INTEGRATING EMPLOYEE HEALTH

A MODEL PROGRAM FOR NASA

Committee to Assess Worksite Preventive Health Program Needs for NASA Employees

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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Integrating Employee Health: A Model Program for NASA INTEGRATING EMPLOYEE HEALTH A MODEL PROGRAM FOR NASA Committee to Assess Worksite Preventive Health Program Needs for NASA Employees Food and Nutrition Board INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Integrating Employee Health: A Model Program for NASA THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. NASW-02031 TO #102 between the National Academy of Sciences and the National Aeronautics and Space Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Integrating employee health : a model program for NASA / Committee to Assess Worksite Preventive Health Program Needs for NASA Employees, Food and Nutrition Board. p. ; cm. Includes bibliographical references. ISBN 0-309-09623-5 (pbk.)—ISBN 0-309-54955-8 (pdf) 1. Occupational health services. [DNLM: 1. United States. National Aeronautics and Space Administration. 2. Occupational Health Services—organization and administration. 3. Health Promotion—methods. WA 412 I598 2005] I. Institute of Medicine (U.S.). Committee to Assess Worksite Preventive Health Program Needs for NASA Employees. RC969.H43I58 2005 658.3’82—dc22 2005021255 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Integrating Employee Health: A Model Program for NASA “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health

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Integrating Employee Health: A Model Program for NASA THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Integrating Employee Health: A Model Program for NASA COMMITTEE TO ASSESS WORKSITE PREVENTIVE HEALTH PROGRAM NEEDS FOR NASA EMPLOYEES JAMES A. MERCHANT (Chair), College of Public Health, The University of Iowa, Iowa City, IA MARTÍN J. SEPÚLVEDA (Vice-Chair), IBM Corporation, Somers, NY ANN M. COULSTON, Eli Lilly & Co, Indianapolis, IN DEE W. EDINGTON, Division of Kinesiology, University of Michigan, Ann Arbor, MI PAMELA ANN HYMEL, Sedgwick CMS, Orange, CA J. RICHARD JENNINGS, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA TOM B. LEAMON (until March 2005), Liberty Mutual Research Center for Safety and Health, Hopkinton, MA REBECCA M. MULLIS, Department of Food and Nutrition, University of Georgia–Athens, Athens, GA MICHAEL D. PARKINSON, Lumenos, Inc., Alexandria, VA CLAUDIA PROBART, Department of Nutrition, Pennsylvania State University, State College, PA NICOLAAS P. PRONK, Center for Health Promotion, HealthPartners, Minneapolis, MN GLORIAN SORENSEN, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA Consultant TAHIRA M. PROBST, Washington State University, Vancouver, WA Staff ANN YAKTINE, Study Director CRYSTAL RASNAKE, Research Associate (until January 2005) CARA JAMES, Research Associate (from March 2005) SANDRA AMAMOO-KAKRA, Senior Program Assistant

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Integrating Employee Health: A Model Program for NASA FOOD AND NUTRITION BOARD CATHERINE E. WOTEKI (Chair), College of Agriculture, Iowa State University, Ames ROBERT M. RUSSELL (Vice-Chair), Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA LARRY R. BEUCHAT, Center for Food Safety, University of Georgia, Griffin MICHAEL P. DOYLE, Center for Food Safety, University of Georgia, Griffin SUSAN FERENC, SAF*Risk, LC, Madison, WI NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center, Denver SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia REYNALDO MARTORELL, Department of Global Health, Emory University, Atlanta, GA J. GLENN MORRIS, JR., Department of Epidemiology and Preventive Medicine University of Maryland School of Medicine, Baltimore SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, DC NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research Laboratory, University of California, San Diego REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell University, Ithaca, NY JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Boston, MA BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, Pennsylvania State University, University Park Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ANTON L. BANDY, Financial Associate IOM Boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authoring committee and the institution.

