Measuring and Acting upon Well-Being: The Learnings, the Application and the Impact. with John Harris and Katie Bell

Measuring and Acting upon Well-Being:
The Learnings, the Application
and the Impact
John Harris Katie Bell
Chief Well-Being Officer Partner
Vice President, Innovations Global Wellbeing
Healthways, Inc. Gallup, Inc.

Copyright ® 2011 Gallup-Healthways Well-Being Index. All rights reserved.
Copyright © 2011 Gallup, Inc. All rights reserved.
1
Copyright © 2011 Healthways, Inc. All rights reserved.

2
2

GDP Doesn’t Help us Understand
How People will Behave
Egypt: Recent Trends in Percentage “Thriving” and GDP per Capita (PPP)

2005-2010 GDP Per capita (PPP) estimates are from the International Monetary Fund’s
World Economic Outlook database.

3

3

Leaders Have Corrected Public Health

4

Obesity Rates Trending up Globally

5

Reducing Obesity Saves Money

6

Americans’ Health Habits Are Getting Worse

Fewer Americans are
eating healthy.

Fewer Americans
are exercising.

7

Obesity and Related Chronic Conditions Are
on the Rise:

More Americans
have high blood More Americans
More Americans pressure. have high
are obese. cholesterol.

More Americans
have diabetes.

8

Americans’ Job Satisfaction Is Decreasing and Future Outlook for
Their Community Is Still Recovering From the Recession:

Fewer Americans
are satisfied with their jobs.

Americans’ optimism about the
future of their community has yet
to recover from the recession.

9

Well-Being Index Measures

Global
Wellbeing

Objective Subjective

Evaluative Experienced
GDP
Health
Employment
What one
Literacy How one rates
experiences
his or her life
Poverty in daily life

10
10

The Gallup-Healthways Well-Being Index

• 25-year commitment, initiated January 2, 2008
• Telephonic-based for “community” survey Six Domains:
• 1,000 completed surveys per day/7 days/week
1. Life Evaluation
• 1,310,000+ surveys completed as of October 15,
2011 2. Emotional Health
• The maximum 95% margin of sampling error is ±0.1 3. Physical Health
percentage points
4. Healthy Behavior
• Science-based design, support and oversight:
5. Work Environment
• Behavioral economists
• Psychologists 6. Basic Access
• Experts in psychometric statistical analysis
• Largest and most comprehensive well-being survey
of its kind
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11

Life Evaluation on a Scale From 0 to 10: The
Cantril Ladder
Cantril Self-Anchoring Striving Scale:
“Please imagine a ladder. . . . On which step of the ladder would you say you personally feel
you stand at this time? On which step do you think you will stand about five years from now?”

Thriving 7/8

Struggling

Suffering 4/4

12

Germans Rate Their Lives Lower Despite Superior
Results in Health, Work, and Basic Access
Germany U.K. U.S.
(n=4.811) (n=7.843) (n=208.013)

Well-Being Index Composite Score
67.9 67.0 66.4
Average of six sub-indexes

Life Evaluation
35.3 48.0 49.4
Ranking one’s life today and in the future

Emotional Health
80.1 80.8 79.3
Daily feelings; clinical depression

Physical Health
77.3 80.4 76.9
Chronic conditions, obesity, physical pain, cold/flu

Healthy Behavior
70.2 66.8 64.0
Smoking, healthy eating, exercise

Work Environment
54.8* 39.5* 47.1*
Using strengths, supervisor relationships

Basic Access
89.8 86.7 82.0
Healthcare, community satisfaction, money for basics

*WEI sample includes only respondents employed by an employer.

13

Germans Rate Their Lives Lower Than
Americans and Britons

14

Germans More Likely to Exercise and Express
Satisfaction With Cities

15

Noteworthy Trends from U.S.
2010 WBI Data

16
16

2010 Well-Being Index Findings

• Work Environment down 2.7 points since 2008

• Healthy Behavior score improved slightly in 2010

• Life Evaluation up 9.8 points since 2008

• Hawaii: highest state well-being score

• Boulder, CO: highest city well-being score

17

Well-Being in America 2008
2009
2010

Ranking: Top Quintile Second Quintile Third Quintile Fourth Quintile Bottom Quintile

18

Well-Being in Virginia

Result Rank
2009 2010 2009 2010

Well-Being Overall 67.0 66.7 12 21
Life Evaluation 49.7 50.5 5 15
Emotional Health 79.3 79.0 15 22
Physical Health 77.4 77.0 16 22
Healthy Behavior 63.1 63.6 22 24

