Small Steps to Health and Wealth™:Available Resources and Potential Economic Impacts

Small Steps to Health and Wealth™:Available Resources and Potential Economic Impacts

Barbara O’Neill, PhD, CFP®, CRPC®, AFC, CHC, CFEd, CFCS
Specialist in Financial Resource Management
Rutgers Cooperative Extension
Cook College Office Building Room 107
55 Dudley Road
New Brunswick, NJ 08901

Karen Ensle EdD, RD, FADA, CFCS
Family and Community Health Sciences Educator
Rutgers Cooperative Extension


This article describes components of Rutgers Cooperative Extension’s Small Steps to Health and Wealth™ (SSHW) program and its potential to demonstrate a high cost-benefit ratio and return on investment. SSHW encourages participants to make positive behavior changes to simultaneously improve their health and personal finances. The target audience for SSHW and its associated research is adults ages 25 to 65. SSHW, which is being replicated in more than a dozen states, includes various components including a Web site, a 132-page workbook, a six-week team Challenge competition, PowerPoint presentations for consumers, and an on-line registration and impact evaluation system. Economic analyses of potential SSHW impacts are illustrated using cost-benefit and return on investment (ROI) analyses.

Keywords: health and wealth, cost-benefit analysis, return on investment


A previous article in The Forum (O’Neill 2004) described similarities between health and personal finances and parallel behavior change strategies. That article concluded by outlining a program that integrates health and financial management programming called Small Steps to Health and Wealth™ (SSHW). The present article describes components of this Rutgers Cooperative Extension program and its potential to demonstrate a high cost-benefit ratio and return on investment.

SSHW was introduced with a logo that incorporates the USDA food pyramid, a dollar sign to represent personal finance, and characters representing diverse audience outreach. State-specific logos include the state name in a circle around the SSHW brand. To further build identity, the national logo was used as the cover of the Small Steps to Health and Wealth™ workbook and on the program Web site. A DVD of a SSHW training session for professionals was produced by the University of Arizona. (Available by contacting

Following is the “elevator statement” for SSHW: Small Steps to Health and Wealthencourages participants to make positive behavior changes to simultaneously improve their health and personal finances. The target audience for SSHW and its associated research is adults ages 25 to 65. Program components are described below.

SSHW delivery methods

  • Small Steps to Health and Wealth™ PowerPoint presentations: Two, two-hour presentations for consumers (Small Steps to Health and Wealth™ and 25 Days to Health and Wealth), with marketing and evaluation materials, are available on CD-ROM for use and adaptation by educators.
  • Small Steps to Health and Wealth™ games: On the CD-ROM containing the PowerPoint presentations are two interactive games that highlight subject matter from the SSHW program: a BINGO game and an interactive Jeopardy-style PowerPoint game.
  • Small Steps to Health and Wealth™ workbook: A 132-page Small Steps to Healthand Wealth™ workbook (O’Neill and Ensle 2006) was published by the Natural Resource, Agriculture, and Engineering Service (NRAES), a publisher of books written by Cooperative Extension faculty. (See; quantity discounts are available.) The book includes a description of 25 SSHW behavior change strategies and a worksheet for each.
  • Small Steps to Health and Wealth™ Web site: Each chapter of the workbook is available on-line as a free downloadable fact sheet at Some fact sheets are also available in Spanish. The Web site also includes an order form for the SSHW workbook and a narrated PowerPoint presentation by the co-authors.
  • Small Steps to Health and Wealth™ Web site posters: Four downloadable PDF-format posters, licensed from the University of Tennessee Extension, are used to illustrate the amount of money that can be saved by eliminating unhealthy practices such as smoking and eating “junk food.”
  • Small Steps to Health and Wealth™ Web site monthly messages: To attract visitors back to the SSHW Web site and continue providing health and financial information, new health and wealth messages are uploaded each month. Prior messages are archived for easy retrieval and can easily be used by Extension educators as newspaper or newsletter articles.
  • Small Steps to Health and Wealth™ calculators: Advantage Publications, a Boston firm that produces cardboard financial calculators, developed a calculator for Small Steps to Health and Wealth™. Side 1 helps users identify the daily cost of “little things” (e.g., cigarettes and snack foods) that drain money away from savings. On Side 2, calculations are provided of savings possible in six time periods with the money previously spent on these items.
  • The Small Steps to Health and Wealth™ Challenge: The Small Steps to Health and Wealth™ Challenge is a six-week team competition where small groups earn points for practicing recommended health and financial behaviors on a daily basis. Enrollment and tracking forms to organize a Challenge are available on the CD-ROM described above and on-line, including Spanish translation. Among the daily behaviors for which points are awarded are eating four or more cups of fruits and vegetables, walking 10,000 steps with a pedometer, saving pocket change, and tracking spending.
  • On-line registration and impact evaluation: To collect data about SSHW participant goals, demographics, and program outcomes, a Web-based registration and impact evaluation system was developed in cooperation with the University of Arizona. (See Registrants are contacted semi-annually by e-mail to report their progress, beginning on the six-month anniversary of their on-line registration. Planned research topics include reported progress toward health and wealth goals, participants’ perception of the impact of their health on finances and finances on health, and relationships between demographic and personality characteristics and participant progress. Descriptive “success stories” and participants’ shared advice will also be captured. Extension educators are encouraged to recommend the on-line registration site but may also elect to collect and analyze local impact data.

