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Anthem Inc. is an American health insurance company founded in the 1940s, prior to 2014 known as WellPoint, Inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. It was formed when Anthem Insurance Company acquired WellPoint Health Networks, Inc., with the combined company adopting the name WellPoint, Inc.; trading on the NYSE for the combined company began under the WLP symbol on December 1, 2004. On December 3, 2014, WellPoint changed its corporate name to Anthem Inc, and its NYSE ticker changed from WLP to ANTM.

History

Anthem Insurance Company

Anthem Insurance Company grew out of two Indianapolis, Indiana based mutual insurance companies, Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc. formed in 1944 and 1946. The companies grew significantly, controlling 80% of the medical insurance market in Indiana by the 1970s. In 1972 they came together to create a joint operating agreement, and merged in 1985 as parent company, Associated Insurance Companies, Inc, to form Blue Cross and Blue Shield of Indiana.

In 1986 Associated Insurance Companies changed its name to The Associated Group (TAG) to reflect its expanded focus, and began heavily expanding outside Indiana, acquiring numerous insurance companies and creating new subsidiaries throughout the late 1980s through the mid-1990s.

Formerly Anthem Inc. was an insurance company which began in the 1980s as a spin-off of the group insurance operations of American General Insurance.

Anthem Blue Cross and Blue Shield was created as part of the merger of The Associated Group with Community Mutual Insurance Co. of Cincinnati.

From its move to a publicly traded company in 2001 until its final merger in 2004, it merged the Blue Cross Blue Shield organizations of several states to achieve economy of scale, converting them in the process from non-profit to for-profit status. In late 2004, Anthem and WellPoint merged, with the combined company taking the WellPoint name. That Anthem no longer exists as a company, but the Anthem Blue Cross and Blue Shield brand name is used by WellPoint in 11 states.

In October 2001, Anthem demutualized and conducted an initial public offering of common stock. WellPoint, Inc. (formerly Anthem, Inc.) was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company.

WellPoint Health Network Inc.'s predecessor was Blue Cross of California, which was founded in 1982 with the consolidation of Blue Cross of Northern California (established in 1936) and Blue Cross of Southern California (established in 1937). WellPoint was formed in 1992 to operate Blue Cross of California's managed care business. In 1993, Blue Cross of California spun off its managed care business into a separate publicly traded entity, WellPoint Health Networks Inc. In 1996, Blue Cross of California completed the conversion of all its business to for-profit status, resulting in a restructuring that designated WellPoint Health Networks Inc. as the parent organization. Anthem and WellPoint achieved a portion of this growth through mergers and acquisitions.

Wellpoint, Inc. was formed in November 2004 following a merger of Anthem and WellPoint Health Networks Inc. The merger was structured as Anthem acquiring WellPoint Health Networks and rebranding itself WellPoint, Inc. When the deal was originally announced in October 2003, the merger was set at $16.5 billion. The fair market value of the merger when completed in December 2004 was approximately $20.8 billion. At the time of the merger's completion, WellPoint was the largest American insurer.

In December 2014: WellPoint changed its corporate name to Anthem Inc..

Timeline

Anthem/Associated Insurance

• 1940's: Anthem began in Indianapolis, Indiana as Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc. The companies grew significantly, controlling 80% of the medical insurance market in Indiana by the 1970s.
• 1972: The two firms, now known as Blue Cross of Indiana and Blue Shield of Indiana, entered into a joint operating agreement.
• 1980's: Anthem Inc. began as an insurance company as a spin-off of the group insurance operations of American General Insurance.
• 1985: The two merged into Associated Insurance Companies, Inc, a holding company. But usage of the name "Anthem" persisted.
• 1986: Associated Insurance Companies began expanding outside of Indiana, acquiring numerous insurance companies and creating new subsidiaries.
• 1986: Associated Insurance Companies changed its name to The Associated Group to coincide with its expanded focus. Associated Insurance's acquisitions included Anthem Health, Inc., a national company offering group life and health insurance; Raffensperger, Hughes & Co., Inc., Indiana's largest investment bank; and the Shelby Insurance Co., a property and casualty insurance business.

The Associated Group

• 1989: The Associated Group founded Acordia, brokerage that sold and serviced insurance and employee benefit programs.
• 1992: The Associated Group took Acordia.
• 1993: Acordia acquired American Business Insurance for $130 million and the Federal Kemper Insurance Company for $100 million.
• 1993: The Associated Group bought Southeastern Mutual Insurance Company, the operator of Blue Cross and Blue Shield of Kentucky. The deal was the first cross-state merger of major Blues plans in America. By the end of 1993, Associated Insurance posted annual profits of $65.4 million with $3.4 billion in revenue.
• 1995: The Associated Group acquired Community Mutual Insurance (a provider of Blue Cross and Blue Shield insurance plans in Ohio with over 1.9 million policy holders), then set up Anthem Blue Cross and Blue Shield.
• 1995: The Associated Group began offering its Blue Cross Blue Shield products to consumers under the Anthem name.
• 1996: The Associated Group changed its name to Anthem Insurance Company.

Anthem Blue Cross

Anthem Blue Cross (in full 'Anthem Blue Cross and Blue Shield') is a subsidiary of insurance giant Anthem Inc.. Anthem has about 800,000 customers, and has more individual policyholders in California than any other insurer. It is an independent licensee of the Blue Cross Blue Shield Association based in Thousand Oaks, California. Wellpoint had a net income of $2.49 billion in 2008, and $4.7 billion in 2009. Leslie Margolin became Anthem Blue Cross's company president in January 2008, and also was chief executive officer of the firm’s Life and Health affiliate. Joseph Swedish is currently chief executive officer of the company.

