Strategies to Prevent Heart Attack and Stroke in the Workplace

>>Welcome everyone and thank you
for joining our webinar on strategies to prevent heart attack and
stroke in the workplace. Findings from the Workplace
Health in America survey. This is part of the Make Wellness Your
Business series of webinars and is the product of the Centers for Disease Control and
Prevention Workplace Health Resource Center. My name is Rhonda Robinson, A
CARNA LLC contractor in support of the CDC workplace health program,
and your moderator for today. An archived version of the broadcast, including
the slides, will be available in a few weeks through the CDC Workplace
Health Resource Center. Please take a moment to read
our standard disclaimer. Our first presenter is Jason Lang. Jason is team lead for CDC
Workplace health programs. Jason has managed projects and provided
leadership for the CDC National Center for Chronic Disease Prevention and Health Promotions Workplace
Health Initiative since 2007. His responsibilities includes strategic
planning for worksite health promotion. He serves as a coordinator
for the center’s division and a workplace health liaison
to other CDC centers. Our second presenter is Sharada Shantharam. Sharada is the health scientist with
IHRC Inc., supporting the division for heart disease and stroke prevention at CDC. She focuses on legal epidemiology, developing
assessment protocols, and translating and disseminating research to prevent
and manage cardiovascular disease. Sharada became involved in
workplace health promotion in 2014 when she examined state workplace
health promotion policies. She has continued to translate evidenced-based,
worksite wellness practices for the public. During today’s webinar we will
cover the following agenda. Jason will start with an overview of the burden
of heart disease and stroke and why employers and employees both should be focused on
the number one killer in the United States. He will then describe the CDC
Workplace Health in America survey. Sharada will present specific findings from
the survey focused on the questions related to heart disease and stroke
prevention in the workplace. Jason will conclude with an overview of
CDC’s Workplace Health Resource Center. Now, I’d like to turn it over to
Jason Lang to kick off our webinar.>>Thanks Rhonda. many of these statistics are familiar to us. Each year in the United States, more than 1.5
million people have a heart attack or stroke, and more than 800,000 adults
die from cardiovascular disease. Cardiovascular disease is the leading cause
of potentially preventable death in the US. And cardiovascular disease is the
greatest contributor to racial disparities and life expectancy among African Americans. Accounting for more than one year of
the almost four years shorter lifespan. So, heart disease and stroke as the
number one and number five cause of death in the country respectively are
the top public health priorities. Here we see a January 2017 research article
by Mensa et al in the journal circulation that depicts the rate of decline and the death
rate for cardiovascular disease in green. Coronary heart disease in
blue and stroke in red. Over the last 65+ years, we have enjoyed
considerable public health success in preventing heart attack and stroke deaths. What is alarming, however, is after 40 years
of steady improvement, the rates of decline in both heart disease and stroke
deaths have recently slowed. The CDC Division for Hearth Disease and stroke
prevention and Million Hearts Initiatives, are focused on priorities and strategies
to reverse this troubling trend. We know, too, that cardiovascular
disease risk increases with age. At age 24, one’s risk for CVD is just 20%. At age 45, the chances of
developing CVD more than doubled 50%. And at age 65, the risk of CVD is 80%. These high-risk groups are all of working age. Approximately 80% of 25 to
54 year old’s are employed, and 37% of those 55 and older are employed. And despite Millennials now comprising
the largest generation of workers in the US workforce, workers at
higher risk for CVD, such as Boomers and Gen X’ers remain the majority of the work. The cost to individuals, employers, and
the US economy as a whole is staggering, as more than one in every seven healthcare
dollars are spent on cardiovascular disease. Translating to nearly $300 billion every
year in medical costs and lost productivity. But if we can keep healthy employees healthy and
prevent cardiovascular problems from developing, or better manage these conditions for
those who may have developed them, there are ample savings available to employers
and their workers through wellness programs. The high cost of heart disease and stroke, both
in terms of human life as well as economic loss, coupled together with a setting
where a large population of high-risk individuals can be reached. With cardiovascular health
promotion and prevention programs, makes the worksite an ideal setting to
impact the health and wellbeing of workers and the bottom line for businesses. I’d like to turn for a moment now
and describe the Workplace Health in America survey and how it was developed. The Workplace Health in America
survey is the first federally-funded, nationally represented survey of
US employers in over a decade. We set out to describe the current
state of workplace health promotion and protection programs and practices in the US. In doing this, we sought to lay the groundwork
for ongoing surveillance of these issues. Why we disseminate the findings from the
