A Retrospective on 2014: Is Prevention Gaining Traction?

2014 has been quite a year for the Vitality Institute, particularly since it was our first full year of operation. I am enormously proud of what we have achieved to date, and hugely excited by the work we have set in motion for the years ahead.

In June 2014, our Commission on Health Promotion and the Prevention of Chronic Disease in Working-Age Americans reached the end of their mandate and released the report “Investing in Prevention: A National Imperative” featuring the following five recommendations:

1. Invest in prevention science
2. Strengthen and expand leadership to deliver a unified message for health and prevention
3. Make markets work for health promotion and prevention
4. Integrate health metrics into corporate reporting
5. Promote strong cross-sector collaborations that generate a systemic increase in health promotion and prevention across society

These recommendations shape our focus going forward. I highlight important developments in health promotion and disease prevention over the past year that link to our work, and give a flavour of what is to come in 2015.

Workplace and Community Health

The workplace is a key site for improving health. Employers have the opportunity to improve employee health as well as broader family and community health, and to see significant financial benefit in doing so.

This year we witnessed further escalating workforce healthcare costs and corresponding employer concern regarding workforce healthcare and productivity costs due to chronic disease. However, there have been numerous debates in the popular and scientific literature regarding the effectiveness of workplace health programs to address these issues. The Vitality Institute examined key obstacles to implementing a workplace culture of healthnd outlined the following recommendations that would ensure benefits for employees, their families, and communities:

• Corporate reporting of health metrics alongside financial metrics
• Training of senior executives and managers in charge of implementing workplace prevention initiatives to strengthen leadership and advocacy within government, business, and employee groups
• More investment in better research, including longer term longitudinal studies with independently verifiable metrics, and research into implementation within businesses
• Adjustment of government regulation to support the use of evidence-based practices
• Creation of better linkages between workplace and community-based programs to achieve common goals

To begin to address these hurdles, we called for companies to collect and publicly report the health metrics of their workforce to ensure that health is measured and promoted in workplaces, to improve the health of employees while improving the financial bottom line of businesses. We formed a working group of cross-sector representatives to develop a proposal for health metrics incorporation into corporate reporting by the end of 2015 and have started work with the Dow Jones Sustainability Index team on this.

We are also focused on improving the level of training of leaders within organizations with responsibility for employee health. We are represented on the new RWJF/IBM led Corporate Health Leaders Advisory Committee to develop a corporate health leaders program, and have started our own webinar series for health leaders.

Research wise, we are conducting substantive investigations on the costs of major diseases and health risks in adults with the IHME and investigating the relationship between businesses and community health, with reports on both due during 2015.

Tobacco

2014 was the year of innovation related to tobacco control. Oxford dictionary named “vape” (“to inhale and exhale the vapour produced by an electronic cigarette or similar device”) as the 2014 word of the year. The e-cig global market is estimated at $5 billion annually, with $2.5 billion in the US. While critics are concerned that e-cigs renormalize tobacco use and target children, research has found that children are not using e-cigs as a gateway to tobacco use, and only 0.5% of “never smokers” use e-cigs. One recent study found that smokers using e-cigs are six times more likely to quit smoking.

Studies are underway to investigate if e-cigs can support tobacco cessation, including one we are supporting in collaboration with UPenn and The Vitality Group to identify the best way to support tobacco cessation in the workplace, using cessation aids including e-cigs and financial incentives. The study is launching in January 2015, with results expected in early 2016. In March 2015, I will chair a session at the World Tobacco and Health Conference in Abu Dhabi to advance support for global tobacco control.

Behavioral economics

Using behavioral economic principles to promote healthy behaviors continues to offer opportunities to improve population health, yet is in its infancy in being used by public health programs. The latest World Development Report of 2015 is likely to change this. The recent International Conference on Behavioral Economics hosted by UPenn’s Center for Behavioral Economics highlighted many novel applications for health.

On this front, the Vitality Institute has initiated numerous research projects that use behavioral economics to influence health choices, the results of which we look forward to publishing next year.

