Global Health is Global Wealth

2. Global Health is Global Wealth Michael Taylor, MD, FACP Medical Director for Health Promotion, Caterpillar Inc Linda Gzehoviak, Corporate Global Resources, ACS

3. Projected Deaths for Selected Causes In 2010, cancer will become the world’s leading cause of death

4. Tobacco: 1 billion Lives

5. Obesity • Overweight and obesity: 1 billion (increasing) • Obesity is quickly replacing malnutrition as the critical nutrition-related health challenge in many emerging economies like China • Mexico has second highest obesity rates in the world (first is U.S.)

6. Tobacco Quitlines Publicly financed quitlines exist in the following countries: Brazil Iran New Zealand South Africa Europe: at least 27 countries Asia: Hong Kong, Taiwan, Thailand, Malaysia, Singapore Australia Canada U.S. Quitlines vary in scale and sophistication.

7. Costs to Employers - Direct versus Indirect Most countries have government sponsored health care In some of those countries, individual co-pays remain so high that companies provide additional coverage Access to care is “the issue” in most of the developing world Myth plays a huge role in early detection

8. The Role of Myth Belief in survivorship – must be fostered Education that cancer is preventable through- nutrition, physical activity, and tobacco No one deserves cancer-but many believe they have caused their own cancer Financial concerns – would rather not know

9. Myths - Around the World In Malaysia, many men abandon or abuse a wife with breast cancer. Quote from African patient: “A short man with an arrow shoots you and you get cancer. Sometimes his wife can stop him and then you don’t” Quote from Indian Cancer Expert: “Even my mother didn’t want me to share my breast cancer experience. Her fear was that I would not find a husband”

10. Why is Cancer So Devastating in the Developing World Access to care Guidelines must match the resources to follow them No global cancer “wiki” Lack of translated materials to educate around cancer Lack of government policy

11. Employer Challenges Traditional viewof global health Health benefits as a direct cost Federal funding “covers” the issue Reality Poor health= productivity loss Indirect cost is a concern Global employees need to be: Healthy Well trained Engaged

12. Impact on Employers Issue is productivity loss Absence due to illness Presenteeism Training cost of replacement employees Retention Global competitiveness

13. Caterpillar- Principles of Global Health Promotion Healthy employee is a competitive business advantage Corporate Medical Department Set overall direction Help identify the needs Broker local resources Solution is local

14. Caterpillar- Principles of Global Health Promotion Local needs vary India China Mexico Europe

15. Caterpillar- Principles of Global Health Promotion Successes Aligning diabetes data in India Some traction around smoking policies in China Brazil 50 year history of worksite wellness Onsite MDs, dentists Physical therapy Highest engagement scores at Caterpillar

16. Examples of Workplace Wellness Programs TOBACCO CONTROL Quit lines In-person Counseling: individual & group (e.g., Freshstart) Smokefree worksite polices “No Tobacco” days

17. Examples of Workplace Wellness Programs DIET & PHYSICAL ACTIVITY Physical activity programs offered in the workplace, e.g., RFL Onsite exercise facilities or sponsored gym memberships Encourage active commuting and discourage motorized transport, using price and other incentives Encourage use of stairs Healthy onsite food options: cafeterias, vending machines

18. Findings to Date

19. Key Findings from the 2009 ACS Global Workplace Wellness Program Feasibility Study: Survey of Employers Demand for programs is broad based: corporate management, employees There is need for employers and employees to understand the value of wellness programs - better documentation of ROI is needed There is demand for ACS EI programs, and companies are willing to work with ACS directly and/or collaborate with partners selected by ACS. Many companies have partnered in the past Most either have existing programs or plan to implement a wide range of programs in the near future

20. Key Findings from the 2009 ACS Global Workplace Wellness Program Feasibility Study: Survey of Employers The majority of companies either have or are working on a global program Most companies have long-term objectives but are approaching them using sort-term programs based on local demand and resources Challenges include global consistency, privacy laws, resource allocation, local management buy-in, translation, cultural appropriateness, funding The global economic recession has served to emphasize the importance of maintaining health and most companies surveyed report pressing ahead with plans

