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Bonfire Health Wellness Foundations

IGNITE YOUR HEALTH

“The United States is experiencing an unsustainable disease burden – 130 million people today suffer from chronic illnesses. We spend over $2 trillion a year – about 16 percent of our gross domestic product – on health care. The vast majority of our health care dollars are spent treating chronic disease.”

Dr. Richard H. Carmona, MD17th Surgeon General of the United StatesAlmanac of Chronic Disease, 2008 Edition

3

If left unchecked, chronic diseases will cost our economy over $4.1 trillion by the year

2023…

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500

2003

2006

2009

2012

2015

2018

2021

Lost Economic Output

Treatment Expenditures

Projected costs associated with seven of the most common chronic diseases*

*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke.

Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. Full report and methodology available at: www.chronicdiseaseimpact.com.

4

…And could cost the U.S. almost $6 trillion in lost economic output by 2050

0

1

2

3

4

5

6

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

$US

Trill

ions


Projected lost economic output associated with seven of the most common chronic diseases*


5

Workplace health promotion programs have been shown to reduce health care costs, increase

productivity and reduce absenteeism

-27%

-28%

-30%

-31

-30

-29

-28

-27

-26

-25

Ave

rag

e C

han

ge

Health costs

AbsenteeismWorkers’ comp./ disability

management claims costs

Average percent change in employers’ costs resulting from workplace health promotion and wellness programs

Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).

Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt

Wellness Foundations Series

IGNITE YOUR HEALTH

Wellness Series Objectives•Information that empowers, inspires and equips

•Environment that promotes and rewards healthier choices

•Resources that make it easier to make healthier choices

•Community that supports a healthier lifestyle

•Specific team interests like weight-loss and stress reduction

IGNITE YOUR HEALTH

Bonfire Health Wellness Foundations Program• Bonfire Wellness Foundations: $1200

(Single event 45 – 90 mins)

Recorded / DVD produced and provided for company lending library

• Complete Series: $3900(Four events 60 - 90 mins) Bonfire Wellness Foundations Seminar Bonfire FUEL (how well people EAT) Bonfire AIR (how well people MOVE) Bonfire SPARK (how well people THINK)

Recorded / DVD produced and provided for company lending library

IGNITE YOUR HEALTH

“Overwhelming evidence from a variety of sources, including epidemiological, prospective cohort, and intervention studies, links most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption.” Roberts CK, et al. Effects of exercise & diet on

chronic disease. Journal Applied Physiology 2005; 98: 3-30

“You don’t GET sick… You DO sick.”

10

Chapter One: The Human Cost Today

Introduction:

Chronic diseases are a significant problem in the United States, accounting for many of the most prevalent and costly illnesses that affect Americans. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition. These conditions include arthritis, asthma, cancer, cardiovascular (heart) disease, depression and diabetes, though these are only a few of many chronic illnesses that negatively impact the lives of Americans.

Many chronic diseases are caused or exacerbated by poor nutrition, lack of exercise, smoking and other lifestyle choices. As a result of these factors, as well as a lack of emphasis on preventive care, incidence rates of chronic disease have increased substantially over the last two decades. Risk factors like obesity are also on the rise. Since 1980, obesity rates have increased 250 percent, now affecting 71 million Americans. This has tremendous implications for future generations; for example, it is predicted that 1 in 3 children born in 2000 will develop diabetes over the course of their lives, given current trends in overweight and obesity.

Not surprisingly, chronic diseases have become the leading cause of death and disability in the United States. Seven out of every 10 deaths are attributable to chronic disease, and illnesses like heart disease and cancer top the list of most common causes of death. Minority populations are often disproportionately impacted by chronic disease, with African Americans and Hispanics often 1.5 to 2 times more likely to have a certain condition than their white counterparts.

11

States in the South and New England have the highest rates of chronic diseases*

Top QuartileSecond Third Bottom Quartile

States in the top quartile have the lowest rates of seven common chronic diseases*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke.