Anthem Insurance Company

• 1996: Anthem began to exclusively focus on healthcare benefits. Anthem later added 850,000 policy holders with its purchase of Blue Cross and Blue Shield companies in New Hampshire, Colorado, Connecticut, Maine and Nevada.
• 1997: Anthem acquires Blue Cross and Blue Shield of Connecticut.
• 1997: Anthem Group sold Acordia to a group of private investors.
• 1999: Anthem acquires Blue Cross and Blue Shield of New Hampshire and Blue Cross and Blue Shield of Colorado and Nevada.
• 1999: Anthem Group's revenue had grown to $6.3 billion. Among its customer base were 2.4 million PPO enrollees and 964,000 with HMOs.
• 2000: Anthem acquires Blue Cross Blue Shield of Maine.
• October 2001: Anthem converted from a mutual insurance company to a publicly held stock company, which made it the 4th largest public managed health care company in America.
• 2002: Anthem acquires Trigon Healthcare of Virginia, a Blue Cross and Blue Shield plan in Virginia, the largest insurer in Virginia, for $4.04 billion. Associated Insurance reached 11.9 million members

Blue Cross of California

Blue Cross of California was WellPoint Health Network Inc.'s predecessor

• 1982: Blue Cross of California was founded with the consolidation of Blue Cross of Northern California (established in 1936) and Blue Cross of Southern California (established in 1937).
• 1992: WellPoint was formed to operate Blue Cross of California's managed care business.
• 1993, Blue Cross of California spun off its managed care business into a separate publicly traded entity, WellPoint Health Networks Inc. Blue Cross of California retained 80% of the company and had "nearly all" of the company's voting shares.
• January 1993: Blue Cross California became an independent for-profit subsidiary with an IPO. Blue Cross of California retained 80% of the company and had "nearly all" of the company's voting shares.
• 1996: Blue Cross of California completed converting all its business to for-profit status, resulting in a restructuring that designated WellPoint Health Networks Inc. as its parent organization. After this, WellPoint Health Networks Inc. began heavy expansion.

WellPoint Health Networks

• April 1996: WellPoint completed its acquisition of Massachusetts Mutual Life Insurance Company's group life and health insurance subsidiaries for approximately $380 million. With the acquisition, WellPoint had nearly 4 million policy holders, which made it the second largest publicly held managed health company in the US.
  • WellPoint continued its expansion and acquired into 10 other states such as Massachusetts, New York, New Jersey, and offer life, disability, and dental insurance to all its rosters.
• March 1997: WellPoint acquired the group health and life businesses of John Hancock Mutual Life Insurance Co. for $86.7 million. With this acquisition, WellPoint expanded its presence into Michigan, Texas, and the mid-Atlantic and gained a unit that concentrated on serving the needs of large employers.
• 2000: By then Wellpoint's net income was $342.3 million with revenues of $9.23 billion.
• 2000: WellPoint acquires PrecisionRx, a mail service pharmacy fulfillment center in Texas.
• 2001, WellPoint acquired Rush Prudential Health Plans, a Chicago provider, for $204 million.
• March 2001: WellPoint acquired Cerulean Companies, the parent company of Blue Cross Blue Shield of Georgia.
• 2002: WellPoint acquired RightChoice Managed Care, a Missouri-based company, for $1.5 billion in 2002.
• WellPoint acquires HealthLink in the mid-West.
• 2002: WellPoint acquires MethodistCare in Houston, Texas.
• 2003: WellPoint acquires Golden West Dental and Vision in Camarillo, California.
• 2003: WellPoint acquires Cobalt Corp. and its family of companies, including Blue Cross and Blue Shield United of Wisconsin.
• October 2003: Anthem announced it would acquire WellPoint Health Networks for $16.5 billion.

WellPoint, Inc.

• November 2004: Wellpoint, Inc. was formed by merging of Anthem Insurance Company and WellPoint Health Networks Inc. The merger was structured as Anthem acquiring WellPoint Health Networks and rebranding itself WellPoint, Inc. When the deal was originally announced in October 2003, the merger was set at $16.5 billion. WellPoint still used Anthem as the brand name under which it operated. It sold its Blue Cross and Blue Shield products in 11 states. Ultimately, Anthem became the name that consumers knew the company as.
• December 2004: The Anthem and WellPoint Health Networks deal was completed. The fair market value of the acquisition at time of its completion was approximately $20.8 billion. The newly merged company was renamed WellPoint, Inc.
• 2005: WellPoint acquired Alexandria, Va.-based Lumenos, a provider of consumer-driven health plans, for $185 million. Lumenos was the pioneer and market leader in consumer-driven health plans.
• 2005: WellPoint, Inc. and WellChoice, Inc., merge, making New York the 14th state in which WellPoint is a Blue Cross Blue Shield licensee.
• December 2005: WellPoint acquired WellChoice, a New York-based Blue Cross Blue Shield provider, for approximately $6.5 billion.
• 2007: WellPoint acquired Chicago-based American Imaging Management, the leading radiology benefit management company, that creates software to help physicians choose cost-effective locations for their patients to receive medical imaging tests.
• 2007: WellPoint, Inc. acquires Chicago based American Imaging Management (AIM), the leading radiology benefit management company.
• 2008: WellPoint acquired Resolution Health, a firm that analyzes patient history for potential medical problems such as adverse drug interactions.
• 2009: WellPoint acquired DeCare Dental (a dental insurance firm).
• 2011: WellPoint acquired CareMore, a Cerritos, California-based company that provides insurance and care centers for elderly patients.
• 2012: WellPoint acquired Amerigroup for $4.9 billion, anticipating significant revenue growth due to Medicaid expansion under the Affordable Care Act.
• 13 August 2014: WellPoint announced it intended to change its name to Anthem, Inc.

