prostate Cancer Prostate Cancer Screening Screening –– 2929WellWell--Child Care Child Care –– 3333

* Required in Michigan* Required in Michigan

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Insurer Wellness IncentivesInsurer Wellness Incentives

Blue Cross/Blue Shield NCBlue Cross/Blue Shield NCHealthy Lifestyle Choices programHealthy Lifestyle Choices program•• 4 weight4 weight--related physician visits each related physician visits each

yearyear•• Diagnostic tests for obesityDiagnostic tests for obesity•• Dietician consultationsDietician consultations•• 2 prescription weight loss drugs2 prescription weight loss drugs

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Return on Investment on Worksite Return on Investment on Worksite Wellness ProgramsWellness Programs

Modifiable health risks can be improved Modifiable health risks can be improved through workplace sponsored health through workplace sponsored health promotion and disease prevention promotion and disease prevention programs.programs.Wilson et al., 1996, Heaney & Wilson et al., 1996, Heaney & GoetzelGoetzel, 1997, Pelletier, 1999, 1997, Pelletier, 1999

Citibank had a savings of $8.9 million over 2 years vs. Citibank had a savings of $8.9 million over 2 years vs. program cost of $1.9 million for $4.70/$1 benefits/cost program cost of $1.9 million for $4.70/$1 benefits/cost ratio.ratio.

Ozminkowski et al. AJHP Jan/Feb 1999Ozminkowski et al. AJHP Jan/Feb 1999

Johnson & Johnson from 1990Johnson & Johnson from 1990––1999 generated savings of 1999 generated savings of about $8.5 million/year.about $8.5 million/year.

Goetzel et al. J Occ Hlth & Environ Med 2002Goetzel et al. J Occ Hlth & Environ Med 2002

Analysis of 32 studies found 28 with average ROI of $3.48 Analysis of 32 studies found 28 with average ROI of $3.48 per dollar in program cost.per dollar in program cost.

Aldana AJHP May/June 2001Aldana AJHP May/June 2001

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State Employee Wellness State Employee Wellness ProgramsPrograms

State employee wellness programsState employee wellness programs•• Health promotion initiatives for state Health promotion initiatives for state

employees employees –– AZ, DE, KY, NC, OK, RI, SDAZ, DE, KY, NC, OK, RI, SD

•• Statewide wellness programs for all citizens Statewide wellness programs for all citizens --AR, IN, ND, OH, VTAR, IN, ND, OH, VT

•• Legislation for state wellness programs:Legislation for state wellness programs:State employee wellness program State employee wellness program –– FL HB 913 FL HB 913 (proposed 2004), FL HB 121A (proposed 2003)(proposed 2004), FL HB 121A (proposed 2003)NC HB 557 NC HB 557 –– Proposed increases to wellness benefits Proposed increases to wellness benefits under teachers’ and State employees’ major medical under teachers’ and State employees’ major medical plan (proposed 2003)plan (proposed 2003)

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Other Options to Support Worksite Other Options to Support Worksite Wellness ProgramsWellness Programs

Pilot test innovative health promotion Pilot test innovative health promotion programs at state agencies. programs at state agencies.

Honor and reward your state’s Honor and reward your state’s healthiest organizations. healthiest organizations.

Create an employers' Health Create an employers' Health Promotion Resource Center.Promotion Resource Center.

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State Employee Wellness State Employee Wellness ProgramsPrograms

ColoradoColoradoColoradoColorado is developing a work plan between the Colorado Wellness Committis developing a work plan between the Colorado Wellness Committee and ee and the Metro Denver Health and Wellness Commission to improve wellnthe Metro Denver Health and Wellness Commission to improve wellness for state ess for state employees through evidenceemployees through evidence--based strategies.based strategies.

ConnecticutConnecticutConnecticutConnecticut is creating an Interdisciplinary Health Policy team to advise tis creating an Interdisciplinary Health Policy team to advise the governor he governor on creating a wellness agenda for state employees. on creating a wellness agenda for state employees.

GeorgiaGeorgiaGeorgiaGeorgia will develop a worksite wellness initiative targeting schoolwill develop a worksite wellness initiative targeting school--based employees.based employees.

