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Co-morbidities: cracking a hard nut

While there were few surprises in the National Council on Compensation Insurance, Inc.'s (NCCI) report on the impact of co-morbidity on Workers' Compensation claims, it did verify that the cost of medical treatment when co-morbidity is a factor is substantially (double) higher than less complicated claims. Co-morbidities begin to show up in workers in their mid-30s and rise with age. Injuries to workers with co-morbidities are more likely to involve lost time, transforming what normally would be a medical-only claim into one involving indemnity and increased costs. Hypertension, drug abuse, chronic pulmonary problems and diabetes are the conditions most likely to drive up a cost of the claim.

The outlook for the future is no less challenging. While the United States spends more per person on health care than any other nation, it lags on many important health measures amid higher rates of obesity and heart disease than other rich countries. As illness in the general population continues to increase, especially in the areas of hypertension, obesity and diabetes, the workforce will mirror this incident growth.

It's no surprise then that many wellness initiatives focus on chronic health risks. While such initiatives are critical to long-term savings and improved productivity, they rely heavily on individuals' changing their behavior, such as increasing physical activity and reducing calorie intake. Maintaining high participation rates and achieving positive outcomes is going to take time.

An area that often is overlooked, but can have a positive impact on improving health, is the condition of the workplace and the barriers it can create for the workforce to achieve a healthier lifestyle. This was addressed in a recent study, Obesity/Overweight and the Role of Working Conditions: A Qualitative, Participatory Investigation, a collaborative effort of community groups, UMass Lowell and the University of Connecticut. Four primary themes emerged:

Recommendations from this study as well as earlier studies include:

An understanding of the composition of the workforce and attitudes toward wellness is also helpful. Studies have shown that women are generally more likely to participate in worksite wellness programs than men and younger workers have a higher participation rate than older workers. In some cases, men can have a false sense of bravado and different attitudes about prevention. Shift workers, lower income, and less educated workers also display much lower participation rates.

Failing to address the physical and psychosocial stressors at work may undermine the very health goals that are targeted by lifestyle and wellness programs.