Anthem name revived

• December 2014: WellPoint changed its corporate name to Anthem Inc. and its NYSE ticker symbol from WLP to ANTM.
• December 2014: Anthem Inc. announced that it was to acquire Simply Healthcare Holdings, Inc., a leading Medicaid and Medicare managed care company in Florida.
• June 2015: Anthem announced an offer to acquire Cigna, a global health insurance service company, for more than $47 billion in cash and stock.
• July 2015: Anthem and Cigna announced that they have entered into a definitive agreement, valuing the transaction at $54.2 billion on an enterprise basis.
• February 2017: A US District Court ruling blocked the Cigna merger on anticompetitive grounds. In February 14, 2017, Cigna Corp. called off its $48 billion merger agreement with Anthem Inc., with Anthem stating it would "continue to enforce its rights under the merger agreement and remains committed to closing the transaction."

Quality of care

In the category of "Meeting National Standards of Care" California's state patient advocacy office gave Anthem a rating of 2 out of 4 stars in its 2011 annual report card. In 2014 it received 3 out of 4 stars in the same category.

Controversies

Giving for uninsured

In 2007, WellPoint pledged to spend $30 million over three years, through the company's charitable foundation, to help the uninsured. In March 2010, the Los Angeles Times reported that WellPoint's tax records and website showed that the company gave only $6.2 million by 2009. The company disputed that, saying that the foundation did fulfill its $30-million commitment by mid-2009, but declined to provide any financial details to support its position.

Policy cancellations

In 2007, the California Department of Managed Health Care (DMHC), a California state regulatory agency, investigated Anthem Blue Cross's policies for revoking (rescinding) health care insurance policies. The DMHC randomly selected 90 instances where Anthem Blue Cross canceled the insurance of policy holders who had been diagnosed with costly or life-threatening illnesses, to find how many of these cancellations were legal. The agency concluded that all these cancellations were illegal. "In all 90 files, there was no evidence [that Blue Cross], before rescinding coverage, investigated or established that the applicant's omission/misrepresentation was willful," the DMHC report said.

In July 2008, Anthem Blue Cross agreed to a settlement with the California Department of Managed Health Care. To resolve allegations of improper policy rescissions (cancellations), WellPoint paid $10 million and reinstated 1,770 policy-holders whose plans they had cancelled. They also agreed to provide compensation for any medical debts incurred by these policy-holders in the meantime. However, WellPoint did not officially admit liability.

In April 2010, a report in Reuters alleged that Wellpoint "using a computer algorithm, identified women recently diagnosed with breast cancer and then singled them out for cancellation of their policies." The story not only caused considerable public outrage, but led Secretary of Health and Human Services, Kathleen Sebelius, and President Barack Obama, to call on WellPoint to end the practice.

In 2011 Anthem Blue Cross began cancelling policies of members who had been paying premiums with credit cards, sometimes without calling or emailing the member ahead of time.

Opposition to health care reform

The former Vice President for Public Policy and External Affairs at WellPoint, Elizabeth Fowler, is the Senior Counsel to Max Baucus, the chairman of the Senate Finance Committee and a leading opponent of the public option in health care reform.

In August 2009, WellPoint’s Anthem Blue Cross unit, the largest for-profit insurer in California, contacted its employees and urged them to get involved to oppose Congress' plan for health care reform. Consumer Watchdog, a nonprofit watchdog organization in Santa Monica, asked California Atty. Gen. Jerry Brown to investigate its claim that WellPoint had illegally pushed workers to write to their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches the firm’s interests. According to Consumer Watchdog, California's labor code directly prohibits coercive communications, including forbidding employers from controlling, coercing or influencing employees' political activities or affiliations. WellPoint had not been contacted by the California attorney general and had not seen any complaint.

Through 2010 and into 2011, WellPoint senior executives met monthly with executives of other major health insurers to blunt the effect of the health care reform law.

2009 premium increase in Maine

In 2009, Anthem Health Plans of Maine, a WellPoint subsidiary, sued the state of Maine for the right to increase premiums further. Since Maine licenses insurance companies through its Department of Insurance, Anthem would need the state's permission to raise rates. The Court disagreed with Anthem and found that, unlike other forms of insurance, the Maine Insurance Code does not require the Superintendent to consider profits at all.

2010 premium increase in California

In February 2010, WellPoint announced that some Anthem Blue Cross individual policies in California would see a rate increase as high as 39%. This announcement resulted in an investigation by the US Federal and California government regulators. Because of this, Anthem Blue Cross gained worldwide media attention and became a poster child for the problem of rising US health costs, when it announced that it was raising rates on some individual policy holders by as much as 39% as of March 2010. The rate increase came one year after Anthem had raised rates 68% on individual policy holders. This announcement resulted in an investigation by the US Federal and California government regulators.

