Tag Archives: Wellness

National Health Observance for April – World Immunization Week (April 22-28)

April 17, 2019


Each year, the last week of April is marked by the World Health Organization (WHO) as World Immunization Week.  The purpose of this week is to promote the use of immunizations to protect people of all ages against disease. The standard definition of “immunization” is the action of making a person or animal immune to infection, and to stimulate the body’s own immune system to protect the person against subsequent disease.  According to WHO, immunizations currently prevent between 2-3 million deaths every year in all age groups, and are recognized as one of the most successful and cost-effective health interventions in the world.  They are an important piece of the puzzle when it comes to overall health and wellness.  However, the WHO also found that only 85% of the world’s children receive their recommended immunizations.

In order to understand the prevalence of immunizations overall, the World Health Organization analyzes the global vaccination coverage each year, which is defined as the proportion of the world’s children who receive recommended vaccines.  The WHO is working extensively to improve the 85% statistic.  The United States may not feel the burden of limited access to vaccinations but it is felt in countries such as Afghanistan, Ethiopia, India, Indonesia, and South Africa.  The WHO wants every country to intensify their efforts to ensure that all people have access to lifesaving vaccines.

In recent national news, vaccines have become a frequent topic of conversation – good and bad.  Because of this, the theme for 2019 is Protected Together: Vaccines Work!  The primary goal of World Immunization Week is to raise awareness about the importance of full vaccinations.  For social media purposes, the WHO is using the tagline “#VaccinesWork” in order to further increase awareness and spark a global movement.

2019 Campaign Objectives:

  • Demonstrate the value of vaccines for the health of children, communities and the world.
  • Highlight the need to build on immunization progress while addressing gaps, including through increased investment.
  • Show how routine immunization is the foundation for strong, resilient health systems and universal health coverage.

Information contributed by Kelsey Kempen, a St. Louis University dietetic intern. Kelsey spent time at J.W. Terrill learning about community nutrition and corporate wellness.




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Social Determinants of Health

March 8, 2019


Population Health Managers have long known that the health of an individual is dependent on a complex variety of factors, not just genetics and lifestyle. Health can also be determined by the places and conditions where employees work and live. Poor social and environmental conditions can negatively affect the health outcomes of those employees. For example, unsafe neighborhoods, low income, poor access to healthcare, poor quality education and low literacy can affect the health and wellbeing of the employee population. These conditions are referred to as the Social Determinants of Health (SDoH). Healthy People 2020 defines SDoH as: conditions in the environment in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. The Kaiser Family Foundation has organized the SDoH around five key categories and their sub categories:

  1. Economic Stability: Employment, income, expenses, debt, medical bills, support
  1. Education: Literacy, language, early childhood education, vocational training, higher education
  1. Health and Health Care: Health coverage, provider availability, provider linguistic and cultural competency, quality of care
  1. Neighborhood and Built Environment: Housing, transportation, safety, parks, playgrounds, walkability, zip code
  1. Social and Community context: Social integration, support systems, community engagement, discrimination, stress

Understanding and addressing how these social determinants can affect the health outcomes of an employee population is imperative for an employer. Although employers may feel that they have no influence on the conditions and environments where their employees were born, live, learn or play, they have a substantial influence on the conditions and environments at the workplace. For example:

  • Employers can offer financial wellbeing resources to assist employees with economic instability and make sure that all employees earn a living wage. http://livingwage.mit.edu/
  • Employers can offer tuition reimbursement and allow employees travel time to attend evening classes.
  • Employers can provide affordable healthcare benefits to employees.
  • Employers can offer bus tickets and train vouchers for employees who use public transportation.
  • Employers can assist employees with food insecurity by directing them to appropriate resources or by providing meals or snacks at the workplace.
  • Employers can offer resources on stress management and access to appropriate care through an Employee Assistance Program (EAP).

Many initiatives have been launched at the federal and state levels, but many challenges remain. Employers should proactively seek ways to decrease the burden of poor conditions in which their employees may work by assessing their current environment and needs of their employee population and commit to find ways to improve.





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Retail Workers and Fatigue

December 17, 2018


During the holidays, many retail workers experience irregular and extended shifts and often take on additional workload due to reduced staff. This can lead to overexertion, stress and fatigue which ultimately can cause poor overall health in the population.

