Health Risk Assessments
Health Risk Assessments: The Purpose
Every day, many people mortgage their long-term health with the lifestyle they lead today. Behaviors such as lack of exercise, smoking, poor diet, and not wearing seat belts are among the factors that increase a person's risk of getting sick or dying prematurely. However, general knowledge of these risks do not always change behavior, and people don't necessarily know which of their risks needs the most attention. Health risk assessments (HRAs) provide a scientific way of turning intuitive knowledge into measurable odds.
Health Risk Assessment: Components
Health Risk Assessments have three standard elements:
- A questionnaire.
- A computation of risk.
- Educational messages and individual risk reports.
The questionnaire asks about Family history, general health parameters (weight, blood pressure, cholesterol levels, etc.) and lifestyle behaviors (diet, tobacco and alcohol use, safety precautions, etc.).
An Health Risk Assessment risk computation compares questionnaire answers to the data gathered from a large general population. Individual risk factors are matched with disease "precursors" such as high-fat diet and sedentary lifestyle which have been measurably associated with disease in the larger population. Every precursor has a numerical "relative risk" for every associated disease which indicates how much that precursor contributes to the disease. A number of diseases have multiple precursors. For example, heart disease can be affected by diet, exercise, and smoking.
Put simply, individual risk reports are based on statistics for the population group that matches the individual's surveyed characteristics. The Health Risk Assessment report generally includes the individual's chronological age; his or her calculated risk age (meaning how old the general population is that matches the individual's health status); a target or achievable age (meaning the age of the general population that has the characteristics the individual could achieve with improvements); and a summary of the person's various health risks and lifestyle behaviors with suggestions on how to reduce risk for disease.
Health Risk Assessments: Limitations
Health Risk Assessments are extremely useful for assessing individual and group health risks. However, they are not substitutes for complete medical histories or medical exams. Health Risk Assessments are also not appropriate for all people. People with chronic illnesses such as cancer or heart disease, for instance, will not obtain accurate risk projections in those areas. Also, some reference population databases exclude information on the very young or elderly, on socio-economically challenged populations, and on some minorities. In these cases, Health Risk Assessments may not accurately project risks for these groups.
Health Risk Assessments and Health Care
Health Risk Assessments were introduced more than 20 years ago by Lewis C. Robbins, M.D. to help doctors communicate health risks to their patients. Dr. Robbins and Jack Hall, M.D. published a book for physicians entitled How to Practice Prospective Medicine which explained how to create a health risk questionnaire and how to calculate and interpret the results. However, with advancing sophistication of health risk estimation methods, Health Risk Assessment use has become more widespread. A recent U.S. study reported Health Risk Assessment use in as many as 30 percent of workplaces. In the past decade, the number of Health Risk Assessments has risen from 12 to over 50.
The questions asked by today's Health Risk Assessments are not noticeably different from those asked 20 years ago, but how the answers are used is different. Today, prospective (preventive) medicine and Health Risk Assessments play a big role in disease management. In fact, in recent years, large employers, insurance companies and managed care networks have used Health Risk Assessments and national health statistics to project and prioritize group risks and plan health intervention programs.
For example, results of an employer's Health Risk Assessments might indicate that a large number of employees are not physically active and could benefit from an exercise program at lunch. Or, a managed care network might discover that a large percentage of its members have high blood pressure and therefore might decide to develop and promote education information about diet, exercise and medication options for hypertension. One of the key benefits of Health Risk Assessments is the identification of high risk individuals whose health status can be closely monitored.
Health Risk Assessment: Individual Use
The last decade has seen increasing use of Health Risk Assessments in group settings usually for the purpose of assessing group health needs. However, individual use of Health Risk Assessments offers truly personalized health education, and possibly the greatest potential for personal health improvement. The individual is in control throughout the entire process. Not only does the individual input their own data, but they receive prompt feedback on their personal health risk. This gives the individual control over the educational aspects of the instrument and provides them with prompt and detailed information about how health risks can be modified with changes in behavior.
Health Risk Assessments: How Much Do They Cost?
Prices for a group-based Health Risk Assessment typically range from about $5 to $15 per person for an online / electronic version. Paper Health Risk Assessments are more expensive and typically cost $15 to $25 per person. The higher cost is a direct result of the cost of printing and mailing of the results. To find out how much it would cost for your group there are some excellent, free proposal services that we recommend, including the following:
Adapted From Source: KW Peterson and SB Hilles, (Editors): Society of Prospective Medicine. Handbook of Health Risk Appraisals, 3rd. edition. 1996, pages 5-29.