Conference coverage: Employers take action on employee health matters

Casselman discussed the importance of implementing prevention and screening initiatives, and how organizational health needs to be viewed as a continuum and a cultural shift rather than as a response to isolated events. In other words, the attitude and approach are as important as the offerings—especially when it comes to mental health.

“You can have the best prevention strategies out there within an organization, but if there’s a toxic culture—poor workload management, poor performance indicators within the organization— employees won’t necessarily participate in those programs,” she warned.

For employees returning to work after a disability leave or in cases of presenteeism—which, Casselman pointed out, can actually result in greater productivity loss than absenteeism—there are several key factors that will better enable employees to transition back to work or be more engaged. Among those are a caring culture in which employees feel well supported; strong supervision that offers clear priorities and performance requirements; job autonomy; and the opportunity for career development.

These factors clearly extend beyond traditional benefits and disability plans to the heart of an organization’s environment—the crux of a healthy workplace. “All of those layers and intricate elements that come into creating positive, healthy organizations are important to us as individuals, as we look to manage our health and reduce risk, and to be the most positive and proactive contributors that we can be within our organization,” Casselman explained.

Opportunities for Managing Diabetes in the Workplace
“Diabetes is not becoming an epidemic. It really is an epidemic,” said Andrea Frankel, manager, private payers, government affairs and market access, with Janssen Inc.

The federal government has reported that there are 2.4 million Canadians today living with either Type 1 or Type 2 diabetes—and that number jumps to nine million when you include pre-diabetics. What’s more, the International Diabetes Federation estimates that, by 2030, there will be a 36% increase in prevalence in North America and the Caribbean, meaning that this disease will continue to be a concern well into the future.

According to a report commissioned by the Canadian Diabetes Association, the estimated economic burden of diabetes was $12.2 billion in 2010, with a projected increase of more than $4 billion over the next decade. Mortality and disability accounted for 79% (more than $9 billion) of the total cost of diabetes in Canada in the same year. And these costs are not just a result of diabetes itself but also of its associated co-morbidities, which include blindness, limb amputations, obesity, cardiovascular problems and depression.

One of the reasons diabetes has such a hold on the population is the reach that it has within a patient’s life, noted Gail MacNeill, clinical nurse specialist/ manager, Leadership Sinai Centre for Diabetes, at the Joseph and Wolf Lebovic Centre.

“Diabetes is a unique disease in that it affects everything from the time you get up in the morning to the time you go to bed at night, and then also all night long,” she explained. Asking people to control their diabetes requires them to rethink the food they eat, the amount of activity they do and the stressors in their lives—an entire lifestyle change that, for many, may simply be too much.

Being on the front lines of diabetes treatment, MacNeill advises customizing plans to the individual, taking into account his or her particular motivational triggers and providing a sense of empowerment. “It takes a leap of faith to motivate and change,” she added.

Employers, too, can make a difference. “The role of the employer—and the role of the workplace—is to start off by understanding the complexity as well as the burden of diabetes, introducing workplace disease management programs and providing access to medications that effectively manage the illness,” said Frankel.

Prioritizing Men’s Health to the Top of the Wellness Agenda
It’s often joked that some men have too much testosterone—but, in fact, too little testosterone can be a serious problem. Why? Because low testosterone levels (hypogonadism) are associated with common medical conditions, according to Dr. Jack Barkin, chief of staff at Humber River Hospital and associate professor in the Department of Surgery at the University of Toronto.

Men’s testosterone levels actually begin to decrease at about age 40, he explained. But unlike the cessation of estrogen in women at menopause, testosterone does not abruptly stop. “The decrease of testosterone is gradual, and it never really gets to zero,” said Barkin. “In some men, just a low level of testosterone is enough for them.

But it depends on what they’re trying to do and how much functionality they’re hoping to achieve.” In Canada, almost one-quarter of men between ages 40 and 75 have clinically significant low testosterone levels, he noted. “But we’re only treating about 10% of that group of individuals.” And the impact on men’s health can be significant. “Obesity, hypertension, diabetes, metabolic syndrome all have, or can have, a co-relationship to low testosterone,” Barkin added.

