Prevention

Truth be told, we are not exactly sure what a "fryolator" is, but it's probably a good thing that the Somerville, Mass high school no longer has one.

With bike lanes and pedestrian crosswalks on its streets, healthful food in its school cafeterias, and cheap salsa classes offered by its recreation department, Somerville has become a model "Fit City." Healthy policy, the town has found, creates healthier people, and other communities are paying attention, the Boston Globe reported this week.

Five years after the Boston suburb embarked on an ambitious collaboration with Tufts University called Shape Up Somerville to see whether systemic changes that encourage healthy eating and physical activity would help children stave off obesity, 10 communities across the country have begun testing whether they can replicate Somerville's success. In a separate initiative, the Robert Wood Johnson Foundation plans today to name Somerville one of nine "leading sites" for a $44 million "Healthy Kids, Healthy Communities" program that will spread to 70 communities. The state expects to launch a wellness program informed by innovations in Somerville and elsewhere.

A few months ago we wrote about a provocative study that questioned whether job-based wellness programs really paid off—and if so when, and for whom. If a business pays for wellness and prevention in 2008, would any of the workers still be on that payroll when the health-savings accrued years in the future (assuming that the investment did pay off in better health and lower costs?)

It's going to take more than one more study to answer that question, but new research from Blue Cross and Blue Shield of North Carolina does provide some encouraging results. According to a report in the Raleigh News and Observer, companies willing to make even modest investments in wellness initiatives—such as health screenings in the workplace or giving workers paid time off for doctor's visits—saw a healthy return (pun intended) within a few years.

"The things that employees value the most aren't always the things that cost a lot of money, and in fact, it can be just the opposite," Don Bradley, chief medical officer for Blue Cross told the newspaper. "You don't have to build a gym, but just give the opportunity to get outside and do some exercise."

You hear a lot these days about all the miles Americans aren't driving because of $4 gas. How about all the cigarettes they aren't smoking because of some sensible anti-smoking investments? And the money saved on health care (not to mention the improved health of ex-smokers). New research finds that California's anti-tobacco program has yielded a 50-to-1 return and prevented 3.6 billion--yes, billion with a "b"--packs of cigarettes from being smoked in 15 years.

The report in the Aug. 25 issue of PLoS Medicine by a University of California, San Francisco team found that between 1989 and 2004 the $1.8 billion program saved $86 billion (in inflation-adjusted 2004 dollars).

"The benefits of the program accrued very quickly and are very large," senior author Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, was quoted as saying. The California program showed rapid health care costs savings because it was directed at adults, not youths, so the impact on heart and lung disease, even cancer, could be seen.

Another reminder that with health policy, we often know less than we think we know. And that even when things like job-based wellness programs make sense intuitively, the supporting evidence might not materialize as quickly as we'd like —or work out exactly as we hope when we hope it.

Health and Wellness Initiatives: The Shift from Managing Illness to Promoting Health, released this week by the Center for Studying Health System Change, found that health plan initiatives to promote workers' health and wellness are now common—partly because of the mounting concern about U.S. obesity rates. But we don't yet know whether the investment is paying off —or for whom.