survey and provide data to researchers and practitioners in the field to advance
intervention and practice-based research. We had wide-ranging input from inside
and outside of the federal government. We reviewed more than a dozen
surveys of similar scope to construct the Workplace
Health in America Survey. And once we had drafted the
survey, took steps to test and pilot it before full-scale data collection. Workplace Health in America is a very
broad and comprehensive survey covering all of the content areas listed here. For our discussion today, we’ll be focusing
on data related to heart disease and stroke, which is related to the health promotion
program area topic as well as health screenings, disease management programs
and health insurance. Because of the size of the survey and the
total number of items, we broke the survey into a core set of questions and
a set of supplemental questions. After completing the core, respondents
were given the option of continuing to the supplemental questions, which
covered several additional health topics and emerging issues as examples. As I mentioned, we reviewed more than a
dozen earlier workplace health surveys in developing workplace health in America, including the 2004 National Worksite Health
Promotion survey, which before Workplace Health in America, was the most recent
government-sponsored survey. We included many questions from that survey
so that we could track and trend changes in practice over the last decade or so. We drew our sample from the
Dunn & Bradstreet database, which represents all US employers
with at least 10 employees. We set up our sample to be
able to create estimates for geographic region as the primary level. These regions are multi-state areas where CDC coordinates many
state-based health promotion programs. Within each region we additionally
generated estimates based on employer size and industry sector categories based on a
proportional allocation to the population. We initially screened employers for
their eligibility to participate, and also to identify a primary point of contact. Ideally, someone knowledgeable about the
wellness program to respond to the survey. We provided multiple modalities
to allow for survey completion, 86% of all respondents use the web mode. The survey took approximately 40 minutes
to complete, and we collected data for nearly a year beginning in November
of 2016 and ending in September of 2017. We started with more than 35,000 employers. We found more than 4,700 were ineligible
because they did not have at least 10 employees, and/or they had not been
operational for at least 12 months. If we could not confirm a worksite was
ineligible, it was considered eligible. We received over 3100 responses to the survey,
but we only included 2843 in our final sample, which we considered complete surveys, meaning
that the respondent had to, either one, provide a valid, yes/no response
to the key base question, do you have any type of health
promotion program? Or two, provide a valid response to at least 50%
of the applicable items after the base question. Of these, 44% completed both the
core and supplemental questions. Estimates with a sample size of 30 or less, or where the relative standard error was
greater than 30% or deemed unreliable. And that data has been suppressed
and is not presented. Now that you have a bit of a feel for
what the survey is and what it covers, I will turn it over to Sharada to
walk us through some of the results.>>Thank you Jason, so yes. Let’s go over some of the results. I’ll start broad with some of the
general workplace health programming at the national level but spend most
of my time going over the results, as related to heart disease and
its associated risk factors. And we’ll look specifically at
employer sizes and geography today. So, we found that 46% of all employers
had some type of health promotion program, which could be something like a walking club, diabetes education classes,
or even on-site flu shots. We know from research that a comprehensive
program is the most effective approach to building a wellness program. One that is sustainable and achieves the health
and economic outcomes that employers want. The comprehensive approach looks
to put interventions in place that address multiple risk factors and health
conditions and recognizes that the interventions and strategies chosen influence
multiple levels of the organization. Our survey found only about 12% of
employers have all five elements of a comprehensive program. So, that means having a supportive social and physical environment,
linking to relay their program. Having a health education program. Integrating health promotion
into the organization structure. And also, offering some sort
of health screening program. You can see that the support of social and physical environmental element
is the most common among employers. This can include tobacco use bans or
having walking trails around the office. Screening is the least common element,
but I will get to that in a little bit. We also found that employers who
have had a wellness program for more than five years are three times more
likely to have the comprehensive program than those with shorter programs. Seeing as less than half those employers
have any one of these elements shows that as a community, we still
have a lot of work to do. One way for employers to build
comprehensive programs is to dedicate more resources to the program. Looking at budgets, of that 46% of
