Prof K Srinath ReddyPresidentPublic Health Foundation of India &Professor of CardiologyAll India Institute of Medical Sciences, New Delhi

Prof K Srinath ReddyPresidentPublic Health Foundation of India &Professor of CardiologyAll India Institute of Medical Sciences, New Delhi

INTRODUCTION TO THE INDIAN WORKSITE WELLNESS PROGRAMINTRODUCTION TO THE INDIAN WORKSITE WELLNESS PROGRAM

Based onSentinel Surveillance for CVD in Indian Industrial Population-SSIIP

7%

8%36%

11%

7% 2%

29%

CVD

Chronic resp. ds.

Other chronic ds

Communicable ds,perinatal, maternalconditions & nutritionaldeficiencies

Injuries

Cancer

Diabetes

7%

8%36%

11%

7% 2%

29%

CVD

Chronic resp. ds.

Other chronic ds

Communicable ds,perinatal, maternalconditions & nutritionaldeficiencies

Injuries

Cancer

Diabetes

Deaths In India (2005)

Source : WHO

2007 2025

No. of Persons with HYPERTENSION

125 Million 214 Million

No. of Persons with DIABETES

41 Million 69 Million +

No. of Persons Dying from TOBACCO

1 Million 2 Million +

Rising Chronic Disease Burdens

Worksite Survey: Study SettingsWorksite Survey: Study Settings

Ten large/ medium industries across India, employing 1500-5000

people (public & private) twinned to medical colleges (public &

private)

Employees and their family members

Surveillance of CVD risk factors

Age Group : 20-69 years (n=19973 for the questionnaire survey and n=

10442 for biochemical investigations).

Ten large/ medium industries across India, employing 1500-5000

people (public & private) twinned to medical colleges (public &

private)

Employees and their family members

Surveillance of CVD risk factors

Age Group : 20-69 years (n=19973 for the questionnaire survey and n=

10442 for biochemical investigations).

Graph 1: Age adjusted prevalence of CVD risk factors

18.4

40.2

26.0

45.8

25.5

40.2

8.3

35.0

15.5

26.3

48.1

30.3 34.4

9.00

10

20

30

40

50

60

Overweight CentralObesity

Dyslipidemia Diabetes Hypertension Tobacco Use MetabolicSyndrome

Risk factors

Prev

alen

ce %

Men

Women Graph 1: Age adjusted prevalence of CVD risk factors

18.4

40.2

26.0

45.8

25.5

40.2

8.3

35.0

15.5

26.3

48.1

30.3 34.4

9.00

10

20

30

40

50

60

Overweight CentralObesity

Dyslipidemia Diabetes Hypertension Tobacco Use MetabolicSyndrome

Risk factors

Prev

alen

ce %

Men

Women Age adjusted prevalence of risk factors 2002-2003

KS Reddy et al WHO Bulletin 2006

Worksite Wellness ProgrammeWorksite Wellness Programme

COEXISTENCE OF MULTIPLE RISK FACTORS (SSIP 20-69

YRS) COEXISTENCE OF MULTIPLE RISK FACTORS (SSIP 20-69

YRS)

Age>50, Current regular use of tobacco, SBP>=120 to <140, PG 100-125.9 mg/dl, Tg>150 mg/dl, Tc/HDl >=4.5, HDL <40 (m)/HDL<50 (f)

BMI>23, WC >80 (f), or WC>90 (m) and Family history of CVD

2.2

97.889.9

60.2

43.5

25.8

0

20

40

60

80

100

120

0 1 2 3 4 4 plus

No of risk factors

Pe

rce

nta

ge

2.2

97.889.9

60.2

43.5

25.8

0

20

40

60

80

100

120

0 1 2 3 4 4 plus

No of risk factors

Pe

rce

nta

ge

CVD Risk Factor Survey in 10 Industries Risk Factors by Educational Status in

Men

CVD Risk Factor Survey in 10 Industries Risk Factors by Educational Status in

Men

Risk Factors ES I(%)OR

ES II(%)OR

ES III(%)OR

ES IV(%)OR

P for trend

Tobacco Use 19.81

26.5 1.4 (1.2-1.7)

40.22.7 (2.4-3.1)

77.313.8 (11.7-16.2)

<0.001

Smoking 15.21

16.71.1 (0.9-1.3)

24.41.8 (1.5-2.1)

21.81.5 (1.3-1.8)

0.04

Regular Physical Activity

41.61

40.00.9 (0.8-1.1)

34.70.7 (0.6-0.8)

13.20.2 (0.18-0.25)

<0.001

Diabetes 8.41

10.41.2 (0.95-1.6)

13.31.6 (1.3-2.1)

7.60.9 (0.6-1.3)

0.056

Hypertension 27.21

29.91.1 (0.99-1.3)

28.61.1 (0.9-1.2)

32.61.3 (1.1-1.4)

0.05

Metabolic Syndrome 19.21

20.91.1 (0.9-1.4)

20.61.1 (0.9-1.3)

