Following on from a tremendous surge in interest in the Olympics last summer, enthusiasm around cycling has grown dramatically, and this is expected to be the most popular year for Bike Week yet. Events have been organised all over the country through a true partnership among community organisations, local authorities, cycling groups and charities.

The next few days will see free cycling events and activities for all ages and skill levels. Opportunities include free bike safety check-ups, road races, school fun cycles and lunchtime city cycling rides. A full schedule of events is available here >>

Source: Bike Week 2013 website here >>

***

This is an update of two earlier Alerts – 24 October 2012 (here >>) and 18 February 2013 (here >>) – that described what is happening around the global framework on non-communicable diseases, progress in incorporating NCDs into the successors to the Millennium Development Goals (due to expire in 2015) and relevant developments of Sustainable Development Goals (as proposed at the Rio+20 conference in 2012).

Things are no less complicated – but there has been significant progress, with the adoption in May of an ‘Omnibus Resolution’ on NCDs at the World Health Assembly and the publication of the UN High-level Panel’s report A New Global Partnership, which gives a strong steer on the shape of the post-2015 development landscape.

Global action on NCDs

Consultation

There was extensive consultation around the Global Action Plan on Non-communicable Diseases 2013–2020 (the ‘GAP’), including ‘informal dialogues’ with relevant NGOs and selected private-sector entities, held at the WHO on 6 and 7 March,  followed by a round of consultation with member states and UN agencies, on 11 and 12 March. This led to the publication of an updated version of the GAP, including an estimated cost of implementing the GAP, the addition of multisectoral action and conflict of interest as overarching principles, and a ‘reporting cycle’ (see below), and a final round of online consultation.

Success! The 66^th World Health Assembly ‘Omnibus Resolution’ on NCDs

On 20 May, an ‘Omnibus Resolution’ on NCDs was tabled at the World Health Assembly (WHA). A formal drafting group (co-chaired by Pakistan and the United States) was formed to negotiate the Resolution and the final version was unanimously adopted after a week of discussion, on 27 May.

The Resolution, entitled Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, was co-sponsored by 41 countries, and fulfils many of the commitments made in the 2011 UN Political Declaration on the Prevention and Control of NCDs (here >>). The Resolution:

• endorses the new Global Action Plan on NCDs 2013–2020. The drafting group at WHA reviewed the GAP paragraph by paragraph – there is now stronger reference to NCDs in children, for example. Whether the menu of policy options (Appendix 3) should remain in the GAP was particularly discussed – but it has been retained, including cost-effectiveness data;
• adopts the global monitoring framework, including 9 global targets and 25 indicators;
• agrees to develop a global coordination mechanism by the end of the year. There will be a process of consultation on the form and function of the global coordination mechanism (informal consultation from June to October, and then formal consultation with member states in November), with a view to submitting the terms of reference to the WHO Executive Board and World Health Assembly in 2014.

It also recommends that member states develop a national monitoring system, strengthen surveillance and explore sustained resources for NCDs, that the UN Task Force on NCDs be formalised, and – crucially – that progress is regularly reported. In addition, ‘action plan’ indicators will be developed, which will link to the GAP’s recommended actions for states, international organisations and partners. These indicators will also go to the Executive Board and World Health Assembly in 2014.

The NCD Alliance has produced a helpful briefing on the Omnibus Resolution, available on its website here >> and for a summary of the resolution, see C3’s news alert here >>.

As WHO Assistant-Director General, Dr Oleg Chestnov stated, ‘the adoption of the global action plan moves the process from the political to the practical realm’.

NCD Alliance side event

An indication of the importance afforded to NCDs at the WHA was the excellent attendance at the NCD Alliance’s side event, at which its report Healthy Planet, Healthy People: The NCD Alliance Vision for Health in the Post-2015 Development Agenda was launched. This report includes recommendations on a framework for health in post-2015, including specific goals, targets and indicators. It can be downloaded here >>  and a webcast of the event itself is also available here >>.

Progress on the post-2015 development agenda

The Millennium Development Goals are due to expire in 2015 (for progress to date on the health MDGs, see WHO factsheet here >>), and discussions are well under way on their replacement.

