the HAES® files: Workplace Wellness—What can we do?

by Health At Every Size® Blog

By Fall Ferguson, JD, MA

I and others writing for this blog have pointed out some significant problems with our current approach to workplace wellness. Employers have indicated in recent polls that they intend to increase their use of coercive incentives and penalties in workplace wellness programs/initiatives. As of January 1, the Affordable Care Act gives U.S. employers who offer health care benefits the right to penalize employees who don’t comply with workplace wellness requirements by having them pay up to 30% more than their compliant peers.

Suggested workplace wellness agenda items for the HAES® community

Suggested workplace wellness agenda items for the HAES® community

Some readers have asked for a more positive approach: what are some positive steps that we (the HAES community) can take? At ASDAH’s June 2013 conference, I gave a talk about policy issues and identified a number of HAES-positive agenda items that we might want to take on. I identified four possibilities with respect to workplace wellness programs (see illustration of slide):

  • Advocate for abolition of incentives.
  • Create models/templates for alternative workplace wellness programs that do not problematize weight or weight-related criteria.
  • Develop ways to measure success other than weight loss.
  • Develop strategies for convincing corporate management of the value of such alternative programs.

I thought I’d elaborate a bit about each of these here.

Advocate for Abolition of “Incentives”

One of the most destructive aspects of the current workplace wellness environment is the ubiquitous belief that financial or material incentives are an effective way of motivating long-term health behavior changes. Employers rely on evidence that incentives persuade people to comply with wellness programs in the short term, but fail to take into account that external rewards are ineffective long term and sometimes even have a dis-incentivizing effect in the long term.

This is an argument that actually goes far beyond a HAES perspective and calls for a complete overhaul of how we conceive of workplace wellness programs as a whole, including our legal/policy framework around them. I can’t explain why health promotion professionals persist in designing programs using material incentives, despite the clear evidence against them, except to speculate on the self-reinforcing nature of certain health ideologies (for another example, consider the entire weight-based paradigm…). It may be more productive to appeal to the employers directly here. My educated guess is that employers are less susceptible to ideology and will be more responsive to evidence about what actually works. So, we need evidence that alternative workplace wellness approaches– ones that don’t use incentives – will lead to better results.

Alternative Programs

That kind of evidence won’t be forthcoming on a large scale until we have more employers building better workplace wellness programs. Some enlightened employers are already doing so, recognizing that problems such as absenteeism, presenteeism, and health care costs are best addressed by building programs that (1) give employees intrinsic reasons for pursuing health rather than bribing them and (2) support “whole person health” rather than focusing on conventional health metrics such as BMI or cholesterol that account only for physiological health in one particular way. As educator and workplace wellness program designer Jon Robison has convincingly argued, employers should be focusing on getting employees “engaged” rather than incentivized.

We also need to create models and templates for alternative workplace wellness programs that do not problematize weight or use weight-related criteria. This involves more than simply being “silent” about weight in the program design or not using obviously weight-based criteria to measure success. It’s important to create a wellness environment that welcomes employees of any health status and any size.

The legal framework for employer-provided health benefits in the United States (ERISA & HIPAA) generally prohibits employers from discriminating on the basis of health status in the provision of health insurance benefits. As described in my post last month, the law carves out a gaping exception  for workplace wellness programs. However, just because it’s legal to discriminate does not mean it is right or advisable to do so. We should be dialoguing with employers to convince them that this type of discrimination—while it may be legal—puts a wedge between employer and employee and actually creates stigma, division, and ill will among their employees.

There is no such thing as “perfect health”—and no such thing as a “perfectly healthy” employee. It’s important to help employers understand that using a one-dimensional definition of health will not bring long-term benefit to anyone, employees and employers alike. Employers should be promoting health-positive environments that encourage everyone toward what brings joy, connection, and meaning into their lives at work and at home. How different that sounds from an environment created by bribes, penalties, and discrimination.