24.91.3 (1.1-1.7)

0.05

ES I: Post Graduate; ES II: Graduate; ES III: Secondary or High School; ES IV : Primary or Illiterate

(Ongoing Indian Industrial Surveillance Study; Baseline Survey in 2002-03)

YEARS OF LIFE LOST DUE TO CVD IN POPULATIONS AGED 35-64 YEARS

PPYLL= Potentially Productive Years of Life Lost

0.04

0.3

1.6

3.3

6.7

9.2

0.05

0.4

2

3.2

10.5

17.9

0 2 4 6 8 10 12 14 16 18 20

Portugual

S. Africa

USA

Russia

China

India

NUMBER IN MILLIONS

PPYLL IN 2030

PPYLL IN 2000

Health Promotion Component Health Promotion Component

Health Interventions at other sitesHealth Interventions at other sites

Population approach: Pamphlets, posters, health talks, health promos on visual medium, health melas, healthy cooking competitions,

High Risk Approach: Individual counseling, group counseling, referral to medical doctor for management of hypertension, diabetes and dyslipidemia

Environmental changes: Provided healthier alternatives at canteen, banned tobacco inside the premises etc

Population approach: Pamphlets, posters, health talks, health promos on visual medium, health melas, healthy cooking competitions,

High Risk Approach: Individual counseling, group counseling, referral to medical doctor for management of hypertension, diabetes and dyslipidemia

Environmental changes: Provided healthier alternatives at canteen, banned tobacco inside the premises etc

Interventions were targeted to

Create readiness to change Influence aspiration to change and espouse new

behaviors Improve engagement of the individuals and the

community-interaction, self-efficacy, relapses Change environmental barriers( work-site,

educational inst., canteens, hotels, overcoming cost factors, availability)

Eliminate environmental societal stimulants Introduce behavioral supports

Create readiness to change Influence aspiration to change and espouse new

behaviors Improve engagement of the individuals and the

community-interaction, self-efficacy, relapses Change environmental barriers( work-site,

educational inst., canteens, hotels, overcoming cost factors, availability)

Eliminate environmental societal stimulants Introduce behavioral supports

Worksite Wellness ProgrammeIntermediate changes (2004-2005)

Worksite Wellness ProgrammeIntermediate changes (2004-2005)

Behavioral changes % changes

Physical activity levels ↑ 17.1%

Fruits and vegetable consumption ↑36.3%

Conscious effort to decrease oil/ghee/butter consumption ↑ 31.3%

Age adjusted prevalence of risk factors in females

(before and after intervention)

Age adjusted prevalence of risk factors in females

(before and after intervention)

48.1

30.3

15.5

26.3

9

28.5

17

4.2

24.8

6

0

10

20

30

40

50

60

Overweight Centralobesity

Tobacco use Hypertension Diabetes

Before

After

48.1

30.3

15.5

26.3

9

28.5

17

4.2

24.8

6

0

10

20

30

40

50

60

Overweight Centralobesity

Tobacco use Hypertension Diabetes

Before

After

Trends in mean levels of variables in Men

(six centre data) Trends in mean levels of variables in Men

(six centre data) Variable Baseline:2002

n=6428First Annual

Surveillance: 2004n=1236

Final survey: 2006n=4698

SBP 128.4 (16.7) 127.1 (16.8) 123.4 (16.7)

DBP 79.9 (10.8) 78.4 (10.5) 74.7 (10.5)

Weight 62.2 (12.6) 61.8 (12.3) 61.7 (11.8)

WC 84.0 (11.1) 81.8 (11.0) 81.0 (10.3)

PG 92.1 (29.0)n=2894

90.1 (30.5)n=1207

83.6 (31.8)n=4062

TC 176.5 (43.0) 173.1 (42.2) 165.7 (43.8)

TG 132.9 (76.1) 132.0 (80.1) 135.5 (80.9)

HDL 43.2 (11.6) 45.8 (11.5) 49.5 (10.3)

Proportion of individuals above the Framingham 10 year CVD risk of >=10%

Proportion of individuals above the Framingham 10 year CVD risk of >=10%

34.1

25.426.8

34.7

0

5

10

15

20

25

30

35

40

Intervention Control

Pe

rce

nta

ge

%

Baseline Final

34.1

25.426.8

34.7

0

5

10

15

20

25

30

35

40

Intervention Control

Pe

rce

nta

ge

%

Baseline Final

PRIMARY PREVENTION OF CVD Risk Detection + Risk Reduction in

IndividualsPeople

Professionals

Self -Referral

+ Opportunistic ScreeningHBP, Overweight, Tobacco, Physical Inactivity, Diet, Age, Gender, Personal/Family History

GUIDELINES

(Diagnostic Algorithms)

Risk stratification (Step I)

Targeted Screening

Diabetes, Dyslipidemia, Assessment for CVD

GUIDELINES

(Management Algorithms)

Risk Stratification (Step II)

Appropriate Therapy

Lifestyle Measures + Drugs

EDUCATION