the HAES® files: WHAT’S MISSING? Promoting Health at the Workplace (Part I)

by Health At Every Size® Blog

by Jon Robison, PhD, MS

Like many people in this country, I have a chronic “pre-existing condition” which has me paying exorbitant rates for mediocre health insurance and prohibits me from looking around for a better option. As a health professional I have also, over the past two decades, been involved with worksite health promotion as a creating partner of a unique, holistic, HAES®-based employee wellness program entitled KAILO that has won awards in both the United States and Canada. Additionally, I regularly speak at Employee Health Conferences throughout North America. For all of these reasons, I have been watching the controversies over “Obamacare” with great interest. On the one hand, I am excited (and mildly hopeful) that I may qualify for more reasonable and effective health insurance in the not too distant future. With respect to employee wellness, you would think I would also be excited by the prospect of millions of dollars for workplace health—certainly many of my colleagues are. But I have issues with what is happening in the workplace around health and I am worried that this health care reform may actually make things worse.

Some of the responses to Linda Bacon’s recent blog stimulated me to want to write more about my concerns. I agree wholeheartedly with Linda’s assessment of what will happen in regards to weight at the workplace—it will not be good—it will not improve health—and there will be significant iatrogenic consequences.

Coincidentally, I had a recent email conversation with one of the leading Health Promotion experts in the country regarding weight loss programs at the worksite. He said that there was no need for me to harp on the failures of traditional weight loss programs because every health professional was already well aware of the complete lack of efficacy of these approaches. I realized that this statement might actually not be too far from the truth. As Dr. Dee Edington from the University of Michigan, one of the most seasoned and well-respected names in worksite health for as long as I can remember, put it:

Weight loss money is money down the toilet.

I thought a bit more about this and asked my colleague this question: “If health professionals all know about the failure of these programs, why are they all still promoting and implementing them at the workplace? Why are weight loss programs, contests and competitions still a mainstay of worksite health initiatives?” Perhaps not surprisingly, I never got an answer back from him on this one

The response to Linda’s blog that really caught my eye was from Joanna. She commented that she believed that “a focus on health” [at the worksite] “would be just as destructive as a focus on weight.” She continued, explaining her reasoning for opposing such a focus by saying, “does anyone really think that governments and employers, in our deeply healthist culture, will not abuse the power given to them?” She continued on, decrying HAES for not speaking out on this issue. In fact, this is an issue I have been deeply concerned about, have written and spoken about for more than decade, and one that I believe warrants further exploration.

Our culture’s traditional approach to promoting health is based on a paradigm that developed some 400 years ago during the time of the Scientific Revolution in Europe. Often referred to as “The Mechanistic Worldview,” it sees everything within the universe, including living things as machines. Understanding any of these “machines” is accomplished through a “reductionist approach” which entails taking the thing apart and fixing or replacing the broken part.

The Mechanistic Worldview divides the entire universe of things into two; one universe includes everything that can be measured and quantified and the other contains all those things that cannot be. So blood pressure cholesterol and weight, etc. would be included in the first universe and feelings, thoughts, emotions and spirituality would be relegated to the latter. According to this worldview, nothing in the second universe (mind/spirit) can impact anything in the first (body) and therefore the former should not be considered appropriate topics for scientific study. Here we have the original separation of the body from the mind and the spirit. Finally, this worldview is decidedly patriarchal, valuing highly the masculine characteristics of aggression, competition and control.

For the health professions, the result of this worldview is our traditional biomedical model which views human beings as complicated machines whose diseases (diagnosed mostly using physical determinants) are caused by biological malfunctions that can be cured (fixed) by physicians (mostly male). Of course, we have moved off this worldview to varying degrees, but it still underlies much of what we do in the health fields. For instance, the idea that we can calculate how much someone needs to eat to lose a certain amount of weight, the use of BMI as a proxy for health, and the stubborn reliance on calories in/calories out calculations are clearly throwbacks to the “human being as machine” assumption. After all, these kinds of mechanistic calculations work pretty well with lawnmowers!

Our traditional approach to health promotion and health promotion at the workplace evolved directly out of this biomedical perspective. I will explore the approach and examine the associated problems in my next blog.