Work Environment 48.7 47.7 29 28
Basic Access 83.7 82.8 16 21
TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE

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19

Well-Being in Virginia Cities
Washington-Arlington-Alexandria, DC-VA-MD-WV
Charlottesville, VA Richmond, VA Kingsport-Bristol-Bristol, TN-VA
Virginia Beach-Norfolk-Newport News, VA-NC
Washington
DC Charlottesville Virginia Beach Richmond Kingsport
5,358,130 192,779 1,658,292 1,225,626 303,686 STATE

Overall Rank 2010 10 39 55 73 168 21
2009 8 #N/A 35 106 179 12

Life Evaluation 2010 6 16 28 87 166 15
2009 6 #N/A 15 104 185 5

Emotional Health 2010 18 67 27 42 175 22
2009 20 #N/A 24 69 172 15

Physical Health 2010 12 25 57 38 187 22
2009 12 #N/A 20 59 186 16

Healthy Behavior 2010 37 38 103 133 119 24
2009 51 #N/A 76 136 69 22

Work Environment 2010 81 168 141 84 74 28
2009 106 #N/A 142 132 116 29

Basic Access 2010 32 47 59 91 100 21
2009 31 #N/A 53 84 108 16
TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE

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20

Life Evaluation
Life Perception & Correlation to Healthcare Costs
“Please imagine a ladder with steps numbered from zero at the bottom to
ten at the top. The top of the ladder represents the best possible life for you and the
bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time?”
Suffering Struggling Thriving

53 48 55
61 58 56

44 47
41 42 42
37

2 2 2 3 5 3

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21

The Residents of the Top 10 Wellbeing
Cities in America…
1. Learn new and interesting things each day.
2. Have very low rates of clinical depression.
3. Have supervisors at work that treat them like partners, not bosses.
4. Have a lot of energy each day.
5. Have low rates of chronic conditions such as high blood pressure,
high cholesterol and diabetes.
6. Have low rates of obesity.
7. Have very few smokers.
8. Find it easy to get clean and safe water.
9. Have safe places to exercise.
10. Have enough money to buy food at all times.
11. Visit the dentist each year.

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22

A New Orleans Super Bowl Wellbeing Bounce?

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23

U.S. vs. New Orleans:
% “Thriving” Trended Over Time
U.S. New Orleans
70

61.9 62.9

60
54.7 54.1
53.0
50.8
50 53.1 53.0 53.4 53.4
52.0

46.0
40 Saints Win Super Bowl!
February 7, 2010

30
June-July 09 August-Sept Oct-Nov 09 Dec 09-Jan 10 Feb-March 10 10-Apr
09
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24

Compelling Findings Since Inception

25
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Cost Disparity of Life Evaluation
“Please imagine a ladder with steps numbered from zero at the bottom to
ten at the top. The top of the ladder represents the best possible life for you
and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this
time?”
Thriving
Average 20% Lower
Six well-being Medical Costs
domains
1. Life Evaluation 7.0
2. Work Quality
3. Basic Access Struggling
4. Healthy Behavior
5. Physical Health
4.0
6. Emotional Health
Suffering
Average 50% Higher
Medical Cost

Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey 2008

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Risk Disparity By Life Evaluation

Risk Category by Life Evaluation

80%

60% 0-1 risks
2-3 risks
40% 4-5 risks
6-9 risks
20%

0%

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

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27

Life Evaluation
% With Significant Stress % Feeling Well Rested

Suffering 80% Suffering 30%

Struggling 61% Struggling 57%

Thriving 33% Thriving 82%

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

% With Sufficient Energy % Satisfied with Job

Suffering 50% Suffering 50%

Struggling 79% Struggling 74%

Thriving 95% Thriving 91%

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

28

Life Evaluation & Presenteeism Drivers
During the past four weeks (28 days), how often have you been at work but had trouble concentrating or
doing your best because of:

Thriving Struggling Suffering Thriving Struggling Suffering
80% 69% 70%
65% 60%
70% 60%
60% 54% 49% 48%
50%
50%
40% 33% 40% 35%
24% 24% 30%
30% 21% 30%
20% 11% 20% 15%
10% 10% 11% 7%
0% 10% 4%
% With Personal % With Financial % With Caregiver 0%
Problems Stress or Responsibilities Depression/Anxiety Health and Regulatory/Legal
Concerns Physical Condition Issue