The National Institute for Occupational Safety and Health (NIOSH) looked at the retail sector and provided suggestions to reduce worker fatigue that can be implemented at the workplace. These include:

  • Allow for adequate rest breaks. Frequent breaks every 1 or 2 hours are more effective than one or two long breaks.
  • Allow at least 10 hours between shifts and try and avoid scheduling workers for an opening shift if they worked a closing shift the day before. Employees will have a better chance of getting 7-8 hours of sleep if they have adequate time off.
  • Schedule one or two days of rest for every five consecutive work days that are 8 – 10 hours long.
  • Provide anti-fatigue mats and/or chairs or stools for employees who stand for long periods of time.
  • Schedule strenuous and difficult work when employees are most alert. Fatigue related-incidents are at increased risk from 4am to 6am and then again in the middle of the afternoon.
  • Ensure adequate lighting, comfortable temperatures, ventilation and minimal exposure to noise in the workplace.
  • Offer healthy snacks or vending, access to cold water and refrigerators or microwaves for employees to bring healthy food from home.

For more information, visit NIOSH: https://doi.org/10.26616/NIOSHPUB2019102

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September is Fruits & Veggies – More Matters Month

September 21, 2018


Most Americans know the importance of eating fruits and vegetables, but most still aren’t getting the daily recommended servings. The minimum requirement is 5 cups of fruits and vegetables a day. A cup is equal to one tennis ball-size piece of fruit or one cup of cooked or raw vegetables. Most individuals need to do some planning to ensure they are getting the minimum daily intake. Planning involves, purchasing, cleaning and preparing the fruit and vegetables. Keep a fruit and vegetable bowl in the refrigerator with a variety of ready-to-eat fruits and vegetables to snack on. Be sure to add a vegetable at meal time and double the portion so that fruits and vegetables make up one-half of you plate. For more ideas visit www.choosemyplate.gov .

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Navigating the Wellness Program Rules for 2019

September 17, 2018


What a difference a year can make. Dealing with the various and differing wellness program requirements under HIPAA, the ADA, and GINA remains challenging, but we finally had a regulatory framework to work with for all three laws in 2017 and 2018. That was apparently too easy as a federal court determined that the Equal Employment Opportunity Commission (EEOC) hadn’t done enough to justify its ADA and GINA wellness incentive limit rules and ordered the EEOC to try again.  After the EEOC indicated it would be unable to complete revising its rules before 2021, the court issued an order vacating the existing ADA and GINA wellness incentive rules as of January 1, 2019.

So now what?
This leaves employers with a few options to consider heading into 2019:

  1. Leave existing wellness programs that comply with the current HIPAA, ADA, and GINA regulations alone without making any design changes;
  2. Modify existing wellness programs by eliminating or reducing incentives for activities that are subject to the ADA and/or GINA; or
  3. Determine whether to implement new wellness program activities with incentives that are subject to the ADA and/or GINA.

We recommend employers discuss their wellness program design with their legal counsel before choosing a course of action, but leaving an existing compliant wellness program alone seems to be a reasonable course of action for now for reasons we will discuss below. We also recommend employers carefully consider whether to implement new or additional programs that rely on the soon-to-be-vacated wellness incentive limits until further guidance is available.

Recap of the existing wellness incentive rules
The three sets of wellness rules have much in common, such as a general requirement that a wellness program be reasonably designed to improve health and/or prevent disease without being overly burdensome or a subterfuge for discrimination against participants. A key difference between them is when and how their wellness incentive rules apply.

  • HIPAA – Only “activity-only” and “outcome-based” wellness programs are subject to HIPAA’s incentive limits. An activity-only program requires participants to complete an activity related to their health status without actually requiring a specific health outcome. Examples include walking and healthy eating challenges. An outcome-based program requires participants to actually achieve or maintain a specific health outcome. Examples include requirements for participants to be tobacco free or achieve biometric targets. The cumulative amount of all incentives cannot exceed 30% of the total cost of coverage (employee + employer contribution) or 50% of the total cost of coverage provided the excess over 30% is used toward tobacco cessation incentives. A wellness program could utilize the entire 50% limit for tobacco incentives. If spouses and/or dependents may participate, the incentive may be based on the total cost of coverage for the enrolled tier such as employee + spouse instead of employee-only. A program must include reasonable alternatives to qualify for incentives if it is medically inadvisable or unreasonably difficult for a participant to participate in an activity-only program or if a participant fails to achieve a required outcome in an outcome-based program.
  • ADA – Wellness programs are subject to the ADA’s rules if the program includes questions that may relate to whether the participant has a disability, such as family medical history questions, or requires the participant to undergo a medical examination. Participation must be voluntary. Under the ADA’s wellness regulations, participation is considered voluntary if the cumulative amount of all incentives does not exceed 30% of the total cost of employee-only coverage. There are no reasonable alternative requirements, but reasonable accommodations must be provided to enable participants with disabilities to participate. For example, an accommodation may be required to enable hearing and/or visually impaired participants to complete a health risk assessment. An employer cannot limit or deny access to health plan coverage based upon participation which prevents an employer from using participation as a gateway to a richer plan design.
  • GINA – GINA prohibits the use of genetic information for health plan underwriting. In today’s wellness program context, GINA primarily impacts health risk assessments as family medical history questions are considered genetic information. Participation must be voluntary and occur after enrollment. Under GINA’s wellness regulations, a spouse’s completion of a health risk assessment is considered voluntary if the incentive does not exceed 30% of the total cost of employee-only coverage. The GINA regulations do not address permitted incentives for employees to complete health risk assessments as these are already covered by the ADA’s rules. No incentives may be offered for dependent children to participate.