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Integrating Employee Health: A Model Program for NASA Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: WAYNE N. BURTON, Bank One HELEN DARLING, National Business Group on Health ALLEN J. DIETRICH, Department of Community and Family Medicine, Dartmouth Medical School JOHN HOWARD, National Institute for Occupational Safety and Health MARY KAY HUNT, Worksite Intervention Research BRIAN MARTINSON, HealthPartners Research Foundation RONALD J. OZMINKOWSKI, Thomson Medstat, Cornell University Institute of Health and Productivity Studies, Cornell University Institute of Policy Studies CHARLES H. STARLIPER, National Research Council Office of Human Resources (Retired), National Research Council Task Force on Goals and Operations (1999-2000)

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Integrating Employee Health: A Model Program for NASA RON STOUT, Health Care Research Center, Procter & Gamble Company REDFORD WILLIAMS, Department of Behavioral Psychiatry, Duke University Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by LESTER WRIGHT, New York Department of Correctional Services. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Integrating Employee Health: A Model Program for NASA Preface The American workforce is changing, creating new challenges for employers to provide occupational health services to meet the needs of employees. First, a shift from manufacturing to services, knowledge-centered, and mobile work has changed the focus of occupational health from physical injury and exposure-related illness prevention and management to enhancing performance, productivity, and resilience of workers. Second, the impact of non-occupational illness on performance, productivity and health care costs now outweighs that of occupational illnesses and injuries for many employers. There is, however, an opportunity to lessen the impact of these illnesses through an integrated, total health approach. The National Aeronautics and Space Administration (NASA) is an organization that includes 14 independent geographically diverse centers. NASA employs more than 72,000 people in its workforce; approximately 75 percent are non-federal contract employees and 25 percent are civil servants. The NASA workforce is highly skilled and competitive, and employees frequently work under intense pressure to ensure mission success. NASA also has an aging workforce that, like their colleagues in other agencies and in the private sector, is at risk for chronic diseases associated with an older population. These include heart disease, hypertension, overweight and obesity, and diabetes, which are frequently associated with sedentary lifestyle and poor eating habits such as high fat, high sodium, calorie-dense food choices. A healthy, productive workforce is integral to the success of NASA’s

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Integrating Employee Health: A Model Program for NASA technically challenging high-risk missions. Responsibility for the health and wellness of NASA employees falls under the Office of the Chief Health and Medical Officer (OCHMO). The office is responsible for policy and oversight for occupational health, aerospace medicine, medicine in extreme environments, protection of research subjects and patients, quality assurance, public health issues, and professional health education and development. The OCHMO administers a broad range of health, wellness, and environmental programs and guides occupational health program planning at the various centers. The goal of the OCHMO is to ensure that every agency employee, upon separation from NASA, is healthier than the average American worker as a result of their experience with NASA occupational and preventive health programs. In 2003, the OCHMO requested that the Institute of Medicine at the National Academies review NASA’s occupational health programs, employees’ awareness of and attitudes toward those programs, and recommend specific options for future worksite preventive health programs focusing on, but not limited to nutrition, fitness, and psychological well-being, incentives or methods to encourage employees to voluntarily enlist and sustain participation in worksite preventive health programs, ways to create healthier workplace environments that are conducive to more active lifestyles, supportive nutrition options to reduce risk factors for chronic disease, and ways to evaluate the effectiveness of such programs. In response to this charge, the Committee to Assess Worksite Preventive Health Program Needs for NASA Employees reviewed current literature, held an information-gathering workshop, and made site visits to occupational health facilities and programs at six NASA centers. The Committee’s findings showed that NASA has a history of being forward-looking in designing programs aimed at improving the health and wellness of its employees. The agency was a pioneer among federal agencies in its efforts to incorporate wellness into occupational health programs. In the early 1990s the agency developed and implemented a 10-year agency-wide competitive plan to meet the Healthy People goals. Currently, occupational health programs are developed by a health and wellness committee with representation from each of the NASA centers. All occupational health programs, including health and wellness programs that are offered agency-wide are posted on the NASA occupational health website. The Committee also found that, although NASA has a variety of health care, preventive health, and health promotion programs for its employees, the current approach to implementing occupational health follows a more traditional rather than an integrated model. Further, data-gathering at NASA does not provide for NASA-wide or center-specific health care cost, health care utilization, or health outcome data. The ab-

