Category — Free Wellness Program

The most common screening performed in wellness programs is heart health assessment.

The screening can include a written heart health test, blood pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, tobacco use, and weight.

The health professional conducting the screening then provides a consultation and assists set objectives with the participant.

The backbone of wellness programming at the worksite is health testing. It is the first major activity a company should do when first beginning a wellness program.

Medical screening is often used joined with the administration of a Health Risk (Assessment|Appraisal} .

The most effective way to screen is to utilize a health expert trained in wellness screening techniques and counseling to privately and individually assess participants.

This wellness expert takes a brief health history and measures blood pressure and cholesterol. With computerized cholesterol desktop analyzers, results are obtained in about four minutes.

Immediate feedback, consultation, and educational materials are provided. for those identified at-risk, follow-up appointments can be scheduled at this time. the whole process takes about twenty minutes per individual.

The screening also provides an immediate opportunity to register participants in various health improvement programs based on their interests and identified health risks.

Biometric testing may be done annually and used to monitoring health risks within the worksite.

A biometric screening program needs to provide multiple opportunities for participation. the service should be provided for all the various shifts of a company. the screening program should be conducted in highly visible areas so the process may be observed.

Reluctant workers often like to be able to see what the program is about before they participate. When wellness screeners are not busy, they ought to perform outreach going to areas where workers gather and try to recruit workers.

When well-planned and promoted, health testing can attract participation rates of 60 percent to 100 percent. These high participation rates have a positive impact on management producing support for further programming.

Objectives are broad-based statements about what the program is expected to do. the goal of the wellness program is to enhance the health of the individual and the organization. Objectives like mission statements provide direction in a program.   

Goals are specific and provide a means of measurement of the program to determine effectiveness. There are two kinds of goals, process and outcome.    

Process goals state the activities that need to occur to achieve a desired outcome.

Examples of process objectives are –

• Number of participants screened

• Number of participants in and completing health improvement programs

• Satisfaction of program participants

• Number of participants who were medically referred and saw their physician

• Number of promotional activities

• Number of participants seen in follow-up

Example of outcome goals are –

• Number of participants who improved fitness level

• Number of participants who lowered cholesterol level

• Number of participants who lost weight, body fat

• Number of participants who quit smoking

• Number of participants with high blood pressure who reduced their blood pressure

• Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk

• Number of participants with risk factors who saw their doctor and are being treated for high blood pressure or cholesterol years later

Wellness committees are important in that they develop a sense of ownership in the program, and facilitate various tasks involved in wellness programming at the workplace.

The committee must be composed of a cross-section of employees representing various occupations, levels, and subgroups with the organization.

A common mistake is filling the committee with the most health/fitness-conscious individuals  in the business. Don’t rely solely on volunteers to fill a committee. Be certain that your committee members have enough power in the business to run an effective wellness program.

The wellness committee is made up of employees from the workplace. It oversees the wellness program and helps carry it out.

The committee ought to meet about once a month to review the previous month’s activities and plan future ones. When the program is just beginning, the committee may meet each week until things get going.

Committee members do not carry out medical procedures, counsel customers, or handle confidential health information. Wellness specialists perform these tasks.

In general, the committee’s duties fall into three areas –  planning, promoting, and assisting to run programs.

Planning the programs can include –

• Locating space for activities

• Planning and organizing worksite-wide events like contests

• Analyzing reports prepared by the program staff and making recommendations

Promoting the program can include –

• Recruiting staff members to participate in screening and health betterment programs

• Encouraging workers to participate in follow-up counseling

• Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the workplace

Assisting to run the program can include –

• Setting up equipment for various activities

• Assisting to conduct worksite-wide activities

• Monitoring all activities and analyzing  the performance of the specialist staff

• Acting as wellness mentors to fellow staff members

The size of the wellness committee will be dependent on the size of the organization. Pick members by asking day management to nominate or appoint staff members.

Make an announcement through flyers, memos, and meetings to recruit potential members. Explain the purpose of the committee, duties and responsibilities, and the time commitment.

Recognize your wellness committee volunteers. Allow them to participate in programs at a decreased cost. Hold appreciation breakfasts/lunches/dinners.