To explain the latest rate increases, some which were four times the rate of medical inflation, Anthem said the company has experienced a death spiral, as unemployment and declining wages led healthy customers to drop their insurance, the remaining risk pool becomes sicker and more expensive to insure, and, in turn, prices are forced up and push more people out of the market.

In response to the outrage from politicians and consumers, Anthem postponed the rate increase until May 1, 2010. Given Anthem’s rate increase plans, Senator Dianne Feinstein, Democratic Senator of California, has proposed giving the federal government authority to block insurance premium hikes considered to be "unjustified".

Reclassifying expenses

On 17 March 2010, WellPoint announced it was reclassifying some of its administrative costs as medical care costs in order to meet new loss ratio requirements under the health care law, which requires insurers to spend at least 80% or 85% of customer premiums on health care services, depending on the type of plan.

2009-10 security breach

In June 2010, Anthem sent letters to 230,000 customers in California warning them that their personal data might have been accessed online. After a routine upgrade in October 2009, a third-party vendor stated that all security measures had been properly reinstated, when in fact they had not. As a result, personal information of thousands of coverage applicants who were under the age of 65 was exposed in the open. After a Los Angeles-area woman found that her application for coverage was publicly available, she filed a class-action lawsuit against Anthem. While gathering evidence for the proceeding, the woman's lawyers downloaded some confidential customer information from Anthem's website and alerted Anthem about the breach. According to the lawyers, confidential information had remained out in the open for five months.

Denying benefits

In May 2014, Anthem Blue Cross refused to pay for the hospitalization of a Sonoma County, California man for stage four cancers, although he had paid Anthem over $100,000.00 in premiums. Anthem ended up paying for coverage following public outcry.

2015 medical data breach

On February 4, 2015, Anthem, Inc. disclosed that criminal hackers had broken into its servers and potentially stolen over 37.5 million records that contain personally identifiable information from its servers. According to Anthem, Inc., the data breach extended into multiple brands Anthem, Inc. uses to market its healthcare plans, including, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, and UniCare. Healthlink says it was also a victim. Anthem says the medical information and financial data was not compromised. Anthem has offered free credit monitoring in the wake of the breach. According to Bloomberg News, China may be responsible for this data breach. Michael Daniel, chief adviser on cybersecurity for President Barack Obama, said he would be changing his own password. According to The New York Times about 80 million company records were hacked, and there is fear that th e stolen data will be used for identity theft. On February 7, 2015 Elizabeth Weise wrote in USA Today that the compromised information contained names, birthdays, medical IDs, social security numbers, street addresses, e-mail addresses and employment information, including income data.

References

Further reading

• International Directory of Company Histories, Vol. 25. St. James Press, 1999
• Anders, George, "Blue Cross of California Sells Stake in WellPoint Health for $476 Million," Wall Street Journal, January 28, 1993.
• Connolly, Jim, "California Blue Cross Plans to Start For-Profit Sub," National Underwriter Life & Health-Financial Services Edition, September 14, 1992.

External links

• Wellpoint Website
• Article about unethical practices of Blue Cross of California
• Sourcewatch profile
• Center for Responsive politics profile (Blue Cross/WellPoint)
• Investors
• Anthem Insurance and Anthem Blue Cross web site
• Blue Cross Blue Shield national web site
• Summary of Anthem rate increase news [1]
• Center for Responsive politics profile (Blue Cross/WellPoint)- www.opensecrets.org

Learn more »

Health promotion is "the process of enabling people to increase control over their health and its determinants, and thereby improve their health", according to the World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion in a Globalized World.

Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions. More recent work has used the term Health in All Policies to refer to the actions to incorporate health into all public policies. Health promotion is aligned with health equity and can be a focus of NGOs dedicated to social justice or human rights. Health literacy can be developed in schools, while aspects of health promotion such as breastfeeding promotion can depend on laws and rules of public spaces. Health promotion is focused on preventative healthcare rather than a medical model of curative care.

There is a tendency among public health officials and governmentsâ€"and this is especially the case in neoliberal nations such as Canada and the USAâ€"to reduce health promotion to health education and social marketing focused on changing behavioral risk factors.

History

The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least year 1986, is "the science and art of helping people change their lifestyle to move toward a state of optimal health". This definition was derived from the 1974 Lalonde report from the Government of Canada,<refcap name=Minkler1989/> which contained a health promotion strategy "aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health". Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States, which noted that health promotion "seeks the development of community and individual measures which can help... [people] to develop lifestyles that can maintain and enhance the state of well-being".

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:

• In year 1984 the World Health Organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health". In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organisational change, community development and spontaneous local activities against health hazards" as health promotion methods.
• In 1986, Jake Epp, Canadian Minister of National Health and Welfare, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report". This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments".

The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences on health promotion as follows:

• 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion". According to the Ottawa Charter, health promotion:
  • "is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being"
  • "aims at making... [political, economic, social, cultural, environmental, behavioural and biological factors] favourable through advocacy for health"
  • "focuses on achieving equity in health"
  • "demands coordinated action by all concerned: by governments, by health and other social organizations.