employers with wellness programs, 36% do not have an annual wellness budget. We asked employers generally, what
their plans are for the wellness budgets in the next 12 months, and almost 80% said that they expected their
budgets to remain about the same. So, think about this. Experts recommend spending between roughly $150 and $300 per person annually
to get the most impact. Roughly two-thirds of employers are spending
$20,000 or less on their wellness programs. That’s about $100 per employee;
clearly below the recommended $150. Once again, we can see an
opportunity for employers to increase their investments just a little
bit, to see an improvement in employee health. And you’ll see in the next couple of slides,
that while many employers don’t spend a lot of money on their wellness programs, small and
large employers alike are still doing something to improve the health of their employees. So, let’s jump back to that
screening idea where only about 27% of employers provide health screenings. We broke down our results
by the number of employees and compared smaller businesses
to the medium and large ones. That’s the hundred-plus category. You can see in this slide and the
coming ones, that there’s a trend. As businesses get bigger, more of them are
providing health programs and services. High blood pressure, or hypertension, and cholesterol are among the most common
risk factors for heart disease and stroke. And so, in the survey, we asked about the level
to which employers were screening for them. You can see that blood pressure is the
most commonly screened for condition, and cholesterol’s not far behind with
roughly the same rate as any other condition, such as diabetes, obesity, cervical
and colorectal cancer, etcetera. So, when we compare small employers
to those with 100 or more employees, you can see a much larger difference. Keep in mind that larger businesses typically
have more resources to offer their employees. And blood pressure screenings may be
more common because they’re cheaper and they can be easily offered
on-site, and don’t require lab work for blood draws like some other screenings. And with heart disease being the number
one cause for death in the country, seeing employers identifying
individuals with high blood pressure through their wellness programs is good news. So, looking at the screenings
from a geographical perspective, we see more blood pressure screenings occurring
in the central region of the United States. Within Nebraska, Iowa, Kansas, and
Missouri — those are the green states — 30% or more of employers are
offering blood pressure screenings. The southern and southeastern region of the
states from New Mexico to North Carolina — the orange states — are also seeing at least
a quarter of employers offering screening. Keep in mind that these are
not at state estimates. We took a regional approach to this question, so
it may be that the actual rate in one state was in the region, falls outside
the range for the entire region. taking a look at cholesterol
screenings, once again, employers in the central region offer screenings
between 25% to 34.9% more than any other region. This is fairly consistent with
the blood pressure screenings, which [inaudible] not quite as common. While 15% to 24.9% of employers in the majority of the states are providing
cholesterol screenings, it’s interesting to see the southeastern
region as one of the top providers. We saw the same with blood pressure. This area contains what is
known as the “stroke belt”. Where strokes occur more than 10%
higher than the national average. Several initiatives from top organizations,
including the CDC and the National Institutes of Health have targeted this
region in particular. So, it’s really encouraging to
see that employers are also trying to identify high-risk employees in these states. Let’s shift to employers who are providing
referrals to their — for their employees. The community preventative services task
force is a top public health organization that provides evidence-based recommendations for interventions aimed at
improving population health. In 2007, they recommended pairing
health screenings with feedback to change employee health as a best practice. This could be referrals for treatment,
or follow-up education and counseling. In terms of high blood pressure and
cholesterol, we can see once again, high blood pressure is taking the lead, even
if it’s not by much, amongst small employers. However, these numbers are still low,
and so we’re not seeing much success with referring employees once their
high risk factors are identified. Even the largest employers are
doing it less than half the time. So, again, there are more opportunities
for employers to help their employees. So, if screening and referrals lead
to identifying an employee at risk for heart disease, employers can help
their employees with keeping the condition under control through disease
management programs. We found that less than 20% of all
employers offered disease management programs for any conditions and most — almost 70%
— with a disease management program — are using multiple methods, including both
distance-based and in-person to engage and provide assistance to their employees. For employers with these types of programs,
19% target heart disease management assistance. So, as we continue to see a shift in the nature
of how work is done in the US, like telework and shift work, employers will likely continue