UN High-level Panel of Eminent Persons

The UN High-level Panel (HLP) (information here >>) –  made up of 27 members, and co-chaired by Indonesia, Liberia and the UK – has met four times, each meeting covering different themes. The many consultations (see below) that have been taking place over the last few months fed into the final report of the HLP, which was published on 30 May. The report – A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development (here >>) – recommends a single, universal agenda, based in the existing priorities of the MDGs, and with the aim of ‘eradicating extreme poverty from the face of the earth by 2030′. Integrating economic, social and environmental aspects of sustainable development – which the report notes was insufficiently achieved in the MDGs – will be essential.

The report sets out 12 illustrative goals and 54 targets, which will be debated over the next year. Non-communicable diseases are explicitly mentioned in the HLP’s report – Goal 4 is to ‘ensure healthy lives’, and NCDs are listed in one of the targets within this goal: ‘reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases’.

For a brief summary of the HLP’s report, see C3’s news alert here >>

Thematic consultations and national consultations

There was wide-ranging consultation on the post-2015 agenda, which fed into the HLP’s report. This was particularly important in avoiding a serious criticism that has been levelled at the original MDGs – namely, that there had been insufficient input from countries and groups that would be most affected by the Goals. Around 75 national consultations on the post-2015 agenda were held, and there were 11 thematic consultations, including one on health (co-led by WHO and UNICEF with the support of the Governments of Sweden and Botswana).

The culmination of the health consultation was a meeting on 5–6 March in Botswana (more here >>), at which the report Health in the Post-2015 Agenda was finalised, a synthesis of over 100 contributed papers. It aims to develop a shared understanding on priorities for health post-2015, and is available online here >>. It includes an overarching goal of maximising health at all stages of life, underpinned with two goals to accelerate progress on the health MDGs (MDGs 4, 5, and 6) and to reduce the burden of major NCDs (aiming at the 25 by 25 goal of the WHO).

Sustainable development

The Rio+20 Conference in 2012 mandated the establishment both of an Open Working Group to discuss the Sustainable Development Goals and an intergovernmental high-level political forum on sustainable development.

Open Working Group

The 30-member Open Working Group (OWG), established in January 2013 to discuss the Sustainable Development Goals, has now met three times (March, April and May – more here >>):

• Summary bullet points on the 2^nd meeting (‘clusters’ discussed included poverty eradication): here >>
• Summary bullet points of the 3^rd meeting (‘clusters’ for discussion included food security, nutrition and sustainable agriculture, and the importance of the early origins of health – the first 1,000 days of life – for long-term health was noted): here >>

The 4^th session will be on 17–19 June, and the clusters for discussion include ‘Employment and decent work for all, social protection, youth, education and culture’ and (importantly for those of us working to ensure NCDs are high on the agenda) ‘Health and population dynamics’. It will be webcast here >>

It is co-chaired by the permanent representatives of Hungary and Kenya, and the final report of the OWG will be presented to the UN secretary-general in September 2014.

High-level political forum

The format of the intergovernmental high-level political forum on sustainable development is now also under discussion. This was mandated at Rio+20, and will build on and replace the Commission on Sustainable Development – it will ‘follow up on the implementation of sustainable development’. More information is here >>.

A single agenda?

How the SDGs and MDGs will be brought together is still not clear – indeed, there is disagreement among member states as to whether and to what extent they should be combined. Some feel that there should be a single development agenda, but others think that combining ‘development’ and ‘sustainable development’ could confuse and dilute the existing governance mechanisms and agendas of each.

The report of the UN Task Team, Realising the Future We Want For All (June 2012, here >>)  indicates that this should be consolidated towards the end of 2013, following September’s ‘Special Event’ on the MDGs to be held at the UN, which ‘could provide an opportunity to lay the foundations for consensus on the post-2015 UN development agenda, ensuring convergence with the process to prepare sustainable development goals’ (para. 121).

A ‘One Secretariat’ has been formed within the UN to ‘ensure coherence across the different work streams’, although the different areas all remain ‘substantively independent’ for the time being (read more here >>).

Please do comment below if you have further information on this process!