Workplace

Work site health focus on the prevention and the intervention that reduce the health risks of the employee. The U.S. Public Health Service recently issued a report titled "Physical Activity and Health: A Report of the Surgeon General" which provides a comprehensive review of the available scientific evidence about the relationship between physical activity and an individual's health status. The report shows that over 60% of Americans are not regularly active and that 25% are not active at all. There is very strong evidence linking physical activity to numerous health improvements. Health promotion can be performed in various locations. Among the settings that have received special attention are the community, health care facilities, schools, and worksites. Worksite health promotion, also known by terms such as "workplace health promotion," has been defined as "the combined efforts of employers, employees and society to improve the health and well-being of people at work". WHO stat es that the workplace "has been established as one of the priority settings for health promotion into the 21st century" because it influences "physical, mental, economic and social well-being" and "offers an ideal setting and infrastructure to support the promotion of health of a large audience".

Worksite health promotion programs (also called "workplace health promotion programs," "worksite wellness programs," or "workplace wellness programs") include exercise, nutrition, smoking cessation and stress management.

According to the Centers for Disease Control and Prevention (CDC), "Regular physical activity is one of the most effective disease prevention behaviors." Physical activity programs reduce feelings of anxiety and depression, reduce obesity (especially when combined with an improved diet), reduce risk of chronic diseases including cardiovascular disease, high blood pressure, and type 2 diabetes; and finally improve stamina, strength, and energy.

Reviews and meta-analyses published between 2005 and 2008 that examined the scientific literature on worksite health promotion programs include the following:

• A review of 13 studies published through January 2004 showed "strong evidence... for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators".
• In the most recent of a series of updates to a review of "comprehensive health promotion and disease management programs at the worksite," Pelletier (2005) noted "positive clinical and cost outcomes" but also found declines in the number of relevant studies and their quality.
• A "meta-evaluation" of 56 studies published 1982â€"2005 found that worksite health promotion produced on average a decrease of 26.8% in sick leave absenteeism, a decrease of 26.1% in health costs, a decrease of 32% in workers’ compensation costs and disability management claims costs, and a cost-benefit ratio of 5.81.
• A meta-analysis of 46 studies published in 1970â€"2005 found moderate, statistically significant effects of work health promotion, especially exercise, on "work ability" and "overall well-being"; furthermore, "sickness absences seem to be reduced by activities promoting healthy lifestyle".
• A meta-analysis of 22 studies published 1997â€"2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety.
• A review of 119 studies suggested that successful work site health-promotion programs have attributes such as: assessing employees' health needs and tailoring programs to meet those needs; attaining high participation rates; promoting self care; targeting several health issues simultaneously; and offering different types of activities (e.g., group sessions as well as print materials).

Entities and projects by country

Worldwide, government agencies (such as health departments) and non-governmental organizations have substantial efforts in the area of health promotion. Some of these entities and projects are:

International and multinational

The WHO and its Regional Offices such as the Pan American Health Organization are influential in health promotion around the world. The main eight health promotion campaigns marked by WHO are World Health Day, World Tuberculosis Day, World Blood Donor Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Hepatitis Day and World AIDS Day.

The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences.

The European Union is co-funding a Joint Action on Chronic Diseases and Healthy Ageing across the Life Cycle (JA-CHRODIS) with a strong focus on health promotion.

Australia

The Australian Health Promotion Association, a professional body, was incorporated in year 1988. In November 2008, the National Health and Hospitals Reform Commission released a paper recommending a national health promotion agency. ACT Health of the Australian Capital Territory supports health promotion with funding and information dissemination. The Victorian Health Promotion Foundation (VicHealth) from the state of Victoria is "the world’s first health promotion foundation to be funded by a tax on tobacco. ". The Australian Government has come up with some initiatives to help Australians achieve a healthy lifestyle. These initiatives are:

• Get Set 4 Life - Habits for Healthy Kid
• The Stephanie Alexander Kitchen Garden National Program
• Healthy Spaces and Place
• Learning from Successful Community Obesity Initiative
• Healthy Weight information and resources.

Health Promotion is strong and well-established in Australia. Since 2008 there has been a number of graduate courses people can take to be involved within Health Promotion in Australia. The government since 2008 has included an initiative that involves the Aboriginal and Torres Strait Island citizens in the preventive health sector.

Health Promotion In Australian Schools

School programs are based on curriculum documents from state and territory councils. Schools mainly focus on health issues that are being supported by funding and special events. Funding for many health issues are the main basis for school curriculum's health subject.

Health Promotion for Aboriginal and Torres Strait Islander Citizens

Aboriginal and Torres Strait Island citizens in Australia in the last couple of centuries have had poor health. The reason behind the poor health conditions is due to major events in the history of Australia, There is an increasing advancement in the promotion of health for Torres Strait Islander and Aboriginal citizens, but this cannot be achieved without the co-operation of non-indigenous Australians. For this Health promotion to be a success the citizens of Australia need to put the history between non-indigenous and indigenous citizens behind them and co-operate as equals.

Canada

The province of Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in year 2005.

The Ministry’s vision is to enable Ontarians to lead healthy, active lives and make the province a healthy, prosperous place to live, work, play, learn and visit. Ministry of Health Promotion sees that its fundamental goals are to promote and encourage Ontarians to make healthier choices at all ages and stages of life, to create healthy and supportive environments, lead the development of healthy public policy, and assist with embedding behaviours that promote health.

The Canadian Health Network was a "reliable, non-commercial source of online information about how to stay healthy and prevent disease" that was discontinued in 2007.

The BC Coalition for Health Promotion is "a grassroots, voluntary non-profit society dedicated to the advancement of health promotion in British Columbia".