12

Chapter Two: The Economic Cost Today

Introduction

Chronic diseases are at the root of a significant portion of rising health care costs. About two-thirds of the rise in health care spending over the last two decades is due to the rise in treated rates of chronic disease. In addition, the vast majority of current spending is for treatment of Americans with one or more chronic conditions. Indeed, more than 75 percent of the approximately $2 trillion Americans spend each year on health care is spent on chronic diseases, and public health programs like Medicare and Medicaid are seeing sizable portions of their budget devoted to treatment of chronic diseases and complications from those conditions.

But direct health care costs represent only a quarter of the total cost of chronic diseases. Indirect costs such as absenteeism and presenteeism* cost businesses – and our economy -- $1 trillion a year. Every year, millions of work days are missed because employees are suffering themselves from a chronic disease, or they have to care for a loved one who is ill.

*Presenteeism is defined as lost productivity that occurs when employees come to work but perform below par due to any kind of illness.

13

Three in four dollars spent on health care in the U.S. are for patients with one or more chronic conditions

25%

75%

Health care costs associated with

patients with one or more chronic diseases

=~$1.58 trillion

Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.

Total U.S. health spending in 2006 = $2.1 trillion

14

Within public health problems, patients with chronic diseases represent an even higher percentage of

spending

More than 96 cents of every dollar spent in Medicare…

…and 83 cents of every dollar spent in Medicaid

Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004 Update. Available at: http://www.rwjf.org/files/research/Chronic%20Conditions%20Chartbook%209-2004.ppt. Accessed on April 17, 2007.

Share spent on patients with chronic diseases

15

Increases in the prevalence and treatment intensity of chronic disease are responsible for about two-thirds of

the increase in health care costs over the past two decades

$0

$100

$200

$300

$400

$500

$600

$700

'87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00

~$211 billion

Level of health spending among thenoninstitutionalized U.S. population, 1987–2000

$313.5

$627.9

= Increase attributable to rise in prevalence of treated chronic disease

(in billions of nominal dollars)

YearsSource: Thorpe K. The Rise In Health Care Spending And What To Do About It. Health Affairs. 2005;6:1436-1445. Also, Thorpe K, Florence CS, Joski P. Which Medical Conditions Account For The Rise In Health Care Spending?

16

The doubling of obesity is responsible for about one-third of the rise in health care costs since the mid-

1980s

No data <10% 10%-14%

1985

No data <10% 10%-14% 15%-19% 20%-24% 25%-29% >30%

Percent of U.S. adults who are obese*

2005

*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person

Source: Thorpe K, Florence, C, Howard, D, Joski, P. The Impact of Obesity in Rising Medical Spending. Health Affairs. 2004. Also, Centers for Disease Control and Prevention. U.S. Obesity Trends 1985-2000. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/trend.maps

17

Health care spending related to chronic diseases is dwarfed by the indirect costs of these health

problems

Direct costs represent about a fifth of the total cost burden of chronic diseases

$277 billion 21%

$1.0 trillion79%

Indirect costs amount to four-fifths of the total burden

Total cost burden in 2003 for seven common chronic diseases*

Direct costs = Health care costs associated with treatment of chronic disease

Indirect costs = Productivity losses such as absenteeism and presenteeism associated with people with chronic diseases



18

Cancer and hypertension are among the most costly chronic conditions, accounting for over $500 billion

annually in treatment expenditures and lost economic output

$48

$33

$46

$65

$45

$271

$280

$171

$105

$94

$105

$22

$27

$0 $50 $100 $150 $200 $250 $300 $350 $400

Cancers

Hypertension

Mental Disorders

Heart Disease

Pulmonary Conditions

Diabetes

Stroke

Treatment Expenditures Lost Economic Output

Treatment expenditures and lost economic output (in billions)per chronic condition*



19

Presenteeism is responsible for the largest share of lost economic output associated with chronic health

problems

Lost Workdays

Caregiver,

$11 billion

Presenteesism Caregiver,

$80 billion

Lost Workdays Individual,

$127 billion

Presenteesism

Individual,

$828 billion

Presenteeism is defined as lost

productivity that occurs when

employees come to work but

perform below par due to any kind of

illness.