Finally

In February, the Comprehensive Global Action Plan on Mental Health 2013–2020 was published and it, too, was adopted at the WHA (A66/A/Conf./4, here >>). It is the first action plan on mental health put forward by WHO, and sets a new direction for mental health, including specific actions for member states, international, regional and national level partners, and the WHO itself.

In January 2014, the revised principles of the WHO’s report on internal governance reform will be presented as a detailed policy for engagement with NGOs, and a further policy for engagement with the private sector.

Action

• OWG meetings can be attended by civil society organisations – and the meeting on 17–19 June will include discussion on health. We need to continue to make the case that NCDs are a threat to sustainable development!
• The NCD Alliance has produced a template letter, downloadable from its website, to use to thank governments for the adoption of the omnibus resolution and offer support in implementing the resolution at national level here >> (opens in Word).

Following on from a key April meeting in Ireland, where the Mary Robinson Foundation, Climate Justice and the Irish government joined forces to debate the interconnected global challenges of hunger, nutrition and climate justice for all, it is excellent to have other important meetings in June 2013 focusing on nutrition and global health.

Obesity and under-nutrition both exact a tremendous toll on society and the global economy. As the World Bank reports, malnutrition is still the primary cause of child death. Investing in nutrition at scale is simple and cost effective; specific nutrition-related interventions are far more beneficial to improving child health than is economic growth alone.

The UN food agency reported recently that 2 billion people suffer from micronutrient deficiencies and 1.4 billion are overweight. Together, obesity and diet-related chronic diseases and undernutrition affect over one third of the world’s population. These diseases have significant negative health and economic consequences in both high and lower-income countries; both of these challenges are affected by the quantity and quality of food. Given the fundamental and increasing role of food and beverage companies in food availability globally, they exert a substantial impact on the nutritional status of consumers worldwide. These issues have become global public health priorities.

Acknowledging the tremendous impact that food and beverage manufacturers have on nutrition, the Access to Nutrition Index, launched in March, also held a stakeholder meeting this week in advance of the G8 Summit. The Index evaluates the world’s 25 largest food and beverage manufacturers on the basis of both over- and under-nutrition (see C3 alert  on the ATNI here >>) .

As the G8 Leaders’ Summit begins, it is clear that encouraging greater transparency and accountability in food and nutrition is crucial.  Investing in health through nutrition will be a key component of global economic development and long-term prosperity.

Sources:  BBC News online, 8 June 2013;  Agence France-Presse, 4 June 2013; London Evening Standard, 9 June 2013; World Bank, Nutrition Country Profiles.

Although cancer rates are set to increase, the good news is that survival rates have doubled over the last 40 years and by 2020 rates will reach 38 per cent – a significant increase from the 1992 rate of 21 per cent. However, despite encouraging figures for survival rates, Macmillan Cancer Support raised concerns around the fact that cancer treatment has serious side-effects, which can lessen quality of life. The chief medical officer at Macmillan Cancer Support, Professor Jane Maher, commented that ‘Many patients can be left with physical … and emotional problems long after treatment has ended.’

There is much that can be done to prevent cancer – and this report serves to highlight the importance of tackling the risk factors.

Sources: J. Maddams et al., ‘Projections of cancer prevalence in the United Kingdom, 2010-2040‘, British Journal of Cancer, 25 September 2012; The Guardian, , 7 June 2013; BBC News online, 7 June 2013; The Telegraph, 7 June 2013.

According to the UK’s National Institute for Health and Clinical Excellence (NICE), only 4 per cent of people who try to give up smoking on their own are successful for longer than one year, so reducing the harm from smoking by offering nicotine-replacement options as part of a structured support system of  behavioural and self-help techniques could be a significant step in the right direction for many people.

New guidelines published by NICE  are the first in the world to advise health professionals to help people who are finding it hard to give up by offering nicotine replacement therapies such as nasal sprays and patches, as part of a harm-reduction  approach to smoking.

Professor Mike Kelly, director of the NICE Public Health Centre, said: ‘Over 79,000 deaths in England each year are due to smoking tobacco. Put simply, people smoke for the nicotine, but die because of the tar in tobacco. However, nicotine inhaled from smoking tobacco is highly addictive, which is why people find it so difficult to stop smoking. If you are a smoker, quitting smoking is the best way to improve health, and stopping in one step is most likely to be successful. This guidance recommends harm reduction as an additional new option, particularly for those who are highly dependent on smoking who want to quit but can’t just stop in one go.’