Print names of committee members on corporation communications about the wellness program.

Buy special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Develop awards certificates for members.

The following could be used as a guide for committee size –    

• Less than 300 employees   2 to 4

• 300 to 1,000 employees   4 to 6

• 1,000 workers or more   6 to 12

Effective wellness programs recognize the importance of building a supportive cultural environment. the workplace culture includes shared values/heartfelt beliefs about what’s important. It includes social standards of expected and accepted behavior called “cultural norms.”

It includes peer support from family, friends, and peers. This support can help one adopt healthy lifestyles. Tools are available to audit a company.

The long-term success of any wellness program is dependent on the corporate culture.

Some healthy culture signs in a corporation are –

• Staff Members communicate openly

• Leaders support diversity and opinion

• Staff Members have fun

• Policies support wellness

• Workers are encouraged to grow

• Staff Members work together as a team

• Employees’ skills and talents are matched to their jobs.

• Flexible work schedules are available

• Businesss consider employees as their most asset

Effective wellness programs attempt to develop healthy workplace climates. A healthy workplace climate is one which encourages teamwork, cooperation, and empowerment of the individual.

Individuals  have a sense of community, a shared vision, and a positive outlook. Policies promote and support wellness efforts within the workplace.

• Effective programs identify ways that corporation policies and organizational traditions encourage wellness.

• Effective programs work at the group and organizational level to build support for healthful lifestyle choices.

• Effective programs set clear target goals and goals for the health improvement of the worksite.

An initial medical testing can include a recent survey of employees’ interests as part of the assessment. Successful wellness programs are designed to meet the needs and interests of the employees.

The information you need to get from a recent survey depends on the scope of your program. A sample survey could be acquired in the HOPE Publications Web site.

If you plan to adapt this sample survey or develop your own survey, keep the following hints in mind –

• Ask primarily closed-choice questions, especially when you will be sending the survey to a large number of workers. Closed-choice questions provide specific options and are easy to tabulate. You may want to use a computer for data entry and analysis.

• Invite comments, suggestions and recommendations, or ask open-ended questions after the survey. Open-ended items are more challenging to summarize.

• Include a brief explanatory cover letter with the survey with the signature of the corporation president. Be sure to include a statement about confidentiality and anonymity.

• Ask a group of representative employees to review the survey before it’s distributed. Find out if the questions will be understood by employees and won’t be objected to.

• Include demographic information at the beginning or end of the survey. Consider various ways that you might analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When considering who should get the survey, a simple rule is if you have under 500 workers, everybody should receive one. the public relations advantage of everybody receiving a recent survey could be significant.

Over 500 workers, a sample of the work population will suffice. A sample saves on costs and time. You could want to consider consulting with a statistician to determine an appropriate sample size for your worksite.

Needs surveys are confidential and anonymous; they do not request information that may identify a person.

Getting support from management is vital to the success of the program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the organization. You can use the surveys here or make up your own.

When you decide to do your own, keep the survey short. It should not take more than ten minutes to complete.

The interview process can also serve to educating management. Give concise fact sheets on the benefits of wellness programs for management.

When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Give these reports to management.

Once completed present a brief executive summary to management. Highlight a few interesting findings that can be used immediately to make decisions about the program.

Utilize charts and graphs to make your points. Prepare a detailed report for wellness committee members itemizing each response. Provide a short article about the survey in the corporation newsletter.

The higher the response the more precise and reliable the results. A minimum response of 40% to 50% is acceptable.

Comprehensive wellness programs involve all employees, deal with all major health risks, offers choices, and target both the employees and the worksite environment; provide periodic evaluation of its results.     

Comprehensive wellness programs emphasize follow-up and offers support for the worker if he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and analysis.   

Planning robust wellness programs involve performing a needs and interest assessment, appointing a wellness committee, picking  wellness providers, setting goals/objectives for the wellness program, marketing and advertising/promoting the program, and establishing procedures to ensure confidentiality.   

