Your fries, my wallet

Why an unhealthy lifestyle hurts us all


It’s tempting to think that a person’s health behavior is confined to his or her own body.

Paul Blow

After all, who are we really hurting by ordering that second basket of curly fries? But try telling that to health economists armed with myriad data that show how much a person’s addiction to fried food or aversion to the exercise cycle costs the rest of us.

According to a 2004 study from the Centers for Disease Control and Prevention and the nonprofit RTI International, medical costs associated with obesity alone totaled $75 billion in 2003, with the government-funded Medicare and Medicaid programs — i.e. taxpayers — financing about half of those expenses. That same year, the U.S. Surgeon General announced that employees who smoke cost American businesses $74 billion in health-care costs each year.

“Companies are getting really squeezed with health-care costs — both with current employees and retirees,” says James Fries, MD, a Stanford professor of medicine who has analyzed numerous companies’ attempts to curb medical costs by implementing wellness programs. “They’re desperate for some way of dealing with that.”

But it’s not just medical costs that business has to worry about. Employers often spend a larger chunk on lost productivity due to poor employee health than on direct medical and disability costs, according to Ron Goetzel, PhD, director of the Cornell University Institute for Health and Productivity Studies. A 2005 study commissioned by California’s Department of Health Services found that the cumulative physical inactivity and obesity among the California workforce costs employers $11 billion in lost productivity, compared with $10.2 billion for direct and indirect medical care and $338 million for workers’ compensation.

 INTERVIEW: Michelle Brandt talks to Larry Cohen, MSW, executive director of the Oakland-based Prevention Institute (XX minutes).

It makes sense that an unhealthy person is more likely to miss work than a person with good health habits. But recent research also shows a direct relationship between on-the-job performance and modifiable health risks, such as obesity and smoking. A 1999 study from Northwestern University researchers, for example, found that as employees’ health risks increased, their work productivity — demonstrated by such things as the speed of completing a task, ability to concentrate and quality of interpersonal communication — decreased.

And businesses pass the costs on to the consumer. “Every one of us has picked up the tab for the lifestyles these people lead, whether  hrough automobiles or dish detergent,” says David Chenoweth, PhD, professor at East Carolina University in Greenville, N.C., who conducted the California study on obesity costs.

Chenoweth estimates that $1,500 of the sticker price on most cars manufactured by the United Auto Workers in the United States goes toward health insurance benefits for union employees.

Higher health-related costs for employers also mean lower salaries for you and me. Alain Enthoven, PhD, a Stanford business school professor and a faculty member in the Center for Health Policy/Center for Primary Care and Outcomes Research, points out that employers routinely put money that could otherwise be used for pay increases toward health-care costs. For this reason, he says, inflation-adjusted wages in the United States have not increased for two decades.

A world of healthier, fitter people would benefit all of us. Chenoweth’s 2005 report showed that if just 5 to 10 percent of overweight Californians became leaner and more physically active, the state — due to decreased health-care costs and increased employee productivity — could see savings of more than $1 billion per year. And the state’s health department estimates that the California Tobacco Control Program, which has helped reduce tobacco use across the state, saved more than $3 billion in medical costs between 1990 and 1998.

But don’t expect large numbers of Americans to drop their cheeseburgers upon hearing these statistics. Wes Alles, PhD, director of Stanford’s faculty/staff wellness program and a senior research scholar in the Stanford Prevention Research Center, stresses that few people will be swayed by the argument that their behavior costs society money. “Making that argument to someone who has an emotional attachment to the way they’re doing things is a mismatch,” he explains.

Instead, Alles says, people should be encouraged to think about how living more healthfully will ultimately benefit them. “The primary beneficiary is the individual, secondary is his or her family, third is the community and the nation,” he says.

In an effort to help people make this jump to a healthier lifestyle, many employers have launched wellness and health promotion programs, usually including exercise classes and stress management and diet workshops. 

Experts say these types of programs can be effective at changing knowledge and behavior, preventing or delaying the onset of disability and disease and ultimately cutting costs for the company.

“If done right, wellness programs can have a significant impact,” says Cornell’s Goetzel. “The programs can help employees not just with decisions but behaviors: exercising more, eating healthier, not smoking, avoiding stress.”

At USAA, a San Antonio-based financial services company with 22,000 employees, the number of employees who smoke, are overweight or have other health risk factors has decreased since the 2003 launch of its Take Care of Your Health wellness program. In turn, workplace absences have decreased, with an estimated three-year savings of more than $105 million.

Many experts believe more focus should be put on these prevention programs — not just in the workplace, but in all communities. Larry Cohen, MSW, executive director of the Oakland-based Prevention Institute, a nonprofit organization dedicated to improving community health, is one such advocate. “It’s a lot more fun and cost-effective to stay healthy than it is to recuperate after being sick or injured,” he points out. “From a societal perspective, we really need to make the healthy choice the easy choice. And a community health approach is central to this endeavor.”

And, as luck would have it, the healthy choice also means healthier wallets for us all.


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