We’ll provide an example of how the existing wellness incentive limits under HIPAA and the ADA work at the end of this article.

Because, because, because
The court in AARP v. EEOC held that the EEOC failed to sufficiently justify the use of a 30% incentive limit to satisfy the voluntary requirement under the ADA and GINA because it largely relied on the use of the 30% limit standard from HIPAA without sufficient explanation for why this should be considered “voluntary” or addressing the differences between the laws. However, the court didn’t say that the EEOC’s wellness incentive limits were inappropriate. Instead, it merely indicated that the EEOC hasn’t provided enough guidance to justify the 30% limit yet. The court also didn’t vacate any other provisions of the ADA and GINA wellness regulations, so the rest of the rules remain in effect. There hasn’t been any indication from the EEOC that it intends to back down, so the EEOC’s next attempt may simply rehash the 30% limit with additional support (i.e. the 30% standard is voluntary “because, because, because”).

Be careful what you wish for
Was this a victory for the AARP and potential plaintiffs contemplating suing their employers in 2019 over wellness programs? We’re not so sure.

Potential plaintiffs generally have to file a charge with the EEOC before filing a lawsuit under the ADA or GINA. The EEOC investigates the claim and issues a right to sue at the conclusion of the investigation. It seems unlikely the EEOC will find discrimination and intervene if a wellness program complies with the EEOC’s existing final regulations as drafted, particularly if the EEOC intends to stick with its wellness incentive rules and provide greater justification for them later. Plaintiffs might anticipate this and choose to request a right to sue before the EEOC’s investigation is completed. A lack of support from the EEOC isn’t fatal to a plaintiff’s claims of discrimination in court, but it certainly doesn’t help.

It’s also worth a mention that employer wellness programs were faring pretty well under the ADA in court before the final regulations were issued.[1] The court in AARP v. EEOC vacated the existing wellness incentive rules under the ADA and GINA and ordered the EEOC to try again, but it did not explicitly reject the incentive limits or find that they couldn’t be justified. There’s no basis to assume a wellness program that relies on those incentive limits will automatically lose in court.

In the meantime…
For these reasons, it seems reasonable for employers to stick with existing wellness programs that comply with the HIPAA, ADA, and GINA wellness rules as currently drafted until further guidance becomes available. That said, employers may consider tapping the brakes and not implementing any new or additional programs that rely on the soon-to-be vacated wellness incentive rules. There will be lawsuits and with the current uncertainty, employers may wish to avoid potential trouble they do not already have.

Example under the existing wellness incentive rules:
In the example below, assume the total cost of employee-only coverage is $5,000/year and only employees are eligible to participate in the wellness program.

Wellness Activity and Incentive HIPAA ADA
$250 incentive for completing a health risk assessment with health-related questions N/A
(participatory-only activity)
$250 counts toward
incentive limit
$250 incentive for participating in biometric screening without regard to results N/A
(participatory-only activity)
$250 counts toward
incentive limit
$1,200 annual surcharge for using tobacco based solely on employee attestation $1,200 counts toward
incentive limit*
Total permitted incentives


$1,500 (30% * $5,000) or up to $2,500 (50% * $5,000) if excess over $1,500 used for tobacco incentives $1,500 (30% * $5,000)
Total incentives used $1,200 = compliant $500 = compliant

*HIPAA’s reasonable alternative standard rules apply.

[1] Remember, only the wellness incentive rules have been vacated. The EEOC specifically rejected the bona fide benefit plan safe harbor relied upon in Seff v. Broward County and EEOC v. Flambeau in the preamble to its final ADA regulations and attempted to strip this approach out, so this probably remains unavailable today.

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Wellness to Wellbeing: Is it time for a change to your program?

