Five noncommunicable diseases — heart disease, mental illness, cancer, respiratory disorders, and diabetes — will account for approximately 16 million premature deaths annually and an estimated cumulative loss of $47 trillion in economic activity worldwide over the next two decades. That’s according to a new report from the World Economic Forum in collaboration with Willis Towers Watson.

The impact of these diseases has continued to increase despite traditional approaches emphasizing treatment of existing disease. The report advocates designing systems, programs and environments that promote healthier behavior of individuals to reduce risk factors and improve population health.

[image credit: Bloomberg]
[image credit: Bloomberg]

The implication of these conclusions for employers is clear: To avoid huge productivity and economic losses, employers should design their employee health and wellness programs to address the behaviors that lead to these diseases.

So how can employers work to fight these diseases in their programs?

The report recommends the use of behavioral economics — the application of psychological insights into human behavior that explain our decision making — as a key element of program design. By fostering behavior change among their employees, employers can expect both productivity gains and economic growth.

It will be essential that companies transform the way they communicate with their workforce. At the heart of this transformation will be the need to make communications personally relevant to employees. Plus, employers can create environments to increase the propensity for employees to make healthier decisions.

With trillions of dollars at stake, employee health and productivity — which has largely been the purview of CHROs — should now be a front and center concern of CEOs and CFOs as well.

Mitigate key risk factors

According to the report, it will be imperative to mitigate five key risk factors — tobacco use, unhealthy diet, inadequate exercise, indoor and outdoor air pollution and excessive alcohol use. These risks account for a substantial portion of the five noncommunicable diseases. As employers develop programs and incentives for employees to change their behaviors related to these risk factors, here are key issues to understand:

Employees are preconditioned and take shortcuts when making decisions using a series of mental shortcuts or “rules of thumb” to simplify decisions. These shortcuts are also known as heuristics. That’s a good thing, because we would be paralyzed if we had to carefully consider every single decision, every hour, every day.

But we make these decisions using a primitive portion of the brain that evolved in prehistory when humans led brutishly short lives on the edge of protein-calorie malnutrition, and were frequent prey of animals higher up the food chain.

Employers can program health and well-being programs to use the way our brains are hardwired to help improve employee health.

Here are a few of these shortcuts, often clustered under the heading of behavioral economics:

· Present bias: Present bias is our tendency to give stronger weight to immediate payoffs. In prehistoric times, present bias helped us be sure to get the calories we needed when we could. In modern times, present bias makes us likely to overeat in a calorie-rich world. We can urge people to stop smoking in the future (not today), and they are more likely to make such a commitment. We should recognize that any incentive will be more potent if offered immediately after the desired activity.

· Loss aversion: Loss aversion is a human tendency to hate losses even more than we like gains. This helped us protect what we already had in prehistory, but it makes us hoarders today. Charging a tobacco surcharge on insurance premiums can help motivate people to quit smoking. Loss aversion helps explain why it is so painful to remove existing benefits.

· Optimism bias: Optimism bias is the tendency to underestimate the likelihood people will experience adverse events and overestimate our own beauty, intelligence or luck. It helped our prehistoric ancestors get out of the cave in the morning to face an uncertain day, but now encourages us to believe we won’t fall ill due to our own behavior. We use the optimism bias when we offer raffle tickets for program participation.

· Availability: Availability means that we remember powerful narrative stories better than dry statistics, so we should look to influence behavior through engaging storytelling and not just rely on facts.

· Status quo bias: Status quo bias means that we tend not to make active decisions if there is an opportunity to avoid decision making. If the highest value health plan or the best retirement plan is the default, more people will passively choose this.

· Virality of behavior: Virality of behavior shows that both bad behaviors (smoking and obesity) and good behaviors (regular exercise) can be reinforced through social networks. Programs that use social networking can have increased impact.

According to the report, technology plays a unique role in driving prevention, is an accelerant of the dissemination of critical health-related knowledge and can be used as a multiplier. For example, mobile cell phones with accelerometers make activity challenges easy — and they can scale through a community and even around the world. Commitment contracts — to exercise, quit smoking or adhere to medicine prescription schedules — are easy to execute using sensors and mobile technology. Big data can help us learn which interventions work best in what circumstances, allowing individualization that would have otherwise been impossible.

What works
In the report, we identified companies and organizations all over the world that are using behavioral economic precepts to encourage decreased risk factors and design optimal programs to encourage good health. Here are some techniques that can lead to success:

Choice architecture. Many of our case studies focused on choice architecture — making the best choice an easy one. For example:

· Designing new buildings with attractive and accessible stairs encourages increased steps and better fitness.

· Offering attractive healthy options in company cafeterias leads to better nutrition. Many cafeterias make bagged mini-carrots the default, and workers can request potato chips as an alternative.

· Co-locating behavioral health services with maternity services in South Africa increased treatment of perinatal depression in South Africa.

· Locked community storage for pesticides in rural India decrease suicide rates.

· Avoiding junk food placement near the grocery store cash registers improved children’s diets in Europe and North America.

· Even simple packaging changes (like putting segments in chocolate bars to indicate healthy portion size or using smaller plates) can go a long way to improving eating habits.

See also: Can architectural wellness slash employers’ costs?

Social support. Many programs are most effective when they include a social support element, and we found organizations that were effectively leveraging social networks to help improve health behaviors. For example:

· Latin American and American cities have blocked urban roadways on weekends to encourage increased activity. Programs to prevent or treat diabetes around the globe are most effective when they include a social support element.

· Many programs to help manage risks for disease include a social element, whether it is an in-person support group at a workplace or an in-app support group as part of a mobile program.

Supporting narratives. Finally, we found organizations used heuristics by sharing compelling stories to encourage healthier behavior. These included programs encouraging increased physical activity and better nutrition.

Bottom line: employers as well as governments and nongovernmental organizations can help improve health and increase global productivity by using the nudges of behavioral science to tailor efforts to the way our brains make automatic decisions.

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Jeff Levin-Scherz

Jeff Levin-Scherz

Jeff Levin-Scherz is a senior consultant the co-leader of North American Health Management practice at Willis Towers Watson.