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Transcript of Valley Health Occupational Health Services Seminar Winchester, Virginia 4 November 2011 John Howard...
Valley Health Occupational Health Services Seminar
Winchester, Virginia
4 November 2011
John HowardNational Institute for Occupational Safety and Health
U.S. Department of Health and Human ServicesWashington, D.C.
Future of the Workforce
Seven Billion in 2011
Challenges to the Future of Work
• How Safe is It?– Hazards
• Persistent• Emerging
• How Stable is It?– Employment
• Flexible vs. Precarious• Unemployment
The Future of the Workforce
• We do not talk about the state of the workforce itself
• Challenges:– Employers– Workers– Government
• Demographic, health, social, economic
Workforce Challenges
1. Limited Availability All Ages
2. More Chronologically-Gifted
3. Health Challenges for Younger Workers
4. The R-Word & Pension Funding
5. Global Competition for Workers
6. Work Extension & Recareering
7. Aging Productively
Occupational Safety & Health Act 29 U.S.C. 651(b)
• Congress declares it to be its purpose and policy
–To assure as far as possible every
working man and woman in the Nation safe and healthful working conditions, and
–To preserve our human resources
Source: Employment Policy Foundation analysis and projections of Census/BLS and BEA data.
Millions of People
Expected Labor Force and Labor Force Demand
0
50
100
150
200
250
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
Labor Needed
Labor Available
Growing Shortage of U.S. Workers
Screeching to a Halt:Growth in the Working-Age Population
Source: Deloitte Research/UN Population Division (http://esa.un.org/unpp/) It’s 2008: Do You Know Where Your Talent Is? Why Acquisition and Retention Strategies Don’t Work, p.6
-50%
0%
50%
100%
150%
200%
Mexico Brazil India China South Australia Canada US Netherlands Spain France UK Russia Italy JapanGermany
Korea
1970-2010
2010-2050
5% 5%
-9%
18%
48%
15%
-20%
0%
20%
40%
60%
80%
16-24 25-34 35-44 45-54 55-64 65+
Age of Workers
Percent Growth in U.S. Population by Age: 2000-2010
Dramatically Different Patterns of Growth by Age
1. Declining number of mid-career workers
2. Few younger workers entering
3. Rapid growth in the over-55 workforce
Source: U.S. Census Bureau. 2000
. . . Continuing Into the Future
Age of Workers
Percent Growth in U.S. Workforce by Age: 2000-2020
7% 8% 7%
-10%
3%
73%
54%
-20%
0%
20%
40%
60%
80%
under 14 15-24 25-34 35-44 45-55 55-64 65+
Source: U.S. Census Bureau
In 2000, A Fairly “Young” World . . .
Under 5% 5% to 12.4% 12.5% to 20% Above 20%
Source: U.S. Census Bureau, 2000
Percent of Population Age 60+ in 2000
. . . Rapidly Aging by 2025
Source: U.S. Census Bureau,. 2000
Under 5% 5% to 12.4% 12.5% to 20% Above 20%
Percent of Population Age 60+ in 2025
Why? “Sudden” Boom in Life Expectancy
Source: U.S. Census Bureau, 2000
Life Expectancy at Birth: 1000 - 2000Age
76.5
47
383635
30
25
0
10
20
30
40
50
60
70
80
1000 1200 1400 1600 1800 1900 2000
And a Dramatic Drop in Birth Rates
Source: Age Wave
Tota
l Fer
tility
Rat
e
3.32.8 2.9
3.6
2.02.5 2.5
4.0
5.9
2.01.7 1.7 1.6 1.4 1.3 1.2
1.8
3.1
0
1
2
3
4
5
6
7
US UK France Canada Japan Germany Italy China India
1960 2000
Total Fertility Rate: 1960 ▀ and 2000 ▀
Why? The Baby Boom Pattern
Source: U.S. Census Bureau International Data Base
1930 1940 1950 1960 1970 1980 1990
4.5
4.0
3.5
3.0
2.5
2.0
Birth
in M
illion
s
The Boom Years: 1946-1964
• to disappear • to go away • to withdraw
Source: Webster's New Twentieth Century Dictionary
Webster's Definition of Retirement
More Years Spent in “Retirement” After First Career
0
5
10
15
20
25
30
35
1900 1980 1990 2000 2010
13.6
19.420-25
1.2
Yea
rs
Source: Age Wave, based on U.S. data, and The Concours Group
30 +
Pension Primer• Bulk of retirement income comes from the government
