Archive for August, 2012

August 21, 2012

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

by Health At Every Size® Blog

by Jon Robison, PhD

In the first part of this 3-part series, we traced the roots of our traditional approach to health promotion and health promotion at the workplace as they evolved out of the 17th century worldview of the Scientific Revolution according to which: 1) the Universe and everything in it are conceptualized as machines; 2) understanding these machines can only be accomplished by analyzing them (reducing them to their constituent parts); and 3) a biomedical (fix the machine) model explains what we need to know about health. We also mentioned that this worldview held the values of competition, aggression and especially control in very high regard.

Accordingly, traditional approaches to promoting health have generally been about:

  1. Reducing, measuring and quantifying health (using mostly physiological risk factors);
  2. Scaring, cajoling, pressuring and persuading (and shaming when deemed necessary);
  3. Employing behavior modification techniques; and
  4. Getting people to change.

I have bolded the term getting above because the desire for control and manipulation has unfortunately become a mainstay of traditional approaches to promoting health.  As a widely utilized Health Education Textbook of the 1990’s described it:

“As science and technology advance, the least conquered force of nature remains the human being and his actions.”

It is important to understand that it makes perfect sense that this is the approach to health promotion that emerged from The Mechanistic worldview and the Biomedical Model. The problem is that this 400 plus-year-old worldview is outdated, leaving us with an understanding and an approach to health that is similarly lacking.

For instance, we now know that the two separate universes envisioned in the Mechanistic Worldview are, in fact, one; what happens in the mind is inextricably interconnected with what happens in the body and vice versa. We only have to examine the rich literature on placebo and nocebo phenomenon to know this to be true. (See Part I, Part II, and Part III of my series of blog posts on placebo and nocebo.) Furthermore, the idea that we can make people healthier by scaring and shaming them is simply not supported by the literature – certainly the dismal failure of weight loss interventions is the ultimate testament to that.

Then there is the use of externally applied behavior change techniques to coerce people into doing what they don’t necessarily want to do. I mentioned the originator of these techniques—B.F. Skinner—in a previous post. The application of Skinnerian behavior modification in the form of contingent incentives to get people to change is ubiquitous in our culture; from grades in school, to bribing kids to eat their broccoli by promising them ice cream, to rewarding productivity at the work site. As for health promotion; rewards, incentives, contracts, contests and competitions continue to be at the core of the vast majority of programs. Ironically, though the Skinnerian approach to motivation is rarely questioned, decades of research substantiates that rewarding people in this manner retards learning, suppresses creativity, inhibits productivity and reduces internal motivation. (see Alfie Kohn, Punished by Rewards).

Finally, there is the ultimate goal of “getting people to change.” Make no mistake about it. Health promotion experts are clear about their intentions. Incentives are about:

“…getting people to do things they would not otherwise do. Like it or not, people frequently don’t do what will help them stay healthy and live longer. Changing this situation is what wellness is fundamentally about.”

And by using incentives, practitioners can:

“Jar the attention of someone in precontemplation and force them to at least think about improving their health.”

So, there we have it. We can now go back to Joanna’s original comments concerning her fears about focusing on health (not just weight) at the workplace. She asked, “does anyone really think that governments and employers, in our deeply healthiest culture, will not abuse the power given them?” Well, I think it is a good question, and the answer, in my opinion is that we should not assume the power will not be abused. In fact, I would argue that it has been and is being abused. Here, for example, is a short list of really, really creepy things organizations are doing in the name of wellness.

Clarion Health Partners – docking pay up to $30 every 2 weeks unless employees meet cholesterol and blood pressure guidelines

United Healthcare – $5,000 v. $1,000 deductibles for smoking or obese individuals

Wal-Mart – $2,500 v. $500 deductible if height/weight standards are not met

LL Bean – “twinkie tax” on fatty foods

Weyco – tobacco use testing for all employees and spouses

WellPoint, Inc. – 5% of bonus pay linked to a 20-point health index

Oh yes, and there is Dr. Delos Cosgrove, Chief Executive Officer of the Cleveland Clinic, who won accolades a few years ago for his decision not to hire smokers, who stated that “if it were up to him, if there weren’t legal issues, he would not only stop hiring smokers, he would also stop hiring obese people.”

So, Joanna’s fears are well founded and the slippery slope is ever more slippery as organizations get more and more into the business of “getting” people to be healthy. Not a pretty picture indeed.

In the 3rd and final part of this series, I will propose an alternative holistic, relationship-based approach for promoting health at the workplace.

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