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Latest Research on Tobacco Use and Health Care Cost Has Global Implications

By Derek Yach, Executive Director, The Vitality Institute, and a former executive director of the World Health Organization (WHO), and Katie Tryon, M.D., Clinical Director, The Vitality Institute.
This month’s articles on health care costs and tobacco control in the South African Medical Journal (SAMJ) have far reaching implications beyond the shores of South Africa. The latest Global Burden of Disease data (Lancet, 2012) show that two of the top three risk factors that contribute to the highest burden of disease in Western Europe and the U.S. are tobacco and high Body Mass Index (BMI). This not only has serious health consequences, it has significant financial implications for governments, businesses and individuals — both in terms of direct health care costs and indirect costs such as work productivity.
One of the papers, published by RAND Corporation and Vitality, looks at the direct health care cost impact of these two risk factors. They show that severely obese individuals have a 23 percent higher health expenditure than those at a healthy weight, and moderately obese individuals have an 11 percent higher health cost. Furthermore, current or past smokers have an 11 percent higher health expenditure. The research was carried out on an insured South African population with similar demographic and health care profiles to counterparts in Western Europe and the US. It supports recent research carried out by Pandya et al. in the U.S. (Health Affairs, 2013) which predicted a significant increase in healthcare costs in the U.S. from cardiovascular disease due to the aging population, declining mortality and ever increasing obesity rates.
While Pandya et al. research highlighted declining smoking rates in the U.S. as positively influencing cardiovascular disease cost projections, they were not outweighed by the other pressures increasing the costs. An additional paper published by Reddy et al. also adds caution to the enthusiasm over declining smoking rates. It shows that while there has been a significant decline in smoking in school age children in South Africa between 1999 and 2008, there has been a marginal increase between 2008 and 2011 (to 16.9 percent in 2011). This has been mirrored in the U.S. by the CDC Youth Risks Behavior Surveillance that showed a significant decline in youth smoking rates between 1997 and 2009, but no significant decline between 2009 and 2011 (remaining at 18.1 percent in 2011). As today’s young smokers are our tomorrow’s smoking adults, a leveling of the decline, or even a potential increase could have significant impact on future health care costs.
Continued cigarette consumption worldwide, despite all interventions that have been tried, argues for a look at new breakthrough interventions to prevent the inevitable future costs.The editorial co-authored by David Sweanor of the University of Ottawa highlights the need to provide smokers with alternative viable options, rather than continuing along the same lines of controlling combustion cigarette supply and demand. Taxes have played a key role in getting smoking rates down across the world but an improved approach, complimentary to accepted policies in place, is needed to better tackle addiction. E-cigarettes have been a consumer breakthrough that should be embraced by public health personnel and governments rather than vilified. As they state, “We can still strive for complete nicotine cessation… but we are currently presented with the very real prospect of massively reducing the individual and population risks of smoking by something in the range of two orders of magnitude.”
High BMI and smoking remain among the top three risk factors that contribute to the highest burden of disease in Western Europe and the U.S., and the research mentioned above highlights this issue and discusses potential solutions, with implications far beyond South Africa.
The Vitality Institute is a global health think tank with the mission to advance knowledge about the evolving science and art of prevention and health promotion in order to build healthier societies. To join the conversation, follow us on Twitter at The Vitality Institute @VitalityInst.
http://www.huffingtonpost.com/dr-derek-yach/tobacco-use-research_b_4164593.html