Sources: NHS Choices, 5 June 2013; National Institute for Health and Clinical Excellence, ‘Tobacco: harm-reduction approaches to smoking’, June 2013

‘Our industry has an important role to play in helping people lead healthy lives and our actions are having a positive impact,’ said Indra Nooyi, HWCF chair, and chair and CEO of PepsiCo. ‘We see continued opportunities to give consumers the choices they’re looking for and to work collaboratively with the public and non-profit sectors on initiatives that enable continued progress.’

The Healthy Weight Commitment Foundation is a coalition of more than 230 retailers, food and beverage manufacturers (including General Mills, Inc., Kraft Foods, Mars, Nestlé USA, PepsiCo and Unilever), restaurants, sporting goods and insurance companies, trade associations and non-governmental organisations, and professional sports organisations. The HWCF was set up with the aim of helping to reduce obesity, particularly childhood obesity, by 2015, and promotes ways to help people achieve a healthy weight through energy balance – calories in and calories out. It focuses its efforts on two critical areas — families and schools – through its Together Counts™ campaign.

Sources: Healthy Weight Commitment Foundation press release, 30 May 2013; Stone Hearth News, 30 May 2013.

The MDGs are due to expire in 2015, and discussion as to what will replace them is now well under way. A UN High-level Panel of Eminent Persons on the Post-2015 Development Agenda (HLP) was established by the UN secretary-general in July 2012 to draw up recommendations that fully incorporate the results of extensive consultations. The HLP has met four times – in New York, London, Monrovia and Bali – and is co-chaired by President Susilo Bambang Yudhoyono of Indonesia, President Ellen Johnson Sirleaf of Liberia, and Prime Minister David Cameron of the United Kingdom. It interacted with more than 5,000 civil society groups from 121 countries in developing its recommendations – there have been 11 thematic consultations (including one on health, culminating in a meeting in Botswana in March – read more here >>) and 75 national consultations around the world.

The report of the HLP – A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development – was published on 30 May (click here >> for the report). Central to the report is ‘eradicating extreme poverty from the face of the earth by 2030′. It emphasises that the post-2015 agenda needs to be universal (relevant to all countries, not just low-income countries) and driven by ‘five big, transformative shifts’ (pp. 7ff):

• Leave no one behind – no one must be denied basic economic opportunities and human rights
• Put sustainable development at the core – shift rapidly to sustainable patterns of production and consumption, with developed countries in the lead. (The report also strongly states that ‘there is one trend – climate change – which will determine whether or not we can deliver on our ambitions’. There are strong links with sustainability throughout the report – a huge change in focus since the original MDGs.)
• Transform economies for jobs and inclusive growth – profound economic transformation can end extreme poverty and promote sustainable development
• Build peace and effective, open and accountable institutions for all – peace and good governance are ‘a core element of wellbeing, not an optional extra’
• Forge a new global partnership – built on shared humanity, and including not only governments and international institutions, but also businesses, civil-society organisations, philanthropists and scientists, and, indeed, everyone!

Annex 1 of the report (pp. 29ff.) is an illustrative framework of 12 goals, under which there are a total of 54 targets by which progress can be measured. These will be debated over the next year – the report informs, but will not necessarily shape, the intergovernmental negotiations around the successors to the MDGs.

As in the original MDGs, health plays a prominent role, with goal 4 being a stand-alone health goal (‘ensure healthy lives’). Unlike the original MDGs, non-communicable diseases are specifically mentioned in one of the five health targets: to ‘’reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases’. Steady progress towards universal health coverage is also essential (p. 38).

Tackling NCDs requires a multisectoral, ‘whole of society’ approach, as many of the drivers of the diseases are rooted in social determinants. Many of the other goals and targets are, therefore, indirectly related to preventing NCDs, including goal 5 to ‘ensure food security and good nutrition’ and goal 2 to ‘empower girls and women’. Puzzlingly, however, the HLP report does not mention alcohol or tobacco control (tobacco use is the leading risk factor for disease globally, and kills around 6 million people a year), and obesity is mentioned but (seemingly) primarily in relation to developed countries (p. 39).