Ireland

Health Promotion Research in Ireland

The Health Promotion Research Centre (HPRC) at the National University of Ireland Galway was established in 1990 with support from the Department of Health to conduct health promotion related research on issues relevant to health promotion in an Irish context. The Centre is unique in that it is the only designated research centre in Ireland dedicated to health promotion. It produces high quality research of national and international significance that supports the development of best practice and policy in the promotion of health. The Centre is a World Health Organisation (WHO) Collaborating Centre for Health Promotion Research, has an active multidisciplinary research programme, and collaborates with regional, national and international agencies on the development and evaluation of health promotion interventions and strategies.

Objectives of the HPRC include:

• The generation and dissemination of health promotion research that is of national and international relevance.
• The translation of research that will lead to the development of healthy public policy and evidence-informed practice.

New Zealand

The Health Promotion Forum (HPF) of New Zealand is the national umbrella organization of over 150 organisations committed to improving health. HPF has worked with The Cancer Society in order to produce a personal development plan for health promoters, which may be helpful to inform personal development reviews, to identify the competencies of individuals and to provide ideas for future development.

The Health Promotion Agency (HPA), formed July 1, 2012, is a Crown institution that has been established under the New Zealand Public Health and Disability Amendment Act 2012. Its board has been appointed by the Minister of Health. The work of HPA is divided into three main areas:

• Promoting the wellbeing and health of the community
• Enabling health promoting initiatives and environments
• Informing the public on health promoting policies and practices

HPA has a variety of programs based around many areas of work, including alcohol, immunisation, mental health, and skin cancer prevention. The agency aims to promote the wellbeing of individuals and encourage healthy lifestyles, prevent disease, illness and injury, enable environments that support health and wellbeing, and to reduce personal, economic and social harm.

Health Workforce New Zealand (HWNZ) is an organisation that is part of the National Health Board which provides national leadership on the development of the health workforce. Some health promotional programs supported by HWNZ include education and training initiatives, and the Voluntary Bonding Scheme, which rewards medical, midwifery and nursing graduates who agree to work in hard-to-staff communities, and sonography, medical physicist and radiation therapy graduates who stay in New Zealand.

Health promotion in New Zealand has become an established approach in addressing public problems since the 1980s, through increasing use of intersectoral action, the use of public policy and mass media as promotional strategies, and the increasing control Maori have taken over the provision and purchase of health promotion services. An example of health promotional initiatives is the action put in place to reduce childhood obesity in primary schools. Research was completed to identify the barriers to improving school food environments and promoting healthy nutrition in primary schools in New Zealand.

Considerable progress has also been made in the health impact assessment (HIA) research on the impact of policies on health in New Zealand. The approach has an important contribution to make in the strengthening of health and wellbeing in policymaking in New Zealand

Sri Lanka

In 2015, the life expectancy of Sri Lankan people was 72 for male and 78 for female. The disease burden has started to shift towards non-communicable diseases related to lifestyle and environmental factors. The 2012 estimated “healthy life expectancy” at birth of all Sri Lanka population is 68 for females, 63 for males, and 65 overall.

The development of the Sri Lankan National Health Promotion Policy is related to the State Policy and Strategy for Health and the Health Master Plan 2007â€"2016. It emphasises advocacy and empowerment to enable individuals and communities to take control of their own health, as well as improving the management of health promotion interventions across sectors.

United Kingdom

The Royal Society for Public Health was formed in October 2008 by the merger of the Royal Society for the Promotion of Health (also known as the Royal Society of Health or RSH) and the Royal Institute of Public Health (RIPH). Earlier, July 2005 saw the publication by the Department of Health and Welsh Assembly Government of Shaping the Future of Public Health: Promoting Health in the NHS. Following discussions with the Department of Health and Welsh Assembly Government officials, the Royal Society for Public Health and three national public health bodies agreed, in 2006, to work together to take forward the report's recommendations, working in partnership with other organisations. Accordingly:

1. the Royal Society for Public Health (RSPH) leads and hosts the collaboration, and focuses on advocacy for health promotion and its workforce;
2. The Institute of Health Promotion and Education (IHPE) works with the RSPH Royal Society for Public Health to give a voice to the workforce;
3. the Faculty of Public Health (FPH) focuses on professional standards, education and training; and
4. (4) the UK Public Health Register (UKPHR) is responsible for regulation of the workforce.

In Northern Ireland, the government's Health Promotion Agency for Northern Ireland which was set up to "provide leadership, strategic direction and support, where possible, to all those involved in promoting health in Northern Ireland". The Health Promotion Agency for Northern Ireland was incorporated into the Public Health Agency for Northern Ireland in April 2009.

Recent work in the UK (Delphi consultation exercise due to be published late 2009 by Royal Society of Public Health and the National Social Marketing Centre) on relationship between health promotion and social marketing has highlighted and reinforce the potential integrative nature of the approaches. While an independent review (NCC 'It's Our Health!' 2006) identified that some social marketing has in past adopted a narrow or limited approach, the UK has increasingly taken a lead in the discussion and developed a much more integrative and strategic approach which adopts a holistic approach, integrating the learning from effective health promotion approaches with relevant learning from social marketing and other disciplines. A key finding from the Delphi consultation was the need to avoid unnecessary and arbitrary 'methods wars' and instead focus on the issue of 'utility' and harnessing the potential of learning from multiple disciplines and sources. Such an approach is argu ably how health promotion has developed over the years pulling in learning from different sectors and disciplines to enhance and develop.