6 Responses to “the HAES® files: WHAT’S MISSING? Promoting Health at the Workplace (Part I)”

  1. It’s evident that “Big Brother” and the context of the film “Modern Times” are still literally plus figuratively alive in our Medical and Health “realms “/castes (primarily male-dominated) in society today. How archaic and unevolved is that thinking or implementation of thought in the “Health Field” of 2012. We are All One and One with All; therefore, HAES is the best way to truly live our lives while being Connected, Unique and Aware in every moment of each day. The “New World Order” (also male-dominated) loves to bring dissension forth in any way they can. They enjoy dividing and weakening us while they remain the “Elite/SuperElite” in our Medical/Health Fields, Law, Media, Government, Publications, Financing, Celebrity Status and other parts of society. Let’s Keep Fighting for what’s right, good, loving and true. PEACE 😀

  2. What an excellent, eloquent, yet accessible account of the current “state of the union” with regard to the dangers and downfalls of the new meaning of the term workplace “health and safety.” While working at a vegetarian and vegan restaurant recently, this conversation of “we should all join the Goodlife gym down the road” was raised. You can imagine my dismay that not only was my argument against such an invasive and insulting suggestion (that we all *need* to join a gym) not really heard, but that my coworkers seemed insulted by my inability to jump on board. Apparently autonomy has very little place or space in discussions of workplace “weight loss” and “health” programs. Looking forward to the next post!

  3. As an RN and social activist, I see serious harm and injustice perpetuated by the construct of “health promotion”, which relies on the discourses of medicine and healthism while promoting oppressive and false beliefs about the significance of personal responsibility in determining health outcomes, and which, moreover, socially constructs the medicalization of human life by maintaining the focus of analysis (of health, illness, and disease) firmly at the level of the individual–a rhetorical strategy that obscures and denies the far-more-powerful social determinants of health (such as gender, social status, economic security, environmental safety, ethnicity, access to reliable transportation, education, lived experience as a member of a stigmatized and/or oppressed group, community cohesion and support, cultural norms, access to regular and routine dental care, survivor of chronic trauma resulting from systemic and institutionalized domination or violence, and so forth). Even homelessness has routinely been medicalized (by social workers and journalists, for instance) as largely resulting from individual health problems (related to mental illnesses and/or chemical dependencies) and poor “self care” skills–which, again, blames individuals and medical conditions–rather than identifying and analyzing systemic causes related to socially constructed injustices and inequalities. In addition, “health promotion” advances and expands medicalization and healthism by constructing (through medical discourse) human health–and human life–as commodities that can be effectively managed or controlled with careful monitoring of “risk factors”, increased self-efficiency in personal stress management skills, savvy purchasing of the most advanced medical commodities (including technology, diagnostic and screening tests, and medications), assertive self advocacy in obtaining only Evidence-Based health care and disease prevention, and–of course–eternal vigilance over the quality and quantity of one’s dietary choices and physical activities. Health promotion activities help to keep individuals focused on their own (comforting) illusions of control–and shift responsibility for health problems away from environmental, political, social, and economic forces of harm. Hence, we are becoming a culture of “health care” consumers who cannot envision health (or health problems) as anything more than an individual concern, and who cannot imagine solutions to our health problems originating at an environmental, political, social, or economic level.

  4. As a health promotion practitioner and academic with over 25 years experience, I wholeheartedly agree that the principles of health promotion described by Jon and hopefulandfree are prominent in health promotion practice today. However it is important to recognise that this is not the form of health promotion espoused in health promotion charters, and neither is all health promotion like this – though I agree it is the dominant form. Health promotion values and principles exist on a continuum from traditional (as described by Jon and hopefulandfree) to modern (see http://www.ncbi.nlm.nih.gov/pubmed/17501703 and Jon’s excellent book The Spirit and Science of Holistic Health). Based on this work my colleague and I have published a new model of modern health promotion called the Red Lotus Health Promotion Model(http://www.ncbi.nlm.nih.gov/pubmed/17501706) that helps practitioners move away from the traditional form of health promotion described here towards the modern form.

  5. Unfortunately, there is a further dynamic going on here, driving people to the gyms, and determining how they look at those who don’t join. Thin and slender is not just associated with wealth, it is a kind of visible bank-balance in the attention economy, a visible shorthand resume’ of your net personal worth. That is why is it pursued with such fervor. People simply value you higher if you can display it, and everyone knows it cannot be faked, stolen, bought [without the time and efforts], transferred, etc, as almost all other status signs and symbols can be. Look for it to stick around a long time, because based on this formula, it’s hard to see how a better one can be developed. Meanwhile, I have, in various contexts, proposed that people try *not* to value the thin/fit any higher than the fat/normal. The response is overwhelmingly one of gut-level, pre-rational, absolute resistance. Until we can raise consciousness about this, nothing, imho, will change.

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