We have a lot of choices to make about our diet.
Add to that, doing the right thing
when it comes to preventing
and treating a chronic disease,
fighting a virus, or losing weight,
and suddenly our nutrition choices
can seem almost overwhelming.
Well, I’m here to help.
Welcome to the Nutrition Facts Podcast.
I’m your host, Dr. Michael Greger.
Today we take a look at how some employers
are taking steps to help us become healthier.
In our first story, we look at how workplace wellness programs
report an average ROI of 3,
returning $3 for every $1 invested.
An impressive number of studies have shown that lifestyle is
the root cause of what ails us, particularly for chronic conditions.
The studies also show that changing one’s lifestyle can have
a dramatic effect on health improvement,
both in the prevention and treatment of disease.
So, given the benefits of lifestyle medicine interventions,
it would seem that our health care system
would rush to embrace this movement;
however, little could be further from the truth.
Now, I know we have a for-profit healthcare system,
but even just from a dollars-and-cents perspective,
it may make sense—and dollars!
A majority of Americans have health care insurance through their
employers, the cost for which is rising at an alarming rate.
Health insurance premiums continue to go up year after year.
Unfortunately, all the money we’re spending has not translated
into healthier employees or healthier Americans.
We spend more on healthcare per person by far,
yet the U.S. population is not healthy.
By 2014, our life expectancy had slipped down to 43rd in the world.
And since then, our life expectancy declined year after year.
It’s not just that other countries are doing better,
we now may be living shorter and shorter lives.
And unhealthier lives—again even just from a financial
bottom-line perspective, hundreds of billions
in productivity lost, beyond all the healthcare costs.
One employee gets diabetes, and it costs
about $10,000 more per year.
So, if a self-insured company
could prevent or reverse that case, they could save
the company a lot of money, raising the possibility
that workplace wellness programs could not just be cost-neutral,
in other words pay for themselves, but actually save
the company money, even make the company money.
This brings up the concept of ROI, or return on investment.
That’s how much money you get back for every dollar spent.
So, an ROI of 3 to 1 means every dollar you spend yields $3 back;
so, by investing in such a program you’d end up tripling your money.
You don’t know though... until you put it to the test.
Johnson & Johnson, for example, claimed that investing
in employee wellness yielded around 2 to 4 dollars
for each dollar they spent.
Citibank estimated their return on investment
was $5 saved for every dollar spent.
A compilation of a handful of such studies found an average ROI
of more than three dollars of healthcare cost savings
for each dollar spent on health promotion.
A more recent review including more than 20 studies came up
with a return on investment exceeding 5 to 1,
though an even more recent review out of Harvard looking at
more than 30 studies found the ROI closer to three dollars.
Spend one dollar, get three back. Not a bad deal.
One heavy manufacturing company reported an outstanding
34-to-1 return on investment,
and that’s just direct healthcare costs.
Some of their indirect costs, like lost workdays and disability,
fell even more.
Then, you can imagine other potential benefits—happier employees,
more productive employees, making them more likely to stick around.
So, do companies that invest in health promotion
have a competitive advantage?
Publicly traded companies that got
Corporate Health Achievement Awards outperformed
the S&P 500 by 40 percent.
C. Everett Koop Award winners
outperformed the S&P 500 two to one.
Those scoring higher on workplace
health promotion best practices, same trend.
And the same thing most recently with companies
investing in an internal culture of health.
Of course, instead of healthier employees leading to
a more profitable company, maybe more profitable companies
have more money to spend to make employees healthier.
Is there a link between stock market price growth
and having a great employee wellness program?
Maybe, but correlation doesn’t mean causation.
Maybe prioritizing wellness is just a sign
of a great management team, and that’s the real reason
they’re raking in the dough.
Even most of the ROI studies lacked an adequate control group.
You can’t just compare the costs of employees that signed up
versus those that didn’t, because maybe healthier people
are just drawn to such programs in the first place.
That’s why you need randomized clinical trials to really
put it to the test, which we’ll cover, next.