July 24, 2018


Workplace wellness programs have definitely grown in the past 20 years. While the focus in the past was on wellness programs that addressed the physical health of employees, an important shift has taken place. Employers are shifting their focus and addressing the whole person, not just the physical health of an individual. Wellness programs are confirming this change in direction and are changing their name from Wellness to Wellbeing. Wellbeing programs involve coordinated and comprehensive strategies to meet the health and wellbeing needs of their employees. Comprehensive wellbeing programs focus on several aspects of an employee’s health such as:

Physical Health – Wellbeing programs still offer physical health programs such as walking challenges, flu shots, biometric screenings, walking challenges, healthy vending options, healthy food & beverage policies, smoking cessation programs, lactation rooms and other programs that address the physical aspect of employee health.

Mental/Emotional Health – Wellness programs have addressed the mental health of employees primarily with stress management programs, but wellbeing programs integrate mental health & wellbeing as part of the culture. Wellbeing programs offer onsite meditation rooms, onsite yoga classes, employee assistance programs with unlimited one-on-one counseling, mindfulness resources, access to natural lighting and other programs and policies to address the mental and emotional wellbeing of employees.

Financial Health – The management of financial resources can be very stressful for employees and the ability to make wise financial decisions becomes essential. Wellbeing programs address the financial health of employees by first of all offering comprehensive benefits packages. Other offerings can include voluntary benefits, legal resources, employee assistance programs that offer financial planning resources, tuition reimbursement, retirement planning, identity theft protection and others.

Career/Intellectual Health – These types of programs may seem most foreign to traditional wellness programs, but an employee’s wellbeing is certainly affected by their personal satisfaction and investment in their career development at the workplace. These types of wellbeing programs address flexible work schedules, guest speakers on various educational topics, employee training, mentorship programs, paid time off policies, leadership development and more that treat the employee as a creative asset to the organization.

Social/Community Health – These programs are especially important to Millennials at the workplace, but affect all generations. Social or Community health looks at the connections that employees make at the workplace and in the larger community. Leverage the social activities that may already be part of the organization. Programs that communicate the importance of relationship such as social outings, interest groups or clubs, employee appreciation events, team building and projects in the community.

A comprehensive Wellbeing program will address the employee holistically and provide opportunities for employees to improve their overall health and wellbeing. Is it time for a title change and focus for your wellness program?

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Staying Hydrated

July 9, 2018


When temperatures rise, we know that drinking water can be life-saving. But how much water do we really need every day? Well, the answer can be a bit complicated. Water has many roles including transporting nutrients, removing waste, regulating body temperature and keeping our cellular level working properly. But the amount of water we need varies day-to-day and person-to-person depending on several factors such as age, where you live, gender, activity level, body composition, outside temperature and humidity. Certain medications such as diuretics and diabetes medications can also affect hydration level, so be sure to discuss with your physician or pharmacist. When the body is properly hydrated, the heart can pump efficiently to the muscles and brain. Dehydration can be a serious condition which can lead to life threatening illnesses such as heat stroke.

Thirst is not the best indicator of dehydration. If you feel thirsty, you are already dehydrated. Many physicians recommend paying attention to the color of your urine to help determine your hydration level. Pale and clear urine means you are well hydrated whereas dark colored urine may indicate that you need to drink more fluids. According to the American Heart Association, if you want to know how much fluid to replenish, weigh yourself before and after exercise to determine how much you have lost due to perspiration. For every pound of sweat that you lose, you will need to drink 2 cups of water to replenish.

As discussed, there is no magical number of cups of water to drink for everyone. Drinking 8 eight-ounce glasses of water every day is a good place to start for most individuals. Foods and beverages also count toward the total since most people get about 20% of their fluid intake from food. Bottom line, don’t let yourself get thirsty and take extra precautions in the hot summer months, when taking certain medications and during physical activity.

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June is National Safety Month

June 6, 2018


Did you know that injuries are the leading cause of death for Americans ages 1 to 40? Poisonings are the number 1 cause of unintentional death in America. This statistic is driven by drug overdose predominantly from prescription pain killers. The National Safety Council, in conjunction with an independent research group, has designed a Substance Use Cost Calculator for Employers. This tool can be used to find information regarding the cost of substance abuse on the workplace and to provide guidance on taking action:


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World Health Day – 7 April 2018

April 9, 2018


2030 Agenda

This will be the 70th anniversary year of World Health Day and the World Health Organization (WHO) is calling on world leaders to live up to the pledges they made when they agreed to the Sustainable Development Goals in 2015. What are the Sustainable Development Goals (SDGs)? They are a collection of 17 global goals set by the United Nations. The SDGs cover a broad range of social and economic development issues including poverty, hunger, health, education, climate change, gender equality, water, sanitation, energy, environment, and social justice. The SDGs are also known as “Transforming our World: the 2030 Agenda for Sustainable Development” or “2030 Agenda” in short.

