One out of two Americans will require treatment for diabetes or prediabetes-at an annual cost of $3.35 trillion-less than 10 years from now, according to a report issued by UnitedHealth Group. Will the rising cost of medical care, whether paid individually or collectively through government, trigger a change in behavior? Will individuals trim their bodies to fatten their wallets?
While the diabetes report with its startling statistics is making headline news in the United States, a less dramatic but no less useful report is providing insight into worrisome health perceptions and unhealthy behaviors of our northern neighbors.
The percentage of Canadians who are overweight or obese has risen to 60 percent, slightly less than the United States' rate of 68 percent. And like the children in the United States, Canadian youth are getting fatter: one in four is overweight or obese compared to one in three in the United States.
But unlike residents of the United States, Canadians have enjoyed publicly funded healthcare provided either free or at minimal cost. As healthcare costs have risen in Canada, however, the financial burden has started to shift from the government and employers to individuals.
In 2005, Canadian residents paid for an estimated 20 percent of their healthcare costs, with employers and governments picking up the balance. According to projections in a 2007 Sun Life Financial healthcare and benefits trends report, in 2015, individuals may be responsible for as much as 34 percent of healthcare costs, and this number will continue to increase.
Can a Strategy of Prevention Work?
The most obvious way to keep healthcare costs from continuing to rise is through prevention of illness. Not only does prevention ensure optimum health for individuals, it is also the key to affordability for individuals, employers and the government. Less obvious, however, is how to encourage individuals to make daily choices that result in optimum health.
In an effort to understand the health perceptions and behaviors of Canadian residents, Sun Life Financial, a Toronto-based international financial services organization, undertook a study of nearly 4,000 Canadian residents, ages 18 to 80. The respondents were asked 45 questions on topics ranging from current behaviors to barriers preventing healthy choices.
Participants were asked to note which of six healthy behaviors they engaged in:
- Exercised 30 or more minutes each day
- Stayed away from tobacco
- Ate 7-10 servings of vegetables and fruit each day
- Received seven hours of sleep nightly
- Felt in control, were coping
- Maintained a healthy weight
The study of the respondents engaged in three or more unhealthy behaviors. For example, they didn't exercise, they didn't maintain a healthy weight and they smoked.
The study also found that 81 percent of those surveyed believe that common diseases are completely or mostly preventable. Yet despite this belief, almost two-thirds (63 percent) have adopted a pattern of unhealthy behaviors. Their actions indicated a major disconnect between behaviors that are in their best interest and behaviors that increased their health risks.
When asked who was responsible for their choices, 96 percent of the respondents accepted some responsibility; however, most felt the responsibility was somewhat shared in varying degrees with their employer, the government, and their doctor or healthcare provider.
The question then arises: if the respondents knew their behaviors were not healthy and that they had the primary responsibility for the choices they were making, why not change? Why not simply adopt healthier behaviors? The majority (61 percent) cited a lack of willpower.
When respondents were asked to cite their resolutions, the majority of the goals involved improving their health. But the level of follow-through was impressively low: 8 out of 10 respondents had not kept their resolutions. Why not? Once again, 76 percent cited a lack of willpower as the cause.
In addition to analyzing responses, researchers also sought to categorize the respondents into five health profiles:
- Overconfident: These individuals tend to be young males who underestimate their health risks.
- Overextended: These individuals are burdened with responsibilities and have little time or energy left for their own health.
- Health achievers: These individuals meet or exceed the requirements for healthy behaviors.
- Resilient: These individuals are seeking to adopt healthy behaviors despite obstacles, such as a chronic medical condition.
- Inhibited: These individuals underestimate their own health and tend to place responsibility for their wellness on others, including medical professionals.
Within the entire group, however, less than half of those surveyed (45 percent) made health the number one priority, citing shortages of time, knowledge and money as barriers toward a healthy lifestyle
When does health become a priority?
Given the insights from the study, I asked Lori Casselman, assistant vice president, group benefits, at Sun Life Financial, to share the latest ideas on how attitudes and behaviors can be shifted so that health becomes a priority. How can willpower be strengthened? Casselman cited two significant ways to influence employee choices.
First, new education and lifestyle change tools are being implemented that rely on technology. In increasing numbers, high-performing companies are relying on e-learning programs and social networking tools to encourage healthy behaviors among employees.
Second, employers find that incentives increase participation in programs promoting healthful behaviors. Incentives are provided in a variety of ways, from gift certificates to weekend getaways, health spending account credits to gym memberships. Because of the success of incentives in increasing participation, the use of incentives is growing dramatically.
Can these and other tools shift the behavior of the majority of employees? Will financial incentives, lifestyle change programs and education be sufficient to strengthen individual willpower? Or is the issue more deeply rooted than that?
In explaining why some people succeed in making changes and others fail, Dr. James Gordon, author of Unstuck, asserts that "It's not that some people have willpower and some don't. It's that some people are ready to change and others are not."
Is Dr. Gordon's discerning insight on target? Because if he is right, in addition to focusing on how to beef up individual willpower, we also need to figure out how to encourage entire communities in Canada and the United States to get fit and lose weight while medical care is still affordable.
Focusing on community programs rather than individual efforts can produce large scale shifts in values.
As a community fitness organizer, I know that pioneering technology used for weight loss and fitness events in geographic communities can be applied to corporate communities. Support for the corporate programs is also available through online groups. Both efforts can create synergy by shifting the focus from individual effort to group effort, from personal willpower to teamwork and accountability.
For the majority of us, if we trimmed our bodies, we would ultimately fatten our wallets. But to achieve maximum leverage with the greatest number of individuals in the shortest possible time frame, we'll have to move beyond personal financial rewards. To overcome won't power with willpower, we need to go beyond individual effort and tackle the issues of fitness and weight as a community, whether that community is physical, geographic or online. And we need to execute this shift quickly, while medical care is still affordable.