Cost of chronic diseases by category, 2003

Total = ~$1 trillion



20

When it comes to presenteeism, arthritis, hypertension, and depression are among the most

costly conditions

Estimated average annual cost of presenteeism per employee with condition

$33

$71$72$76

$159

$189

$222$246$247$252

$0

$100

$200

$300

A rth ritis Hyp e rte n sio n Mig ra in /He a d a c h e De p re ssio n /S a d n e ss/Me n ta l Illn e ss A lle rg y Mig ra in e /He a d a c h e Dia b e te s A n y C a n c e r A sth ma He a rt D ise a se R e sp ira to ry Diso rd e rs

Co

st

pe

r E

mp

loy

ee

wit

h C

on

dit

ion

Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.


Arthritis Hypertension Depression/Sadness/

Mental Illness

Allergy Migraine/Headache

Diabetes Any Cancer

Asthma Heart Disease

Respiratory Disorders

21

Depression and stress are the most common causes of absenteeism

25.6

16.914.7

12.0 10.78.2 6.8 5.9

2.0 0.90

10

20

30

40

50

60

Da

ys

pe

r Y

ea

r A

bs

en

t (L

ow

, Av

era

ge

, Hig

h)

Number of days absent per affected individual per year due to 10 conditions, 1997-1999

Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.


Depression/Sadness/Mental Illness

Any Cancer

Respiratory Disorders

Asthma Migraine/Headache

Allergy Heart Disease

Arthritis Diabetes Hypertension

22

… And mental illnesses, when comorbid* with other chronic diseases, significantly decrease work

productivity

0

1

2

3

4

Hypertension Arthritis Asthma UlcersAv

era

ge

Nu

mb

er

of

Imp

air

ed

Da

ys

pe

r M

on

th

Chronic Disease

Chronic Disease and Mental Illness

Source: Kessler, RC, Ormel, J, Demler, O, et al. Comorbid Mental Disorders Account for the Role Impairment of Commonly Occurring Chronic Physical Disorders: Results From the National Comorbidity Survey. Journal of Occupational & Environmental Medicine. 45(12):1257-1266, December 2003.

*Cormorbidity is the condition of having two or more diseases at the same time.

Number of 30-day role impairment days associated with pure and comorbid* chronic illnesses

(Role impairment = sickness absence days plus work cut-back days)

23

Chapter Three: The Cost Tomorrow

Introduction:

While chronic diseases exact a huge toll on Americans today, the future is even more troubling. Over the next 15 years, the prevalence of chronic conditions in the U.S. is expected to rise dramatically. According to a study by the Milken Institute, there will be 230 million reported cases of chronic disease in 2023, an increase of 42 percent from 2003. Cases of cancer, diabetes and mental disorders are expected to rise most substantially, by 53 to 60 percent per illness. In addition, the number of obese Americans, currently one third of the total population, is also projected to increase. By the year 2015, it is predicted that 75 percent of Americans will be obese, significantly contributing to the rise in chronic illnesses.

Indeed, if current U.S. health trends continue, the results could be catastrophic for future generations, the health care system and the economy. Without immediate focus on prevention, the direct and indirect costs of chronic diseases are predicted to grow exponentially. Research has shown that, if left unchecked, chronic conditions will cost the U.S. economy over $4.1 trillion annually in treatment expenditures and lost economic output by the year 2023. Certain diseases, like heart disease and cancers, will be the most costly.

24

By the year 2023, the incidence of chronic disease is expected to rise dramatically

6254 53

41 3931 29

0%

20%

40%

60%

80%

100%

Cance

rs

Men

tal D

isord

ers

Diabet

es

Heart

Disea

se

Hyper

tens

ion

Pulm

onary

Conditi

ons

Stroke

Projected rise in cases of seven of the most common chronic diseases, 2003-2023*

Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. Full report available at: www.chronicdiseaseimpact.com. Note: Statistics only include data for top seven chronic diseases


25

The rate of obesity is also expected to increase, and contribute to rising rates of chronic diseases

13

3241

0%

20%

40%

60%

80%

100%

Year

By 2015, it is predicted that 41 percent of Americans will be obese

1960 2004 2015

Source: Wang, Y and Beydoun, M. The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiologic Review. 2007 29(1):6-28; doi:10.1093/epirev/mxm007

By 2015 without major changes, researchers predict 75 percent of adults and 24 percent of children will be overweight or obese