Implementation of robust wellness programs consist of five major tasks –    

1   Health testing and referral

2   Follow-up and counseling employees

3   Follow-up with physicians

4   Health improvement programs

5   Organizing worksite-wide activities.

Analysis involves monitoring wellness programs to find out if it is working and to help you refine it. Measuring success shows what you’ve achieved, helps justify costs, and provides information for management to support continued programming.   

Extensive wellness programs involve all employees, deal with all major health risks, offers options, and target both the employees and the worksite environment; provide periodic evaluation of its results.     

Comprehensive wellness programs emphasize follow-up and offers support for the worker since he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and evaluation

Planning comprehensive wellness programs involve performing a needs and interest assessment, appointing a wellness committee, choosing  wellness providers, setting goals/objectives for the wellness program, marketing and advertising/promoting the program, and establishing procedures to ensure confidentiality

Implementation of comprehensive wellness programs consist of five major tasks –

• Health screening and health risk (assessment|appraisal}

• Follow-up and counseling employees

• Follow-up with doctors

• Health improvement and disease avoidance programs

• Organizing worksite-wide wellness program activities.

Evaluation involves monitoring wellness programs to find out if it is working and to help you refine it.

Measuring success shows what you have achieved, helps justify costs, and provides information for management to support continued programming.

Initially introduced by Halbert Dunn in the 1950’s, wellness became a popular buzzword during the late 1970’s and received considerable academic attention in the 1980’s.     

Wellness programs for workers became more widespread during the following decade, and credible evidence for their economic viability began to be published.     

There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase costs.  Medical and health insurance costs escalate with both age and number of risks present.8,10   the number of risks is also strongly related to sick time absenteeism, Employee’s Compensation costs, short-term disability, and lowered productivity (”presenteeism”).

Early staff member wellness programs were relatively basic and usually produced a return on investment (ROI) of less than one dollar for every dollar spent operating the program (ROI = <1 - 1).8

Such programs could  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there is no particular focus on the reduction of specifically identified high risks.  

Interventions and activities are not personalized, and there’s no emphasis on the management of healthcare costs.  These programs are usually site-based only, lack choices to address all the major behaviorally-related health risks, and lack multimodal presentation.  

Minimal or no incentives are provided to staff members for participation, and services to spouses and family members are not available.  Most such programs lack meaningful examination.  

More conventional programs are “activity-oriented” and have shown an ROI of between 1 – 2.5 and 1 – 3.5.8 These programs may have a greater emphasis on health and risk reduction, although the efforts are relatively wide and not customized.  

They might have some generalized emphasis on health care cost management, although not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.  

Modest incentives may  be utilized to encourage participation.  Formal evaluation may  be weak.

The newest and most economically viable programs are “results-oriented” and exemplify the health and productivity management model.  These programs consistently produce return rates of 1 – 4 or greater within a 12-24 month period.8  

Such programs are strongly focused on the reduction of specifically identified high risks and the management of medical costs.  They’re usually voluntary, but use strong financial and other incentives to promote participation.  

They are multi-component in nature (address all major risks), and have both onsite and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses in addition to staff members.

For corporations, the cost of providing medical insurance for their staff members is of excellent importance.  Those costs have been increasing at annual rates between 6% and 14%.

Chapman’s 2007 systematic review7 reported an typical reduction in healthcare costs of 26.5 percent thus of employee wellness programs.  His review covered 60 of the most scientifically valid studies, with an typical of 3.77 years of study.

Absenteeism due to illness is another cost driver.  Chapman’s review7 reports an typical reduction in sick time of 25.3%.   Cost for Employee’s Compensation was lowered by 40.7%, and disability costs by 24.2%.

There’s also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk decreased through a wellness program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11

Some businesses have achieved a zero% increase in health care costs across at least brief periods of time.10  Doing so requires 90-95% participation of the worker population in focused wellness programs, with 75%-85% of the employees falling into the low risk category.10     

Although extensive efforts to lower the risk status of those in moderate or high risk categories should be made, the needs of currently healthy staff members should be addressed as well to avoid increases in risk-status.   

Given the size of the federal workforce, meaningful cost savings in the government’s contribution to health insurance premiums for employees can be achieved when a majority of that population were participating in active wellness programs.     

