working well with an equity lens -...

working well with an equity lens

Rick Foster, MD Executive Director, Catalyst for Health SC Hospital Association Jen Wright, MPH Director, Working Well SC Hospital Association

@HealthierSC #HealthierSC HealthierSC.org

Viewing the health of South Carolina employees through an equity lens

https://twitter.com/HealthierSC


The most important number for determining health status?

•Genetic Code •BMI •Age •Zip Code


The Neighborhood and The Need

The 5.6 square mile area of CPN is marked by under-education, teenage pregnancy, poor healthcare, violent crime, unemployment, and intergenerational poverty. We aim to break that cycle.

Note: 2016 Federal Poverty Line for a family of 4 (200% FPL) = $48,500

10/26/2016 4

0

10

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MedianHousehold

Income

HomeOwnership

No HealthInsurance

PublicInsurance

No HSDiploma

Living BelowPoverty Line

Free andReduced

Lunch

Area Comparison Mt. Pleasant, Charleston County, CPN Neighborhood

Mount Pleasant Charleston County CPN Residents


The Newly Insured Population Approximately 50% Minority

5



population health big picture

• The overall health of people and populations is determined by a continuous interplay of social, environmental, economic and clinical factors/drivers.

• Certain populations are more adversely impacted by these factors resulting in inequitable differences in healthcare access and health outcomes.

• Effective solutions to the greatest health challenges at a community/population level will require collective actions that address both the major drivers of health and healthcare for the population overall and the equity gaps for those subpopulations most at risk


Population Health

"the health outcomes of a group of individuals, including the distribution of such outcomes within the group"


social determinants of health • conditions in the

environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks



the health equity challenge

• Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

• Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.



Understanding Health Equity



Race and Ethnicity

Education Level

Income and

Assets

Location and Built

Environment

Health Equity Triad • Living in poverty-

amplified in early childhood

• Lack of access to high quality education & jobs

• Unstable/unhealthy housing options

• Unfavorable work or neighborhood conditions

• Exposure to neighborhood violence



Relative Risk of All-Cause Mortality by US Annual Household Income Level

Sources: McDonough P, Duncan GJ, Williams D, House J. Income dynamics and adult mortality in the United States, 1972 through 1989. American Journal of Public Health. 1997;87(9):1476-1483. Williams D. “Race, Racism, and Racial Inequalities in Health.” Presentation to Harvard Kennedy School Multidisciplinary Program in Inequality and Social Policy. February 8, 2016. http://inequality.hks.harvard.edu/files/inequality/files/williams16slides.pptx?m=1455915158



Disparities in Mortality Rates for Three Health Status Indicators: Black and White Americans

(1990 and 2005)

Source: Orsi JM, Margellos-Anast H, Whitman S. Black-white health disparities in the United States and Chicago: A 15-year progress analysis. American Journal of Public Health. 2010;100(2):349-356.



South Carolina’s Health

People in 41 other states have better health than people in South Carolina

…people who live in low-income neighborhoods or rural areas, and people of color have even worse outcomes

…our children are the first generation projected to live shorter lives than their parents

Hundreds of people and organizations in our state are doing

great work,

..but we have not been as coordinated and aligned as we

should be.

For the first time in our state’s history. We are working together to

change this.



Alignment with goals is our primary way of impacting health in SC



The Alliance for a Healthier South Carolina

Mission: Coordinating action on shared goals to improve the health of ALL people in South Carolina.



Member organizations



Our Common Agenda for

Health Improvement


1: Stratify data to identify what populations to target.

2: Maximize the potential of diversity in your organization to develop culturally sensitive solutions WITH the community.

Equity Call to Action- Obesity


The health equity ripple effect Obesity/Chronic Disease of the mom prior to conception is a risk-factor for Low-birthweight. Low-birthweight is a risk factor for Infant Mortality and for difficulty to learn. Difficulty to learn is a risk factor for high-school graduation. High-school graduation is a major socioeconomic determinant of health.



Key health equity-based improvement actions

• More fully understand the communities and populations represented by your employees and their dependents- using equity-stratified data

• Focus on the health and well-being of your entire employee population

• Segment vulnerable/high risk populations for targeted health improvement programs and interventions

• Take a holistic approach to health promotion and wellness programs



Equity-focused health improvement actions

• Build cultural competency within your workforce and cultural humility within your organizational culture

• Identify policy/system changes that can most impact specific health equity gaps (“health in all policies”)

• Invest in upstream health improvement solutions focused on the social determinants of health

• Give an active voice to vulnerable employees most at risk for poor health outcomes/high health costs