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Integrating Employee Health: A Model Program for NASA sence of critical, standardized health metric and program utilization data impedes efforts to provide employee-centered programs designed to improve health status and health care consumption behavior of NASA employees. A critical requirement for integrating traditional health and safety with occupational and non-occupational disability and health benefits is integration of occupational health programs, a shift of program focus from center-specific to employee-specific, and centralized collection of uniform health metrics and program utilization data. The Committee believes that NASA’s efforts could serve as a national model for both public and private employers to emulate and improve the health and performance of their workforces. ACKNOWLEDGMENTS The Committee to Assess Worksite Preventive Health Program Needs for NASA Employees was aided in its challenging tasks by the invaluable contributions of a number of individuals. First and foremost, many thanks are due to the committee members who volunteered countless hours to research, deliberations, and preparation of the report. Their dedication to this project was commendable. Many individuals volunteered significant time and effort to address and educate our committee members during the workshops, and the committee thanks them. The committee wishes to acknowledge the invaluable contributions of the FNB study staff, Ann Yaktine, study director, Crystal Rasnake and Cara James, research associates, and Sandra Amamoo-Kakra, senior program assistant. The committee also thanks Geraldine Kennedo for logistical arrangements and Craig Hicks for writing assistance and Hilary Ray for technical editing. This project benefited from the general guidance of Linda Meyers, director of the Food and Nutrition Board. James A. Merchant, Chair Committee to Assess Worksite Preventive Health Program Needs for NASA Employees

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Integrating Employee Health: A Model Program for NASA Contents     EXECUTIVE SUMMARY   1 1   THE NASA WORKSITE   19      How and Why the Committee Was Formed,   19      History of NASA and Development of NASA Culture,   20      Organization of NASA,   26      The Charge to the Committee,   31      References,   33 2   OCCUPATIONAL AND PREVENTIVE HEALTH AT NASA   34      Development of Preventive Health Programs,   34      The Office of the Chief Health and Medical Officer,   35      Organization of Occupational and Preventive Health Programs,   37      Observations of Occupational Health Programs at Selected NASA Centers,   44      Findings,   51      References,   51 3   WORKFORCE HEALTH, PERFORMANCE, READINESS, RESILIENCE: THE CASE FOR CHANGE   53      Introduction and Background,   53      Envisioning the Future,   62      Findings,   72      Recommendation,   72      References,   73

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Integrating Employee Health: A Model Program for NASA 4   ORGANIZING AND MANAGING EMPLOYEE-INTEGRATED HEALTH PROGRAMS AND POLICIES   77      Implementing an Employee-Integrated Health Process,   77      Characteristics of World-Class Programs,   78      Management Systems for Integrated Safety and Health,   83      Findings,   96      Recommendations,   98      References,   100 5   IMPLEMENTING INTEGRATED HEALTH PROGRAMS   102      Worksite Models for Health Behavior Change,   103      Needs Assessment,   105      The Program Implementation Process,   108      Prevention Programs,   114      Disease, Disability, and Injury Management Programs,   129      Program Evaluation,   133      Findings,   136      Recommendations,   137      References,   139 6   DATA INTEGRATION AND HEALTH MANAGEMENT   150      Adopting Characteristics of World-Class Programs to Data Management,   150      Organizational Framework for Data Management,   151      A Data Management System for an Effective Integrated Health Management Program,   153      Findings,   164      Recommendations,   167      Summary,   168      References,   169     Appendixes     A   Glossary of Terms and Abbreviations   171 B   Open Session and Workshop Agendas   176 C   Committee Member Biographical Sketches   180

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Integrating Employee Health: A Model Program for NASA INTEGRATING EMPLOYEE HEALTH

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