26

If left unchecked, chronic diseases will cost our economy over $4.1 trillion by the year

2023…

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500

2003

2006

2009

2012

2015

2018

2021

Lost Economic Output

Treatment Expenditures

Projected costs associated with seven of the most common chronic diseases*



27

…And could cost the U.S. almost $6 trillion in lost economic output by 2050

0

1

2

3

4

5

6

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

$US

Trill

ions


Projected lost economic output associated with seven of the most common chronic diseases*


28

Chapter Four: Opportunity for Improvement

Introduction:

Right now, far too little is being invested in improving Americans’ health and effectively preventing and managing common and costly chronic health problems. In an average year, the U.S. spends less than $10 per person on prevention -- about the same amount of money as a single movie ticket costs in many places in the U.S.!

Improvements in personal health behaviors, investment by business and the health care system in population health improvement could save millions of lives, and trillions of dollars. By the year 2023, the U.S. could save over $1 trillion through investing in prevention, mostly by reducing indirect costs of chronic health problems, such as absenteeism and presenteeism.

29

But simple changes in behaviors could lead to significant decreases in cases of common and costly

chronic diseases

The Centers for Disease Control and Prevention (CDC) estimates up to…

…could be prevented if only Americans were to do three things: Stop smoking Start eating healthy Get in shape

80% of type 2 diabetes 40% of cancer

80% of heart disease and stroke

Source: Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health Webinar. May 23, 2006. Available at: http://www.businessgrouphealth.org/opportunities/webinar052306chronicdiseases.pdf. Accessed April 17, 2007.

30

Workplace health promotion programs have been shown to reduce health care costs, increase

productivity and reduce absenteeism

-27%

-28%

-30%

-31

-30

-29

-28

-27

-26

-25

Ave

rag

e C

han

ge

Health costs

AbsenteeismWorkers’ comp./ disability

management claims costs

Average percent change in employers’ costs resulting from workplace health promotion and wellness programs

Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).


31

By the year 2023, the U.S. can save over $1 trillion through investing in prevention, mostly in indirect

costs*

$0

$200

$400

$600

$800

$1,000

$1,200

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

Lost economic output (indirect)

Treatment expenditures (direct)

*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke. Alternative assumptions on the future path of chronic-disease incidence, prevalence and cost were developed based on best practices in prevention, early detection and new innovations in disease treatment and management.


32

Investing in prevention will save the U.S. billions of dollars in direct and indirect health costs

$696

$731

$587

$292

$340

$310

$74

$410

$196

$116

$213

$90

$24

$73

$0 $400 $800 $1200

Cancers

Hypertension

Mental Disorders

Heart Disease

Diabetes

Pulmonary Conditions

Stroke

Billions

Alternate future Costs that could be avoided through prevention

Costs of chronic disease (in billions) in 2023 due to treatment expenditures and lost economic output


33

… and that the U.S. should invest more in prevention

Four out of five Americans prefer health care dollars to be spent on preventive measures as opposed to treating diseases after the fact.

81 percent of adults interviewed believe the U.S. should prioritize our health care dollars to “invest in preventive measures”

Survey by the Partnership to Fight Chronic Disease: Conducted by APCO Insight, April 27-29, 2007 and based on telephone interviews with a national adult sample of 1,001.

34

Resources

PFCD Resources• PFCD Policy Platform:

http://www.fightchronicdisease.com/advocate/platform/index.cfm • PFCD “Unhealthy Truth” Presentation:

http://www.fightchronicdisease.com/resources/national.cfm • Chronic Care “Chartbook”:

http://www.fightchronicdisease.com/crisis/index.cfm

Partner Resources• Alliance for Aging Research Silver Book: http://www.silverbook.org/• American Cancer Society Cancer Facts & Figures 2007:

http://www.cancer.org/docroot/STT/content/stt_1x_cancer_facts__figures_2007.asp

• American Hospital Association Trendwatch Reports: http://www.aha.org/aha_app/trendwatch/archive.jsp

• Milken Institute “An Unhealthy America” Report: http://www.chronicdiseaseimpact.com/

• Partnership for Prevention

IGNITE YOUR HEALTH

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Bonfire Health Corporate Wellness Seminars