Oct 4 2011
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Employers Join Community Health Movement: NewPublicHealth Q&A

JeffLevi_AndrewWebber Jeff Levi, Trust for America's Health, and Andrew Webber, National Business Coalition on Health

Employer and public health communities have a shared vision: better health and productivity for their employees and community members. Employers are now expanding their efforts from work site health promotion to community-wide health efforts, in partnership with public health and other community stakeholders, to ensure their employees and employees' families have access to an environment that makes the healthy choice the easy choice -- both during the work day and beyond.

NewPublicHealth spoke with Andrew Webber, President and CEO of the National Business Coalition on Health, and Jeff Levi, Ph.D., Executive Director for Trust for America’s Health, about the critical role of employers in community prevention efforts.

NewPublicHealth: Workplace is a critical venue for improving health. But what makes it important to involve businesses in community health efforts outside their walls?

Andrew Webber: In terms of optics at the community level, it says that improving community health is not just the responsibility of the traditional public health community. It is too broad a challenge for that. For us to be successful, we need every stakeholder group involved in making contributions. Each one of us in the community has both a responsibility and can benefit from population health. This is an agenda that we all share.

For the business community, it selfishly comes down to workforce health and productivity as being a business imperative, a competitive asset – something that is critical to the success of a business organization. We’re hoping more businesses understand that the health of their workforce is impacted by community dynamics. Yes, an employer can do a lot in terms of worksite wellness and health promotion programs with the eight hours of the day that they have individuals at work. But if those individuals then go home to unhealthy communities, violent communities, poor public school systems, no parks and recreational facilities, that’s going to have a huge influence on workforce health. And also, obviously, a huge influence on the talented labor pool you can draw on today and tomorrow.

Jeff Levi: The healthier the community, the healthier the people and employees within that community. Employers should help employees make healthy choices and can do so by providing incentives and other rewards for fitness and good health. To make a lasting impact, these steps must be reinforced where people live and spend time with their families, friends and neighbors. Access to parks, bike paths, safe walking routes, healthy foods, etc. provide positive ways to complete wellness and health-related efforts initiated in the workplace.

And for small employers, community prevention is even more important. They may not be able to fully develop workplace wellness programs, but through community-based prevention they too can achieve cost savings and increased productivity for their employees.

NPH: What are some of the challenges in collaborating between public health and business? How do we overcome them?

Andrew Webber: We talked about this in our recent article, “Improving Population Health: The Business Imperative,” published in the Preventing Chronic Disease journal. There are even language barriers and misconceptions. On our side, the business community we think of public health as the folks out there trying to regulate us. And then the public health community looks at us as those terrible people who create stressful worksites and unhealthy products. There’s a conversation that needs to be had to overcome those barriers, and to get everyone to realize, again, that we share this common goal of population health improvement. And not because we’re good people or because it’s written into our mission statement, but because we have a self-interest to work on this agenda together.

A big critical issue that is of particular importance to the business community is they want to know that some of these community strategies are evidence-based and have some opportunity to work to move the needle. Building the evidence-based community prevention strategies, which I know CDC and Robert Wood Johnson are working on, is part of the challenge as well. It’s also about getting buy-in from the leaders. Increasingly, in their first stage of awareness, they understand that health and productivity is important and they have therefore invested in worksite health promotion programs but it is a leap to say it’s time to take leadership and make investments in community health strategies. But that’s what we’ve been encouraging our member coalitions and our unique employer-based infrastructure at a community level to do.

Jeff Levi: Speaking from the public health perspective, there are several challenges to overcome – but they are not insurmountable by any stretch. They include:

Breaking through silos: Public health and business often exist in silos but have common goals in improving health: learning to listen and speak to each other effectively is critical to success.

Showing results: The public health community must frame their work in results – e.g. how smoking cessation improves health and ultimately health care costs and the benefits of programs that are already making a difference.

Using data effectively: A recent study published in The Lancet makes a strong case that slight reductions in BMI can result in significant cost savings. These data can demonstrate to business why it’s important for them to engage and invest in a comprehensive approach to prevention and wellness.

NPH: What about the cost of investing in community prevention? Is it worth it for businesses?

Andrew Webber: At one level, you say, what’s the cost of not investing? Because I think business leaders can get that there is a very important and critical community-wide environmental influence on health and productivity that needs to be addressed. They can connect those dots. This is hurting your health and productivity. You’ve got a sick workforce, you’ve got a delivery system that’s broken, that by the way you’re paying for. You can have leverage as a purchaser to leverage improvements. What we’re trying to say is it is worth your while to be investing first place in the workplace, because that’s where you have the most influence. That’s where you can create a culture of health, and you’ve got the captured audience. But now it’s time to be thinking about smart investments at a community level.

