The Long Term Costs of Lifestyle Risks. Pathways to Change: A Case Study in the UK

1. Introduction

The focus of this paper is on improving health opportunities for the 40-65 age group – tomorrow’s older generation. The discussion takes place against a background of restrictions in funding: so that health services are likely to face a position in which demand rises by 25% over the next five years while funding in real terms rises by 5%. In this situation it is vital to take a preventive approach.

The evidence base is there for such preventive policies. First the positive benefits of exercise have been widely documented. Exercise has been found to be effective in treating and preventing a range of physical and mental health problems. To provide examples, research has shown that:

• People who regularly exercise have a 33 to 50% lower risk of developing type 2 diabetes.

• Exercise increases the efficacy of treatments for conditions as diverse as alcoholism, osteoarthritis and schizophrenia1.

• The overall risk of cancer for people who regularly exercise falls according to the frequency and intensity with which exercise is taken2.

• People who regularly exercise receive psychological benefits and physical activity is at least as effective in treating depression as medication3.

• The incorporation of exercise into treatment regimes gives patients a better sense of involvement in their care as it allows initiative and effort on their part.

• Physical activity could prevent up to a quarter of all falls in patients suffering from osteoporosis4.

• There is a link between mental health and physical health, as people with mental health problems are more likely to develop physical health problems, and vice versa5.

Improving physical health can also play an important role in improving employment outcomes. International evidence suggests that for the unemployed their mobility back into work is influenced by their health6.

Employment status can also influence health outcomes. Professor Harvey Brenner of the University of North Texas Health Science Centre studied the relationship between heart disease mortality and economic changes, including unemployment, in West Germany between 1951 and 1989. Professor Brenner came to the conclusion that increased unemployment and business failures directly increase heart death rates7.

The broader benefits from physical health are less often recognised. These benefits include individuals being healthier and at work more, productivity at work being improved and demand and funding pressures on the NHS being reduced8. As Dame Carol Black recognised in her Government-commissioned review of workplaces and health, in the UK “good health is good business” and a healthy workforce is good for workers themselves and for the economy9.

Other studies support the economic value of a focus on health in the workplace. Studies take a range of approaches and contain different assumptions (especially regarding how to value working time lost due to poor health) but all illustrate that the costs are of a high magnitude. For example:

• Research by PricewaterhouseCoopers has suggested that employee health programs have the potential to provide immediate returns in terms of decreased sickness absences10. It is estimated that 30 million working days are lost in the United Kingdom due to illness and injury and that this costs the economy £30 billion (approximately 3% of GDP). These losses fall disproportionately on small and medium sized businesses.

• Successful employee health programmes also tackle presenteeism (reduced performance and productivity due to ill health at work), which ensures that while individuals are at work they are more productive. Presenteeism, particularly from mental health causes, is estimated to result in 1.5 times as much working time lost as absenteeism and to cost the economy £15.1 billion11.

• Particular lifestyle traits can have a major impact on workplaces. For example, obese employees are twice as likely to experience high level absenteeism and 1.5 times more likely to suffer from moderate absenteeism as those of recommended weight12. Poor eating habits lead to a productivity loss of almost 97 million working days, worth £16.85 billion a year according to a BaxterStorey Workplace Productivity Survey13.

Successfully getting an employee fully integrated back into the workforce after a period of ill health is an integral part of a good employee health strategy. Most other developed countries devote considerable resources to these programmes and this is an area in which the United Kingdom has made insufficient progress14.

International evidence highlights the value of workplace initiatives on health. A review in the United States of 28 separate studies of health promotion in the workplace showed savings three or four times greater than the program costs15. A further study found that in the United States 65% of companies have a health and productivity strategy compared to 16% in Europe16. The research also found that 77% of multinational companies in the United States believe they can improve employee health and productivity.

There have been employer initiatives to increase staff motivation. One particularly successful example is the Global Corporate Challenge, in which small teams of employees compete against other teams globally in terms of steps walked over 125 days. The ideas of team working and competition have engaged the interest of employees.

