2003 Planning Meeting

Summary
The Workgroup had a spirited dialog exploring the barriers to achieving an integrated approach to health protection and health promotion, identifying numerous barriers, strongly supporting efforts to overcome them, and offering specific suggestions for short and longer term actions in support of the effort.

• Fragmentation of the health care system. Economic benefits from improved protection and prevention may not translate into cost savings by those paying for the improved protection and prevention. Financial support for health protection is rarely available through the traditional health care funding mechanisms; funding for health promotion is spotty at best.



• Within larger enterprises, those responsible for health protection are often disconnected from those (if anyone) responsible for health promotion. If there is a connection, the drawing of resources from a common pool results in the two approaches being seen as competitive rather than complementary.



• While, in theory, there are innumerable interested stakeholders, they do not interact effectively with one another on these issues. (see listing of stakeholders, below)



• Inadequate connections, communication in the relevant scientific communities. Collaborative, multidisciplinary research providing credible evaluations of benefits is rare but needed.



• Federal funding for prevention research (including funding for relevant intervention effectiveness studies, research and demonstration projects, translational research, etc) is limited and rarely supports consideration of comprehensive approaches to improvement of worker health through integrated approaches.



• Credible research demonstrating the benefits (particularly the economic benefits) of workplace approaches to protection and prevention is limited; standardized metrics and approaches would be useful. Health benefits of some behavioral goals have not been clearly shown.



• HP 2010 goals and metrics are not comprehensive for health protection at work and do not motivate attention to this area.



• Federal organizations with presumed common interests do not work with sufficient communication and coordination and, in fact, seem at times to those on the outside to be operating at cross purposes.



• Health protection approaches include both carrots and sticks and tend to be regulatory/standard setting in form although voluntary in practice. Health promotion approaches may incorporate incentives but are fundamentally voluntary.



• Certain worker groups with the poorest health status work in circumstances least likely to provide either protection or promotion.
  Opportunities

Many barriers, by definition, suggested one or more opportunities to move this effort forward, with the exception of reducing fragmentation in the health care delivery system which, while an important barrier, was seen as well beyond the scope of this initiative.

• The knowledge base (what has been done, what has been studied, what has worked) needs to be comprehensively summarized and communicated to key stakeholders.



• Successful programs (best practices) need to be identified and their approaches and the reasons for their success communicated. Seek data-driven business models. Identify existing metrics and models that translate across different enterprises.



• Federal efforts should be coordinated with improved communication within the federal family and consideration of coordinated policy development, implementation, and funding of relevant research.



• A comprehensive research agenda should be developed with priorities identified.



• Break down “silos” in the research community by supporting multidisciplinary research incorporating diverse skills and professional disciplines involving health scientists, epidemiologists, behavioral scientists, economists, engineers, etc



• Interact with employer coalitions to learn more about both barriers and opportunities.



• Provide leadership to convene diverse stakeholders to design and promote an initiative in this area.



• Explore the OSHA VPP to see if there are models for success.



• Consider establishing a national award for demonstrated success.



• Look for approaches taken by other successful campaigns such as the National Dialogue on Cancer which focused on engaging CEOs to lead the charge.

Partnership Opportunities

A large but incomplete list of potential stakeholders was identified during a brief brainstorming session. Those listed below might have a interest in various stages of the initiative:

• CDC, particularly the NCCDDP


• HHS/Office of the Secretary & HP 2010


• OSHA, including the VPP


• Insurance companies (health & comp)


• ACOEM, AAOHN, AOEC


• Professional organizations with health promotion or health education focus (?HERO)


• Federal O
H

• OPM, GSA


• AARP


• COSH groups


• Unions, AFL-CIO, CPWR, and other labor organizations, associations, and coalitions


• Small business, NFIB, Chamber, other associations and business coalitions


• Business schools


• Primary care physicians and their organizations


• “Wellness” vendors, and their trade associations (Wel/COA?)


• Academics: public health, economists, occupational health, health education and promotion researchers

Opportunities for action:

Short term

• Develop and move for adoption of a relevant objective for HP 2010 as part of the current review and mid term adjustment


• Add one or more questions to a current Federal survey concerning workplace health promotion programs in order to have the data for the 2010 objective


• Establish an award recognizing best practices in this area


• Improve federal coordination; gather federal partners


• Explore engaging CEO leadership from major employers with exemplary programs

• Conduct broadly inclusive national symposium as a launching pad for a multi-year (3-10 year) initiative


• Seek coordinated federal and private (foundation) funding for research, as well as research and demonstration and evaluation projects


• Promote (and fund) multi-disciplinary Centers of Excellence in academic/public health institutions to take leadership in improving the knowledge base needed for expanded innovative efforts at integrated health protection and health promotion and policy development.


• Identify and advocate for policy and other changes needed to overcome barriers.