Ohio State study: Smokers cost employers $6K more annually

By Alexa Carson
Employees who smoke cost their employers almost $6,000 more annually than nonsmokers, according to a recent study conducted by Ohio State researchers.
Lead author Micah Berman, from the College of Public Health and Moritz College of Law, told The Lantern he decided to research this topic when he was asked to give a presentation on policies involving smoking in the workplace, such as smoke-free policies and not hiring smokers. He discovered no studies had been done on the comprehensive costs of employing a smoker versus a nonsmoker.
“It was odd to me that the question hadn’t been answered given that employers were making decisions about smokers in the workplace,” Berman said.
By performing an analysis of previous studies done on individual smoking related expenses to an employer, Berman and his co-authors estimated a $5,816 annual excess expense from discrete costs related to smoking.
These costs include smoke breaks, health care costs, absenteeism and presenteeism, which Berman described as “reduced focus in the workplace due to going through nicotine withdrawal throughout the work day.” The study adjusted for the fact that smokers tend to make less than nonsmokers, and even factored in a “death benefit,” Berman said.
“Companies with defined benefit pension systems may save some money due to the fact that smokers die earlier than non-smokers,” Berman said. “But the cost savings is very minimal.”
Berman said he had expected to find smokers would incur excess costs, but two results of the study surprised him.
“One is the extent of the cost,” said Berman, “and second is the health care costs. Well, everyone’s aware of those, but in fact the majority of the costs weren’t due to health care costs but due to productivity costs from things like smoke breaks.”
Brooke Cavallo, a third-year in strategic communication, said she thinks productivity costs can be an issue between smokers and employers based on what she has seen at work.
“I work in a bar and most of my coworkers do smoke, and we are constantly getting in trouble because they take smoke breaks,” Cavallo said.
Berman said his research takes no position on whether businesses should or should not hire smokers, and focuses on the economical rather than ethical issues related to smoking policies. He believes, however, tobacco cessation programs, which “cost up front but save money over time,” or tobacco-free policies can reduce costs to employers.
Under the tobacco-free policy OSU plans to implement this semester, no tobacco products of any kind are allowed on any OSU property either indoors or outdoors. Previously, the university followed a nonsmoking policy that prevented smoking indoors but had no restrictions on smokeless tobacco or smoking outdoors, except in certain “tobacco-free” areas. The policy began on Aug. 1, but will not be implemented in earnest until January 2014.
Dr. Peter Shields, co-chair of the Tobacco-Free Implementation Committee at OSU, said the “first and foremost reason we are going tobacco free is because we want to have a healthier community.”
Shields is also the deputy director at the OSU James Comprehensive Cancer Center and a professor at the College of Medicine. He said cost was a factor in deciding to implement a tobacco-free policy.
“There are other reasons that follow behind that are not necessarily as important,” Shields said, “and one of those is the cost to the university for faculty and staff who continue using tobacco.”
Berman said he had similar beliefs about the policy.
“I don’t think cost is the most important reason for the adoption of the policy,” Berman said. “But it may end up saving the university money too.”
http://www.thelantern.com/campus/ohio-state-study-smokers-cost-employers-6k-more-annually-1.3051093#.UhTN2mRUM0M

Employees Who Smoke Cost Businesses $6,000 Extra Per Year; Cigarette Breaks Big Factor In Loss of Productivity

By Zulai Serrano z.serrano@hngn.com
A new study reveals U.S. businesses pay almost $6,000 per year extra for each employee who smokes, according to Ohio State University researchers.
The researchers took an in depth look at the financial burden for companies that employ smokers, and the findings may surprise you.
“By drawing on previous research on the costs of absenteeism, lost productivity, smoke breaks and health care costs, the researchers developed an estimate that each employee who smokes costs an employer an average of $5,816 annually above the cost of a person who never smoked. These annual costs can range from $2,885 to $10,125,” University said in a news release.
One aspect researchers looked into was the loss of productivity.  According to the findings, smoke breaks were the biggest reason businesses were losing money, followed by health-care expenses that exceed insurance costs for nonsmokers.
The analysis used studies that measured costs for private-sector employers, but the findings would likely apply in the public sector as well, said lead author Micah Berman, who will become an assistant professor of health services management and policy in The Ohio State University College of Public Health.
“This research should help businesses make better informed decisions about their tobacco policies,” Berman said in a news release, who also will have an appointment in the Moritz College of Law at Ohio State. “We constructed our calculations such that individual employers can plug in their own expenses to get more accurate estimates of their own costs.”
The University made it clear the study focused solely on economics, and did not address ethical and privacy issues related to the adoption of workplace policies covering employee smoking.
However, researchers added providing smoking-cessation programs would be an added cost for employers.
“Employers should be understanding about how difficult it is to quit smoking and how much support is needed,” Berman said. “It’s definitely not just a cost issue, but employers should be informed about what the costs are when they are considering these policies.”
The research is published online in the journal Tobacco Control, click here to read the study.
http://www.hngn.com/articles/9653/20130808/employees-who-smoke-cost-businesses-6-000-extra-per-year.htm