United States

Government agencies in the U.S. concerned with health promotion include the following:

• The Centers for Disease Control and Prevention has a Coordinating Center for Health Promotion who mission is "Prevent disease, improve health, and enhance human potential through evidence based interventions and research in maternal and child health, chronic disease, disabilities, genomics, and hereditary disorders".
• The National Institute for Occupational Safety and Health has developed Total Worker Health, a strategy incorporating elements of occupational safety and health and health promotion, to advance the health and well-being of employees.
• The United States Army Center for Health Promotion and Preventive Medicine "provide[s] worldwide technical support for implementing preventive medicine, public health, and health promotion/wellness services into all aspects of America's Army and the Army Community".

Nongovernmental organizations in the U.S. concerned with health promotion include:

• The Public Health Education and Health Promotion Section is an active component of the American Public Health Association.
• The National Commission for Health Education Credentialing offers the NCHEC, a competency-based tool used to measure possession, application and interpretation of knowledge in the Seven Areas of Responsibility for Health Education Specialists. The exam reflects the entry-level Sub-competencies of these Areas of Responsibility.
• The Wellness Council of America is an industry trade group that supports workplace health promotion programs.
• URAC accredits comprehensive wellness programs "that focus on health promotion, chronic disease prevention and health risk reduction".

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Health Central is a 171-bed hospital in Ocoee, Florida. In April 2012, Orlando Health acquired Health Central for $181.3 million.

References

External links

• Health Central Official Website
• Orlando Health Official Website

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Alabama

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California

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D

Delaware

District of Columbia

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Florida

A seventh VA Medical Center for Florida has been confirmed for construction in Orlando. It may be ready as early as 2011.

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Georgia

Guam

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References

External links

• Media related to United States Department of Veterans Affairs at Wikimedia Commons

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Primary healthcare (PHC) refers to "essential health care" that is based on scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination". In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, e nvironment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems.

This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all. The Alma-Ata Conference mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. There were many factors that inspired PHC; a prominent example is the Barefoot doctors of China.

Goals and principles

The ultimate goal of primary healthcare is the attainment of better health services for all. It is for this reason that World Health Organization (WHO), has identified five key elements to achieving this goal:

• reducing exclusion and social disparities in health (universal coverage reforms);
• organizing health services around people's needs and expectations (service delivery reforms);
• integrating health into all sectors (public policy reforms);
• pursuing collaborative models of policy dialogue (leadership reforms); and
• increasing stakeholder participation.

Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors:

• Equitable distribution of health care â€" according to this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class.
• Community participation â€" in order to make the fullest use of local, national and other available resources. Community participation was considered sustainable due to its grass roots nature and emphasis on self-sufficiency, as opposed to targeted (or vertical) approaches dependent on international development assistance.
• Health workforce development â€" comprehensive healthcare relies on adequate number and distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at the local and referral levels.
• Use of appropriate technology â€" medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community. Examples of appropriate technology include refrigerators for vaccine cold storage. Less appropriate could include, in many settings, body scanners or heart-lung machines, which benefit only a small minority concentrated in urban areas. They are generally not accessible to the poor, but draw a large share of resources.
• Multi-sectional approach â€" recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local governments, voluntary organizations, etc.).

In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing process of improving people's lives and alleviating the underlying socioeconomic conditions that contribute to poor health. The principles link health and development, advocating political interventions, rather than passive acceptance of economic conditions.

Approaches

The primary health care approach has seen significant gains in health were applied even when adverse economic and political conditions prevail.

Although the declaration made at the Alma-Ata conference deemed to be convincing and plausible in specifying goals to PHC and achieving more effective strategies, it generated numerous criticisms and reactions worldwide. Many argued the declaration did not have clear targets, was too broad, and was not attainable because of the costs and aid needed. As a result, PHC approaches have evolved in different contexts to account for disparities in resources and local priority health problems; this is alternatively called the Selective Primary Health Care (SPHC) approach.

Selective PHC

After the year 1978 Alta Alma Conference, the Rockefeller Foundation held a conference in 1979 at its Bellagio conference center in Italy to address several concerns. Here, the idea of Selective Primary Health Care was introduced as a strategy to complement comprehensive PHC. It was based on a paper by Julia Walsh and Kenneth S. Warren entitled “Selective Primary Health Care, an Interim Strategy for Disease Control in Developing Countries”. This new framework advocated a more economically feasible approach to PHC by only targeting specific areas of health, and choosing the most effective treatment plan in terms of cost and effectiveness. One of the foremost examples of SPHC is "GOBI" (growth monitoring, oral rehydration, breastfeeding, and immunization), focusing on combating the main diseases in developing nations.

GOBI-FFF

Selective PHC approach consists of techniques known collectively under the acronym "GOBI-FFF". It focuses on severe population health problems in certain developing countries, where a few diseases are responsible for high rates of infant and child mortality. Health care planning is employed to see which diseases require most attention and, subsequently, which intervention can be most effectively applied as part of primary care in a least-cost method. The targets and effects of Selective PHC are specific and measurable. The approach aims to prevent most health and nutrition problems before they begin:

• Growth monitoring: the monitoring of how much infants grow within a period, with the goal to understand needs for better early nutrition.
• Oral rehydration therapy: to combat dehydration associated with diarrhea
• Breastfeeding
• Immunization
• Family planning (birth spacing)
• Female education
• Food supplementation: for example, iron and folic acid fortification/supplementation to prevent deficiencies in pregnant women.