ASDAH is currently planning a set of guidelines for employers on workplace wellness programs; we would love to hear from readers with ideas for what should be included (or not) in those guidelines. Meanwhile, we are collecting employees’ stories about what’s happening at their workplaces in our Sizing Up Workplace Wellness project.

Develop Alternative Measures of “Success”

Another important piece of the puzzle is to provide employers with non-weight-based ways to measure the effectiveness of a workplace wellness intervention. Non-weight-based measures already exist for other contexts: can we creatively adapt them for employers to use with their employees? Perhaps new measures are needed; it would be great to have that work done by members of the HAES community.

As a start, ASDAH is exploring the creation of a “pre/post” assessment tool for employers to use in their workplace wellness programs. Targeted specifically toward the workplace setting and designed to be given before (“pre”) and after (“post”) a particular intervention, such a test would hopefully show employers how low-tech, high-accessibility, non-healthist interventions improve the health and well-being of their employees. Again, we would love to hear from readers of this blog if they have ideas about how to develop this pre/post test.

Convincing Employers of the Value of Alternative Programs

I listed the importance of convincing employers as a separate point in my conference slide, but the reality is that most of the “convincing” will lie in our successes. We (HAES-minded health professionals) need to get involved with workplace wellness, and write up the programs we design and implement. We need to demonstrate the effectiveness of what we do by conducting evaluations. We must look for ways to bring employers’ attention to the damage being done by discriminatory and weight-based workplace interventions. We need to offer them viable and effective alternatives. Eventually, they will think better of spending money on programs that may shift costs in the short term but fail to provide a lasting benefit to either employees or employers.

9 Comments to “the HAES® files: Workplace Wellness—What can we do?”

  1. You seem to be under the mistaken impression that “workplace wellness” programs are actually about the health and well being of employees. They’re not. Plain and simple. They have absolutely nothing to do with increasing employees’ real or perceived health or well being.

    They are all about reducing (or at least quantifying) INSURANCE COMPANIES’ financial risk. If a “wellness” program could require something that was actually BAD for an employee’s overall health or well being but that reduced the INSURANCE COMPANY’s financial uncertainty — you can be sure they will “incent” that eventually. It may be couched in “its for your own good” verbage, but its not. Its really for the insurance company’s bottom line.

    • Hi rg, I understand your frustration with conventional workplace “wellness” programs. I have no illusion about the financial motives of the stakeholders here. And I would even go one step further and say that many worksite programs already DO promote activities that are likely to be “bad” for employees’ health – to wit, any program that encourages weight cycling (e.g., biggest loser contests and the like).

      However, most workplace wellness program decisions are made by employers, not by insurance companies. Insurance companies may recommend or promote certain programs etc. but in general, employers ultimately decide what programs are implemented. And, perhaps revealing my essential optimism, I do think that it is possible to show employers that these discriminatory programs and these programs that bribe and penalize employees cause more harm than good, both in terms of the bottom line and also in terms of less tangible but also important factors such as recruitment, retention, absenteeism, and employee morale. I think these programs are going to backfire on employers eventually; I am simply saying we need to marshal the evidence and offer alternatives sooner rather than later, before ever more employees are harmed by these practices.

      I also believe that we can make an argument that what is good for the employees IS good for the employer. Will every employer listen? No, of course not, but some will, and when those programs succeed in containing costs and helping the bottom line, we need to document that and convince more employers that it’s actually in their interest to promote health. We have to start somewhere.

      • I agree that employers make decisions about workplace wellness programs. However, these decisions are made by the contract negotiators who negotiate the contracts with the health insurance or HMO provider(s) that provide health insurance benefits for employees. The employer will seek bids or proposals from health insurance providers. In response, health insurance providers send a proposal that says they will provide such-and-such set of benefits at such and such price, or at such-and-such [lower] price IF the employer institutes XYZ “workplace wellness” program(s) (sometimes there may be choices about wellness programs that are negotiated as part of the health insurance contract deal). Once the employee health insurance contract is signed, the “workplace wellness” programs required for compliance with the health insurance provider contract have already been determined. I know this for a fact. I work in enterprise procurement for a large state university system.

