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OCTOBER 3

ROADMAP TO WELLNESS

HAWAI’I HEALTH AT WORK ALLIANCE

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Hawai`i Health at Work Alliance � � � � � �� � mr� � � � � � � � � � � r� � � �� � � �� � � � � s � � � � �

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HAWAI’I HEALTH AT WORK ALLIANCE © 2013 Health at Work Wellness Actuaries, LLC 3

 Announcements and updates

 The Hawaii Physical Activity and Nutrition (PAN) Plan 2013-2020 Loretta J. Fuddy, ACSW, MPH, Director, Department of Health, State of Hawaii

 Getting bike share rolling in Honolulu Tom Brennan and Evan Corey, Nelson/Nygaard Consulting Associates

 Building a roadmap to wellness

AGENDA

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2014 STEP OUT WALK TO STOP DIABETES

The American Diabetes Association Corporate Recruitment Breakfast will be held on Friday, 11/8 from 7:30 a.m. through 9:00 a.m. at the Plaza Club.

RSVP is November 1 and contact person is Danielle Tuata, Events Director of ADA (phone: 947-5979; email dtuata@diabetes.org)

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TODAY’S SPONSORS

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EXERCISE BREAK

Hamstring Stretch 1.  Balance on your right foot bringing your left knee

into your chest. 2.  Bring your leg closer to your chest by clasping the

hands around your knee and pulling in. 3.  Keep your back straight and your core engaged. 4.  Hold this stretch for 30 seconds before repeating

with the opposite leg. 5.  Stop immediately if you feel faint, dizzy,

nauseated or any extreme pain. 6.  Otherwise, stretch those hamstrings!

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OCTOBER 3

ROADMAP TO WELLNESS

HAWAI’I HEALTH AT WORK ALLIANCE 8

WITHOUT VISION THERE ARE NO RESULTS

1. Vision: The destination

2. Status Quo: You’re here now

3. Your Mission: What needs to change to get from where you are to your vision 3. Your Mission: What needs to change 3. Your Mission: What needs to change 3. Your Mission: What needs to change to get from where you are to your vision to get from where you are to your vision

4: Strategy The route you

choose and the vehicle to get

there

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HAWAI’I HEALTH AT WORK ALLIANCE © 2013 Health at Work Wellness Actuaries, LLC 9

 Healthy employees

 Measurably greater health-related productivity

  Improved customer service

 Owning the “healthiest company” mountaintop

WHAT MIGHT YOU BE AIMING FOR?

HAWAI’I HEALTH AT WORK ALLIANCE © 2013 Health at Work Wellness Actuaries, LLC 10

 Please share with the people at your table…

 Why you ARE currently offering a wellness program

 OR

 Why you would offer a wellness program. Your VISION

WHAT’S YOUR WELLNESS VISION?

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BALANCED SCORECARD

WELLNESS VISION

FINANCIAL Program costs Time & people

RESULTS

RETURN Cost reductions

Productivity PARTICIPATION

DEAD SICK SYMPTOMS “HEALTHY” WELL VITAL OPTIMAL

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THE HEALTH CONTINUUM

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THE VALUE OF HEALTH TO EMPLOYERS

0

10

20

30

40

50

Problematic Snoring Low Back Pain

Chronic MS Pain Frequent Heartburn Decreased Sex Drive Difficulty Sleeping Unexplained Fatigue Depression

Anxiety

Frequent Headaches Sexual Problems Impotence

Fit Unfit

Source: ACLS, The Cooper Institute, January 2006

% P

reva

lence

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WHAT ARE THE GREATEST RISKS?

0

0.5

1

1.5

2

2.5

3

3.5

4

Hypertension Current Smoking

Diabetes BMI ≥ 30 kg/m2 Unfit Family History of CVD

HR fo

r HF

Morta

lity

Source: hhtp://circheartfailure.ahajournals.org

Hazard Ratios for Heart Failure Mortality

Heart Failure Risk Factors

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FITNESS PREVENTS HEART DEATHS

*Cardiovascular disease (CVD) & Coronary heart disease (CHD) Mortality Plotted Against Quintiles of Fitness

CRF Quintiles

0

0.5

1

1.5

2

2.5

3

1 2 3 4 5

CVD CHD

Relat

ive R

isk

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FITNESS AND TRIGLYCERIDES

CRF Quintiles

Triglyceride (mg/dL)

0

20

40

60

80

100

120

140

1 2 3 4 5

Unadjusted Adjusted for Body Weight

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FITNESS AND GOOD CHOLESTEROL