Thriving Struggling Suffering Thriving Struggling Suffering
80% 45% 42%
70%
70% 65% 40%
35% 32% 32%
60% 53% 30%
30%
50% 45% 25% 20%
39% 18% 19%
40% 33% 20%
30% 15% 11%
30% 23% 9%
10%
20% 13% 5%
10% 0%
0% Supervisor Issues Insufficient Lack of
Job Overload Co-Worker Technology Training Resources to
Issues Issues Effectively do
Work
29

Risk Disparity By Life Evaluation

Risk Category by Life Evaluation

80%

60% 0-1 risks
2-3 risks
40% 4-5 risks
6-9 risks
20%

0%

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

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30

Productivity Impairment Disparity by
Life Evaluation
Activity Impairment, Work Presenteeism and Work Productivity Loss by Life Evaluation
25%

Activity Impairment
Productivity Impairment

20%

Work Presenteeism
15%

10% Work Productivity Loss

5%

0%
Source: Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

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31

Commute Time and Well-Being

%%% %% Obese
Eating Healthy
Exercising
Feeling Well Rested
Reporting Anger

15 minutes or less
15 minutes or less less
15 minutes or 58%
67%
28%
1-15 Minutes
15 Minutes or Less 13% 71%

16-30 minutes
16-30 minutes 56% 69%67%
16-30 16-30 Minutes
16-30 minutes
Minutes 29%14%

31-45 Minutes
31-4531-45 minutes
31-4531-45 minutes
Minutes
minutes 52% 67%
65% 14%
32%

46-60 Minutes 66%
46-6046-60 minutes
Minutes
46-60 minutes
46-60 minutes 63% 15%
34%
50%

Over 60 Minutes 64%
Over 60 Minutes
Over 60 minutes 63% 17%
Over 60 minutes
Over 60 minutes 50% 36%
60% 62% 64% 66% 68% 70% 72%
0%61%
0% 2%
5%
62% 4%
10% 6% 15%
63% 8%
64%
20% 10% 25%
65% 12% 66%30%
14% 16%
67%
35% 18%
68%
40%
46% 48% 50% 52% 54% 56% 58% 60%

32

Work Environment Affects Health and
Engagement of a Workforce
Impact of Negative Work Environment
More Disengaged Employees / Higher Productivity Losses
80%

70% Negative Positive or Neutral

60%

50%

40%

30%

20%

10%

0%
Job Impacts Disengaged
Health
Service Mark SM 2008 Gallup-Healthways Well-Being Index. All rights reserved. Copyright © 2008 Gallup, Inc. All rights reserved. Copyright © 2008 Healthways. All rights reserved.
33

33

Work Environment Impact on
Employees With Chronic Conditions
Days Unable to Carry Out Usual Activities Per Year

16.2 Days/Year

6.6 Days/Year

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34

2010 U.S. Well-Being Disparities
Age

Well-Being Index Composite Score = 66.8 Life Evaluation Score = 49.8 Physical Health Score = 76.9

Emotional Health Score = 79.3
Healthy Behavior Score = 64.1 Work Environment Score = 48.2

Source: Gallup-Healthways Well-Being Index Community Survey 2010, n= 352,840
35

35

The Interconnectedness of All Domains
Drivers of BMI Risks: Example of New Insight
Healthy Eating

Height Weight
Energy Level

Exercise
Physical Health

# of Health Risks
BMI Risk
Coping with Stress

Emotional Health
Negative Affect

Personal Sources
of Presenteeism Recognition at
Financial Stress
Work
Days of Best Work
traditional approach current approach future areas of exploration

36

36

Cost and Performance Impact

37
37

Well-Being Relationship to Total Medical Costs
ANNUAL MEDICAL AND RX CLAIMS COST | Low:High Well-Being = ~3.5x more cost

Annual Costs
(Indexed)

4.0

3.0

2.0

1.0

0-50 >50-60 >60-70 >70-80 >80-90 >90-100
(n=109) (n=151) (n=347) (n=582) (n=683) (n=363)

Low Well-Being Score (Composite) High

Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)

38
38

Well-Being and Productivity

HIGHER OVERALL WELL-BEING IS ASSOCIATED WITH HIGHER PERFORMANCE & PRODUCTIVITY

Well-Being and Performance Well-Being and Absenteeism

39

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Expanded Value Proposition

Improve Reduce Total Increase Increase Total
Well-Being Medical Cost Performance Economic Value

Adopt or maintain • Hospitalizations • Productivity • States
healthy behaviors
• Event Rates • Engagement • Communities
Reduce health-related
risks • Disease Rates • Absence • Sponsors

Optimize care for health • Lifestyle Risks • Work Impairment • Individuals
conditions and disease

Prevent or delay next new case of disease or condition
Economic
Drivers Prevent or reduce impact of the next new episode of care
Enhance one’s ability to actively manage their well-being

41
41 41

What Can We Do About It?