In the ’70s and ’80s, a loss of libido was considered the main sign of low testosterone. But today, there are many presenting symptoms: decreased muscle strength, muscle girth, cognition, mobility and ability to concentrate. And these symptoms can affect how men function in the workplace. “Work performances have been documented significantly lower in men who have low testosterone,” said Barkin, adding that home life and relationships may also suffer.

He believes it’s important for employers to help manage the health of men with low testosterone. “It’s exceptionally important to identify [these men] because if a man is suffering from low testosterone, it can have a dramatic impact on how efficiently he can work for you, his functionality and his feelings of well-being.” Immunization: It’s Your Best Shot About 10% to 25% of Canadians get the flu every year, resulting in lost time and productivity, according to the Public Health Agency of Canada. Yet the National Advisory Committee on Immunization reports that only 38% of adults between ages 18 and 64 get a shot. According to U.S. research, the cost of flu for this age group is estimated at $8.7 billion in direct medical costs and $6.2 billion in lost productivity annually.

Research has also shown that flu shots in healthy working adults result in 43% fewer sick days. “In an organization of 100 people, a flu shot program with 40% participation can pay for itself if influenza is avoided in just one employee,” explained Dr. Vivien Brown, assistant professor at the University of Toronto and vice-president, medical affairs, with Medisys Health Group, Inc.

However, public perception of immunization is flawed, said Brown. Adults think that when they receive a shot, they’ll never get the disease. But successful immunization actually means attenuation of the disease, in the form of very mild cases, rather than complete elimination, she explained.

Aside from the flu shot, the other two top vaccines for those age 50 and older are for shingles and, depending on one’s health issues, pneumonia, according to Brown. She stressed that vaccinating older adults is important because, “as of age 20, your immune system is on the way down.”

Companies must remember that there is a changing demographic in the workplace, she added, noting that not everyone is retiring at age 60 or 65. Shingles and pneumonia shots— particularly for the 50-plus age group— may be a worthwhile offering in a workplace setting.

Employers should also provide preventative health awareness programs, including lunch and learns, posters and vaccination programs. “If, as a company, you value immunization, there will be more uptake [from employees]. Don’t just talk about the flu in the fall,” she advised, adding that instead of asking about the cost of immunizing employees, employers should consider the cost of not immunizing them.

Ride Away Stigma: On the Road to Mental Health Awareness
Danielle Berman was only 13 years old when she lost her father, a physician in Hamilton, Ont., to suicide in 1999.

While the initial years after her father’s death were difficult, the situation got much worse when Berman entered Grade 11. She was a good student with lots of friends, yet she had what she describes as a “dark cloud” hanging over her. Struggling with feelings of grief, anger and helplessness, she became withdrawn and unable to concentrate.

“My fear was, if people knew what was going on, I’d lose friends,” she explained. “I was hiding behind the stigma of mental health.”

Fortunately, her mother noticed the change, and Berman received counselling as well as antidepressants. The treatment worked, and she was eventually weaned off the medication. But then, as Berman was entering her first year at Dalhousie University, the depression returned. She came off the medication for a second time after graduating from Dalhousie and has now been off it for three years.

To honour her father, who was an avid cyclist, Berman has created her own foundation—Ride Away Stigma—to help others who are dealing with mental illness. On July 15, she began cycling from Vancouver to Hamilton, Ont., to bring awareness to Canadians across the country.

Employers, too, can do their part to help fight the stigma, explained Berman, noting that they need to create a positive mental health environment and provide benefits to ensure that employees can get the counselling and medication they need. “Mental health needs to be discussed in the workplace,” she said, “not pushed under the rug.”

Tammy Burns is a freelance writer and editor based in Toronto, and Brooke Smith is managing editor of Benefits Canada.

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