MaineMaineMaineMaine is focusing on the significant small business population withinis focusing on the significant small business population within their state by their state by developing a toolkit for employers with fewer than 25 employees.developing a toolkit for employers with fewer than 25 employees.

MichiganMichiganMichiganMichigan will target private sector businesses by demonstrating the costwill target private sector businesses by demonstrating the cost effectiveness effectiveness of healthy workplaces.of healthy workplaces.

MinnesotaMinnesotaMinnesotaMinnesota is also targeting private sector businesses by encouraging workis also targeting private sector businesses by encouraging workplace place health promotion programs and implementing an obesity campaign. health promotion programs and implementing an obesity campaign.

2020

State Employee Wellness State Employee Wellness ProgramsPrograms

NebraskaNebraskaNebraskaNebraska is focusing upon improving the health of state employees by prois focusing upon improving the health of state employees by providing viding financial incentives and improving the worksite environment.financial incentives and improving the worksite environment.

OklahomaOklahomaOklahomaOklahoma is encouraging state residents to eat better, move more, and beis encouraging state residents to eat better, move more, and be tobaccotobacco--free through the development of training modules for the "Make Ifree through the development of training modules for the "Make It Your Business" t Your Business" curriculum designed for private sector businesses. curriculum designed for private sector businesses.

South DakotaSouth DakotaSouth Dakota is targeting wellness efforts within the Native AmeSouth Dakota is targeting wellness efforts within the Native American and American rican and American Indian populations.Indian populations.

WashingtonWashingtonWashingtonWashington will use their Health Care Authority and Department of Health twill use their Health Care Authority and Department of Health to work o work with other state agencies to launch "Washington Wellness Works,"with other state agencies to launch "Washington Wellness Works," a statewide a statewide wellness initiative to improve the health of state employees andwellness initiative to improve the health of state employees and retirees. retirees.

WisconsinWisconsinWisconsinWisconsin is creating a Healthier Wisconsin Worksite Project that will wois creating a Healthier Wisconsin Worksite Project that will work with rk with businesses and industry to improve worksite wellness for state ebusinesses and industry to improve worksite wellness for state employees.mployees.

2121

Employer/Worksite Wellness Employer/Worksite Wellness ProgramsPrograms

Employer/worksite wellness programsEmployer/worksite wellness programs•• Employer wellness programs encouraged Employer wellness programs encouraged

–– GA Resolution 24A (passed Senate GA Resolution 24A (passed Senate 2004).2004).

•• RI HB 7627 RI HB 7627 –– “Worksite Wellness Act of “Worksite Wellness Act of 2003” 2003” –– Proposed tax credit to small Proposed tax credit to small businesses for expenses of offering businesses for expenses of offering worksite wellness programs to worksite wellness programs to employees.employees.

•• HI HB 1733 HI HB 1733 –– Proposed a “worksite Proposed a “worksite wellness income tax credit.” wellness income tax credit.”

2222

Business Wellness Programs and Business Wellness Programs and IncentivesIncentives

Florida Power and LightFlorida Power and Light-- healthy cafeteria healthy cafeteria menumenu

Motorola Motorola –– employee fitness centeremployee fitness center

AnheuserAnheuser--Busch Busch –– raffle for vacation for raffle for vacation for people who got preventive health checkspeople who got preventive health checks

Shelton, R. “Businesses try to promote fitness, healthy eating iShelton, R. “Businesses try to promote fitness, healthy eating in workplace.” n workplace.” Orlando SentinelOrlando Sentinel, October 20, 2004., October 20, 2004.

2323

Studies, Task forces, Advisory Studies, Task forces, Advisory CommitteesCommittees

•• At least 7 states have enacted wellness or obesity At least 7 states have enacted wellness or obesity task forces, commissions or studies. (AR, CA, task forces, commissions or studies. (AR, CA, ME, NY, TX, RI, WA)ME, NY, TX, RI, WA)

Examples:Examples:•• CA SCR 81CA SCR 81-- Task force on youth and workplace Task force on youth and workplace

wellness wellness –– (2004, enacted)(2004, enacted)•• NY AB 3344 NY AB 3344 –– Blue Ribbon Advisory Committee Blue Ribbon Advisory Committee

on Wellness to recommend a comprehensive on Wellness to recommend a comprehensive wellness program for NY state, local health wellness program for NY state, local health depts., physicians, insurers, HMOs, hospitals, depts., physicians, insurers, HMOs, hospitals, other health care providers (2004, proposed)other health care providers (2004, proposed)

