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How Big is the Health Promotion Market? Small but Getting Big, with Medicare Leading the Way

Virtually every month for the past 10 years someone has asked me for reliable data on the size of the health promotion field. My usual response was “We don’t have any reliable data, but the entire field is smaller than a large car dealership.” I might have to change my story pretty soon.

In the opening comments of our March, 2006, Art and Science of Health Promotion Conference, I estimated the size of our field at $380 million for corporate fitness centers and $550 million for corporate wellness, and I compared it with reported sizes of $1.2 billion for disease management, $17 billion for health and racquet clubs, and $49 billion for weight loss. My method of estimating the size of the field was rather unscientific. I had called my friends who owned the eight largest companies in the field and asked their opinions. Most told me their revenues, growth rates, and guesses on the size of the field. Some had hired consultants to make similar estimates. We are still a tiny field, but the current annual growth, estimated at 10% for corporate fitness centers and 30% for corporate wellness programs, is exciting. If this pace continues, the corporate fitness center field would reach $560 million by 2010 and $896 billion by 2015. The corporate wellness field would reach $1.6 billion by 2010 and $5.8 billion by 2015. The revenues from these two fields would be $6.7 billion, about the size of Northeast Utilities, a small utility company that provides power to 1.7 million people in New England and is ranked #310 on the Fortune 500 list.

I also suggested that our growth could explode with pending federal policy changes, including annual revenues of $3 billion that are likely to accrue from passage of Senator Harkin’s Healthy Workforce Act and $1.75 billion from implementation of the Medicare Senior Risk Reduction Program. On top of that, I reflected on what would happen if health promotion were integrated into medical care. Epidemiologists have known for decades that lifestyle factors like smoking, sedentary lifestyle, and poor nutrition account for at least 40% of premature deaths or nearly 1 million deaths a year. My informal estimate is that 30 million people have chronic diseases caused by lifestyle. Those of us who work in health promotion have been citing these data for so long with no response that we rarely expect anyone to listen. Employers are starting to listen. They pay the lion’s share of the $2.2 trillion spent on medical care in the US every year, and they know they cannot survive if these costs continue to grow. If health promotion accounted for just 1% of the medical care spending, budget revenues would be $22 billion; 10% would be $220 billion. Assuming a 10% annual growth rate for medical spending, the field would grow to $322 billion by 2010 and $518 billion by 2015, just a little less than the entire new car industry. Sounds like a pipe dream doesn’t it? It does to me, even though the logic is solid.

The nation took a step closer to this pipe dream in June, 2006, when Medicare officials approved coverage of Dean Ornish’s Heart Disease Reversal program. They made this decision because they felt this was a cost effective approach to treating heart disease. It is not yet entirely clear how much Medicare will pay, and early indications are that it will cover only 36 sessions in 18 weeks with a possible extension of 72 sessions in 36 more weeks. Dean Ornish has stressed the importance of a five-year program to provide people with the social support necessary to change and maintain long-standing lifestyle habits. The significance of this development is not the Medicare coverage per se but the fact that health promotion programs will start to occupy a valued place in respected medical care settings. Annual program funding will jump from $10 to $50 per person to several thousand. Insurance companies will start to cover programs for heart disease, and eventually for diabetes, hypertension, some cancers, and other chronic conditions. Psychologists, nutritionists, nurses, health educators, physicians, exercise scientists, and others will be able to plan for stable careers in health promotion. The brightest minds will be attracted to the field. Techniques will be refined and outcomes will improve. Most important, the health of the nation will improve.

In a less visible decision, Medicare also decided to do an experimental trial of a less intensive health promotion intervention, called the Senior Risk Reduction Program. If it is successful, a similar program could eventually be offered to all of the 35 million seniors covered by Medicare. The significance of this program is that health promotion could become a standard part of the fabric of our society.

Michael P. O’Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion

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