Poor Diet, Tobacco Use and Lack of Physical Activity Taking Toll on Nation's Health

By Derek Yach, executive director, The Vitality Institute, and a former executive director of the World Health Organization (WHO), and Will Rosenzweig, institute commission chair and managing partner, Physic Ventures
While we’re living longer, poor diet, tobacco use and inadequate physical activity are negatively impacting our health. These are some of the findings of research released this week by the U.S. Burden of Disease Collaborators, prompting much discussion and debate. To those of us on the front lines of promoting workplace health this comes as no surprise. This study should only add to the sense of urgency that we as a nation must have in solving this crisis.
There is a direct link between the health of the U.S. workforce and the overall wellbeing of the U.S. economy. Currently, greater than 50 percent of Americans live with one or more chronic disease. With this rising burden of chronic disease comes rising costs within the health care system, and increased premiums at a cost to employers. Compounding this, employees with chronic disease take more sick days and are less productive on the job. Workplace health is of significant importance to the economic productivity of the nation and critical to reducing the national debt. The U.S. is slipping behind its major Organization for Economic Co-operation and Development Countries (OECD) competitors regarding improvements in population health. Specifically, the U.S. falls in the bottom 20 percent of the 34 OECD countries for the following chronic diseases: ischemic heart diseases (rank: 27), lung cancer (28), COPD (32), diabetes (31), cardiomyopathy (31), chronic kidney disease (31), and hypertensive heart disease (27). Poorer health today could translate into lower productivity tomorrow.
This is the first major analysis of the health status of the U.S. population in more than 15 years, led by a global collaborative of scientists from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The study found that while Americans are showing progress in reducing death rates (adjusted for age, across a variety of diseases), we aren’t living healthier. Additionally, death rates from illnesses associated with obesity, such as diabetes and kidney disease, as well as neurological conditions like Alzheimer’s disease, are on the rise. Poor diet, tobacco use and physical inactivity are driving the disease burden.
The negative impact on our health care system cannot be understated as people who live longer and unhealthier lives are costly — not only in terms of health care spend, but the impact on the productivity of our workforce and the ability of U.S. businesses to compete in a global economy. A point made recently in the Bipartisan Policy Center’s recent report.
None of this is news to The Vitality Institute, a global health think tank focused on reducing chronic disease risk. In fact, we recently released new data indicating a dangerous gap in the chronological age of Americans and their risk adjusted Vitality Age, as calculated based on a variety of factors including those cited in this new report.
So now that we so clearly understand the problem, what are we going to do about it? To that end, we’ve recently assembled The Vitality Institute Commission. We’re bringing together prominent thinkers in health and business including: Dr. Rhonda Cornum, with deep expertise from the Department of Defense; Susan Dentzer, with Robert Wood Johnson Foundation; Ginny Ehrlich, with the Clinton Health Matters Initiative; Jeff Levi, with Trust for America’s Health; Ellis Rubinstein, with the New York Academy of Sciences; Dr. Dennis Schmuland, with Microsoft; and Dr. Kevin Volpp, from the University of Pennsylvania. All with the urgent goal of placing the power of evidence-based prevention at the center of health care policies and actions in the U.S. Better evidence, smarter laws and higher levels of innovation we believe could make a difference.
There is strength in numbers, and we are working with corporations, associations, federal, state, and local government to identify multi-stakeholder solutions that will address the issues facing our nation’s health in bold and transformative ways.
For the U.S. to maintain its economic competitiveness, our health policy efforts need to address the risk factors of preventable chronic diseases that disproportionately affect the U.S. population (e.g., physical inactivity, diet, and alcohol and tobacco consumption) by effectively investing resources to ensure that each individual has the opportunity to make beneficial contributions to society and therefore progress the economy. We will soon issue a call for wide participation to harness the myriad of great ideas and actions already making a difference at the community, city or state level to ultimately improve America’s health.
http://www.huffingtonpost.com/dr-derek-yach/americans-health_b_3588588.html