to rely more and more on multiple approaches to offering these types of programs. a disease management program can range
in intensity from providing information through brochures and videos to
coaching and counseling sessions. This slide shows that the level of disease in risk management information
dissemination is on-par with the rates we’ve seen
for screening and referral. Meaning, there’s still plenty
of room for improvement. This is one of the easier and cheaper ways to
impact employee health, but it’s not being done to a higher degree, so there’s plenty
of room for opportunities here. And so, working through the
continuum of prevention strategies, we started with primary prevention
through screening to identify employees at
high-risk for heart disease. Employers can build their programs to include
secondary prevention by referring those with high-risk for more education and treatment. And that’s the employers, and with tertiary
prevention strategies through coaching and counseling sessions, designed
to teach participants skills on how to make healthy lifestyle choices,
such as exercising more, proper diets, or managing their medications correctly. Here we asked if employers were providing
one-on-one counseling or coaching sessions as a follow-up to their screening. Small employers — those with
the 10 to 24 employees — rarely include these kinds of
sessions in their wellness programs. The strategy is one of the more
intensive methods, so we didn’t expect to see a lower rate, however, it is
one of the more effective strategies; certainly more than providing brochures. And I do want to mention that the
cholesterol sessions among employers with 250 to 499 employees’ data with fewer
respondents, so that data has been suppressed. So, I’ll end my portion of this presentation
with this slide, and some additional strategies to prevent heart disease for employers. In addition to education, screening
with referrals and counseling, work places can also make policy environmental
changes that can positively affect heart disease and stroke outcomes among their employees. If you remember, almost 48% of
employers have some sort of social and physical environment
component to their program. These kinds of strategies usually come
at little to no cost to implement. So, things like providing blood pressure
cuffs, having maps of measured walking routes, or making the majority of choices available in cafeteria healthy ones are supportive
strategies for employee wellness. If there is one message to take
away from this presentation, it would be that the most effective approach
is to blend individual risk reduction with policy and environmental supports. This will lead to healthier
lifestyle, creating an evidence-based and comprehensive health promotion program. If you can provide the five elements
I mentioned before, a supportive, social and physical environment, linking health
promotion programs, offering education program, integrating health promotion
into your organization structure and offering screening programs, then you’re
going to make a great impact on employee health. And from the data and strategies I highlighted
today, there are plenty of opportunities for improving employee heart health. And so with that, I will turn it back to Jason.>>Thanks, Sharda. Knowing which evidence-based strategies
employers can use to promote healthy lifestyles and reduce heart attack and stroke
among employees is very important. However, knowing and doing
are two separate issues. CDC has developed a one-stop online
database to help employers launch or expand a workplace health promotion
program, which contains hundreds of evidence-based credible
resources all in one location. Called the Workplace Health
Resource Center, or WHRC. The WHRC database currently has over 500
workplace health-specific resources with more than 20 focused just on heart
attack and stroke prevention. And that list will continue to grow. The free website includes case
studies, offering real life examples of organizations of different sizes. Resources on emerging issues
such as improving sleep quality to address health and safety at the worksite. Workplace health strategies
tailored specifically for the needs and issues of small business. Evidence-based summaries and issue briefs. And a suite of webinars and videos that provide
training, testimonials and promotional material. this easy-to-navigate website and searchable
database helps employers find actionable workplace health information,
guidance and tools, to develop or expand their workplace
health promotion programs. Bookmark the resource center
website at as new resources are added regularly. And again, this is where we will post
the archived version of today’s webinar, including the slides, as well as a companion
issue brief highlighting the heart disease and stroke data from the
Workplace Health in America survey. stay connected by checking to learn about new product updates and upcoming events. Follow us on social media to get the latest news
and updates via Facebook, Twitter, and LinkedIn. And finally, if you have any follow up
questions from today’s presentation, please email [email protected]>>That concludes todays webinar. Thank you to our presenters,
Jason Lang and Sharada Shantharam. And thank you everyone for joining us today. We appreciate your interest
in workplace wellness. On behalf of the CDC workplace health resource
center, thank you all for participating, and don’t forget to make wellness your business. Have a great day.

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