CRF Quintiles

HDL-Cholesterol (mg/dL)

52

54

56

58

60

62

64

1 2 3 4 5

Unadjusted Adjusted for Body Weight 18

FITNESS AND BAD CHOLESTEROL

CRF Quintiles

Non-HDL Cholesterol (mg/dL)

120

125

130

135

140

145

150

155

1 2 3 4 5 Unadjusted Adjusted for Body Weight

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FITNESS AND CHOLESTEROL RATIO

CRF Quintiles

TG/HDL Ratio

0

1

2

3

4

5

6

1 2 3 4 5 Unadjusted Adjusted for Body Weight 20

FITNESS AND SYSTOLIC BP

CRF Quintiles

100

105

110

115

120

125

130

1 2 3 4 5

SBP (mmHg)

Men Women

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FITNESS AND DIABETES

CRF Quintiles

0

1

2

3

4

5

6

1 2 3 4 5

Diabetes Mellitus (%)

Men Women

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FITNESS AND SMOKING

CRF Quintiles

0

5

10

15

20

25

30

1 2 3 4 5

Smokers (%)

Men Women

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FITNESS AND 10 YEAR CHD RISK

CRF Quintiles

0

2

4

6

8

10

12

14

1 2 3 4 5

10-year CHD Risk (%)

Men Women

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FITNESS & METABOLIC SYNDROME

*Metabolic syndrome for men and women plotted against quintiles of CRF.

CRF Quintiles

Metabolic Syndrome (%)

0 5

10 15 20 25 30 35

1 2 3 4 5

Men Women

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GYM A DAY KEEPS HOSPITAL AWAY

0.82 0.84 0.86 0.88

0.9 0.92 0.94 0.96 0.98

1+ every 2 weeks 1+ per week 3+ every 2 weeks 2+ per week

Odds ratios and 95% confidence intervals for the probability of hospital admissions per number of additional gym visits per week

Odd R

atio f

or H

ospit

al Ad

miss

ions

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Low Engagment Medium Engagement High Engagement

No Engagement

Highly Engaged spend 30% less on hospitals in total per year

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LOWER HOSPITAL COSTS

60% 65% 70% 75% 80% 85% 90% 95%

100%

Cardiovascular

Digestive

Nervous & muscularskeletal

Cancer

Kidney and urinary tract

Respiratory

Mental

Endocrine, nutritional and metabolic

Overall

No Engagement

Source: International data from Health at Work 27

ENGAGED HOSPITALIZED LESS

No Engagement

HAWAI’I HEALTH AT WORK ALLIANCE © 2013 Health at Work Wellness Actuaries, LLC 28

How do you currently measure health?

 Health care costs  Absenteeism rates  Presenteeism rates  Biometric screening/risk factors  Health risk assessments  Fitness tests

Please share with the people at your table how you measure health today

WORKSHOP TIME

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CARDIOVASCULAR FITNESS

The Sub-Max VO2 test is…

an evaluation of your body’s utilization of oxygen and your heart’s ability to recover from bursts of energy. an evaluation of your body’s utilization of oxygen and

SAVI

NGS

DEAD SICK SYMPTOMS RISKS HEALTHY

IT’S NOT JUST ABOUT WELLNESS

PROD

UCTI

VITY

UNF

IT

ACT

IVE

FI

T

DEAD SICK SYMPTOMS RISKS HEALTHY

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BALANCED SCORECARD

WELLNESS VISION

FINANCIAL Program costs Time & people

RESULTS Fitness scores

Risk factors

RETURN Cost reductions

Productivity

PARTICIPATION Attendance

Exercise rates

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“WHERE ARE YOU?” HAS TWO ANSWERS

1. Vision: The destination

2. Status Quo: You’re here now

3. Your Mission: What needs to change to get from where you are to your vision. + What will get you there vital habits

3. Your Mission: What needs to change 3. Your Mission: What needs to change 3. Your Mission: What needs to change to get from where you are to your vision. to get from where you are to your vision. to get from where you are to your vision. + What will get you there vital habits 4: Strategy

The route you choose and the vehicle to get

there

HAWAI’I HEALTH AT WORK ALLIANCE © 2013 Health at Work Wellness Actuaries, LLC 35

1.  What is the current health status of your employees?

2.  How complete is your habit change approach?

“WHERE ARE YOU?” HAS TWO ANSWERS

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BEHAVIOR CHANGE IS PHYSICS… …OF THE BODY, MIND AND HEART

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To help people adopt new habits we need to apply FORCES to their BODIES, MINDS and HEARTS…

Barriers

Forces that are sufficient to overcome current and future barriers to change

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Barriers

FORCES

Forces that are sufficient to overcome not only those barriers but also the inertia of always doing what we’ve always done…

Inertial forces

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FORCES

Forces that get and keep us in new action, so that our new behaviors become new habits.

