Nutrition and Physical Activity Initiative Examines Impact of Healthy Institutions

The Bipartisan Policy Center’s Nutrition and Physical Activity Initiative closed out another busy month in February with a two-day panel discussion on “Healthy Institutions.” The forum brought together leaders from the federal government, private sector and health and insurance industries to explore ways to improve the nutritional offerings in large venues—hospitals, hotels, federal buildings, school systems, and sports and entertainment venues—and to enhance employee wellness efforts in worksites across the country.

Large institutions are uniquely positioned to affect Americans’ daily choices about health. Whether it’s the food offered in public venues or employer-sponsored programs to monitor and improve health in the workplace, the choices we make where we work, learn and play significantly affect our health. Together, these large players are responsible for buying and serving millions of meals to Americans, holding the potential to affect real outcomes in the food supply chain and to jumpstart the institutional and cultural shifts needed to effectively combat the obesity crisis.

DAY ONE brought together several institutions that are leading the effort to deliver healthier foods. Co-Chairs Dan Glickman and Ann Veneman hosted the day’s proceedings. The Healthier Hospitals Initiative, founded by six leading health systems, is encouraging hospitals to provide healthier food choices through local farmers markets and patient menu education. Major non-profit health systems like Kaiser Permanente and Inova Health System have implemented significant sustainability efforts, engaging with the community and prioritizing nutrition and exercise for their patients and staff. In the hospitality industry, Hyatt Hotels recently joined the Partnership for a Healthier America to announce a commitment to provide healthier menu options for their guests.

Ned Holland, Assistant Secretary for Administration at the Department of Health and Human Services (HHS), also joined the discussion, highlighting federal efforts to improve food services. Leading by example, in March 2011, HHS and GSA released Health and Sustainability Guidelines for Federal Concessions and Vending Operations. Based on the 2010 National Dietary Guidelines, the HHS/GSA guidelines are the first to require that government food service procurement meet certain standards, especially with regard to nutrition and environmental responsibility. HHS is currently implementing the guidelines, which will eventually affect all government agencies. The Department of Defense (DOD) has also shown tremendous leadership in this area. Lt. Col. Sonya Cable joined in the discussion to describe the changes DOD has made to its food offerings to improve the health and performance of servicemen and women. Jeff Mills, with DC Public Schools, described similar changes taking place at the local school district level. Overall, the panel showcased a number of innovative nutritional advancements in large-scale food services and identified areas for improvement moving forward.

DAY TWO featured former HHS Secretary Donna Shalala, another co-chair of the Initiative and President of the University of Miami, who has led a multi-pronged wellness campaign on Miami’s campus. President Shalala stressed that employers, too, can significantly affect a population’s health. Most Americans spend a majority of their time at work, affording an employer great opportunity to influence individual behaviors, monitor health care costs and coverage, and collect data on health risks and trends. And because many employers pay a significant portion of their employees’ medical bills, they have built-in incentives to invest in promoting healthy behaviors and preventive strategies.

Presenters included researchers who gather data on employee wellness cost-savings, return on investment (ROI) and programmatic effectiveness, as well as organizations who offer employers technical support to tailor and implement wellness programs. Both small and large employers, including the Arkansas Department of Health and the Veterans Health Administration (VHA), offered insights into building their programs and highlighted multiple positive impacts, for employees and the corporate bottom line. Though the VHA, for example, has long prioritized wellness for over 250,000 employees, the agency recently restructured its wellness approach to certify and support employees to become wellness coaches, and create a guidebook on wellness programming now used in several federal agencies. Johnson & Johnson has also been a leader in this area for a number of years and has ample data on the ways in which their programmatic changes have benefited the company and its employees. Healthwise, a 200-person health information company located in Idaho, has similarly been recognized as a model for their innovative wellness programming as a small employer. Though many in the room noted that data collection is a nascent and growing movement in worksite wellness, there also appears to be a clear ramping up of metrics and evaluation, with an eye toward refining ROI numbers as the national effort grows.

Panelists agreed that integrated, diverse programs have the highest rates of success, and that strong leadership, customized incentives and a culture of wellness are critical to the most effective programming. Representatives from Cigna of South Texas and Louisiana and Blue Cross Blue Shield North Carolina spoke about the insurer’s perspective, as well as local success stories from their regional work. UnitedHealth’s Diabetes Prevention and Control Alliance shared an impressive example, partnering with the YMCA on a Diabetes Prevention Program that targets the pre-diabetic population. The program reimburses trained YMCA lifestyle coaches to conduct a 12-month, group-based program aimed at curbing the development of type 2 diabetes, and is at the leading edge of thinking about ways private insurers can reimburse non-clinical providers for prevention work. It is a critical example of a scalable model at the forefront of a much-needed shift to prevention. In addition, Weight Watchers—well-known for their work over decades in this area—described a recent expansion of their model. Traditionally, Weight Watchers has focused primarily on individuals; currently, they are increasing their efforts to work directly with employers, which will allow them to broaden their reach and affect groups of employees.

As BPC continues to explore the levers for change—and the tremendous potential that large institutions and employers have to shape both supply and demand and workforce health—we ask that you continue to share your policy ideas with us as we look forward to releasing our report this spring.