– Despite insurance label, pension systems are pay-as-you-go systems in which benefits are paid out of current taxes
• Immediate cash cost is not the big problem– Key figure is the support ratio (ratio of workers to pensioners)
• Defined Benefit (DB) – Risk on Employer– Workers promised pensions linked to salaries
• Defined Contribution – Risk on Worker– Pension depends on amount contributed, investment
performance
• Public Sector (States and Cities)– Has underfunded pension schemes for years– Relied on stock market to come to the rescue, but gamble failed
Over to You! Private Sector Bails on DB Plans
Workers Per Medicare Beneficiary
Beneficiaries (Millions) Workers Per Beneficiary
2000 2010 2020 2030
2000 2010 2020 2030
Source: Kaiser Family Foundation, based on 2001 and 2008 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
The Case of Social Security
• Social Security Act of 1935– In 1935, life expectancy at birth was 62– Retirement benefits started at 65!– Intended to be brief period of assistance for
the hardy few at the sunset of life– Now, life expectancy is causing $$$ strain
• In 2010, SSA ran a cash deficit first time since 1983
• 6 years earlier than expected, due to high unemployment
Taxes Must Rise or Benefits “Cut”• “Cuts” by raising retirement age or increasing # contribution years
• Nations are now banning early retirement & raising eligibility age • France – Raised early retirement age to 62 by 2018 and had strikes• Greece – Raised full benefit retirement age to 63; banned early
retirement at 55 altogether; and had riots• Italy -- From 2015 on, future changes in retirement age will be indexed to the rise in life expectancy• U.S.
– 1983 Amendments phased in a gradual increase in the age for collecting full Social Security retirement benefits. The retirement age will increase from 65 to 67 over a 22-year period, with an 11-year hiatus at which the retirement age will remain at 66.
– 70 for maximum benefits?– Disadvantages workers in physically demanding jobs?
Demographics Summary
• People are living longer; a high proportion of their lives will spent in 21st century in mid-20th century “retirement”
• Large generation is now retiring, but following generations are much smaller in number; as a result, the support ratio is falling, leaving a huge cost burden on pension systems
• Challenge for employers:• How to provide right incentives for work extension?• How to manage a health-challenged workforce?
• Challenge for workers• How to age productively?• How to plan 21st century worklife?
Health-Challenged Young Workers
Childhood Obesity by Country
Diabesity and the Future Workforce
• 39 States with 40% of young adults considered to be overweight or obese in just last decade!– In Kentucky, Alabama and Mississippi, >50% young adults are
overweight
• Medical Consequences:– High Blood Pressure– High Fats in the Blood– Type 2 Diabetes (formerly called adult-onset)– Sleep apnea (too much fat around the upper airway)
• Musculoskeletal Stressors– What workers at all ages have in common!
Too Fat to Fight• Reasons for Rejection:
– Education, criminal record, medical– In 2010, 99% of recruits had HS diploma– Criminal record still an obstacle
• Since 1995, proportion of recruits who failed their physical exams because they were overweight has risen by nearly 70%
• Being overweight is now the leading medical reason for rejection.
Global Competition for Workers from BRICS
• In 1900s, U.S. benefited from immigration of skilled workers from sending countries
• In 2000s, these sending countries are now keeping their workers
BRICS and More• BRICS: Brazil, Russia, India, China, South Africa
– U.S. cannot count on acquiring skilled workers from sending countries
– International labor market may not be that international!• Global competition for talent • Leads to global skilled worker scarcity• Effects on employers?
