Working for Permanent Change
A statewide health program helps improve work-site wellness -- for the long term.
BY KATE PETERSON
Rachel Cohen, SHIP communications coordinator, and Pat Adams, assistant commissioner, Minnesota Department of Health, and SHIP program manager.
After years of offering its 230 staff members various health improvement programs, SW/WC Service Cooperative, an educational institution based in Marshall, decided it was time to shift its focus. "For years, the Service Cooperative has done programs like 10,000 Steps, weight
management and the different 'challenges' that are typical of workplaces. In the last two and a half years, we began to focus on health cost management, so our focus moved beyond a program that lasts a week and then is done," says Kari Bailey, SW/ WC's health cost management
While SW/WC continues to offer health improvement programs to its employees, it has evolved in recent years, embracing what many in the public health field now recognize: Long-term, sustainable changes in behavior are best achieved through permanent changes in policy and
environment. In other words, "Biggest Loser" type events are fine, but if employees are going to change their health habits permanently, employers have to revamp or develop policies governing issues such as vending machine options, food choices at company-sponsored events and
paid time off for midday exercise.
Bailey says at SW/WC, the first step was developing a nutrition policy for the many SW/ WC-sponsored lunches. As a provider of education and training for school districts in 18 counties in southwest and west central Minnesota, SW/WC several times each week hosts client
meetings that include lunch. With no policy governing what was served, Bailey says the meals were often unbalanced, offered too-generous portions and were nutritionally weak.
A new policy -- put in place in September -- created very specific guidelines for approved caterers and gave staff members who were ordering the meals a menu of options that creates balance in their choices. In addition, SW/WC has purchased software that allows them to provide
nutrition facts for every meal served. "As a provider for these school districts, we need to set a good example," Bailey says.
Prevention essential to reform
The initiative at SW/WC was supported in large part by a key provision in the groundbreaking health reform legislation signed into law by Gov. Tim Pawlenty in 2008. Driven by concerns about rising costs, as well as clear evidence of a decline in the health of Minnesota
residents, lawmakers included a bold measure to reduce the key factors leading to preventable disease and death: obesity and tobacco use.
The Statewide Health Improvement Program was created and funded as part of the healthcare law to give communities resources to address these risk factors, which magnify overall health costs and also promise great potential for cost saving. With tobacco use adding nearly $2
billion to Minnesota's medical costs annually, and obesity and physical inactivity adding another $1.8 billion, prevention was essential to the reform effort.
As lawmakers considered prevention initiatives, one program's success helped encourage them to include a statewide public health improvement element in the bill. Since 2004, Steps to a HealthierMN, a program funded by the federal Centers for Disease Control and operating in
St. Paul, Minneapolis, Rochester and Willmar, had promoted policy, system and environmental changes to address tobacco use, poor nutrition and lack of physical activity.
Modeled after Steps to a HealthierMN, SHIP provides grants to community health boards and tribal governments, which in turn work with communities, schools, work sites and healthcare providers to create sustainable, population-based changes. The four areas were chosen to reach
people where they live, learn, work and seek care, says Rachel Cohen, communications coordinator for SHIP.
The emphasis on permanent change -- rather than a one-time or limited program -- is critical. "A program has a beginning and an end," Cohen says. "There might be behavior changes during the program, but they may not be sustainable; after the program is over, people go
back to their old way of doing things."
The approach through SHIP is different. "A policy is in place and the changes are more cultural, more permanent," she says. "A company might put a policy in place that allows employees to take 15 to 30 paid minutes per day to walk or exercise." These policies remain in
place unless changed, Cohen says, citing as other examples of sustainable changes moving to a tobacco-free campus or establishing vending machine and catering policies.
Reaching communities through SHIP
Since July 2009, SHIP has distributed grants to 53 community health boards and 11 tribal governments to fund what are called health-care "interventions," initiatives that change policy, systems or environments to create long-term changes in attitudes and behaviors about
The interventions include a spectrum of activities, from creating community and school gardens and farmers' markets to helping employers implement tobacco-free policies while linking their employees with smoking cessation programs.
In the case of SW/WC, SHIP staff helped Bailey find sample policies, create policies and find existing policies she could customize to address the catering issue. In addition, SW/WC applied for and received one of SHIP's mini-grants; the money was used to buy the software that
allows SW/WC to provide nutrition information on all meals provided at company functions.
In the short time since the grants have been distributed, there have been many successes -- including community gardens, farmers' markets, farm-to-school programs and tobacco-free campuses, Cohen says. "Whether we can see movement in obesity, it's too early [to tell]. It
takes a while to see behavior changes and a while longer to see health outcomes. There are some exceptions -- if you change school lunch menus, you have immediate behavior changes because kids are eating more fruits and vegetables," she says.
Another exception: work sites, where results can often be seen very quickly. "You can easily see changes in health-care costs, absenteeism and productivity," Cohen says. "SHIP looks at the state as a whole, but work sites are more micro, so you can see ROI changes and
healthcare utilization changes."
Employers interested in taking advantage of the information and grants available through SHIP should contact their community health board. Each of the boards is required to work with all four of the key players identified in the health care legislation: communities, schools,
work sites and health-care providers. That means each community board will have experience helping employers develop and implement programs that boost employee health, cut costs and enhance productivity.