Jeff Levi: The data are compelling: more than one-quarter of health care costs are related to chronic diseases – such as heart disease, stroke, diabetes, and some forms of cancer. Lack of physical activity, being overweight or obese and substance abuse are each contributing factors to poor health and chronic diseases. Workers with one or more chronic conditions average two to four times as many lost work days as employees with no chronic conditions. The indirect costs to employers of workers with poor health can be two to three times the direct medical costs.

Studies, including Prevention for a Healthier America that TFAH developed, show that a small strategic investment in disease prevention could result in significant savings in U.S. health care costs. Our study concluded that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1.

NPH: How would you suggest public health officials get started in involving businesses in their community health efforts?

Andrew Webber: First, I would advise the public health community to understand that the business employer community is a key constituent and needs to be at the table. And not just in terms of workforce and worksite health promotion strategies, but you look at all the determinants of health – job creation, environmental influences, the healthcare delivery system that needs to be transformed to focus more on prevention, that the business community pays for – they can be an influence on all the things that need to change.

Regarding how to get them at the table, we’ve started with very practical things. Speak their language, with health and productivity as the goal. If you’ve got an employer-based coalition in your market with staff that is focusing 100% of their time on health and healthcare, you’ve got an entry into the business community that’s been thinking about these issues. Draw that coalition in, or other business associations. We have 53 business and health coalitions that are NBCH members, but there are other associations and chambers of commerce you can approach. In approaching individual employers, know who speaks this language. Health benefits people, for example, health promotion directors and corporate medical directors at larger employers.

Also bring your resources to the table. I think of the treasure chest of resources at CDC or the data a local public health department has on the health of the community. Some of the tools, data, resources, program evaluation skills that reside in traditional public health are resources that would be of interest to the business community.

And offer practical solutions. For example, particularly smaller employers are struggling with how to do these programs and they are totally unaware of the resources that may exist in the community. In some communities, the public health department is actually putting that together in a menu form. Go in with the answer.

Jeff Levi: Recently, TFAH has been doing a significant amount of outreach to the business community because of the synergy between workplace wellness and community-based prevention and wellness efforts through initiatives like the recently announced Community Transformation Grants as part of the Prevention and Public Health Fund. So, here are a few places to start:

Research: Start with researching business organizations and/or companies to find out where your areas of common interest are and what they already doing in prevention/wellness.

Develop approach and/or asks: Know what you want (your long-term goal) and take steps to move toward the goal. It will be a build or work-in-progress, but you want to take small steps that will move you in the right direction.

Be prepared to share success stories – even if they aren’t your own: Be prepared to demonstrate relevance of what’s happening in your community/state that’s working well, or how another community/state is making an impact through partnerships that you can replicate.

NPH: What are some of the strategies that have been proven to work in community-based prevention programs that collaborate with employers?

Andrew Webber: Through our Community Health Partnership seed grants, we award coalitions that are working with other stakeholders on community health strategies. The initial phase was simply for our members to establish a dialogue between our employer-based coalitions and the more traditional public health community. These are worlds that are sort of independent of one another, and yet we were convinced that they share a broad, population health improvement goal and should be talking to one another. The next phase is leading to some projects and activities where they could actually start to do something at a community level together. Here are some of the projects we’ve seen through our seed grant program:

  • Wichita Business Coalition on Health Care for diabetes prevention. WBCHC in partnership with the Sedgwick County Health Department and the Health & Wellness Coalition of Wichita developed a program called Healthy Wichita, based on the Partnership for Prevention model.
  • Employers Coalition on Health in Rockford, IL for childhood obesity prevention. This program provides after school programing for students to participate in activities at the Blackhawk Boys and Girls Club.
  • New Jersey Health Care Quality Institute’s Mayors Wellness Campaign for weight loss. The Mayors Wellness Campaign (MWC) was created to equip mayors and other key leaders with the tools to develop and implement active-living initiatives in their communities.

Jeff Levi: We have recently seen many good examples of strategies and efforts specifically in Minnesota and Indiana. In Minnesota, the Alliance for a Healthier Minnesota includes state-based corporations working together with the Department of Health to improve the health and well-being of residents. The Alliance harnesses the power and influence of Minnesota’s employers to engage community members in wellness-related programs and efforts.

In Indiana, the Indiana Tobacco Prevention and Cessation Commission has cultivated an employer network that is taking a leadership role on this important issue. The employer network is now made up of over 400 businesses that have leveraged the resources of the commission to reducing smoking rates in Indiana.

NPH: Anything else to add about employers and public health working together?

Andrew Webber: The punch-line is that the business community has a strong self-interest in being at the table. Other stakeholders need to understand how important the business community is to community prevention efforts. This is a leap, this is difficult work. Establishing multi-stakeholder community collaboratives isn’t an enterprise that comes together magically overnight. We need to work on it, identify opportunities, and implement evidence-based strategies. We all need to have patience in knowing this doesn’t happen quickly. I think it’s very exciting though. Getting the key stakeholders at a leadership level, at a community level, is foundational.

Tags: Business, Community Health, Nurses and Nursing, Prevention, Public Health Departments, Public and Community Health, Q&A