Cardiovascular disease (CVD) and stroke are the leading causes of death in the United States. The estimated expense associated with all heart disease combined is $304.6 billion, with $24 and $98 billion due to lost productivity from cardiovascular morbidity and mortality, respectively, according to the American Heart Association (AHA) policy strategy on worksite wellness programs for CVD prevention.

The financial burden associated with stroke in 2009 was estimated at $68.9 billion in direct and indirect costs for diagnosis and treatment. The estimated lifetime cost for hospital stays, rehabilitation, and follow-up care to treat lasting neurological deficits is $140,048 (in 1999 dollars).

With 130 million Americans in the workplace, wellness programs play an important role in preventing the major risk factors for CVD and stroke, said the AHA statement. "An estimated 25 percent to 30 percent of companies’ annual medical costs are spent on employees with risk factors such as cigarette smoking, obesity, hypertension, dyslipidemia, physical inactivity, and diabetes. Worksite wellness programs that reduce these risk factors can ultimately impact the physical and economic burden of chronic diseases, including CVD and stroke."

The Healthy People 2010 goal is for 75 percent of all worksites, regardless of size, to develop comprehensive wellness programming. Towards that goal, the AHA said it supports incremental efforts to achieve comprehensive worksite wellness programs that address CVD and stroke prevention.

According to the AHA, comprehensive wellness programming should include:

• Tobacco cessation and prevention, regular physical activity, stress management/reduction, early detection/screening, nutrition education and promotion weight management, disease management, CVD education that includes cardiopulmonary resuscitation and automated external defribrillator training, and work environment modifications to encourage healthy behaviors and promote occupational safety and health.
• Integration into the workplace organizational structure through validated health education interventions focusing on skill development and consistent with employees’ readiness to make behavior changes; initiatives that are incorporated into existing employee assistance programs; and voluntary worksite screenings linked with medical care for follow-up on modifiable risk factors.
• Health risk appraisals administered in combination with structured organizational health promotion processes so that health needs in the workplace can be identified and employees can learn their risks and health status. Comprehensive worksite programs must address employee health risks.
• Research into the effectiveness of wellness programming and how to tailor programming and policies for maximum effect.

Environmental modifications should include:

• A social and physical workplace environment supportive of recommended behaviors;
• Optimal environmental modifications that promote healthy behaviors while minimizing physical, organizational, and occupational risk; and
• Workplaces that are free from hazards that jeopardize cardiovascular health and employee safety and well-being.

Regulations/Policy strategies should include:

• An increased opportunity for employers to reach a majority of the employee population and produce health benefits.
• Compliance with regulations that address hazards to employee health and safety and the provision of working conditions that are optimal for cardiovascular health and well-being.
• Where healthy lifestyle behavior incentives are offered in the workplace, such as wellness credits and financial incentives, these benefits should go directly to the employee. Financial incentive should not be attached to healthcare premiums or health status.

Vulnerable/Special population strategies should include:

• Wellness programs that address the needs of all employees at a given workplace, regardlessof gender, age ethnicity, socioeconomic status, culture, job type, or physical or intellectual capacity.
• Culturally sensitive and all-inconclusive program design, as well as targeted, complementary interventions for more vulnerable employees, such as those who are economically challenged, less educated or underserved.
• Programs to help working families balance work and family commitments and policies built around child care, elder/dependent care telecommuting, and flexible work schedules.
• Research to determine how to improve participation among employees who have the highest risk behaviors.

To view the AHA Policy Statement in its entirety, visit http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192653.

Address: American Heart Association, 7272 Greenville Ave., Dallas, TX 75231; (800) 242-8721, www.heart.org/HEARTORG.