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Staff Health Screening: A Great Place to Start

Over the past 100 years, lifestyles in the western world have changed significantly. In general, we are less physically activity, eat a diet higher in refined carbohydrates and fats, suffer from greater levels of mental stress and sleep far less than our counterparts of 1900. In this article Chris Jones looks at why staff health screening could now be the most powerful weapon in a businesses arsenal when it comes to tackling employee health and wellbeing issues.

As our lifestyles have changed, so have the major causes of morbidity and mortality. In 1905, the major causes of death were acute infectious or viral conditions, such as tuberculosis (death rate of 162.1 per 100,000 people), pneumonia and influenza (150.9 per 100,000)1. In comparison, the leading causes of death in the UK in 2003 were chronic conditions associated with modern lifestyles, with malignant cancers being the number one cause of death (27.9% of deaths), ischemic heart disease coming second (21.6%), strokes third (8.7%) and chronic lung diseases fourth (5.8%) (2). These diseases have appropriately been labelled as lifestyle diseases by some researchers.

Long term ill-health is a major burden for employers

Whilst the acute conditions that were major killers 100 years ago usually progressed rapidly, today’s major killers tend to progress slowly and are often asymptomatic (symptom-less) until they have progressed to a dangerous stage. For example, ischemic heart disease typically develops over four or five decades and may not produce any symptoms until a major artery has been narrowed by around 70%(3), whilst the symptoms of many cancers may not become evident until the cancer has metastasised (spread) to other body parts, by which point it may have been developing for ten years or so(4). Similarly, there are around 500,000 individuals who have diabetes in the UK but have not yet been diagnosed(5) with the risk of amputation, kidney damage and blindness increasing in relation to length of time undiagnosed. In addition to the obvious personal burden that these diseases cause, they also impose a significant burden on the economy, with heart disease, stroke and cancers having a worldwide annual economic cost of €456.42 billion in 2003(6). According to the Chartered Institute of Personnel and Development (CIPD), cardiovascular disease and cancer were cited as being major causes of long-term absence by 54% of employers of non-manual workers and 60% of employers of manual workers in the UK in 2009(7). Managing ill-health is therefore likely to be a key way for employers to maintain control over productivity and absenteeism.

Early detection of lifestyle related disease is key

Given the long time frame in which a lifestyle disease usually develops before it manifests itself in clear symptoms, a key step in decreasing the impact of these conditions lies in detecting them as early as possible. For example, 90% of cancer deaths occur once the cancer has metastasised and detecting a tumour before it has metastasised correlates with an increased likelihood of survival(4). Similarly, identifying individuals who are showing signs of mild resistance to the hormone insulin (coined “pre-diabetes” by some) may allow for interventions that prevent them from going on to develop Type 2 diabetes(8). By performing a wide range of tests designed to identify commonly encountered diseases (heart disease, diabetes, cancer, etc), health assessments attempt to identify them at an early enough stage to be able to ensure effective treatment and thus prevent disability or death. In addition to detecting an existing disease, health assessments also allow for identification of risk factors that could lead to the development of disease in the future. For example, measuring someone’s waist size, cholesterol level, blood sugar control or alcohol intake all give an insight into whether an individual has an increased risk of suffering from a chronic disease or not. Thus, health assessments play a vital role in identifying high risk individuals and ensuring they are directed towards treatments that will reduce their future risk of disability or death, ultimately reducing the impact that these diseases have on the economy.

The benefits of staff health screening goes far beyond the identification of risk

However, a contemporary corporate health screening programme should be designed to do far more than just identify illness or risk factors. Whilst the benefits of tackling classical illnesses such as the ones discussed above are well known, there is now a growing recognition that many adults may not be suffering from classical illnesses, but may instead be suffering from so called functional health issues, such as excessive stress, poor sleep, depressed moods or low energy levels. For example, an estimated 415,000 employed individuals in Britain in 2008/09 believed they were experiencing work-related stress at a level that was making them ill, whilst the 2009 Psychosocial Working Conditions survey indicated that around 16.7% of all working individuals thought their job was very or extremely stressful(9). Similarly, the Royal College of Psychiatrists states that, at any given time, one in five people feel unusually tired and one in ten have prolonged fatigue(10). Thus, contemporary health assessments should be designed to act as proactive health tools focused on decreasing risk and improving total wellbeing, rather than reactive tools waiting for a disease to develop and then simply aiming to identify it.

