Why do we get sick and how do we get well were the enormously complex and controversial questions explored by a gathering of labor and community activists, health policy experts and academics attending a one-day conference at the University of California Berkeley on July 27th. In particular, speakers critically reviewed corporate Wellness Programs that essentially blame personal habits like smoking and excessive eating for poor health and for ballooning medical costs. Under the soothing, holistic rubric of "Wellness," these employer-sponsored programs are ostensibly designed to improve health. For example, most programs urge employees to stop smoking, lose weight, improve cholesterol and lower blood pressure. These goals appear quite laudable.
Seems like a good idea, everyone wins. Employees get healthier and companies save money on rising health insurance costs? However, opening speaker Lewis Maltby, president of the National Workrights Institute, dryly observed, it seems almost too good to be true. Get my drift? It seems wellness programs are a mixed bag, some do better than others. But they are most ineffectual when following the uniform business model of faulting workers, in this case, for causing steep increases in health care costs.
There are several problems with this corporate blind spot. To begin with, as speakers pointed out, a genuinely comprehensive health care program must involve more than changing personal behavior.
Katy Roemer, a registered nurse (RN) and member of the California Nurses Association/National Nurses United (CNA/NNU), sat next to me in the audience and agreed that "health conditions often have broader social and economic causes for which individuals have no control. For example, obesity, high blood pressure, smoking and elevated cholesterol result from complex factors including poverty, stress and working conditions."
But corporate wellness programs, according to critics, would rather place the blame solely on the plate of individual workers. The worst plans actually infer workers are unhealthy because of bad attitudes.
Jacqueline Hart, a sociologist at Sarah Lawrence College, took the podium and acknowledged that "all of us want people to take personal responsibility for their health but most corporate wellness programs focus on the mind, essentially abandoning the body."
Just Say No! to Your Body
Disregarding crucial warning signals generated by the body's defense system, wellness staff of large businesses repeatedly told Hart that "attitude is the biggest part of health."
"In other words," Hart explained, "it's all in the mind, thus de-legitimatizing use of sick leave" when the body just finally gives out and pleads for a break.
This is bad health policy. Contagious or physically impaired employees should not be at work. This is only one example of how corporate wellness programs, primarily interested in lowering medical insurance costs, often depart from appropriate standards of care.
In other examples cited, the worst of these programs financially penalize employees who do not stop smoking, do not reduce their weight, do not lower their cholesterol or do not decrease their blood pressure.
Again, there are many factors that affect these benchmarks that have nothing to do with personal behavior, DeAnn McEwen, RN, MSN and vice president, NNU, emphasized to me during the conference: "In addition to socio-economic factors, genetic predisposition plays a significant role in determining many health factors including excess weight, high blood pressure, blood sugar, and cholesterol levels."
"As a nurse," Roemer added, "I see the health problems associated with stressful work environments, the collapse of our economy and the pressure of increasing workloads and I am concerned that wellness programs that focus exclusively on individual unhealthy habits are seen as separate from a discussion about these larger issues."
This advice was echoed by panelist Dr. Jeff Ritterman, a retired 30-year Kaiser Permanente cardiologist and prominent community health activist:
"Anti-biotics and vaccines play a huge part improving our health but social factors have by far the biggest influence, much more than anything I do in my office. For example, mortality and class are inextricably linked. The poor die quicker and just like a step ladder your health advantage keeps getting better by degree of your wealth and education."
Dr. Ritterman described how this all works. More income gives you more options and "more autonomy" to make healthy lifestyle choices such as the kind of food you eat. He gave a vivid example of Richmond, California where he serves on the city council.
"Soda-drink companies target the poor communities and those children suffer far higher rates of obesity and diabetes because of its excessive availability." In middle and upper class communities, Ritterman explained, there are many more product alternatives, People have more choices.
Nurse McEwen agreed: "Low-income individuals or racial and ethnic minorities are more likely to have the health conditions that wellness programs target, and, they often face more difficult barriers to achieving better health. These include unsafe neighborhoods, substandard/decaying housing, poor air quality, lack of access to affordable healthy food, and little or no access to public transportation."
Pay or Play
Many wellness programs now charge employees higher premiums if they refuse to participate or if they fail to reach normally prescribed levels for obesity, blood pressure, cholesterol and body mass. As we have seen, these general goals must be interpreted differently for each individual depending on their genetics, physiology and depending where they work and where they live.
Being treated as an individual is the original and fundamental aspect of holistic, wellness care because we actually are all different. But this principal is clearly not sufficiently recognized by the broad brush corporate wellness approach of establishing the same standards for everyone.
Ignoring this genuine holistic method becomes extremely problematic as companies like Wal-Mart begin charging employees who fail to make the average grade up to $2000 a year for health premiums. Legally, federal law already allows companies to pass along 20 percent of premiums to workers who fail to meet wellness standards. This penalty increases to 30 percent in 2014.
Unfortunately, reproaching and targeting some employees for higher health costs gets a hearing among co-workers because of current abysmally low levels of solidarity and class consciousness. This disunity suits the business agenda just fine as it justifies shifting more premium costs to those isolated workers who simply don't fit the corporate health profile of weight, body mass, blood pressure and cholesterol levels.
As we have seen, this burden generally falls on the most vulnerable among us and it is those who need healthcare the most. Just as bad, keeping the focus on individual behavior avoids a discussion of more basic social health problems caused by corporate irresponsibility.
Labor journalist and experienced union negotiator Steve Early was also at the conference and suggested very effective negotiating tools to help get around these problems: "In my union bargaining experience, manufacturing employers wanted to get smokers to quit so the company could save on its medical plan costs but management never wanted to address job-related hazards like chemical exposure or excessive noise levels that have an equal or greater impact on workers' health.
"So, when employers try to push wellness programs, unions should always be countering with proposals to reduce forced overtime, to decrease workload or line-speed, to lower related job stress and to prioritize other occupational safety and health problems" that should be part of the discussion.
Despite all the problems discussed, panelists still believed wellness programs could actually improve one's health and successfully convince employees to make better health choices if enrollment is genuinely voluntary, if privacy of their health status is absolutely guaranteed and if healthy choices are rewarded such as by employers subsidizing gym memberships, lowering prices for healthy meals in the employee cafeteria and paying for recommended physical examinations.
It also helps, speakers advised, if administration of the wellness program is by a third party and not directly controlled by management. It was pointed out how labor unions UNITE-HERE and SEIU 1199 administer programs that have been extremely successful in reducing costs while also actually markedly improving the health of workers.
Workers trust the union and do not fear retaliation or imposition of added premium costs if they fail to meet certain goals. Professional counseling and group encouragement, indeed, is a healthy environment where one can better succeed.
The concept of wellness originally developed from a critique of western medicine's primary reliance on treatment, largely with drugs from big pharmaceutical companies. Critics describe it this way: "How much can we poison you to kill the thing that is ailing you without actually killing you?"
On the contrary, traditional wellness philosophy emphasizes proper nutrition, exercise, adequate rest and emotional and spiritual balance. Its treats the whole body and not just our various parts and it prioritizes prevention.
If we can successfully introduce these concepts into the wellness debate at the workplace, it will perhaps open further a "healthy" examination within our society of why major corporations pushing their version of wellness are yet allowed to enormously profit from the production and marketing of so many fatty foods, sugary beverages and empty caloric snack products.
In the end, the one-day conference could not and did not attempt to answer all our questions. But it did provide, dare I say, good food for thought.