  2. I am alternately amused and horrified by so-called workplace wellness programs. My husband is a nurse and his employer does absolutely zilch to improve their employees’ health. No breaks (yes, I know they are mandated by law; tell that to the nurses who don’t even have time to go to the toilet), crazy schedules, not knowing until two hours beforehand if you’re going to work, etc, etc, etc. Because this is a female-dominated profession, there is little respect for nurses and the stress they are under. In easy ways, the employer could lessen the stress and make work more humane, but that would take an enormous change in mentality.

    • Hi Elizabeth, I wonder what that change in mentality would take. I remember reading a study some years ago about how when anesthesiologists began to examine their error rates adn approach it from the perspective of actually creating a “best practices” environment rather than “defensive medicine” – they actually began to address things such as working conditions and error rates went way down. It seems common sense to me that even if one does not care about being humane to one’s employees, there would be an argument that error rates go down and quality of care goes up when the humans providing the care are treating humanely…

      Meanwhile, it may be that employers in the health care industry are among the worst offenders, if even half of what we hear is true. A colleague recently put together a wellness program for physicians, who had been identified at that workplace as extremely stressed and unhealthy (which is consistent with the data for physicians nationwide). The physicians had actually asked for the program, which was promising — except that apparently management kept scheduling mandatory meetings for physicians during the meeting times of the program, so few physicians were actually able to attend.

  3. History has shown that the actual wellness of its employees is usually way down on the list of corporate priorities, if it is there at all. A middle manager who shows too much empathy toward the wellness of those in his or her charge, is usually considered suspicious in the corporate pecking order. I believe the first two commenters would agree with that. I also believe that blogger Ferguson has done a fine job in discussing the things that can be done to counter the current trend.

  4. I wish you luck and success in this endeavor. I would love to take a pre-designed program to our local HR dept and help them implement a viable wellness program. I do have some level of influence locally. On an international corporate level, HR has just rolled out a FitBit walking program, which I signed up for. I’m mixed on my feelings about this as (a) walking / moving is a good thing to promote and it is not weight-based and (b) it’s a little bit of “big brother” watching me which I’m not such a fan of. Being of a science and problem solving background, I firmly believe that “If you can’t measure it, you can’t improve it”. Defining the metrics to be measured in a fair and non discriminatory way is the tricky part, right? Measuring the wrong metrics will lead to wrong wellness activities being supported and reinforced. In my mind, a good wellness program would include education on nutrition, cafeteria meals that offer real true, not false, healthy food choices. (False option is the chicken salad with 600 calories worth of processed hydrogenated mayonnaise and extra salt, or the yogurt with artificial flavors and extra refined sugars and un-pronounceable additives). Cooking classes on how to prepare yummy vegetable dishes (to support an “eat more veggies” philosophy). Include non-food related educational programs, for example: information and actual practice on exercise and movement and proper ways to do strength training without injury. Also mental health: reducing stress, how to counteract feelings of depression, etc.

  5. I still think it is extremely naïve to believe that “workplace wellness” programs have anything to do with concern for employees’ well-being. They are negotiated deals between employers and insurance companies to “keep the cost of insurance down.” The objective is to negotiate a “deal” with the insurance company to keep employers’ and employees’ premiums lower. The insurance companies are the ones that decide whether or not they will lower the premiums for activity “X.” If you want to target “employee wellness programs” then you need to target INSURANCE COMPANIES with messages of what works or doesn’t work, and those messages need to be about reducing the insurance company’s liability exposure, not about actual well-being of people.

    If you want to influence employees’ well-being with things under the control of the employer, the thing to target is “employee benefits” – NOT “workplace wellness programs” which are highly negotiated package deals between employers and insurance companies.

    It is under “employee benefits” (NOT “wellness programs”) that there is some hope of getting yummy cooking classes, more nutritious cafeteria food, stress-reduction programs that actually reduce stress caused by the employer and don’t just teach employees “coping skills” for coping with all the stress that the employer is causing, etc.

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