– New immigration laws in Arizona, Utah, Indiana and Georgia
– Alabama:» Latino pop grew by 145 % to about 185,600» New law allows authorities to question people
suspected of being in the country illegally and hold them without bond. It also lets officials check the immigration status of students in public schools
Aging Productively
Aging: A Balance of Factors
• Limitations?– Physical Capacity– Chronic Medical Conditions– Mental Capacity & Cognitive Limitations
• Compensating Factors?– Attitude– Judgment – Flexibility– Interest in learning new things
Physical Capacity• Physiology Facts
– Maximal strength at 20-30 years
– O2 uptake reduced to 70% (max) by 65 years
– Older adults work closer to capacity!• Decreased Performance, Yes But …
– For physically demanding work only– Work uncommonly demands maximal effort
• Manufacturing to service economy• Robotics
Physical Capacity: Match Worker to Task
• Maintaining musculoskeletal health will be increasingly important
• Workers’ abilities need to be matched to the job– Results in less morbidity– Based on practical ergonomic and accommodation
principles– Need for expertise in providing reasonable
accommodations growing and will grow more– Studies show only 10-20% of workers needing
accommodations are provided accommodations
ADA Amendments Act of 2008• Definition of disability:
– Construed in favor of broad coverage and generally “shall not require extensive analysis”
• Makes it easier for individuals to establish that they have a disability– Many with MSDs are considered individuals with a
disability
• ADA Amendments Act will increase need for reasonable accommodations practice skills– In safety and health professionals
• EEOC issued final rule on March 25, 2011– 76 Federal Register 16,978
Age and Chronic Medical Conditions
Workers with >1 Chronic
Condition by Age (U.S.)
0
10
20
30
40
50
60
70
>1
51-64 65-74 75+ Non-workers
HRS 1998
Mental Capacity• Learning and recall slower, equally successful by age
• Factors other than psychometric cognitive abilities appear important to perform well at work
– How well worker gets along with co-workers
– Worker engagement
– No evidence that older workers are rigid or stifle innovation
What About Mental Retirement? • “Use it or lose It” (in the popular literature)
– Stave off normal cognitive aging or dementia by engaging in cognitively demanding activities
– Converse: Un-demanding environment may fail to impede or even accelerate the process of cognitive decline
• Hypothesis that people can maintain their cognitive abilities through mental exercise is not proven, but suggestive
• 2010 Journal of Economic Perspectives’ paper addresses the question of whether retirement leads to cognitive decline
– Uses cross-national comparable surveys of older persons from US, UK and eleven EU countries in 2004
Mental Retirement
Essential Points About Aging Workforce
• Do aging workers need special accommodations?
– A well-designed workplace benefits everyone– Job tasks need to be matched to the capacity of each worker– Reasonable accommodations at all ages; matching task to worker
• Any specific health and safety concerns related to aging workers?
– No consistent relationship between aging and work performance!
– Older workers have fewer injuries, but when one occurs, that injury tends to be more severe and it takes worker longer to get better.
– Emphasizes the value of return to work policies, programs and practices!
EVALUATION OF WORKSITE HEALTH PROMOTION PROGRAMS — DO THEY WORK?
CDC COMMUNITY GUIDE TO PREVENTIVE SERVICES REVIEW – AJPM, FEBRUARY 2010
49
Employee Wellness Practices: What’s the Evidence?
• Evidence:– More than opinion, anecdote or testimonial
• “…Growing body of empirical evidence*– Large proportion of diseases are preventable (risks are
modifiable)– Risk-dependent diseases are costly & reduce worker
productivity within short time window– Targeting risk can decrease costs/increase productivity– Worksite health promotion and disease prevention
programs save companies money and produce + ROI
* Goetzel & Reuters, Value in Health Care , Institute of Medicine (2010)
HEALTH AFFAIRS ROI LITERATURE REVIEWBaicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings.
Health Affairs(Millwood). 2010; 29(2).
51
Health Reform Initiative
http://www.metrokc.gov/employees/M_E_Report/
HEALTH CARE ENVIRONMENT
• 13,000 employees
• 30,000 plan members
• Strong Labor Unions
– 92 separate bargaining units
• Dwindling tax base, rising public expectations
• Comprehensive medical, dental, vision
• 2012:
– Health plan costs will double under status quo to $300+ Million
Healthy Incentives Plan Design
Healthy IncentivesSM Program
Group HealthKingCareSM
$600
$400
$200
Hospital Copay* *
$5020%$500/ ind.
