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Employers Can Prevent Loss of Lives and Dollars

By Francois Millard, chief actuarial officer, Vitality Group

The start of a new year comes with many personal health aspirations. It is also a good time for businesses to think afresh about the importance of health within the workplace, as well as how our actions and products impact the health of the communities we live in or the consumers we serve. All of which ultimately impacts the health of our country.

Our preferred measure to gauge the health of our country and how we compare to other countries is Disability Adjusted Life Years (DALYs). It is used by the Institute for Health Measurement and Evaluation (IHME) at the University of Washington as the primary metric supporting the Global Burden of Disease[1] studies. It estimates the impact of disease by looking at both the years of life lost as a result of premature death, and the years lived in sub-optimal health, or disability, as a result of disease. Data released in October showed that for 2015 DALYs in the US amounted to 88.6 million (healthy years lost), up from 83.4 million in 2010. On a per capita basis, the US ranks 28th out of 35 Organization for Economic Co-operation and Development nations[2].

This result might come as a surprise, given consistent improvement was seen in US life expectancy over a number of decades. For many years the increase in US DALYs came from people living longer, but with higher levels of disease. However, a recent paper in The Lancet[3] shows how the US, unlike other high-income countries, has seen mortality rates plateau in 2010 and increase slightly in 2015, possibly because of rising premature mortality. These increases were mainly attributable to accidental deaths (primarily drugs), chronic liver disease and cirrhosis, and suicide. The authors noted that the magnitude of annual mortality increases in the US is extremely unusual in high-income countries, and a rapid public health response is needed to a
vert further premature deaths.

The news doesn’t improve from there. Another study[4] from IHME in December 2016, co-sponsored by the Vitality Institute, expands the view of disease from DALYs and introduces the direct healthcare spending associated with 155 conditions. It shows diabetes as the highest cost disease. Along with low back and neck pain, diabetes represented the biggest driver of increased cost. Overall 20 of the 155 conditions account for more than 50% of the $2.1 trillion US healthcare spending evaluated.

These numbers on the impact of disease on people’s lives and direct health cost is a renewed call for action. A typical action is targeted at how to improve the healthcare system, which will likely also dominate solutions to be considered in repealing and replacing the Affordable Care Act, but such actions under weigh the importance of effective health promotion and prevention in creating a sustainable and affordable healthcare system. Employers can contribute directly by facilitating healthy behaviors at and outside of the workplace.

Here are some practical initiatives to consider as 2017 progresses:

  • The biggest increases in healthcare spending currently stem from conditions impacting the working age population. These are preventable through targeted programs. It starts by knowing the demographics, behaviors, health care utilization and cost of the population you are serving. These characteristics could vary significantly by region and location, and good internal tracking and transparency could improve executive support and resource allocation to support your initiatives. In addition, consistent external reporting, such as what has been recommended by the Vitality Institute Commission[5] will help establish best practices, shared learnings and broader awareness that human capital is both an input and an output of a company’s performance.
  • Foster a culture and environment that is supportive of healthier choices. In The Paradox of Disease Prevention[6], Dr. Harvey Fineberg offers strategies to help overcome the obstacles that make prevention difficult to put into practice. They include some of the following: pay for preventive services; promote health in the workplace and provide incentives to employees to maintain healthy practices; make prevention simpler, lower in cost, and less dependent on individual action; use policy to reinforce choices that favor prevention and use multiple media channels to educate and strengthen healthy habits. Many of these strategies rest on sound behavioral economic principles that can help employers make healthy choice an easier choice in and outside of the workplace.
  • There are established linkages between workplace health and the health of the greater community. By targeting specific health issues in your community, it is possible to improve more than just the health of your business. A report[7] funded by the Robert Wood Johnson foundation and compiled by the Vitality Institute shows how businesses can use a mix of strategies to improve community health—engaging in strategic philanthropy, exhibiting corporate social responsibility, and extending workplace health strategies to the community.

As we craft our plans for 2017, let’s make health both a personal and collective priority, base our actions on evidence, and do so with urgency.


  1. http://thelancet.com/gbd
  2. http://ihmeuw.org/3zib
  3. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30187-3/fulltext
  4. http://jamanetwork.com/journals/jama/fullarticle/2594716
  5. http://thevitalityinstitute.org/projects/health-metrics-reporting/
  6. http://jamanetwork.com/journals/jama/article-abstract/1707727
  7. http://www.rwjf.org/en/library/research/2015/07/beyond-the-four-walls–why-community-is-critical-to-workforce-he.htm
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