HealthierSC.org


working well

working well

effective cross-sector strategy implementing key components of healthy eating & active, tobacco free living in worksites, establishing cultures of wellness where the healthy choice is the easy choice organizational commitment to integrate wellness into strategic

plan, changing the employee experience investment in human capital; most valuable asset seamless integration with programming and chronic condition

management aligns policy and environment with desired health behaviors,

creating support for and likelihood of healthy choices PSE implementation impacts all employees whereas

programming only impacts those who choose to participate, often missing those who need it most

creates consistent message throughout org that healthy behaviors are supported and expected

programming vs. PSE What is programming? awareness campaigns education sessions screenings challenges participation based

activities

What is PSE? flex time policy for

physical activity tobacco free campus ID tobacco users, refer

to resources, F/U healthy food option

every time food is served walking trail POD prompts at

elevators/stairs wellness in org strategic

plan benefit/incentive tie-in

why policy?

what purpose do workplace policies serve? policies exist to shape behavior

health policy shapes health behaviors not an elimination strategy provides choice (evidence based) access, marketing, education, environment, and benefit

structures make healthy choice easy choice most prominent, easily identifiable, most affordable

policy ensures practice is universal and sustainable policy sets up systems that are supported by

environment…creates culture

culture of wellness

focuses on the organization, not just the individual makes wellness a part of your infrastructure and your

day-to-day operations wellness becomes a part of the fabric of the organization a comprehensive approach that focuses on policy,

systems, benefits, and environment to support healthy living

fills the gap between stated values and how things actually get done

defines the employee experience

cost burden of poor employee health

Presenteeism- loss productivity in job performance due to illness or chronic health issue to the extent that underperformance disrupts work causing output delays or diminishing quality and quantity of other team members’ work.

cost of doing nothing

Behavior % in SC Cost/ Employee

Cost/Business of 100

Employees

Smoking 23.1% $5,800 $125,280

Overweight/Obesity 67.4% $2,676 $179,292

Physical Inactivity 50% $1,984 $99,200

TOTAL $10,460 $403,772

CDC Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. 2011. SC DHEC. 2011 South Carolina Obesity Burden Report. Be Active North Carolina, Inc., The Economic Cost of Unhealthy Lifestyles in North Carolina, 2005.

making the pitch: investing in wellness

Avg. Cost Savings of a Comprehensive Worksite Wellness Program

Health Care Costs 26% reduction Absenteeism 27% reduction in sick leave Disability/Worker’s Compensation 32% reduction

$3-$1 avg. savings-to-cost ratio of implementing a comprehensive worksite wellness program

Partnership for Prevention. Leading by Example: The Value of Worksite Health Promotion to Small and Medium Sized Employers, 2011. http://www.prevent.org/data/files/initiatives/lbe_smse_2011_final.pdf

investing and ROI invest in human capital (your most valuable asset)

salary/benefits often more than 60% annual cost to do business reasonable ROI expectations comparable to other capital purchases

http://www.prevent.org/data/files/initiatives/lbe_smse_2011_final.pdf

investing in corporate wellness

new HERO study found correlation between investment in corporate wellness programs and company stock performance companies with comprehensive, best-practice

wellness programs outperformed the S&P 500 Index over the course of six years appreciated 235% compared to 159% outperformed the S&P 500 in 16 out of 24 quarters produced a comparable dividend yield of 1.97%

compared to 1.95% “Linking Workplace Health Promotion Best Practices and Organizational Financial Performance,” published in the January issue of the Journal of Occupational and Environmental Medicine (JOEM),

core elements of working well

executive leadership strategic partnerships detailed & tailored

technical assistance mapping of progress &

success celebration & recognition

goals of working well assess, implement, and

maintain evidence-based and effective policies designed around the three pillars of an effective worksite wellness culture: tobacco-free people and

places delicious and affordable

healthy food environments

access and opportunity for physical activity during the workday

implement low/no cost, effective wellness policies, systems, environments and benefits that help ALL employees live healthier lives identify missing wellness

opportunities align current efforts evaluate progress sustain wellness culture

over time

missing link in worksite wellness

HRA + Indiv feedback

Programs & Campaigns

Benefits & Incentives

Policy & Environmental Support

mixed messages

integration into current efforts

contracts policies & procedures- health in all policies health risk assessments with outcome tracking stratify risk of population to customize/diversify

programs/interventions disease management tied to benefits wellness/HR committee wellness programs/initiatives tied to benefits and

incentives Tidelands Health System

“Working Well has helped us work smarter, not harder…we couldn’t have achieved our employee wellness goals as quickly without Working Well’s resources, networking, and staff assistance.”

