The value of being heart-healthy, four-day workweeks, , increasing preventive care, and the cost of cancer

March 3, 2023:

Happy Friday!

Today, I’ll discuss findings of a new study showing that having high cardiovascular health prevents other chronic diseases, and review ways to increase use of preventive care. I’ll also present findings from a large study of four-day work weeks in the United Kingdom and a study of the total cost of cancer in adolescents and young adults in the United States. 

1.     Those who have high levels of cardiovascular health have longer life expectancy free of heart disease, diabetes, cancer and dementia

It’s no surprise that those who eat well, exercise, sleep well, and have ideal body weight, blood pressure and blood sugar are less likely to have heart attacks and strokes. We now have evidence that those who are “heart healthy” are also likely to live more years of life free of a wide variety of chronic diseases.

Researchers in this week’s JAMA Internal Medicine look at the outcomes of over 135,000 adults in the UK Biobank study recruited from 2006-2010. They find that those with high scores on “Life’s Essential 8” (American Heart Association) not only have fewer heart attacks and strokes, but also are less likely to have diabetes, cancer, or dementia.  The AHA test creates scores of 0-100 in eight domains: self-reported diet, physical activity, tobacco exposure, sleep, body mass index, non-HDL cholesterol (ie LDL and triglycerides), blood sugar and blood pressure.

The researchers created a composite measure for each person in this study, and correlated this to death (from a death registry) and to hospital inpatient records showing any type of cardiovascular disease, diabetes, cancer or dementia. They found that at age 50, men scoring highly (>80) lived 6.9 years longer free of disease than those with low scores (<50), and women scoring highly lived 9.4 years longer free of disease than those with low scores.

Source: Wang, et al JAMA Int Med February 27, 2023 LINK

Implications for employers:

-        Lower cost interventions, like promoting good nutrition, exercise, and healthy sleep habits can prevent higher cost, major health conditions later in life

-        Effective medical care is often necessary to score highly in cardiovascular health. Even with proper diet and exercise many need to take medicines to control blood pressure, and some are genetically predisposed to have diabetes or obesity.

-        Employers can encourage their employees to learn more about Life’s Essential 8 items, which may support employees to improve their overall health

2.    UK study shows benefits of four-day work week for employees and employers

It’s Friday. Can you imagine having today off?

Twenty-nine hundred workers at 61 employers in the United Kingdom worked four day weeks from June to December of last year, and 92% of participating employers (56) have said they will continue the four day work week after the conclusion of the research. Companies reported higher revenue despite fewer working hours, and employees reported less burnout and more ability to care for family members. Fifteen percent said that “no amount of money” would entice them to return to a five day a week schedule. These companies did not have an increase in new hiring during the six month period. Here’s a link to the full report, and to coverage in the WSJ and the Washington Post.

Source: Lewis, et al Autonomy, February 2023 LINK

A few cautions are in order.  Most of the companies involved in this pilot were small (two thirds had 25 or fewer employees), and the research sponsor was a group advocating for four-day workweeks. Four-day work weeks might be easier to implement for knowledge workers, but could lead to increased disparities as limiting work hours is harder for service workers.

There are other efforts to decrease employee burnout, too. Countries including France, Ireland, Portugal and Italy have legislated a “right to disconnect” so that employees are not required to address emails or other communications outside of working hours. Daimler implemented a “Mail on Holiday” program to delete all emails received while on vacation.

 Implications for employers:

-        The pandemic made many companies rethink the workplace and rethink work. 

-        This provides encouraging data suggesting that increasing employee time off can delight employees without adverse impacts on business.

-        Employers considering four-day work weeks can consider how to provide increased guaranteed time away from work for service workers.

-        Companies can set policies and leaders can set examples to make employees feel comfortable disconnecting when they are off, even absent laws requiring this.

3.   Employers can encourage preventive care

Evidence-based screening tests can identify cancers earlier, when they are more easily cured or treated., Vaccinations can prevent dreaded childhood illnesses and even prevent at least three types of cancer in adults (Cervical, Liver, and Head & Neck).  Nonetheless, many people don’t keep up to date with their preventive care.

Here’s a quick list of what employers can do to encourage preventive care:

-        Education: The best communication about preventive care includes stories and people. Testimony of someone whose cancer was found, or a photo of a family protected from measles is better than statistics. 

-        Make it easy. Offering screening tests and vaccinations in the workplace can increase uptake. Some studies have found that the most effective way to increase vaccination rates is to tell people that there is an appointment reserved for them.

-        No cost sharing. The Affordable Care Act requires that much preventive care is covered without cost sharing. Be sure plan members know that!

-Incentives.  Many employers seek to use financial incentives to boost preventive care.  The evidence of efficacy is not overwhelming, and there is some danger that this could lead to demotivation in the future if the incentive is discontinued. The administrative cost of such a program can also be high. If employers choose to use financial incentives, best to be sure that the incentive is paid very soon after the preventive care - and is not buried in a distant paycheck. Incentives should typically be provided via a compliant wellness program.

4. Medical costs are a minority of the total costs of cancer in adolescents and young adults. 

The Journal of Clinical Oncology just published research demonstrating that the economic cost of cancer in those from 15-39 years old is enormous. The lifetime personal costs to those young adults with cancer outweigh the cost of medical care itself. The researchers looked at many factors impacting cost, including the cost of medical care, lost productivity, value of disability-adjusted years of life lost, and other financial aspects, ranging from tax loss to funeral costs. 

The good news is that the 5-year survival rate in this group is 85%, and death rates continue to decrease. Cancer survivors had a 67% workforce participation rate, compared to 73% in a matched population.

Here is a summary of calculated costs:

The researchers used a federal survey (Medical Expenditure Panel Survey, MEPS), and I suspect this understated medical costs substantially. This research estimated the productivity cost of caregivers based on hourly home health aide wages.

Implications for employers:

-        This study highlights the productivity and other economic losses caused by cancer. 

-        Employers should continue their efforts to encourage screening for early detection of cancer, and encourage childhood vaccinations that can prevent future cancers

The HPV vaccine can prevent cervical and head and neck cancer, and the hepatitis B vaccine can prevent liver cancer.

-        Although treatment of cancer is expensive, the economic value of improved cancer treatment has been enormous.

Next week I’ll cover news that one of the major manufacturers of insulin has announced steep price cuts on some of its insulin products, and a program to cap out of pocket costs for those on employer sponsored health insurance.

Hope you have a great weekend when it comes!

Jeff