Here are the top five science-based reasons these tools are doing more harm than good.
1. HRAs*, at best, tell us what we already know and are usually intrusive, mostly irrelevant, and often incorrect in their prescriptions. And, they’re expensive.
2. Biometric screens at the workplace are the practice of medicine by the employer, and sometimes violate HIPPA. They’re often administered in excess of the recommendations established by the U.S. Preventive Services Task Force. And they’re expensive. See “Wellness programs raise legal issues for employers” by Matt Dunning.
3. Incentives (carrots or sticks) reduce people to lab-rat status, and do not:
a. work over the long term and never have.
b. result, transition to, or cause intrinsic motivation (they destroy intrinsic
c. support, cause, or jump start healthy behaviors.
Note: And, drum roll please… they’re expensive. See “How Financial Incentives/ Disincentives Undermine Wellness” by Dean Witherspoon or “Drive, The Surprising Truth About What Motivates Us” by Daniel Pink.
4. None of the above improves health or wellbeing in a population, reduces healthcare costs, or wins over employees. People understandably hate these things and only go through the drudgery of using this stuff if forced. Think of how much your dog loves going to the vet. See “Penn State Employees Protest Wellness Effort.”
5. All of the above contributes to over diagnosis, misdiagnosis, over treatment, and unnecessary pain, stress, and expense — and in some cases, preventable disability, and maybe worse. Entering any healthcare facility as a patient, for any length of time, is one of the most risky undertakings one can take in our society. Care at any healthcare institution should be used with extreme caution by informed patients and their advocates.
Workplace health screenings result in greater use of the healthcare system, with no apparent benefit in health outcomes. See “What’s a savvy employer to do?” by Vik Khanna, “The Last Well Person, How to Stay Well Despite the Health-Care System” by Nortin M. Hadler M.D., or “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America” by Otis Webb Brawley, M.D. with Paul Goldberg.
*Take a look at Health Risk Assessment on Wikipedia. You’ll notice that Lewis C. Robbins was identified as developing the first HRA back in the late 1970s, which was then called a Health Hazard Appraisal (HHA). I worked as an assistant with Dr. Robbins at that time, was involved in his work with the CDC on this project, and highly engaged in legal challenges against us to privatize the HHA instead of making it a tool available in the public domain. We won — maybe to my regret. The evolution of this tool and its modern use at workplaces has been shocking for me to witness. Dr. Robbins’ HHA reminds me of the first Wright Brother’s flying machine. It was basic, innocent, creative, ingenious, fascinating, and with much positive potential. Today’s HRAs seem like combat aircraft, used in poorly defined missions, killing their own via friendly fire, and used on a lost cause.
The Big Issue We’re Not Talking Enough About
But even as horrible as the above list seems, the reasons are not why I strongly advocate against using these harbingers of stress, anxiety, and unintentional consequences in the name of wellness. My opposition is more fundamental than a list of grievances based in science. My opposition is based on something I was taught as a child. And that was… treat everyone with dignity and respect. Modern workplace wellness programs ignore that lesson.
What has happened to us in wellness?
Someone figured out how to get paid for starting a witches’ hunt for hidden diseases at workplaces, and we forgot about those we pledged to serve. We get paid by employers for administering screenings far in excess of evidence-based recommendations. Then, kickbacks come from the companies and labs providing the screens to the wellness vendor setting them up. And we trick the employer to feed their employees into this grinder by incentivizing their people to “participate.” We make up numbers to show some B.S. ROI that falls apart if you apply fifth-grade math to your review, and we claim all is well in the programs we administer. It’s a scam. And it’s wrong.
See “Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management” by Al Lewis, or “Cracking Health Costs” by Tom Emerick and Al Lewis.
Some very nice, and highly educated, people in wellness make money doing this. And because they do, they can’t see the conflict of interest they’re embroiled in. They justify it. And I understand.
It takes a special soul (or souls) to put the brakes on a money machine that supports their own world. And now with the federal government supporting incentives in workplace wellness via the Affordable Care Act, (see “They All Drank the Kool-Aid®! The Safeway Debacle”), the prospects for change in workplace wellness remain uncertain. This means we’re doing the same thing we have for the last 30 years as Americans’ health and wellbeing remain abysmal.
Three Groups have the Potential to Get Us Out of this Wellness Hell
1. Dissenters: I am in this camp. These are people who have been in and around workplace wellness for many years, and are finally saying, “Enough is enough,” and putting forth viable, common-sense ideas for changing the paradigm. See Salveo Partners (who our parent company works with+) for a glimpse of what the future of workplaces of wellbeing may look like. History demonstrates that controversy is the way of change. Does, Nicholaus Copernicus ring a bell? So when you hear someone say, “He or she is controversial,” look into it a bit more. The controversy will inform your thinking.
2. Employers: With more literature and personalities challenging workplace wellness programs, and offering strong alternatives and resources, employers are thinking more critically about proposals that include the typical elements, and coming up with their own ways for building healthy workplaces. See my blog “The Zappos Way – ‘Return on Community’ – An Excellent Model of What Wellness Could Mean.”
3. Millennials (people born between 1977 and 1992): This is the next generation of workers coming into influence. They’re independent, libertarian-oriented, entrepreneurial, tolerant, and more competitive (by necessity) than baby boomers. Millennials are excellent observers and know what they don’t want in their lives and careers. These people are not going to go from their cubicles to the biometric screening line without a fight. Workplaces must change, or they will not attract these highly skilled workers. And the Millennials will start their own businesses using tech tools, and with new workplace cultures and dynamics still unimagined. See the “New Millennial Values” by T. Scott Gross.
Be The Change You Want to See
On the one hand I am critical of most of what I see in workplace wellness now. But there is a better way. In an effort to get more people thinking differently and more creatively about workplace wellness or wellbeing, we’ve put together two eBooks that might help get a productive conversation started at your workplace.
The names of the two, free eBooks are, Six Questions That Make Creativity More Valuable Than $$$ When Planning Your Wellness Program, and A Champagne & Caviar Wellness Program On A Beer And Nachos Budget. The link will bring you to both of them. Download them if you haven’t yet, and use them to gain a different perspective about what helping people be well could mean.
What happens now?
It’s difficult to tell in the short term (a few years). But one thing is certain. Workplace wellness as it’s practiced now is unsustainable. And until we agree that the wellbeing of people is our only charge, the battle for change will proceed and eventually prevail. It’s OK to change. Let’s work together and help each other redirect our energies to pursuits in wellbeing that we can be proud to be a part of. Let’s first and foremost treat people with dignity and respect. With that value solidly in place, we’ll make a lot more progress in providing people with healthy places to work, and support them in pursuing a life of wellness.
+Hope Health is owned by IHAC, Inc., the publishers of Salveo Partners, LLC’s new book “How to Build A Thriving Culture At Work, Featuring the 7 Points of Transformation,” by Dr. Rosie Ward & Dr. Jon Robison. The book is due out in October 2014.
Shawn is the President and Founder of Hope Health. For over 30 years, his work has focused on bringing clear, easy-to-read and watch health messages to the public via workplaces. He bills himself as the “Best C+ Student in the Wellness Biz” because, as he says, “I like to challenge the notion that there is no such thing as a stupid question.” Shawn is on a mission to tie workplaces into their surrounding communities to share resources and ideas in an effort to improve the health of all Americans.
You may reach Shawn at sconnors@HopeHealth.com or 800-334-4094.