Box

Priorities for Employers: Recommended Clinical Preventive Services with High Health Impact and Value

• Vaccinate children: DTP/DTaP, MMR, oral polio/IPV, Hib, Hep B, varicella.

• Assess adults for tobacco use and provide tobacco cessation counseling.

• Screen adults aged >65 years for vision impairment.

• Assess adolescents for drinking and drug use and counsel them on abstinence from alcohol and drug use.

• Assess adolescents for tobacco use and provide an antitobacco message or advice to quit.

• Screen sexually active women aged >18 years for cervical cancer.

• Screen all persons aged >50 years for colon cancer (FOBT or sigmoidoscopy).

• Screen newborns for hemoglobinopathies, PKU, and congenital hypothy-roidism.

• Screen all persons for hypertension.

• Vaccinate adults aged >65 years against influenza.

• Screen sexually active women aged 15 to 24 for chlamydia.

• Screen men aged 35 to 65 and women aged 45 to 65 for high blood cholesterol levels.

• Screen for problem drinking among adults and provide brief counseling.

• Vaccinate adults aged >65 against pneumococcal disease.

NOTE: DTP/DtaP = diphtheria, tetanus, pertussis/diphtheria, tetanus, acellular pertussis; FOBT = fecal occult blood testing; Hep B = hepatitis B; Hib =Haemophilus influenzae type b; IPV = poliovirus vaccine, inactivated; MMR = measles, mumps, rubella; PKU = phenylketonur-

SOURCE: Partnership for Prevention (2001a).

1997). Furthermore, critics point out that employer-sponsored health insurance distorts the labor market by favoring large businesses over small ones, encourages employers to outsource certain workers, and affects workers' decisions about work and retirement (Congressional Budget Office, 1994; Gruber and Madrian, 1996). These critics recommend changes in tax policy so that tax incentives for the purchase of health insurance would not favor employer-sponsored coverage (Pauly, 1986; Congressional Budget Office, 1994; Gruber and Madrian, 1996; Gavora, 1997; American Medical Association, 1999; Health Policy Consensus Group, 1999).

Until reforms are enacted to assure access to affordable health insurance for all Americans, the committee urges employers to continue to provide and improve health insurance coverage for their employees. Employers should endorse the purchase of evidence-based benefits and work diligently to ensure the quality of the services that they purchase. The committee recommends that the federal government develop programs to assist small employers and employers with low-wage workers to purchase health insurance at reasonable rates.

EMPLOYER INTEREST IN PROMOTING THE HEALTH OF EMPLOYEES: A RATIONALE FOR CORPORATE INVESTMENT IN HEALTH

Employers should be concerned about the health and well-being of their employees for a number of reasons. Healthy employees consume fewer benefits in the form of benefit payments for medical care, short- and long-term disability, and workers' compensation. Furthermore, healthy employees are more productive than their nonhealthy counterparts because they are absent less often and are more focused on their tasks while at work.

Through health insurance premiums and self-insured plans, employers pay large sums of money for the treatment of diseases and disorders, many of which are lifestyle related and often preventable. The leading causes of death in the United States are heart disease, followed by cancer, stroke, chronic lower respiratory disease, accidents, diabetes, pneumonia/influenza, Alzheimer's disease, nephritis, nephritic syndrome and nephrosis, and septicemia (NCHS, 2002). A significant proportion of some of these diseases and disorders can be attributed to lifestyle habits and behaviors. For example, one study suggests that about 57 percent of heart disease deaths, 37 percent of cancer cases, 50 percent of strokes, 60 percent of accidents, 23 percent of pneumonias, 34 percent of diabetes cases, 60 percent of suicides, and 70 percent of chronic liver disease and cirrhosis cases are related to habits and behavior (NCHS, 1999). In the case of cancer and cardiovascular disease, seven modifiable risk factors account for 23 and 65 percent of the cases of morbidity, respectively (Amler and Dull, 1987).

More than 10,000 peer-reviewed articles in scientific journals show a clear causal relationship between specific modifiable risk factors and adverse health consequences. The following modifiable risk factors increase rates of mortality, morbidity, disability, and, in many cases, productivity loss: tobacco use, alcohol and drug use, sedentary behavior, poor nutrition, being overweight, having elevated serum cholesterol levels and high blood pressure, exhibiting high levels of stress and hostility, a lack of social support networks, and having unsafe sex. About half of all deaths in the United States are attributable to nine modifiable risk factors, including tobacco use (Box 6-2), diet and activity patterns, alcohol use (Box 6-3), firearm use, sexual behavior, motor vehicle accidents, and illicit drug use (McGinnis and Foege, 1993). Tobacco use alone caused approximately 440,000 premature deaths annually from 1995 to 1999 (CDC, 2002).

A number of studies have presented information on the distribution of illnesses in different companies. In a comprehensive study of Fortune 500 companies, coronary artery disease was the most costly disease for employers and represented 6.72 percent of total payments (Goetzel et al., 2000). The annual mean payment for claims related to coronary artery disease was $4,639 per patient and more than double the average payment of $2,230

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