The UN secretary-general, Ban Ki-Moon, welcomed the report as ‘the beginning of an historic journey’, with ‘The post-2015 process is a chance to usher in a new era in international development – one that will eradicate extreme poverty and lead us to a world of prosperity, sustainability, equity and dignity for all.’ He is expected to present his own vision for the world’s next development agenda at the UN General Assembly in September 2013, where a ‘Special Event’ on post-2015 will be held..

Sources (in addition to those above): High-level Panel website here >>; WHO factsheet on progress on the health-related MDGs here >>

• Downloadable posters and other promotional materials are available from the WHO here >>

Smoking and other forms of tobacco use still top the list of causes of death, with 6 million deaths each year, including 600,000 who are non-smokers. According to the most recent data available from WHO, one in 10 adults dies of tobacco-related illness.

Most of the world does not regulate tobacco promotion and use; the WHO reports that only 6 per cent of the global population is protected from tobacco by regulation. This year, the theme for WNTD focuses on banning tobacco advertising, promotion and sponsorship. Although the states who have become party to the Framework Convention on Tobacco Control (FCTC) now number 176, regulation is still challenging and the tobacco industry mounts fightbacks at virtually every turn.

During a February conference hosted by the Harvard School of Public Health in conjunction with the WHO, many national governments and intergovernmental organisations, along with civil-society organisations, businesses and the global academic community, came together to support the global Tobacco Free Initiative (TFI).

Civil-society organisation the Framework Convention Alliance has seen some progress in regulating tobacco globally during the year – for example, Fiji is preparing to change its national tobacco policy to require that tobacco industry use graphic health warnings on cigarette packages that cover at least 30 per cent of the front and 90 per cent of the back of the packages by July 2013. Australia’s trailblazing measures on tobacco control through the introduction of plain packaging were introduced at the close of 2012, and will be watched closely by other countries.

Sources: World No Tobacco Day website; Guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control (Tobacco advertising, promotion and sponsorship) (here >>); WHO, ‘Reducing the appeal of smoking – first experiences with Australia’s plain tobacco packaging law’, May 2013 (here >>)

The latest big leap forward is the ‘omnibus resolution’ on NCDs presented to the 66^th World Health Assembly in Geneva. This was co-sponsored by 41 countries, and is a very significant step in ‘mov[ing] the process from the political to the practical realm’, as WHO’s assistant director-general, Dr Oleg Chestnov, put it. The resolution was negotiated for a week by a drafting group co-chaired by Pakistan and the United States, before being unanimously adopted on 27 May.

The key items in the resolution are:

• the endorsement of the WHO Global Action Plan for the prevention and control of noncommunicable diseases 2013–2020 (GAP), which supersedes the Global Action Plan 2008–2012;
• the adoption of a ‘comprehensive global monitoring framework’ on NCDs;
• a commitment to develop, by the end of 2013, a global coordination mechanism to respond to the NCD challenge, including coordinating draft terms of reference and holding consultations with member states, UN agencies and NGOs and private-sector entities, as appropriate.

There was extensive consultation around the Global Action Plan on NCDS (GAP), which went through several drafts. This included ‘informal dialogues’ with relevant NGOs and selected private-sector entities, held at the WHO on 6 and 7 March, followed by a round of consultation with member states and UN agencies, on 11 and 12 March, which led to the publication of an updated version of the GAP, including an estimated cost of implementing the GAP, the addition of multisectoral action and conflict of interest as overarching principles, and a ‘reporting cycle’ (see below).

The vision of the GAP is ‘a world free of the avoidable burden of NCDs’. It is a ‘road map and a menu of policy options for all members states and other stakeholders to take coordinated and coherent action’, and is built on nine ‘overarching principles’: human rights; equity; national action and international cooperation and solidarity; multisectoral action; a life-course approach; empowerment of people and communities; evidence-based strategies; universal health coverage; and management of real, perceived or potential conflicts of interest.

