2003 Planning Meeting

Background:

Goals of the Initiative: The current economically active half of our population spends about 40% of its waking hours in the physical environment of work, where substantial social interaction also takes place. Many of the economically inactive are retired or disabled from this environment as well, and carry its impact for good or ill. Others are dependents of people at work. On work time, people are organized by time and place to receive health services and messages, and are subject to some authority to direct their attention. These features make the workplace a significant locus for “health promotion,” defined as interventions to address lifestyle factors putting persons at increased risk of illness. Lifestyle factors consist of clinical entities such as high blood pressure, diabetes, depression, characteristics such as overweight, and behaviors such as diet and smoking. “Health protection” may be defined as modifying the physical and social environment at work to reduce risk of illness both by direct impact, as with chemical exposure or ergonomic stresses, and indirectly by impact on the host factors listed above.

Necessary activities for the initiative include:1) the generation of strong partnerships with agencies and institutions not already well-associated with NIOSH and traditional workplace safety and health; 2) capacity building, possibly via development of a new core program in universities with federally funded university graduate programs in both health promotion and workplace safety and health; 3) sharing of examples of current successful models in large, medium and small businesses and of the “business case”; 4) research and demonstration projects that address: a) the economic question whether investment in integrated health protection and promotion generates savings over the long-term, b) an understanding of barriers for employers and of what works, and c) improved understanding of relationships of major health outcomes and work; and 5) consideration of societal aspects such as immigrants and other workers missing from the initiative.

Potential approaches to advance a sustainable initiative include: 1) Using the NORA stakeholder approach to gather partners; 2) meetings with trade associations and labor to understand issues and to gain demonstration partners; 3) media involvement to generate excitement and share knowledge widely; 4) getting support of national opinion leaders; 5) sharing of funding by agencies to support new university-based core programs in integrated health promotion and health protection; 6) exploration of possible roles with insurers, the Social Security Administration and CMS; 7) considering major changes needed for sustainability, such as Congressional support for demonstration projects as, for example, tax breaks for employers using integrated health protection and promotion as a strategy to reduce long-term disability payments.

Potential partners and co-sponsors of an integrated initiative include new and existing NIOSH partners. There should be small meetings and involvement of these partners prior to the October conference, and the conference should be co-sponsored by many partners. A NORA-like approach could bring partners. It was felt by the group that these partners and ultimately Congressional support are essential for a genuine national sustainable integrated initiative. Potential partners include:

• NIH (NCI, NIMH, NIDA, NIAAA, NIA, NICHD, NIAID, NIDDK, NHLBI, NIDCD, NEI, NINDS, NIEHS, FIC, NLM, NIAMS, NIGMS, NINR, NCMHD)


• HHS


• Other CDC Centers


• CMS


• ARHQ


• Social Security Administration


• Military


• Veterans’ Administration


• Small Business Administration


• IOM


• Gates Foundation


• Insurers


• Universities ( NIOSH ERCs and those with health promotion programs funded by federal agencies)


• Business organizations


• Labor


• Psychologists/social scientists


• Business schools


• Health promotion business groups