Research on United Kingdom employers who have put in place programmes to improve the health of their workers has highlighted a number of key factors in shaping the success of these programmes. These factors include:

• Commitment at a senior level, particularly as financial resources may be required to cover the start up costs of programmes. Senior managers can also play a key role in signalling the importance of healthy lifestyles more broadly throughout their organisations.

• Services should be tailored towards individual working environments.

• Line managers should be aware of their role in preventing and effectively managing poor health.

• Healthy food choices should be provided, particularly in environments where employees are working long hours.

• Treatment is most effective when combined with flexible working practices and dialogue with employees who are out of the workplace.

A genuine concern with workers’ welfare underpins the adoption of employee health programmes. Companies that have introduced these programmes have also found that they improve their bottom line and save them money. For all of the cases discussed in this report the benefits to the participating firms have been clear. The measures introduced have improved both the attendance and productivity of employees:

• BT has reduced the number of days lost to illness from 2.8% to 2.4% between 2003 and 2008.

• EDF Energy reduced its work causal ill health rate per 1,000 employees from 1.68 to 0.49 between 2004 and 2007.

• GSK has saved £2.4 million through its mental resilience programme since 2002.

• Nestlé has reduced its sickness absence rate to 3.1% from 4.8%.

Not all employers are aware of the business case for employee health programmes. In particular, as well as the examples above, there is also a strong business case for employee health programmes for smaller firms. While many owners of small businesses recorded no impact on their business from sickness — 43% of respondents to a Federation of Small Businesses survey reported that they had not experienced any sickness absence in the past twelve months — small and medium sized business are more likely to feel the potential effects of sickness absence, particularly as finding covering staff can often be problematic17. The potential benefits of a healthy workplace are compelling for companies of all sizes. The benefits of this agenda are increasing as employers are faced with ageing workforces in line with an ageing population.

Nick Bosanquet: Professor of Health Policy, Dept. of Bioengineering, Imperial College, London.
Helen Rainbow: Senior Research Officer Health, REFORM, London.
1 Daley, A. (2002): “Exercise therapy and mental health in clinical populations: Is exercise therapy a worthwhile intervention?”, Advances in Psychiatric Treatment, 2: 263.
2 Davey Smith G., et al. (2000): “Physical activity and cause-specific mortality in the Whitehall study”, Public Health, 114:308-315, in Department of Health (2004): At least five a week: Evidence on the impact of physical activity and its relationship to health, 59.
3 Department of Health (2004): At least five a week: Evidence on the impact of physical activity and its relationship to health.
4 Vuori I. (2001): “Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis”, Medicine and Science in Sports and Exercise, 33: S551-S586 and S609-S610, in Department of Health (2004): At least five a week: Evidence on the impact of physical activity and its relationship to health.
5 Royal College of Psychiatrists (2008): Mental Health and Work.
6 Jusot, F. et al. (2008): “Job loss from poor health, smoking and obesity: a national prospective survey in France”, Journal of Epidemiology and Community Health, vol. 62.
7 Lambert, V. (2009), “Are you suffering from Recession Flu”, Daily Telegraph, 26 January 2009.
8 Association of British Insurers (2005), Improving the Health of the Working Population.
9 Black, C. (2008), Working for a Healthier Tomorrow.
10 PricewaterhouseCoopers (2008), Building the Case for Wellness.
11 Sainsbury Centre for Mental Health (2007), Mental Health at Work.
12 The Oxford Health Alliance (2008), The OxHA Workplace Health Programme.
13 Business in the Community (2008), Nurture and Grow: Your People, Your Business.
14 Association of British Insurers (2005), Improving the Health of the Working Population.
15 The Health Project Consortium et al. (1993), Reducing health care costs by reducing the need and demand for medical services.
16 Watson Wyatt (2006), Adopting a global healthcare benefits strategy.
17 Federation of Small Businesses (2006), Health Matters: The Small Business Perspective.

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