How much is a human life worth?
Ideally, we’d like to think there is no price tag.
Each precious life is of inestimable value,
but there are limited resources and policy decisions to be made,
which leads to fascinating papers like this:
the cost effectiveness of 500 life-saving interventions,
587 to be exact, with some costing more than 10 billion dollars
per year of life saved.
Overall, the average intervention costs $42,000,
which is how much it costs to save a year of someone’s life
putting flashing lights at railroad crossings.
So, how could you justify not installing them?
Well, you could save more lives with the same money
if you added grooved pavement on highways.
But if you really cared about saving drivers, you could save
nearly a hundred times more lives investing the same money
in media campaigns to encourage people to wear their seatbelts.
But if you really want value, if you want to prevent
bangs for the least bucks, there are some interventions
that save more resources than they cost.
Yeah, most interventions cost $10,000 or more per year
of life saved, but check out these.
Studies, for example, suggest
“Workplace Wellness Programs Can Generate Savings.”
Not just saving more than you’re spending but potentially
tripling your money by investing in wellness.
But since employee participation is almost always voluntary,
this introduces the specter of selection bias,
where healthier people are just drawn
to wellness programs in the first place.
And indeed, during the year prior to a wellness intervention,
those who would later sign up already had lower
medical expenditures and healthier behaviors
than future nonparticipants; so, no wonder they could end up
doing better than their nonparticipating colleagues
even if the wellness program had zero benefit.
Thankfully, there are an increased number of randomized
controlled trials of wellness programs to see if we can prove
cause-and-effect, to answer the question
“Do Workplace Health Promotion Programs Work?,”
particularly important given that the workplace wellness industry
is now a multibillion-dollar industry
One of the most recent randomized controlled trials
was published in the Journal of the American Medical Association.
Thousands of employees were effectively randomized to a
workplace wellness program at BJ’s Wholesale Club,
and although program participants reported
they were engaging in more positive health behaviors,
such as getting regular exercise,
there were no significant differences in clinical measures
of health or health care spending and utilization.
The authors suggested we may have to temper our expectations
about the financial return on investment that wellness programs
can deliver, at least in the short term.
Now, some argue that even a break-even program, that is,
one that does not impose additional costs to the company
but produces signiﬁcant population health improvement,
might be a worthy investment, but perhaps the growing evidence
that demonstrates limited or no concrete wellness program
effects should encourage wellness companies and employers
to critically assess the programs and try to improve them.
In a survey of 162 company wellness programs, for example,
only a third offered nutrition counseling.
And even with counseling, it’s more than simply trying
to convince people to take better care of themselves.
It requires that the organization creates an environment
where leading a healthy lifestyle is the “default” option.
What are they promoting in the company cafeteria, for example?
What’s being served up at meetings and in vending machines?
Yeah, a lifestyle management program at PepsiCo failed to save
the company money, but somehow I doubt one of the components
of PepsiCo’s wellness program, Healthy Living, was telling
employees not to eat or drink any of their own products.
In fact, if you go back to that BJ’s case,
yes, a few percentages more employees said
they were more regularly exercising,
but when it came to nutrition, it was a complete flop,
in terms of things like drinking less soda
or more fruits and vegetables.
No wonder their health hardly budged.
In a systematic review of systematic reviews on the
effectiveness of dietary workplace interventions,
the average improvement in fruit and vegetable intake
combined was 0.7 portions a day.
No wonder these programs aren’t doing better.
In Wealth of Nations, Adam Smith wrote that workers
are less likely to be productive “when they are frequently sick
than when they are generally in good health.”
Sickness “cannot fail to diminish the produce of their industry.”
Maybe they just need more produce than 0.7 servings a day.
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Go to nutritionfacts.org/testimonials.
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To see any graphs, charts, graphics, images, or studies mentioned here,
please go to the Nutrition Facts Podcast landing page.
There you’ll find all the detailed information you need –
plus, links to all of the sources we cite for each of these topics.
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