21. Key Findings from the 2009 ACS Global Workplace Wellness Program Feasibility Study: Survey of Academic Community Awareness would need to be created to facilitate buy-in and ensure program success Lack of existing infrastructure is a challenge, for tobacco cessation, cancer screening and treatment, and NCD management Cultural issues can present challenges. They include fatalism, cultural acceptance of tobacco use, KABs on physical activity, diet and weight

22. Key Findings from the 2009 ACS Global Workplace Wellness Program Feasibility Study: Survey of Academic Community Programs should focus on: tobacco, cancer, diet, physical activity, and obesity Main recommendations for ACS involvement are corporate level policy (e.g., smokefree worksites) & program design and planning Program delivery should involve partnering with local organizations and entities It is important to consider local laws and policies

23. ACSU for Global Employers More than 30 participants from across the globe came to Boston in August Topic - global engagement around chronic disease prevention. Confirmed large gaps in global employee services

24. .. it is a beginning to a long journey. Thank you and good luck! Increase participation from Latin America, Asia, and Africa. Because that where the issues are burning and need focus. Thank you!!! This has been a great effort!!! I enjoyed this opportunity and hope to implement some of the great information I learned. This was perfect timing since my company is in the process of building our global wellness strategy. This was an excellent opportunity and extremely valuable. It was great to meet lots of new companies and contacts. I liked it. Was a good mix of MDs and other allied health and benefits people. Need to run ACSU 2-3 times per year to allow companies to get others involved. This presents a great opportunity for networking. Need more participation from employers outside the U.S. GEHC: I would like to do this for all of my medical officers worldwide Thanks! ACSU Global Employer Program: Evaluation

25. ACS approach to Comprehensive Employee Health & Wellness

26. Employers Need… Wellness services/programs that are global in scope but adaptable to local conditions; 80-20 Ikea rule Public-private partnerships: effective coordination of efforts among stakeholders in the for-profit, non-profit and public sectors Assets: NCD and tobacco cessation resources, including vendors and NGOs, by country Translated materials on chronic disease prevention Better data to make the case

27. Collaboration

28. Collaboration World Economic Forum World Health Organization UICC-World Heart-IDF Universities: Emory, Harvard School of Public Health Mercer and other HR consultancies

29. Global Agenda Council of World Economic Forum: Working Towards Wellness Areas of Focus • Economic impact on health systems • Importance of corporate role and supporting behavioral changes amongst business leaders • A “marketplace” of new ideas • Acting as an advocacy group • Bridging of the science gaps • Tackling the non-inclusion of chronic diseases in the Millennium Development Goals • Developing partnerships and finding out what we know and what we don’t know Channels • Regional Forums • Davos • Corporate Partners

30. Country Partners Public Health Foundation of India China, CDC, CACA, CPMA, WHO Brazil – Chronic Disease Prevention Groups and NCI Africa – AORTIC, ACRE

31. ACS Role ?

32. ACS EI Role by Geography

33. Building Platforms for Survivor Voices - International Relay For Life Now available for NCTP Companiesat www.relay.org/relayDow, JBS, Tata McMurdo, Antarctica

34. Advocacy: Tobacco Control

35. Capacity Building: ACSU and Seed Grants

36. Corporate Outreach: Beijing Olympics Reach out to companies around smokefree worksites in China Media event August 9 and platform for engagement with Chinese operations of multinational companies

37. Regional Engagements

38. Greater China Capacity Building: breast cancer programs, patient services, government Tobacco control: cessation and smokefree worksites project Work in Mainland China, Hong Kong and Taiwan

39. Africa North Africa Tobacco Control program, including smokefree worksites Africa Tobacco Control Research Initiative ORACLE Five County Cancer Information and Capacity Project, including worksite engagement

40. Mexico With one in nine Americans of Mexico descent, this is a priority country! Infocancer is modeled after ACS Patient Navigation Support from Midwest Division, Pfizer Mexico, GEHC, and partnership with Mexican NCI

41. Malaysia Relay For Life