42
42

We Can’t Rely on the Status Quo
• Worksite health programs have been in existence for about
40 years
• There is evidence that these programs can generate an ROI
• However, penetration and sustained engagement have
been lacking

Insanity: doing the same thing over and over again and expecting different results
- Albert Einstein
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Making the Transition from Health to
Well-Being

Well-being is bigger
than Physical Health Community
Financial

Physical
Social

Emotional

Career

Individuals ● Experts ● Social Connections ● Environment ●
Policy
44
44

The Best Science Behavioral Change
Prochaska’s Transtheoretical Model
Decision • Rational decision-making through stages of change
Making • Pro-Change Embedded in Healthways Core Products

Behavioral Dynamic Intermittent Reinforcement
• Predictably irrational decision making in humans
Economics • Already in use for medication adherence HEALTHHONORS®

Emotional and Mindfulness and Neuro-plasticity
• Paying attention in a particular way: on purpose, in the
Social Health present moment, and non-judgmentally LifeMatters®
• The changing of neurons via new experiences

Social Social Networks
• A social structure of “nodes” which are connected by
Connectivity one or more specific types of interdependency, such as
friendship, kinship, common interest, knowledge, etc.
Gaming Theory
Gamification
• Fun vs. fulfillment
• Appealing to all…Explorer, achiever, socializer, competitor
Community, Work, School, Home and Play
Environment • Permanent and semi-permanent environmental changes
• Silver “Buckshot” versus the Silver “Bullet”

45
45

Leveraging Emotional and Social Health
To Impact Physical Health

46

46

Think Differently
Often on-line wellness programs don’t work because they are:

UNREALISTIC MISALIGNED
INCONVENIENT DISINGENUOUS
The solution is a light-weight, self-directed, social well-being
product that is realistic, immediate, convenient, and genuine...

…deployed for the typically unengaged.
47

Health is More Like a Game

48

Stop Being Sloppy About Behavior Change

Source: BJ Fogg, Stanford University
49

Make it Fulfilling – “Gamification”

adapted from Dr. Richard Bartle
50

One Small Daily Action…
The likely impact of one person
reducing their soft drink
consumption over time?
•They lose weight
•Their overweight friends may lose
weight
•Their normal weight friends will be
less likely to gain weight

Now, imagine
if 100,000
people do it?
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51

Daily Challenge: Take Small Steps
in All Six Well-Being Domains
Small daily actions | Conversations | Assessment | Social Engagement
1. Complete Daily Challenges 3. Assess & track well-being

2. Share, discuss, celebrate 4. Social support & comparison

52

Make it Social

53
53

Keep it Dynamic
We are connected Health solutions aren’t medical, they’re social
Pixel Tracking System Facebook Data Extraction
Individuals retrieved
660,000+ Unique individuals 88,000 2,000 new added per day

3 MM Events and social connections 20 MM Friends mapped Avg 280 friends per person

Friend connections mapped
300 MM Each person shares 4,400 connections

Harness the understanding of the
network, to help participants build
more effective social systems that
drive engagement and
effectiveness.

54

Create the Ability to Go Deep

• Tracks are unlocked by using keys.
• Keys are bought with a credit card, by exchanging tokens,
or given to you by a sponsor.

Earn points participating Every 1000 points gets Acquire keys to Each track is unlocked
In the daily challenge you one (1) token Unlock tracks for 30 days or more

Healthy Eating

Balance & Flexibility

Stress

Family Health

A sponsor (employer, payer,
Participant purchased or other participant) can
keys with a credit card give/purchase keys

55
55

Make it Mobile

• Mobile apps

• Interactive SMS
messaging being

56

Make it Easy to Track
Build a “well-being sensor” that adds movement to our lives.

Realistic about who will wear it…
Convenient enough to use regularly…
Immediate feedback and sense of daily value…
Genuine care for your personal challenges and goals…
57
57

Optimizing the Community – Beyond Virtual
Blue Zones Community Framework
Power 9 Principles

The Prototype Community
Albert Lea, Minnesota Healthways| Blue Zones
2008-2009 Vitality Cities 2010

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58

Final Thoughts

59
Confidential and Proprietary 59

Measuring and Acting upon Well-Being: The Learnings, the Application and the Impact. with John Harris and Katie Bell

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