$1500/ family Bronze
$3520%$300/ ind.
$900/ family Silver
$2010%$100/ ind.
$300/ familyGold
Office Visit Copay
Co-insurance*
Annual Deductible
*In-network provider** Per inpatient stay
Baseline, Targeted & Actual Employee HC Costs: 2003 - 08
Growth of King County & Employees'/Families' Health Care Costs
2005/2008 Trend Compared to 2003/2004 Trend
$80M
$88M
$109M
$98M
$148M
$134M
$120M
$98M
$109M
$118M
$129M
$140M
$97M
$107M
$113M
$126M
$70M
$80M
$90M
$100M
$110M
$120M
$130M
$140M
$150M
2003 2004 2005 2006 2007 2008 2009
Kin
g C
ou
nty
Cla
ims
+ E
mp
loy
ee
s'/F
am
ilie
s' S
ha
re
Projected Health Care Cost Trend for '03-'04 Pre-HRI: 10.8%
Targeted Medical/Rx Costs Rising at 8.9% after 2006
Actual Health Care Costs
Projected Health Care Cost Trend
Council-approved Health Care Cost Trend Target after 2006: 8.9%
Growth of King County & Employees’/Families’ Health Care Costs
2005/2008 Trend Compared to 2003/2004 Trend
__
FirstWellness
AssessmentHRI
Start-up
NewBronze/Silver/Gold
Incentives
Projected Health Care Cost Trend for ’03-’04 (Pre-HRI): 10.8%
Actual Health Care Cost Trend for ’05-’08 (Post-HRI): 8.8%
Actual Health Care Cost
Source: Naydeck, Pearson, Ozminkowski, Day, Goetzel. The Impact of the Highmark Employee Wellness Programs on Four-Year Healthcare Costs. JOEM, 50:2, February 2008
ANNUAL GROWTH IN NET HEALTH CARE PAYMENTS
0
500
1000
1500
2000
2500
3000
3500
2001 2002 2003 2004 2005
Participants Controls
Sta
rt o
f P
rog
ram
Annual growth in costs, Highmark, Inc.For matched-participants and non-participants over four years
Harvard Business Review
• 6 Pillars of Wellness Program– Multi-level leadership– Alignment with Identity of firm– Scope, relevance and quality– Accessibility– Partnerships– Communications
• “Fruits of Workplace Wellness”– Lower costs
• Claims 1,500K higher in non-participants (H-E-B)• Moving 10% from high/medium risk to low yields ROI estimates of 6 to 1.
– Greater productivity – Lost productivity costs 2.5 x higher than medical costs) Loeppke et al. (2009); Dow Study (2002)
– Higher morale – no data
Berry, Mirabito & Baun, What’s the Hard Return on Employee Wellness Programs? HBR (Dec, 2010)
WHEN EVALUATING EMPLOYEE WELLNESS PROGRAMS
Financial OutcomesFinancial
OutcomesHealth
OutcomesHealth
OutcomesQOL and
Productivity Outcomes
QOL and Productivity Outcomes
Cost savings, return on investment (ROI) and
net present value (NPV).
Where to find savings:• Medical costs• Absenteeism
• Short term disability (STD)• Workers’ comp• Presenteeism
Adherence to evidence based
medicine.Behavior change,
risk reduction, health improvement.
Improvement in quality of life.
Improved “functioning” and
productivity.
WorkLife Extension
• Employee gets more years of wages
• Government receives more in taxes & pays less in benefits
• Economy grows faster as more people work for longer
What’s To Be Done?• Government
– Treat retirement as a process, not as a sudden event– Institute “auto-enrollment” with “opt-out” clauses for
DC plans
• Workers– Under defined contribution plan, contribute sufficient
amount
• Employers– Treat older workers as mentors– Offer different incentives by age– Integrate health protection and promotion
Integrating Promotion & Protection
• Workers’ (modifiable) disease risks increased by exposure to occupational risks
• Workers at highest risk of work hazards are more likely to engage in (modifiable) life risks.