Study: Companies Pay Almost $6,000 Extra Per Year for Each Employee Who Smokes

Employers Can Use Cost Estimates to Develop Tobacco Policies

COLUMBUS, Ohio – A new study suggests that U.S. businesses pay almost $6,000 per year extra for each employee who smokes compared to the cost to employ a person who has never smoked cigarettes.
Researchers say the study is the first to take a comprehensive look at the financial burden for companies that employ smokers.
By drawing on previous research on the costs of absenteeism, lost productivity, smoke breaks and health care costs, the researchers developed an estimate that each employee who smokes costs an employer an average of $5,816 annually above the cost of a person who never smoked. These annual costs can range from $2,885 to $10,125, according to the research.
Smoke breaks accounted for the highest cost in lost productivity, followed by health-care expenses that exceed insurance costs for nonsmokers.
The analysis used studies that measured costs for private-sector employers, but the findings would likely apply in the public sector as well, said lead author Micah Berman, who will become an assistant professor of health services management and policy in The Ohio State University College of Public Health on Aug. 21. Berman began this work while on the law faculty of Capital University in Columbus.
“This research should help businesses make better informed decisions about their tobacco policies,” said Berman, who also will have an appointment in the Moritz College of Law at Ohio State. “We constructed our calculations such that individual employers can plug in their own expenses to get more accurate estimates of their own costs.”
The study focuses solely on economics and does not address ethical and privacy issues related to the adoption of workplace policies covering employee smoking. Increasingly, businesses have been adopting tobacco-related policies that include requiring smokers to pay premium surcharges for their health-care benefits or simply refusing to hire people who identify themselves as smokers.
The researchers acknowledge that providing smoking-cessation programs would be an added cost for employers.
“Employers should be understanding about how difficult it is to quit smoking and how much support is needed,” Berman said. “It’s definitely not just a cost issue, but employers should be informed about what the costs are when they are considering these policies.”
The research is published online in the journal Tobacco Control.
The Centers for Disease Control and Prevention (CDC) estimated a decade ago that productivity losses and medical costs amount to about $3,400 each year per smoker. However, the report looked at overall costs to the American economy from smoking-related deaths and did not try to identify those costs that would be borne by an employer, Berman noted.
The CDC says smoking accounts for nearly one in every five deaths – or about 443,000 – in the United States each year and increases the risk for such illnesses as coronary heart disease, stroke, lung cancer and other deadly lung illnesses.
The researchers used multiple studies that calculated a variety of specific costs to develop an estimate of the overall annual extra cost of each employee who smokes.
According to their annual estimates per smoker, excess absenteeism costs an average of $517 per year; “presenteeism,” or reduced productivity related to the effects of nicotine addiction, $462; smoke breaks, $3,077; and extra health care costs (for self-insured employers), $2,056.
The analysis also took into consideration a so-called death “benefit” in terms of economics. For employers who provide defined benefit plans, meaning they pay retirees a set amount in pension each year, a smoker’s early death could result in an annual cost reduction of an estimated $296. This occurs when smokers pay more into the pension system than they receive in retirement – in effect, subsidizing nonsmokers’ pensions because they live longer.
“We tried to be conservative in our estimates, and certainly the costs will vary by industry and by the type of employee,” Berman said. “Several of these estimates are based on hourly employees whose productivity can be tracked more easily.”
He noted that the analysis takes into account the known disparity in pay for smokers versus nonsmokers. In the calculations, smokers’ salaries were discounted by 15.6 percent to reflect their lower wages.
The researchers describe their findings as “needed factual context to discussions about workplace policies” intended to inform the debate over whether such policies should exist.
“Most of the places that have policies against hiring smokers are coming at it not just from a cost perspective but from a wellness perspective,” Berman said. “Many of these businesses make cessation programs available to their employees.
“Most people who smoke started when they were kids and the vast majority of them want to quit and are struggling to do so. This is a place where business interests and public health align. In addition to cutting costs, employers can help their employees lead healthier and longer lives by eliminating tobacco from the workplace.”
Co-authors of the study include Rob Crane of the College of Medicine and Eric Seiber of the College of Public Health, both at Ohio State, and Mehmet Munur of the Columbus law firm Tsibouris & Associates.