Innovative Technology

Personalized health technology, ranging from wearable tracking devices to smart medication bottles, proliferated in 2014. The National Basketball Association (NBA) integrated biometric testing, and Disney now offers customized wristbands to theme park visitors. Health technology is also becoming more individualized, with Google announcing developments of a nanoparticle platform to promptly detect specific chronic diseases. Nonetheless, challenges associated with privacy, access, and ownership of health data emerge. We saw Apple executives and FitBit’s lobbying firm battling consumer privacy on Capitol Hill, and the Supreme Court of the United States ruling that police officers now require a warrant to search cell phones of arrested individuals.

That’s why the Vitality Institute has partnered with the Institute of Medicine (IOM) to host an IOM-led workshop on the ethical, legal, and social implications of personalized health technology in 2015.

Nutrition

This past year saw promising developments in collaborative efforts to address poor nutrition and diet-related chronic diseases. The announcement that the Healthy Weight Commitment Foundation companies sold 6.4 trillion fewer calories in 2012 compared to 2007 through means including product reformulation, reducing portion sizes, and introducing lower calorie options is a great example of corporate collaboration to improve the quantity and quality of food being consumed.

Government initiatives such as the Healthy Incentive Pilot program highlighted opportunities to incentivize the purchase of healthy fruits and vegetables among Supplemental Nutrition Assistance Program (SNAP) recipients. Meanwhile opportunities for amending the Farm Bill and discussions around food sustainability point to how agricultural production, environmental sustainability and healthy food consumption can be aligned for better planetary and human health.

The importance of food at work and business-led initiatives in promoting healthy food show an ongoing recognition of the need to create environments where healthy food options are available and easy to choose.

Healthy eating influences all areas of health including longevity, quality of life, and preventing and managing disease. In recognition of this, the Nutrisavings program was added to the program offered by The Vitality Group this year, guiding consumers to make healthier purchases through offering financial incentives. In 2015 the Vitality Institute will continue to focus on innovations to promote healthy eating at the workplace and both in and outside the home.

Brain Health

Over the past year we have highlighted the impact of mental illness, touching one in four people worldwide at some point in their lives and a fifth of American adults in the past year alone. We mourned the nearly 40,000 Americans who died from suicide this year, including Robin Williams, whose tragic death shocked the nation and highlighted that no workplace is free of employees struggling with mental illness. We demonstrated the role communities, universities, and employers can play in promoting mental well-being and called on businesses specifically to integrate mental health promotion into existing workplace wellness programs to build a holistic culture of health. We highlighted the international mental health promotion movement underway and effective strategies that the US could adopt to improve the mental health of its citizens and transform it to become a leader in mental health promotion.

A significant area of focus for the Vitality Institute has been investigating and advocating for best practice for employers to improve mental health in their organizations to benefit employees, their families and communities. This will be a strong focus in 2015 that will start when I moderate a session at the World Economic Forum’s meeting in Davos this January that will focus on the complex relationship between aging, cognition and the implications for health and financial services.

Some conferences we spoke at

• US SIF keynote on entrepreneurship and health
• Aspen Ideas Festival panel on engaging with the private sector
• mHealth Summit panel on building a culture of health
• Harvard Business School Shared Value Executive Course featuring a Discovery Case Study

A selection of our key publications

• Forbes – Article “How Corporate America Could Save $300 Billion By Measuring Health Like Financial Performance”
• JAMA – Viewpoint on “New Opportunities in the Changing Landscape of Prevention”
• JOEM – Article “Making the Workplace a More Effective Site for Prevention”
• Fast Company – Article “Can Better Workplace Leadership Solve America’s Health Care Problems?”

Looking back over the past year, there have been significant developments across the US in health promotion and disease prevention including the recent decision to finally appoint Vivek Murthy as Surgeon General (SG). This was a welcome step given how strong the SG’s voice has been in the past to rally national support for tobacco and AIDS (C. Everett Koop) and mental health and disparities (David Satcher). We look forward to Murthy stepping into his role and working collaboratively to further build a culture of health.

The Vitality Institute has undertaken critical work in many important areas. We look forward to a promising year in 2015 to further develop our efforts in this space and sharing information on other projects we have in the pipeline, ranging from design for health to intergenerational mentorship for greater leadership in prevention science.

I would also like to thank the Vitality Institute team, without whom none of this would be possible: Elle Alexander, Christine Brophy, Gillian Christie, Vera Oziransky, Shahnaz Radjy, Katie Tryon, and the various interns and external collaborators who supported us throughout the year.

Derek Yach