culture of wellbeing

key components strategic plan clear goals & metrics visible leadership support budget wellness team comprehensive benefits health in all policies approach

tobacco free people and places

help every employee lead a tobacco-free life key components: policy system approach benefits incentives evaluation

key components quit tobacco system policy

100% tobacco free property wide consistent enforcement communicate policy to employees; empower

employees to approach violators adequate signs throughout property

system approach ID tobacco users (HRA/attestation) assess readiness to quit, refer to multiple

resources, f/u often benefits

counseling, OTC NRT insurance benefit or equivalent, FDA RX meds on formulary

Multi-channel communication & promotion of benefits (employees & covered spouses)

incentives incentives for tobacco free emp disincentive for tobacco using emp (motivate

quit) incentives for enrollment in quit tobacco

program evaluation

healthy food environments (HFE)

provide access to delicious, affordable healthy items in all worksites key components: access pricing marketing benefits education

key components HFE access

adopt healthy food nutrition criteria implement a healthy food policy requiring healthy options

whenever/where ever food provided ensure vendors provide healthy options all hours of

operation train food service staff on prep & portion control partner with local farmers or CSA’s onsite gardens

pricing use pricing structure to incentivize purchase of healthy

options increase price of unhealthy

marketing point of decision nutrition info identify foods meeting healthy nutrition criteria with

consistent icon use product placement to make healthy options more

prominent and accessible benefits

provide nutrition counseling to all employees as insurance benefit or benefit equivalent

use benefit design & wellness incentives to encourage behavior change

constantly communicate benefits and equivalents to employees and covered spouses in multiple formats

education implement HFE promo campaign lunchNlearns, cooking demos, evidence based weight mgmt

worksite of active employees

create a culture where being active is the easy norm key components: policies environment education benefits & incentives

key components active worksite policy

use PA resources on clocked time paid work time set aside for PA flexible work hours to allow PA before, after, lunch

time encourage paid break use for PA consider culture of wellness & safety policy combo

environment access to PA facilities/equipment during/after work

hours – walking trails, workout video library

encourage alternate commutes – access to bike racks/showers

accommodations for special needs – “sit and be fit”- PMC

education point of decision prompts

– elevators, stairs, break rooms, etc communicate policies consistent messaging promo campaign of PA resources management lead walking mtgs

benefits & incentives discount access to local or onsite fitness facilities onsite classes at low/no cost insurance benefits that support PA communicate benefits & equivalents promotion of benefits & incentives through wellness

programming

a healthier state house scaled working well to fit

dynamic partnership & collaboration healthy eating/active living focus organizational and individual

resources mission By increasing access and opportunity, providing skill development, connecting with existing benefits, and encouraging healthy eating and active living through motivating challenges, we hope to instill sustainable health behaviors and a culture of wellbeing at the statehouse.

a healthier state house components biometric measurements and lipid/glucose weekly onsite fitness classes YMCA membership discount (reciprocal to local Ys) fitbits- objective tracking & motivation thru challenges/messages marking/mapping state house walking trail ask the dietitian/trainer resource healthier food environment- catered meals marketing & promotional campaigns evaluation

SC state house parallels state house initial measures 87% SC legislators overweight/obese 53% waist circumference > recommendation sedentary lifestyle poor food options (session days) 21% elevated total cholesterol 20% low HDL 34% elevated LDL 33% elevated triglycerides

weight 98 lbs lost 18 of 31 reduced 9 maintained (w/in 3%)

BMI 69% overweight/obese (87% initial)

waist 31” lost ¼ reduced risk

biometric measurement follow up

total cholesterol 78% reduced risk

HDL 4% low HDL (20% initial)

LDL 30% elevated risk (34% initial) Over ½ reduced risk

triglycerides 13% elevated risk (33% initial)

lipid/glucose follow up

1st sign of sustainable culture change

new dimensions of wellbeing customizable and affordable for any employer in SC includes 9 dimensions of wellbeing:

1. culture of wellness 2. nutrition 3. physical activity 4. tobacco 5. emotional/mental wellbeing 6. financial wellbeing 7. risk assessment/outreach 8. incentives and communication 9. evaluation

worksite wellbeing web platform designed to help employers assess

the extent to which they are implementing evidence-based best practices for effective wellness programs.

questions developed based on content identified in several other evidence-based best-practice wellness program assessment instruments and findings from relevant research studies.

weightings and scoring of responses are based on scientific evidence.

instrument and scorecard have been field-tested for validity and reliability.

tool will be continuously reviewed and revised as new evidence on best practices and outcomes for worksite wellness programs are reported.

scorecard and improvement opportunities

worksite wellbeing with an equity lens

health in all policies organizational and individual interventions common elements but not one size fits all understand health risks of population culturally sensitive, multifaceted approach dependent

on risk give voice to vulnerable employees

diverse & representative wellness team build cultural competence holistic approach

include elements that address social determinants education, location, income, health/healthcare, social

context

Working Well Staff Jen Wright, Director, Working Well SCHA • 803.744.3553 • [email protected]

Emily O’Sullivan, Program Manager, Working Well SCHA • 803.454.6969 • [email protected]

www.workingwellsc.org www.twitter.com/SCHospitals #workingwell www.facebook.com/schospitals

mailto:[email protected]

mailto:[email protected]

http://www.workingwellsc.org/

working well with an equity lens -...

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