Your Role

Even the smallest changes made by few can lead to one day achieving these global goals. Although not all SDGs are equally actionable (compare clean energy with world hunger), major institutions are already getting involved. For example, The Cocoa Life Initiative by Mondelez International has made major changes to improve the economic, social and environmental conditions of around a million cocoa framers and their communities in places like Ghana, India and the Caribbean. Other companies are making major financial investments to create more inclusive and sustainable business models. Check out how you can get involved here.

Resources ~



Information contributed by Emily Hovick, a St. Louis University dietetic intern. Emily spent time at J.W. Terrill learning about community nutrition and corporate wellness.


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March is National Nutrition Month

March 13, 2018


Spring is around the corner so there’s no better time than now to focus on food and some nutrition goals.  National Nutrition Month is a campaign sponsored by the Academy of Nutrition and Dietetics (AND) and its focus is on raising awareness about good nutrition habits and small changes that can lead to healthier lifestyles.  The theme this year for National Nutrition Month is “Go Further with Food” and it is a reminder that food is our fuel and that proper food choices make a big difference in our overall well-being.

So take this month as an opportunity to make one change in your eating habits for the better.  Some common ideas include:

  • Eating breakfast each day
  • Drinking more water during the day
  • Taking your own lunch to work
  • Refrain from using the salt shaker on the table
  • Cooking at home more often
  • What change will you decide to make?

What is a Dietitian (RDN)?: https://www.eatright.org/food/resources/learn-more-about-rdns
National Nutrition Month ® Celebration Toolkit : https://www.eatright.org/food/resources/national-nutrition-month/national-nutrition-month-celebration-toolkit

Information contributed by Danielle Moore, a St. Louis University dietetic intern. Danielle spent time at J.W. Terrill learning about community nutrition and corporate wellness.

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American Heart Month

February 12, 2018


Nine out of 10 Americans consume too much sodium every day.  The American Heart Association recommends we consume no more than 1,500mg of sodium per day and most Americans consume more than 3,400 mg per day.

The American Heart Association states the following six popular foods can add high levels of sodium to your diet:

  • Breads & rolls
  • Pizza
  • Cold cuts and cured meats
  • Sandwiches
  • Canned soups
  • Chicken

This may come as a surprise as not all of these popular foods may seem high in sodium. The best way to know how much sodium a food contains is to read the label on the package before purchasing or consuming. When reading food labels, look at the percent daily value (%DV) for sodium per serving. If it’s more than 20%, the FDA considers it a high sodium food.

Reducing sodium intake is an easy thing YOU can do to help prevent hypertension and thus heart disease. To celebrate American Heart Month this February, give salty foods less room on your plate to take care of your heart.

For more information on how to #breakupwithsalt visit here:

Information contributed by Rachel Frichtl, a dietetic intern. Rachel spent time at J.W. Terrill learning about community nutrition and corporate wellness.

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October is Breast Cancer Awareness Month – What can you do?

October 19, 2017


There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk. Discuss your risk factors with your primary care physician.

Risk Factors for Breast Cancer:

  1. Drinking alcohol. Try to limit yourself to less than one drink every day since even a small increase can cause a greater risk.
  2. Being overweight or obese. Get yourself to a healthy weight. Being overweight may put you at a greater risk for certain types of cancers including breast cancer. Maintaining a healthy weight is especially important for post-menopausal women.
  3. Smoking. The cessation of smoking will not only prevent breast cancer but improve your health in other ways by preventing health disparities such as COPD and heart disease.
  4. Eating in an unhealthy way. Eating more fruits, vegetables, and healthier fats can help to reduce your risk for not only cancer but it improves your heart health and helps to prevent diabetes. Eating too many saturated and trans fats may put you at a greater risk of breast cancer.
  5. Being sedentary. The recommendation is to exercise 150 minutes every week (Department of Health and Human Services). Exercising five times a week for only 30 minutes will have many health benefits and helps to prevent many diseases. Those 30 minutes could be even as simple as walking your dog every day.

Catching breast cancer early could save your life. Get your well women exam every year and discuss your risks with your primary care physician.

For more information

Information contributed by Kelsey Wright, a dietetic intern at St. Louis University. Kelsey spent time at J.W. Terrill learning about community nutrition and corporate wellness.

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