Editor’s note: One of the most-read Health Affairs articles last year was “Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers,” by Jill R. Horwitz,.Brenna D. Kelly, and John E. DiNardo. The article engendered a Health Affairs Blog discussion between the authors and Ron Goetzel. (See here, here, here, and here.) Below is another installment of that discussion, from Ron Goetzel.
I have had several back and forth conversations with Professors DiNardo and Horwitz. I won’t bore the readers with a re-hash of old arguments. We don’t need to re-litigate the basic premises of our debate, from either point of view. Those interested in following that discussion can review our previous posts.
I would, however, like to respond to a central point made by DiNardo and Horwitz that employers should not interfere with the private lives of employees. I agree with this assertion to a certain point. It should be noted that many employers do “interfere” with employees’ private lives by not allowing them to smoke on premises, requiring them to wear seat belts when driving company vehicles, mandating that they wear protective gear (hard hats, work boots, gloves) at construction sites, and so forth.
Certainly, an employer cannot and should not tell workers what to eat or how much to exercise. However, an employer can provide guidance, education, skill building, and support programs to workers who wish to eat healthy foods and become more physically active. That, in my mind, is not interfering in workers’ lives but rather supporting their efforts at leading a healthy lifestyle.
The other examples of potential employer interference in workers’ lives cited by DiNardo and Horwitz are nonsensical. No employer in this country would limit the number of children a family should bring into the world, whether or not people should read newspapers or books, or whether employees should be allowed to vote in elections. These are examples of reductio ad absurdum, a reduction to absurdity of an otherwise reasonable position. Also, no one in the health promotion community would advocate these kinds of rules or restrictions being imposed upon workers.
What health promotion professionals do advocate is providing theory-based programs designed to make workers more aware of health issues through awareness and education initiatives. These programs help workers develop skills needed to maintain good health (e.g., meal preparation, smoking cessation, weight management, stress reduction). The programs also offer motivational interviewing by health coaches to guide workers in making informed and meaningful changes to their health habits. Finally, good individually directed programs are embedded within a healthy company culture where good health is supported by the norms established by the organization, its health-related policies, every day practices, and physical and social environment. These are the hallmarks of best practice health promotion programs.
In contrast, programs that coerce, intimidate, threaten, cajole, bribe, or otherwise undermine individual choices related to health improvement are viewed by workers as self-serving and not in the employees’ self-interest. Poorly designed programs do not work. In fact, they often backfire because employees become resentful of management’s underhanded methods of compelling individuals to do what they would not otherwise do on their own accord. Poorly designed programs — ones not based on best practices — are doomed from the start and will self-destruct in no time.
Returning to DiNardo and Horowitz’s basic premise that employers should play no role in employees’ private lives, let’s look at some ways that can be accomplished. A truly laissez faire employer would eliminate employee assistance programs (EAPs), which are there to help workers cope with their personal as well as work-related problems. These employers would also eliminate such benefits as on-site or subsidized childcare, pension and savings plans, sabbaticals, tuition reimbursement, free flu vaccines, subsidized food in cafeterias, on-site fitness centers, legal assistance programs, commuter assistance, profit sharing and 401k plans, sports teams, dental benefits, and, yes, even health care benefits.
Why do employers offer all of these wonderful benefits to their workers? Certainly, altruism plays a role, as does the notion of corporate social responsibility. But more importantly, employers offer these services because they want to attract and retain the best talent. They also want to keep their workers healthy and productive. Workplace health promotion programs are but another tool from the benefits toolbox that employers can use to maintain a healthy workforce — healthy, in broad terms, physically, mentally, socially, and financially. And, by design, these programs “interfere” with their workers’ lives, by improving the quality of workers’ lives, not by denigrating them.
One final point. The example cited of an employer interfering in workers’ private lives — the Ford Sociological Department Program — is outrageous. The program was set up by Ford in 1915, close to a hundred years ago. To increase workforce efficiency and output, Ford sent investigators to workers’ homes to examine employees’ living conditions and ask intrusive questions about marital infidelity, spending habits, and alcohol use. In those days, there were very few work rules protecting workers’ health and safety, never mind rules guarding against employer meddling in people’s private lives. The program failed miserably. As Ford found out, dissatisfied workers are less efficient, not more efficient, than satisfied ones.
Fast-forward 100 years to the current period. No one today is advocating reinstating the Ford Sociological Department Program. This is another example of taking an extreme case study and presenting it as a moral equivalent of workplace health promotion programs. If DiNardo and Horwitz claim that health promotion and health protection programs send us on a slippery slope that will lead us back to the days of the Ford Sociological Program, they are mistaken. Reinstating the principles of the Ford program would not be a slippery slope — it would shove American business over the edge of a cliff, with severe legal and moral consequences.
To summarize, employers today are providing workplace health promotion and disease prevention programs to help workers lead a healthy and productive life , at work and at home. Employers do this because they see health promotion programs as benefiting workers as well as the organization providing these programs. Workplace health promotion programs are an expense that employers bear with the anticipation that these programs will achieve meaningful rewards — most notably, a more committed workforce, lower healthcare spending, reduced absenteeism, fewer accidents, and higher productivity.
But the main benefits accrue to workers who gain personally, especially if they are successful at quitting smoking, becoming more physically active, eating well-balanced and nutritious meals, better managing their stress, and lowering their blood pressure, cholesterol, glucose and triglyceride levels . And, by the way, money saved on health insurance premiums and related expenses can be re-invested by the organization to create new jobs, boost salaries, and provide training opportunities — all of which benefit workers and their families.