Likewise, improvements in absenteeism, employee’s compensation, disability, presenteeism, and turnover thus of robust worker wellness programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Wellness Programs –   A Robust Review of the Literature.   Am J Wellness 15(5) – 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Wellness  2(3) – 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Wellness –   is it Really as Important as We Think?  the Art of Wellness  7(2) – 1-12.

4   Chapman, Larry.  (2005)   Meta-Evaluation of Corporate Wellness Economic Return Studies –  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)   Staff Member Participation in Corporate Wellness and Wellness Programs –   How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) –   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Wellness Coaching in Corporate Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive –   an Analysis of the cost-Effectiveness of Corporate Wellness.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Businesss” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research –   A View from One Research Center.  American Journal of Wellness 15(5) –  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Company Strategy.  Presentation at the World Research Group “Rewarding Healthful Behaviors for Health Plans and Companys” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Be certain to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) –  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of extensive Health and Disease ManagementPrograms at the Worksite –  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  an Unhealthy America –   the Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health –   Proven Wellness Practices for Workplaces.   http – //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.

Corporate America is increasingly investing in staff member wellness because it is good company.  In order to meet productivity demands, businesses must rely on a healthful, productive workforce to succeed in the highly competitive global marketplace.  

Over a hundred studies in both corporate and governmental settings have documented the economic advantages of worker wellness programs, including decreased absenteeism, decreased injuries and workman’s compensation costs, decreased healthcare costs, decreased worker turnover, as well as increased productivity, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment.  In general, the more focused and intensive the program, the greater benefit realized.  

To enhance their effectiveness federal government staff member wellness programs could  be able to incorporate some features described.  Employee wellness programs shown to have positive returns on investment often include the following features –    

1   Health and productivity management model

Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors like tobacco use, lack of exercise, excess weight, unhealthy diet, high cholesterol, high blood pressure, stress, depression, and so on.     

High-risk employees are particularly targeted for intervention, although the most successful programs also direct efforts towards healthy employees for maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.     

2   Health risk (assessment|appraisal}

Use of a computerized health risk (assessment|appraisal}  instrument with individualized feedback and recommendations is nearly universal in successful programs.  Workers take the questionnaire each year in many cases.     

The HRA serves to raise awareness, provide direction, and motivate individuals to improve specific behaviors.  In some cases, the customized report is directly linked to appropriate resources related to identified risks.     

Research indicates that the use of an HRA is effective when it’s followed by some kind of educational or therapeutic intervention for identified risks.  It often serves as the entry point into wellness programs.   

3   Biometric analysis

Many wellness programs combine the results of the health risk (assessment|appraisal} with measurement of each employee’s biometrics, including weight and Body Mass Index , blood pressure, cholesterol, fasting glucose, and assorted other metrics.     

Combining the results of the HRA with biological measures leads to a more valid risk profile.   Computerized health risk (assessment|appraisal}s often incorporate biometric data in their risk analysis.   

4   Wellness Program Incentives

Employees are frequently given monetary or other meaningful rewards for completing an HRA, participation in a program or class, specific accomplishments like stopping smoking, losing weight, or exercising, and for maintaining healthy status and/or behaviors.     

In many cases the monetary incentives are associated with reductions in medical insurance premiums.  Some programs use disincentives in addition to incentives, such as charging staff members who smoke higher rates for their medical insurance contribution.   

5   High wellness program participation rates

Successful programs use incentives to drive participation rates up.  They also market their programs comprehensively, and may use contest or challenge strategies to heighten enthusiasm and encourage participation.   

6   Wellness coaching

Employees with identified risks or desire to improve their health habits might  be periodically coached via telephone by trained health coaches.     

Coaching assists workers set and achieve realistic lifestyle-related objectives including those addressing stress, work life balance, smoking, weight, exercise, and various behavior modifications.     

Three or more sessions are usually offered.  In some intensive programs, the coaching extends to actual disease management (DM) intervention for employees with identified high-risk illnesses.    