SSHW delivery methods, described above, vary in length (e.g., a six-week team challenge and two-hour classes) for maximum flexibility. New components in progress include a youth activity guide, SSHW lesson plans, an on-line SSHW Challenge, and a mentoring guidebook for one-to-one interaction with learners.

If adopted nationally, SSHW has the potential to demonstrate high impact. Following is a hypothetical calculation of potential economic impact to illustrate the concepts of cost-benefit ratio and return on investment (ROI). Assume, conservatively, that 500 educators nationwide (an average of 10 educators per state or 25 in 20 states) implement SSHW and collectively encourage 25,000 consumers (50 learners apiece, over a period of time) to participate. Additionally, progress reports are received from 5,000 program participants, a realistic 20 percent of the total.

Below is an hypothetical estimate of annual costs and benefits of implementing the SSHW program:


10 percent of $60,000 (salary with fringe)

$ 6,000

Dedicated SSHW operating expenses (e.g., workbooks, copying, postage)

$ 3,000


Total estimated cost: $9,000 per educator x 500 Extension educators

$ 4,500,000


Average savings of $2,500 per person ($50 per week) x 3,000 respondents

$ 7,500,000

Average debt reduction of $1,000 per person x 1,000 respondents

$ 1,000,000

Weight loss of 10 percent of body weight: $3,750 x 1,000 respondents*

$ 3,750,000

*According to the U.S. Department of Health and Human Services, a 10 percent weight loss will reduce an overweight person’s lifetime medical costs by $2,200 to $5,300 (Preventing Chronic Diseases 2003). This calculation uses a per-person savings of $3,750, which is the midpoint of this range.

Total estimated benefit:

$ 12,250,000

Economic analyses

Economic analyses provide perspective on quantitative impacts of programs such as SSHW. The simplest calculation is cost-benefit analysis. Actual or estimated costs of program inputs, such as staff and supplies, are divided into actual or estimated economic benefits. The larger the dollar value of benefits relative to program costs, the better (O’Neill and Richardson 1999). In the above scenario, the cost benefit ratio is $12,250,000 divided by $4,500,000 or 2.72 to 1.

The formula for return on investment (ROI) is net program benefits (i.e., program benefits minus program costs) divided by program costs x 100. In the above scenario, the ROI is:

[($12,250,000 – $4,500,000) / $4,500,000] X 100 = 172%

The description of these figures in an Extension impact report would indicate that every $1 spent on the SSHW program could potentially generate $2.72 in benefits. Even after all program costs are subtracted from estimated benefits, there is $1.72 in net benefits on the program investment. This calculation very conservatively projects that two in ten participants report impact data and not all respondents make behavior changes. Of course, it is important to indicate that other factors could affect program participants’ behavior, such as an employer wellness program or a cash windfall.

Other potential program impacts

The above figures convert SSHW outcomes to monetary figures. Undoubtedly, there will be ancillary benefits such as increased financial security and better lifelong health habits which can postpone or prevent the onset of disease. (The latter can also be estimated in economic impact calculations.)

Qualitative and non-financial quantitative impacts are also important to report and can be captured through participant “success stories.” Examples might include weight loss over time, enrollment or increased savings in an employer retirement savings plan, improved health status as measured by indicators such as body mass index (BMI), and secondary impacts of SSHW on participants’ families.


Extension family and consumer sciences educators, regardless of subject matter assignment, are encouraged to implement SSHW. With their community outreach capacity and ability to adapt programs to meet local needs, SSHW is poised to demonstrate significant national impact similar to that of MONEY 2000™ during the late 1990s. Program components are available for national use and the potential cost-benefit and return on investment is high. Even with conservative assumptions for participation and evaluation response, a case can be made that benefits to consumers will far exceed program implementation costs. Obviously, actual program benefits will be far superior to estimates. For further information about Small Steps to Health and Wealth™, visit




O’Neill, B., and K. Ensle. 2006. Small steps to health and wealth. Ithaca, New York: Natural Resource, Agriculture, and Engineering Service (NRAES).

O’Neill, B. 2004. Small steps to health and wealth. The Forum for Family & ConsumerSciences 9(3)

O’Neill, B., and J.G. Richardson. 1999. Cost-benefit statements: A tool for Extension accountability. Journal of Extension 37(4),

Preventing obesity and chronic diseases through good nutrition and physical activity. 2003. Preventing Chronic Diseases: Investing Wisely in Health. Washington, D.C.: U.S. Department of Health and Human Services,

Cite this article

Barbara O’Neill and Karen Ensle. 2008. Small Steps to Health and Wealth™: Available resources and potential economic impacts. The Forum for Family and Consumer Issues, 13 (2).




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