Public policy initiatives may lend support to work site health efforts
Nine health policies aimed at preventing 1.6 million U.S. deaths
At first glance, the connection may not seem so clear: A report is made to a congressional committee recommending public policies to prevent premature deaths and reduce health care costs. But look a little closer, and you’ll see that the organization presenting the report, the Washington, DC-based Partnership for Prevention, has a membership roster that includes major corporations such as Dow Chemical Co., Eastman Kodak Co., Union Pacific Railroad, and Eli Lilly & Co. (A complete listing of members can be found on p. 63.)
The Partnership’s overriding goals are "to shift the near-total emphasis of the U.S. health care system on the treatment of illness to give prevention equal priority, and increase the resources and incentives that will lead to the adoption of effective preventive approaches."
The study was commissioned by the Partnership for Prevention in 1998 in response to a request by the Congressional Prevention Coalition (CPC) to answer this question: Which policies have the greatest potential to prevent the most disease and injury? The following is a selected summary of the Partnership’s recommendations, which, it says, would save about 1.6 million lives in the next decade:
• Tobacco use: Enact a significant increase in the federal excise tax on tobacco products. Ban smoking in enclosed public places, such as workplaces, shopping malls, and restaurants. Estimated lives saved: over 240,000 per year.
• Alcohol abuse: Establish uniform nationwide drinking/driving laws; enact a significant increase in the federal excise tax on alcoholic beverages. Estimated lives saved: about 6,500 per year.
• Overweight children: Create financial incentives for states to require daily physical education classes in secondary schools. Estimated lives saved: 3,750 per year.
• Gun control: Enact a national handgun licensing and registration system operated by the states. Estimated lives saved: about 775-1,297 annually.
• Fluoridation: Create financial incentives for communities to develop water fluoridation systems. Create programs to increase use of fluoride rinses and/or dental sealants.
Although the report includes a series of policy recommendations, "Political viability was not a criteria," asserts Ashley Coffield, MPA, president of the Partnership for Prevention. "Our study took about a year and a half, and was the result of an impartial and scientific process. We wanted our recommendations to have high marks based on three criteria: strength of the evidence supporting the policy’s impact on health; the amount of disease and injury addressed by the policy; and finally, the cost of the policy. We interviewed dozens of experts, researched the literature, and built a catalog of 200 policy options. Then, our advisory committee narrowed the list to nine." (The American people may not have nearly as good a handle on what’s really killing them as they think. See article, left.)
Each of the nine issues has broad consensus from experts and evidence that a substantial amount of disease and injury could be eliminated at a relatively low cost, Coffield adds.
Does your program look like this?
While tobacco use is high on the list of many health promotion professionals, and alcohol and drug abuse are addressed through a number of employee assistance programs, a scant few (if any) have incorporated gun safety, fluoridation, or even childhood obesity into their work site offerings. Should they? Do issues like those have a place in work site health promotion?
"The simple answer is yes,’" says Dennis Richling, MD, assistant vice president, health services, for Union Pacific Railroad, in Omaha, NE. "When I looked at these [issues] for the first time I had my doubts, but as I stepped back, I realized we’re in this time period where our understanding of what health promotion is all about is broadening. It’s about more than just the prevention of physical disease; it’s about emotional diseases, and quality-of-life issues.
"We as companies work to prevent cardiovascular disease and cancer in part because they have an impact on the bottom line," he continues. "But what we are ultimately trying to end up with are more productive employees. So whether the issue is gun control or childhood obesity, or a tax on alcoholic beverages, these are the kinds of issues that need to be addressed in our community. And our employee community extends into the greater community."
It makes good economic sense, as well, Richling continues. "Look what the [stock] market continues to reward: companies like GE that are innovative, with a vital work force that is able make good decisions," he says.
It’s interesting, notes Coffield, that while many workplaces identify the wearing of seat belts as a health issue, few if any do the same with gun safety. "Yet, gun violence is a public health issue," she asserts. "One idea we’ve been promoting is working with life insurance companies to set premiums based on whether guns are stored properly in the home. If you don’t have a gun safe, your premium goes up." Health promotion professionals interested in speakers on gun safety should contact the Handgun Control and Center to Prevent Handgun Violence, says Coffield.