Health is the absence of disease plus the ability to function optimally

This new concept of health assessments challenges the usual model of health as being merely the absence of disease and replaces it with a model in which health is the absence of disease plus the ability to function optimally – whatever that may mean to the individual. While this may seem like a unique concept, it is important to remember that the World Health Organisation (WHO) defined health way back in 1946 as:

“… a state of complete physical, mental and social wellbeing,
and not merely the absence of disease or infirmity”.

Contemporary Health Assessments could have Financial and Productivity-Related Benefits

Whilst the idea of improving total wellbeing may seem less important, employers should not underestimate the impact that an employee’s function may have on their company. For example, stress is cited as the number one cause of absence from work, accounting for an estimated 11.4 million lost working days and costing UK employers £1.24 billion annually(7, 8, 11), whilst fatigue-related productivity losses cost an average of $1,967 (approximately £1,368) per employee annually(12). In addition, growing evidence is suggesting that functional conditions may also be causative or exacerbating risk factors for many classical illnesses. For example, stress is associated with a dramatic increase in the risk of cardiovascular disease, cancer, and infectious diseases(13,14), which then further increases the risk of absenteeism and lost productivity.

Preventing these issues from developing, as well as tackling them when they have developed, is therefore likely to offer numerous financial and productivity-related benefits to employers. Luckily, evidence suggests that both classical medical illnesses and functional health conditions respond well to increases in healthy behaviours, such as exercise, relaxation, dietary changes and improved sleep(3,8). Given this, contemporary health assessments should be comprised of two important practitioners:

1. A diagnostician (such as a general practitioner) whose role is the identification and diagnosis of illness, and
2. A lifestyle and behavioural change expert (such as a Health and Wellbeing Physiologist) whose role is to recommend expert lifestyle interventions and motivate long-term changes to health-related behaviours to improve function and reduce risk.

The skill sets of these two practitioners complement each other effectively, ensuring that any significant illness or risk factor is diagnosed and identified, yet also ensuring that prevention, function and behavioural change are tackled in a meaningful way.

How important are they?

So, are corporate health screening programmes the most valuable tool for employers when it comes to tackling workplace health issues? As with most things, opinions are likely to be divided. However, given the state of health of the UK population, as well as the economic burden that decreased function brings, the answer is likely to be yes. More and more, employers are recognising the benefits that health assessments may offer them and their employees and, interestingly, researchers are now also proving this to be true. One study in 2005(15) found that the return on investment in tackling health risks in employees was 1:3.96!

About Author: Chris Jones is Professional Head of Physiology for Nuffield Health.

References

1. Centre for Disease Prevention and Control (www.cdc.gov). Leading causes of deaths, 1900 – 1998
2. UK National Statistics (http://www.statistics.gov.uk). Leading causes of death in England and Wales – how should we group causes?
3. American College of Sports Medicine, (2010). ACSM’s Guidelines for Exercise Testing and Prescription (8th Ed.). Baltimore: Lippincott, Williams & Wilkins
4. Weinberg, R.A., (2007). The Biology of Cancer. New York: Garland Science, Taylor & Francis Group, LLC
5. Diabetes UK (www.diabetes.org.uk). What is diabetes?
6. World Heart Federation (http://www.world-heart-federation.org). Economic impact.
7. Chartered Institute of Personnel and Development (www.cipd.co.uk). Absence Management 2009
8. McCance, K.L., and Huether, S.E., (2006). Pathophysiology: The Biologic Basis for Disease in Adults and Children. St. Louis, Missouri: Elsevier Mosby
9. Health and Safety Executive (www.hse.gov.uk). Stress-related and psychological disorders.
10. Royal College of Psychiatrists (www.rcpsych.ac.uk). Tiredness and Sleep Problems
11. Stress Management Society (www.stress.org.uk)
12. Rosekind, M.R., et al, (2010). The cost of poor sleep: workplace productivity loss and associated costs. Journal of Occupational and Environmental Medicine, 52 (1); 91 – 98
13. Black, P.H., et al, (2002). Stress, inflammation and cardiovascular disease. Journal of Psychosomatic Research, 52 (1); 1 – 23
14. Kiecolt-Glaser, J.K., et al, (2002). Psychoneuroimmunology: psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70 (3); 537 – 547
15. Burton, W.N., et al, (2005). The association of health risks with on-the-job productivity. Journal of Occupational & Environmental Medicine, 47 (8); 769 – 777