FORCES

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But what are these forces? And where do they come from?

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There are PULL FORCES that make us want to change…

Pull forces

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Pull forces

Forces that make us feel or think: I want to change It’s worth it for ME to change It’s worth it for others if I change I’m inspired to change I’m expected to change I’m in charge of my change I can DO better I can BE better I’M MOTIVATED

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Push forces

Then there are PUSH FORCES that make us more CAPABLE of change…

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Push forces

Forces that make us feel or think: I know how to change I’m getting better at change Change is easy (and close) If “they” can change I can change I have the time and money to change I am in a place that supports change I will keep trying even if I fail at first I’m confident I can change I’m competent to change I’M CAPABLE

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WELL THAT SEEMS EASY!

BUT WHY DO PEOPLE FIND ADOPTING NEW HABITS SO HARD?

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BECAUSE BARRIERS AND INERTIAL FORCES EXIST IN FOUR CONTEXTS

Things that actively keep us doing what we’ve

always done

Things that stop us from trying or adopting new

actions and habits

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THE SELF SOCIAL SYSTEMS SPACES

WHAT ARE THE FOUR CONTEXTS?

SO WE NEED PUSH FORCES AND PULL FORCES THAT WORK IN THE SAME FOUR CONTEXTS

Things that make us think and feel:

I’M MOTIVATED

Things that make us think and feel: I’M CAPABLE

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Habit change comes from sustained NET POSITIVE forces

Push & Pull

forces

Barriers

& Inertia

l force

s

Barriers

& Inertia

l force

s

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THE SELF SOCIAL SYSTEMS SPACES

…in each of the four contexts

…forces that pull or push you into good actions and habits must exceed the inertia and barriers than are getting in your way

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SOCIAL THE SELF SYSTEMS SPACES

A failure in even ONE context…

✗…is enough to

prevent habit change 51

INERTIA

AN ASSESSMENT MODEL

PUSH

PULL

SELF SYSTEMS SOCIAL SPACES SOURCES:

BARRIERS

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BARRIERS INERTIA

JUST SOME OF THE SOLUTION ELEMENTS

PUSH

PULL

SELF SYSTEMS SOCIAL SPACES SOURCES:

CAPABILITY

MOTIVATION

ACTIVITY TRACKERS CHAMPIONS

STRONG WELLNESS

POLICY

HEALTHY OFFICE

CLEAR VISION & FUN

PROGRAMMING

GROUP EXERCISE ACTIVITY

RECOGNITION PROGRAM

REWARD PROGRAM

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BOTTOM LINE

 Without a clear VISION and a well-defined ROADMAP (plan) to get there, don’t expect much from your wellness programs

 You have to be VERY clear about where you are today to know how to proceed. You MUST measure fitness and ASSESS how you’re currently:

  Inspiring people to change (PULL FORCES)  Making change easy (PUSH FORCES)  So that barriers are easier to over come  And inertia doesn’t causes relapses   In EACH of the four contexts.

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THERE IS A THIRD “WHERE ARE YOU?” ANSWER

 How does your current wellness program compare to other employers?

 Which tools are companies using?

 How are they attempting to or succeeding at driving engagement?

 What results are others getting?

 What is the state of Health at Work in Hawaii?

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NEXT STEPS

 Val will visit with each one of you to learn:

 What you like so far in the Alliance meetings

 What you’d like to see more of

 What you’d like to see less of

 How you’d like to get more deeply involved

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AND…

 To help you complete a short survey of:

 Your current wellness offering, engagement tools, results

This is just a small glimpse of what a full wellness assessment should be

But at least we’ll all know by Feb where we are as a group

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NEXT MEETING

Next meeting: Feb 6 2014 7:30am:

Social Contagion and the role of CHAMPIONS

PLUS GUEST SPEAKER DINNY TRINIDAD

Sponsored by FCH Enterprises, Inc. (parent company of five brands including Zippy's Restaurants, Food Solutions International, Napoleon's Bakery, ACE, and Pomaika'i Ballrooms

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THANK YOU

AND DRAWING

HAWAI’I HEALTH AT WORK ALLIANCE