•• TN HJR 916 TN HJR 916 –– Depts. of Health and Personnel Depts. of Health and Personnel study of effectiveness of current wellness and study of effectiveness of current wellness and disease management programs (2004, proposed)disease management programs (2004, proposed)

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School Wellness, Nutrition and School Wellness, Nutrition and Physical Activity ProgramsPhysical Activity Programs

School wellness programsSchool wellness programsFederal legislation Federal legislation –– Child Nutrition and WIC Act Child Nutrition and WIC Act

of 2004 (Public Law 108 of 2004 (Public Law 108 -- 265) required local 265) required local school districts participating in federal school school districts participating in federal school meals programs to establish local wellness meals programs to establish local wellness policies by the 2006policies by the 2006--2007 school year.2007 school year.

•• State legislation in support of local education State legislation in support of local education agency wellness programs agency wellness programs

•• Physical activity and physical education Physical activity and physical education –– 2006 2006 –– 26 states considered legislation, 10 enacted.26 states considered legislation, 10 enacted.

•• School nutrition legislation School nutrition legislation –– 2006 2006 –– 23 states 23 states considered legislation and 11 enacted it.considered legislation and 11 enacted it.

•• Other Other –– legislation for diabetes care at school, legislation for diabetes care at school, nonnon--invasive diabetes screening.invasive diabetes screening.

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Community Design, Access to Community Design, Access to Healthy FoodHealthy Food

WalkableWalkable communities communities –– through community through community planning and transportation projects that planning and transportation projects that encourage walking, e.g., include funding for encourage walking, e.g., include funding for walking paths.walking paths.

Safe routes to school Safe routes to school –– CA, DE, FL, OR, TX have CA, DE, FL, OR, TX have state laws as of 2003.state laws as of 2003.

Economic development incentives for grocery Economic development incentives for grocery stores stores –– PA Fresh Foods Financing Initiative PA Fresh Foods Financing Initiative makes fresh produce more available through makes fresh produce more available through grocery store development in underserved urban grocery store development in underserved urban and rural areas.and rural areas.

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Additional ResourcesAdditional ResourcesLinks for NCSL and other resources on legislation and policy optLinks for NCSL and other resources on legislation and policy options to ions to

address wellness are:address wellness are:

NCSL State Legislatures Wellness article: NCSL State Legislatures Wellness article: http://www.ncsl.org/magazine/february2007.htmhttp://www.ncsl.org/magazine/february2007.htm

NCSL updated overview of childhood obesity policy options considNCSL updated overview of childhood obesity policy options considered in ered in 2006 at: 2006 at: http://www.ncsl.org/programs/health/childhoodobesityhttp://www.ncsl.org/programs/health/childhoodobesity--2006.htm2006.htm

NCSL overview of childhood obesity policy options considered in NCSL overview of childhood obesity policy options considered in 2005 at: 2005 at: http://www.ncsl.org/programs/health/ChildhoodObesityhttp://www.ncsl.org/programs/health/ChildhoodObesity--2005.htm2005.htm

NCSL information on access to healthy foods in communities at: NCSL information on access to healthy foods in communities at: http://www.ncsl.org/programs/health/publicHealth/foodaccess/indehttp://www.ncsl.org/programs/health/publicHealth/foodaccess/index.htm?x.htm?CFIDCFID=614822&CFTOKEN=54359522=614822&CFTOKEN=54359522

Information about federal school wellness policy requirements onInformation about federal school wellness policy requirements on the U.S. the U.S. Department of Agriculture web site at: Department of Agriculture web site at: http://http://www.fns.usda.gov/tn/Healthy/wellnesspolicy.htmlwww.fns.usda.gov/tn/Healthy/wellnesspolicy.html

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Wellness Program BenefitsWellness Program Benefits

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Thank you!Thank you!

National Conference of State LegislaturesNational Conference of State LegislaturesHealth ProgramHealth Program303303--364364--77007700

[email protected]@ncsl.org