PHC and population aging

Given global demographic trends, with the numbers of people age 60 and over expected to double by 2025, PHC approaches have taken into account the need for countries to address the consequences of population ageing. In particular, in the future the majority of older people will be living in developing countries that are often the least prepared to confront the challenges of rapidly ageing societies, including high risk of having at least one chronic non-communicable disease, such as diabetes and osteoporosis. According to WHO, dealing with this increasing burden requires health promotion and disease prevention intervention at community level as well as disease management strategies within health care systems.

PHC and mental health

Some jurisdictions apply PHC principles in planning and managing their healthcare services for the detection, diagnosis and treatment of common mental health conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care.

Background and controversies

Barefoot Doctors

The "Barefoot doctors" of China were an important inspiration for PHC because they illustrated the effectiveness of having a healthcare professional at the community level with community ties. Barefoot doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. They had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices. The program experienced a massive expansion of rural medical services in China, with the number of barefoot doctors increasing dramatically between the early 1960s and the Cultural Revolution (1964-1976).

Criticisms

Although many countries were keen on the idea of primary healthcare after the Alma Ata conference, the Declaration itself was criticized for being too “idealistic” and “having an unrealistic time table”. More specific approaches to prevent and control diseases - based on evidence of prevalence, morbidity, mortality and feasibility of control (cost-effectiveness) - were subsequently proposed. The best known model was the Selective PHC approach (described above). Selective PHC favoured short-term goals and targeted health investment, but it did not address the social causes of disease. As such, the SPHC approach has been criticized as not following Alma Ata's core principle of everyone's entitlement to healthcare and health system development.

In Africa, the PHC system has been extended into isolated rural areas through construction of health posts and centers that offer basic maternal-child health, immunization, nutrition, first aid, and referral services. Implementation of PHC is said to be affected after the introduction of structural adjustment programs by the World Bank.

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The New York State Insurance Department (NYSID) was the former State agency responsible for supervising and regulating all insurance business in New York State. It was regarded in the industry as one of the most state-of-the-art insurance regulatory agencies.

Effective October 3, 2011, Governor Andrew M. Cuomo and the New York State Legislature consolidated the New York State Insurance Department and the New York State Banking Department and created the New York State Department of Financial Services.

History

Until 1849, insurance companies doing business in New York State were chartered by special acts of the New York State Legislature. In 1849, the Legislature passed a law requiring prospective insurance companies to file incorporation papers with the New York Secretary of State. The law also vested regulatory power over insurance companies with the State Comptroller, who was authorized to require the companies to submit annual financial statements and to deny a company the right to operate if capital securities and investments did not remain secure.

In 1859, the New York State Legislature created the New York State Insurance Department, and assumed the functions of the Comptroller and Secretary of State relating to insurance. The Department began operations in 1860 and William F. Barnes was the first Superintendent of Insurance. The Home Life Insurance Company based in Brooklyn, New York was the first life insurer to be authorized by the newly formed New York State Insurance Department in 1860. Superintendent Barnes supervised the filings of 155 fire insurance companies and 16 life insurance companies during his first year in office.

By the 1870s, each state regulated insurance in some manner and most had an insurance department or agency. However, because different state requirements led to confusion in the insurance industry, New York State Superintendent George W. Miller, in 1871, invited the heads of insurance departments or agencies from other states to meet in New York to strive for more uniform regulation. Eighteen states met that year for the first session of what is now the National Association of Insurance Commissioners ("NAIC").

Mismanagement in the life insurance business, including exorbitant salaries and questionable investments, resulted in a 1905 investigation led by Charles Evans Hughes. The investigation, known as the "Armstrong Investigation", led to the passage of a law that set forth a series of reforms, including mandatory periodic examinations of all life insurers.

During the Great Depression, the Insurance Department promoted new rules clarifying insurer investment requirements, setting more equitable determination of cash surrender values and forfeitures, and recognizing up-to-date values and improvements in mortality tables.

After World War II, the Insurance Department pioneered many consumer protections, including comprehensive mandated health insurance benefits, open enrollment, and prohibitions against insurers arbitrarily dropping an individual’s health insurance coverage.

The New York State Insurance Department was the first insurance department or agency in the United States to establish a capital markets group to examine and measure the risks in insurer investment practices, and was the first state to recognize the importance of segregating multiple lines insurance from financial guaranty insurance as a means of preventing systemic risk.

In 2001, New York was the first state to establish an Insurance Emergency Operations Center ("IEOC"), which was designed to accelerate disaster assessments and expedite claims payments to disaster victims. The IEOC helped New Yorkers recover from the September 11, 2001 terrorist attacks.

During the financial crisis of 2008, the Insurance Department helped stabilize financial guaranty insurers and worked with federal regulators to ensure that AIG did not collapse when it experienced a liquidity crisis.

In 2011, Governor Andrew M. Cuomo and the New York State Legislature consolidated the New York State Insurance Department and the New York State Banking Department and created the New York State Department of Financial Services. James J. Wrynn was the fortieth and last Superintendent of Insurance. Following the creation of the New York Department of Financial Services Benjamin Lawsky (2011--2015) and Maria Vullo (2016--) were each appointed and confirmed as Superintendent of Financial Services thereby assuming the the powers and duties formerly held by the Superintendent of Insurance.

List of Superintendents

References

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