• For workers’ at highest risk, integrating protection and promotion increases wellness participation & program effectiveness
Total Worker Health™
Intramural Program
Research
Demos
Partnerships
Federal
Other
Centers of Excellence
3 Renewals
1 New
Total Worker Health Examples
• Respiratory protection programs that address tobacco use and smoking cessation
• Ergonomics programs that teach joint health and arthritis management
• Stress management classes that seek to diminish workplace stressors, personal stressors and build resiliency
Employment• Global Economy
– Competition for Workers, Products, Services, Knowledge • Benefits Systems
– Rising Health Care Costs – Eroding Distinction Between Work-Related and Non-Work-
Related Conditions • Health, Productivity & Disability Management
– Presenteeism & Absenteeism • Americans with Disabilities Act
– Requirements Related to Wellness & Health Promotion Programs
• Changing Social Policies Related to Retirement– Retirement Age – Benefits
Workers• Older Workers
– Aging Productively – Recareering
• Younger Workers– Health challenges and Skills Deficits
• Groups of Special Concern– Differently abled; military to civilian transition
• Prevalent Chronic Health Conditions– Obesity, Arthritis , Hypertension/CVD, Diabetes , Depression, – Stress, Sleep & Fatigue Issues
• Health Promotion– Smoking Cessation – Diet and Nutrition – Physical Activity – Stress Management & Resiliency
Workplace• Persistent and Emerging Hazards• Environmental Risk Assessment
– Root Cause Analyses – Modify Work to Reduce Risks
• Return to Work Issues– Promote Safe Environment
• Safety Culture • Safety Decision Making • Increased Hazard Recognition
• Promote Health and Wellness Culture– Leadership Support – Worker Involvement – Health in All Decisions
• Improve Organization of Work
Take Home Points• Ida May Fuller
– 1st American to receive a monthly Social Security check
– Ida paid in $24.75 and got out $22,288.92 – She died at 100!
• Winston Churchill– Reached age of 65 with career regarded as a failure– Had he retired then, he would have never become
prime minister, made world-famous speeches, saved Britain from Hitler or topped every poll since of the greatest Britons ever
Thank you for your attention!
Selected References• Americans with Disabilities Act Amendments of 2008. Information available from EEOC
at http://www.eeoc.gov/laws/statutes/adaaa_info.cfm• National Research Council. Health and Safety Needs of Older Workers, National
Academies Press (2004).• Dychtwald K, Erickson T, Morison, B. It’s Time to Retire Retirement, Harvard Business
Review (March 2006).• GAO. Older Workers: Enhanced Communication among Federal Agencies Could Improve
Strategies for Hiring and Retaining Experienced Workers. GAO-09-206 (February 24, 2009).
• GAO. Older Workers: Some Best Practices and Strategies for Engaging and Retaining Older Workers. GAO-07-433T (February 28, 2007).
• James, J. B., McKechnie, S., & Swanberg, J. (2011). Predicting employee engagement in an age-diverse retail workforce. Journal of Organizational Behavior, 32(2), 173-196
• Johnson, Richard et al. Older Workers on the Move: Recareering in Later Life (2009), AARP Public Policy Institute
• National Institute on Aging. Growing Older in America: The Health and Retirement Study. Available at http://www.nia.nih.gov/ResearchInformation/ExtramuralPrograms/BehavioralAndSocialResearch/HRS.htm
• Report of the Taskforce on the Aging of the American Workforce (2008). Available at http://www.aging.senate.gov/letters/agingworkforcetaskforcereport.pdf
• Rohwedder S. & Willis RJ. Mental retirement. Jo Econ Perspectives 2010;24(1):119.• RW Johnson et al. Work Impediments at Older Ages (2006). Available at
http://www.urban.org/UploadedPDF/311313_work_impediments.pdf• Saveri, A. Future of Work, Institute for the Future • Solving the Problem of Childhood Obesity Within a Generation (2010) Available at
http://www.letsmove.gov/tfco_fullreport_may2010.pdf