The GAP then presents six Objectives (below). Under each objective is listed a number of policy options for member states, actions for the WHO Secretariat, and proposed actions for international partners and the private sector. The objectives are:

Objective 1: To raise the priority accorded to the prevention and control of NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy

Objective 2: To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of NCD

Objective 3: To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments

• The policy options for member states under this Objective are divided into the four major risk factors, and are clearly linked to the relevant voluntary global targets, such as a 30 per cent relative reduction in mean population intake of salt/sodium, a 10 per cent relative reduction in the prevalence of insufficient physical activity, and a halt in the rise of diabetes and obesity.

Objective 4: To strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage

Objective 5: To promote and support national capacity for high-quality research and development for the prevention and control of NCDs

Objective 6: To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control

The costs of action versus inaction are also clearly stated:

‘The total cost of implementing a combination of very cost-effective population-wide and individual interventions, in terms of current health spending, amounts to 4% in low-income countries, 2% in lower middle-income countries and less than 1% in upper middle-income and high-income countries. The cost of implementing the action plan by the Secretariat is estimated at US$ 940.26 million for the eight-year period 2013–2020. The above estimates for implementation of the action plan should be viewed against the cost of inaction. Continuing “business as usual” will result in loss of productivity and an escalation of health care costs in all countries.’

Appendix 2 of the GAP is the comprehensive global monitoring framework, which sets out the nine voluntary global targets and 25 indicators for preventing and controlling NCDs. The targets, discussed and officially endorsed at the WHO’s Executive Board meeting in January, are clearly stated in the Overview and Scope of the GAP, and reiterated in the text of the GAP where relevant:

1. A 25 per cent relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
2. At least 10 per cent relative reduction in the harmful use of alcohol, as appropriate, within the national context
3. A 10 per cent relative reduction in prevalence of insufficient physical activity
4. A 30 per cent relative reduction in mean population intake of salt/sodium
5. A 30 per cent relative reduction in prevalence of current tobacco use in persons aged 15+ years
6. A 25 per cent relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances
7. Halt the rise in diabetes and obesity
8. At least 50 per cent of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and stroke
9. An 80 per cent availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

Appendix 3 sets out a ‘menu of policy options and cost-effective interventions’ – this will be updated as evidence evolves over time. The policy options are divided into the six Objective headings. This section was much discussed at the WHA, but remains in the final version.

The global coordinating mechanism for NCDs had not been finalised by the time of the WHA, and the Resolution calls for this to be discussed and finalised by the end of the year.

The GAP recommends that member states develop a national monitoring system, strengthen surveillance and explore sustained resources for NCDs, that the UN Task Force on NCDs be formalised, and – crucially – that progress is regularly reported:

• progress reports on the GAP will take place in 2016, 2018 and 2020;
• there will be ‘evaluations’ of the GAP (with input from a representative group of stakeholders) in 2018 and 2021; and
• the global monitoring framework will be reported on in 2016, 2021 and 2026.

Source: WHO, Resolution on Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases’, May 2013.

The report looked at wellness programmes from about 600 companies with 50+ employees, and analysed medical claims collected by the Care Continuum Alliance (a trade association for the health and wellness industry).

Inevitably, the quality of programmes varies – and key to success is the integration of a number of different elements, including data-gathering, wellness, health coaching and work flow. Without both top-down support and bottom-up employee engagement, they will not succeed.

The report focuses particularly on incentives, and financial benefits of the programmes are brought into question by the report: among participants in a wellness programme, health-care costs per month were just $2.38 less than non-participants in year one of participation, and $3.46 less in year five – figures that are not statistically significant, so could have been due to chance. In addition, warning signs of disease were not picked up on. There are signs that estimates for ROI are decreasing over time (perhaps indicating that the ‘low-hanging fruit’ have been reached). However, the real impact of programmes is often unclear as just 44 per cent of programmes are actually evaluated, and only 2 per cent have precise savings estimates. Encouraging greater participation is also essential – most programmes have participation under 20 per cent (although this is much higher in health risk assessments), but between 35 and 40 per cent of employers are not even measuring participation rates for many initiatives!

The report notes that ‘a dynamic and innovative industry has outpaced its underlying evidence base’. But this should not be a sign to give up – instead, it is a sign that more needs to be done, and done better, and better measured, in workplace health.

Sources: Reuters, 24 May 2013; RAND, ‘A review of the US workplace wellness market’, May 2013.