The Value of Wellness

Jerome M. Adams, MD, MPH

VADM, US Public Health Service

Surgeon General

The United States is the global leader in medical research and medical care. However, there are reasons for concern. Despite spending more than $3.2 trillion annually on health care, which is more than any other country, we continue to have room for improvement when it comes to life expectancy and other indicators of health. ¹

Chronic diseases such as heart disease, cancer, diabetes, and chronic obstructive pulmonary disease are the leading causes of death and disability in the United States and among the most costly, yet these afflictions may be preventable. ² The World Health Organization reports that at least 80% of all heart disease, stroke, and type 2 diabetes and up to 40% of cancer could be prevented if people ate better, engaged in more physical activity, and ceased to use tobacco. ^3,4

And while there has been some stabilization in deaths from some chronic diseases, the United States is now facing unprecedented increases in deaths due to suicide, liver cirrhosis from alcohol consumption, and drug overdoses largely due to overdose deaths involving prescription or illicit opioids. The president called upon then-Acting Secretary of Health and Human Services Eric D. Hargan to declare the opioid crisis a nationwide public health emergency. ⁵ These so-called deaths of despair are affecting Americans across the country and are brought on in part by a lack of hope and opportunity. The opioid epidemic affects our families and communities, and it is taking a toll on our economy. The economic burden of the prescription opioid crisis is $78.5 billion annually in health care, law enforcement, and lost productivity. ⁶

The good news is that, as stated in a 2016 Surgeon General’s report, “research shows that for each dollar invested in evidence-based prevention programs, up to $10 is saved in treatment for alcohol or other substance misuse-related costs.” These prevention programs go beyond preventing or lowering the risks of addiction; they also have been shown to prevent delinquency, teen pregnancy, school dropout, and violence. ⁶

Effective public health interventions and policies that target deaths of despair and chronic diseases lead to a healthier population with lower health care spending, less school and workplace absenteeism, increased economic productivity, and an improved quality of life. By investing in the prevention and treatment of the most common chronic diseases, one estimate shows the United States could decrease treatment costs by $218 billion per year and reduce the economic impact of disease by $1.1 trillion annually. ⁷

The conditions in which we live and work have an enormous impact on our health, long before we ever see a physician. Wellness starts in our families, our schools and workplaces, in our playgrounds and parks, and in the air we breathe and the water we drink. I will briefly discuss wellness and the business sector, wellness and national security, and priorities for my tenure as Surgeon General.

Wellness and the Business Sector

Productivity losses as a result of employees who do not come to work or work while sick cost US employers $225.8 billion annually, or about $1685 per employee each year. For example, obesity and obesity-related illnesses, such as diabetes, cost the nation more than $153 billion per year in lost productivity. ⁸

As an administration, we are focused on the opioid crisis currently affecting our country, and with good reason. Prescription opioid addiction and nonfatal overdoses cost $20.4 billion in lost productivity in 2013. ⁹ According to the National Safety Council, a worker with a substance use disorder is not as productive, is more likely to make a mistake, and may take twice as many sick days as a worker without a substance use disorder. ¹⁰ Companies that recognize addiction and support their staff have found that employees in recovery have lower turnover rates, are less likely to miss work, are less likely to be hospitalized, and have fewer physician visits than companies that do not recognize addiction and provide staff support. ¹¹

A community with poor health results in local businesses with workforce shortages, absenteeism, presenteeism (when workers are on the job but are not fully functioning due to illness or other medical conditions), work-related injuries and illnesses, declines in productivity and profitability, and issues with workforce recruitment and retention. As I have traveled around the country, I have heard that businesses are struggling to fill open positions because applicants are unable to pass their drug tests. Businesses that recognize addiction and help employees get into treatment allow employers to keep valued employees. This also avoids the high costs of termination, recruitment, and retraining new staff.

The business sector is a critical partner in helping achieve gains in the wellness of Americans. The private sector pays for about half of total health care spending in the United States. Health is not just an insurance expense. More companies are seeing the building of a health culture as a business opportunity. ¹²

When CVS took tobacco products off its shelves, lost sales were outbalanced by new revenues. Also, according to CVS, there was an additional 1% reduction in cigarette sales in states where CVS had a sizable market share, and a total reduction in cigarettes sold. ^12,13 General Dynamics Bath Iron Works, a large Maine shipyard, expanded its in-house diabetes prevention initiative into the broader community. The initiative is expected to cut the health care costs of participants by 60% in 5 years. ¹⁴

The health and economy of communities are often strongly correlated. Healthier communities tend to be economically more prosperous and vice versa. Improved community conditions for health, such as clean and safe neighborhoods, access to healthful food options, and opportunities for exercise and physical activity, can change health behaviors for the better, which can, in turn, create a more productive workforce. ¹⁵

Several businesses are implementing health initiatives that go beyond workplace wellness programs to support community health. For example, Target is putting wellness at the center of its corporate social responsibility strategy, having invested $40 million in more than 50 nonprofit organizations around the United States, which focus on increasing the physical activity and healthy eating habits of children and their families in local communities. ¹⁶

Wellness and National Security

As a US Public Health Service (USPHS) Commissioned Corps officer and member of the uniformed services, I know that wellness is at the heart of the safety and security of our nation. It is estimated that 7 in 10 young people aged 17-24 would fail to qualify for military service due to obesity, educational deficits, or behavioral health issues/criminal history. ^17,18

In order to ensure a strong national defense, we need to ensure that threats to service member recruitment, retention, readiness, and resilience are mitigated. As Surgeon General, I am working to bring awareness to this issue by publicizing my annual physical fitness test for the USPHS, which evaluates 4 key components of fitness: cardiorespiratory endurance, upper-body endurance, core endurance, and flexibility. I will be working with members of the USPHS Commissioned Corps, National Guard, and other US Department of Defense reserves to work with local schools in order to implement evidence-based programs to increase physical fitness—not just because our youth deserve to be healthy, but also for their educational benefit and the benefit of teachers and their classrooms. Research demonstrates that students who engage in physical activity have greater attention spans in class and higher test scores in addition to the health benefits than students who are not engaged in physical activity. ¹⁹

Surgeon General Priorities

Recognizing the role of wellness in our country’s safety, security, and prosperity is the reason I will focus my term as Surgeon General on “Better Health Through Better Partnerships.” This means we will strengthen ties with existing public health and health care partners while forging new partnerships with the business, law enforcement, education, and defense sectors, as well as religious, faith-based, and other community organizations.

It is for this reason I have decided my signature Surgeon General’s report will focus on the intersection between health and the economy and how businesses are able to thrive by investing in the health of their employees and communities. By partnering with nontraditional sectors and helping them recognize their role in wellness at the community level, we allow everyone to have a fair chance for good health and opportunities for better health choices. Achieving wellness at the community level is paramount to eliminating chronic disease, improving quality of life, reducing health care costs, and increasing life expectancy. By investing in communities, we can ensure the US Department of Health and Human Services’ goal of healthier people, stronger communities, and a safer nation.