7   Multiple formats

Programs might offer wellness content in online, paper, and seminar formats to provide stimulating variety and alternatives to accommodate the needs of all employees.     

In addition to onsite physical activity and healthful consuming events, on-line programs, e-mail reminders and notices, printed newsletters and materials, and workplace classes and workshops are common dissemination strategies.   

8   Executive management support

Enthusiastic and frequent endorsement by  senior level management is vital to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.   

9   Frequent contact

Successful programs have frequent contact of some sort with every staff member.  This might  be through advertising efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, staff meeting presentations, discussion in new staff member orientation, supervisory sessions, etc.      

The key is to enhance employee awareness of wellness opportunities and reinforce the corporate emphasis on wellness through frequent and multiple “touches”.   

10   Open enrollment

To encourage high participation rates staff members must have easy access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.     

Some businesses automatically enroll all employees and then allow those who don’t wish to participate to “opt-out”.  This practice has been proven to improve enrollment rates in some establishings.   

11   Family involvement

Many programs encourage spouses and other family members to participate in the company wellness activities and to adopt a healthy lifestyle along with the designated worker.  It’s far easier for the worker to have a healthy lifestyle if his/her family does so as well.   

12   Smoking cessation

Because smoking and other smoking is the number one threat to health it is crucial to offer staff members effective and convenient assistance with quitting.     

Access to smoking cessation pharmaceuticals is often part of such programs.  In-house programs provide the most convenient access to these services, although on-line or telephone-based programs might  be available as well.     

13   Physical Activity

Regular physical activity is a core component of every wellness program.  Staff Members should be strongly encouraged to engage in regular physical activity.     

Most programs provide either periodic or continuous onsite opportunities, and some locations have onsite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to community exercise facilities is a common alternative to onsite facilities.   

14   Weight management

Because obesity is a major threat to health it’s imperative that programs offer effective assistance with weight control.  Extensive encouragement from  executive management to shed excess weight is important.     

Internet Based programs, worksite programs, or discounted access to weight control programs in the community may all be available.  Long-term follow-up is critical for maintenance of weight loss.   

15   Stress management

Workplace stress is perhaps the most common complaint among workers and a major contributor to absenteeism, presenteeism (reduced productivity), and low morale.     
   
Nearly all successful wellness programs offer assistance with personal and workplace stress.  Some programs refer employees to outside resources for additional serious conditions like depression and anxiety disorders, but most offer online or frequent on-site general stress reduction programs.     
   
Some corporations endeavor to structure the work environment to minimize stress, both physically and operationally.   

16   Biometric screenings/immunizations

Staff Members are actively encouraged to complete advised health screenings for blood pressure, cholesterol, Body Mass Index (BMI), colorectal and breast cancer, and others.     

Annual influenza immunizations are also encouraged.  Some sites provide these services at the worksite.  Incentives are often awarded for completion of these screenings/immunizations.    

17   Onsite health care

Actual provision of onsite main care medical services is a growing trend.  The quickly escalating costs of medical care insurance for staff members has stimulated this trend.     

Some corporations have found that it is less expensive to provide primary care services themselves than to fund those services through medical insurance.     

On-Site care also lowers the amount of time staff members would otherwise spend away from the worksite getting such services.    

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Wellness Programs –   A Comprehensive Review of the Literature.   Am J Wellness 15(5) – 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Wellness  2(3) – 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Wellness –   is it Really as Important as We Think?  the Art of Wellness  7(2) – 1-12.

4   Chapman, Larry.  (2005)   Meta-Evaluation of Corporate Wellness Economic Return Studies –  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)   Staff Member Participation in Corporate Wellness and Wellness Programs –   How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) –   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Wellness Coaching in Corporate Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive –   an Analysis of the cost-Effectiveness of Corporate Wellness.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Companys” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research –   A View from One Research Center.  American Journal of Wellness 15(5) –  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthful Behaviors for Health Plans and Businesss” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Make sure to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) –  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of extensive Health and Illness ManagementPrograms at the Worksite –  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  an Unhealthy America –   the Economic Burden of Chronic Condition.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health –   Proven Wellness Practices for Workplaces.   http – //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.