As for fluoridation, "There’s a connection between oral health and heart disease — a strong theory," Coffield says. "But it’s certainly a quality-of-life issue, if not premature death. Cavities that occur in childhood are irreversible, and employers end up paying for that later in the form of bridgework.
"An organization in Chicago called Oral Health America could give you information about fluoridation," she adds.
Employers also end up paying for health problems that begin with overweight kids, Coffield asserts. "Physical activity habits begun in adolescence can last a lifetime; if you’re sedentary as an adolescent, you’ll be sedentary as an adult. We picked childhood obesity because we think properly addressing the issue will have a lifetime benefit."
She recommends that employers join forces with a local public health agency, or groups like the American Cancer Society or the American Heart Association to offer exercise programs for employees’ children after work or on weekends.
"Physical activity really falls off in the teen years, but those kids can drive to their parents’ offices," she says. "And that’s why we want to create financial incentives for states to provide daily physical education in secondary schools."
Complementing work site efforts
Initiatives in the public area can serve to support and complement work site health programs, notes Coffield. "There would certainly be a cost benefit," she declares. "My understanding is that the No. 1 cause of workplace death is injury. We have two alcohol policies — one on drinking and driving and a tax on alcohol — that will reduce consumption among heavy drinkers, the ones who most often cause injury. So, policies like these would complement and support behavioral efforts.
"We try to effect behavior change with these policies," she continues. "If you ban smoking, the number of cigarettes smoked each day goes down. In restaurants and bars, exposure to secondhand smoke goes down. There’s a lot of good evidence that 30,000 to 40,000 people die each year from secondhand smoke."
Richling agrees. "There’s been a lot of public activity with regard to smoking. At the same time, we’ve pursued a transition from smoking bans in buildings that contained separate smoking rooms to the point where now we don’t allow smoking in any of our rooms — or even in our company vehicles," he says. "All of this became easier and more possible through the changed [political] environment around us."
Neither Coffield nor Richling is recommending that wellness professionals start pounding the pavement to lobby for preventive health initiatives, but there are ways to become active and support work site efforts at the same time. "For example, it made sense for us to become involved in agencies that work to reduce smoking," Richling says. "I became involved with the American Heart Association, and helped influence the direction in which they were heading. If you look at the data on smoking over the last seven years, it has gone down in the U.S. population."
"We haven’t asked any of our member companies [to lobby]," says Coffield, "but support of our goals is implicit in their membership. We don’t provide them any benefits; they’ve joined because they felt it was the right thing to do. They know we’re out there doing good work, and they support us financially." Coffield notes that the Partnership for Prevention is involved in a far broader range of activities than just policy initiatives.
One size doesn’t fit all
A health promotion professional’s political involvement is an individual matter, adds Richling. "From a company standpoint, a business decision needs to be made on what to spend your time on," he says. "Not one size fits all."
The Partnership for Prevention, he adds, "Has taken care of a lot of community issues and moved forward to complement what we are doing internally. As employers, we truly feel we are being supported."
Is there any chance the Partnership’s initiatives will be enacted? "Some bills are out there," says Coffield. "For example, the PAP [Physical Activity for Progress] act sponsored by Sen. [Ted] Stephens of Alaska. We also hope Congress acts to give the FDA authority over tobacco. But some others, like the alcohol tax and handgun licensing, are very contentious." n
• Ashley Coffield, Partnership for Prevention, 1233 20th St. N.W., Suite 200, Washington, DC 20036. Telephone: (202) 833-0009. Fax: (202) 833-0113. Web site: www.prevent.org.
• Nancy Hwa, Handgun Control and Center to Prevent Handgun Violence, (202) 289-5785.
• Robert Klaus, Oral Health America, (312) 836-9900.
• Dennis Richling, Union Pacific Railroad, 1416 Dodge St., Omaha, NE 68179. Telephone: (402) 271-4326.
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