Food at Work. It’s a Thing.

January 6, 2017 in Uncategorized

I recently celebrated ten years at my current job.

I started in the thick of the holiday season. My first day, a co-worker came over to my cubicle to offer me a gooey chocolate confection she was serving off a piled-high tray. “Wow, what a classy holiday treat!” I thought.

Another co-worker left a tray of Italian cookies on the long credenza down the aisle. Then a couple of gifts came in from vendors — caramel-dipped popcorn from one, mixed nuts from the other — and they also were put on the credenza to share.

We had a big meeting where I was introduced, and a giant bowl of candy was passed around, for reasons unknown to me. It reminded me of my orientation the day prior, when the facilitator did an ice-breaker by asking us trivia questions about the company, and if you answered correctly he threw you — threw you! — a packet of M&Ms.

After the candy-bowl meeting, I was taken to lunch at the company cafeteria, where I enjoyed a good-sized serving of pork tenderloin with a side of fries. For a beverage, I stuck with water — you know, to keep it all healthy.

Holiday feasting and food-sharing are wonderful and important social traditions. Little did I know back in those days that the feasting had little to do with the holidays, and would ebb and flow — but mostly flow — for the next ten years.

It surprised and saddened me back then that, as I was introduced to co-workers as the new wellness manager, they sometimes felt the need to make an awkward joke about whatever food they had around at the time, assuming I was judging them for the muffin on their desk or the McDonald’s bag they were carrying.

But I wasn’t judging and never have. I’ve observed an abundance of edible goodies pervasive in the workplace — my workplace and others — and I’ve learned that it’s a force employees quietly contend with daily. But, indeed, it’s a force that challenges me — I like food, too — so far be it from me to judge anyone else.

Food at work. It’s a thing…for a lot of us. And that’s the topic of my new post, My Nine Assumptions About Workplace Food-Sharing — And Why They Matter to Employee Wellbeing. Please check it out.

 


 

Marvelous Food, Beautiful Food, Glorious Food!

December 22, 2016 in Uncategorized

cookiesCongratulate me! This week, I celebrated ten wonderful years at my current job.

Yes, I started in the thick of the holiday season. I remember my first day, a co-worker came over to my cubicle to offer me a gooey chocolate confection she was serving off a piled-high tray. “Wow, what a classy holiday treat!” I thought.

Another co-worker left a tray of Italian cookies on the long credenza down the aisle. Then a couple of gifts came in from vendors — caramel-dipped popcorn from one, mixed nuts from the other — and they also were put on the credenza to share.

Then we had a big meeting where I was introduced, and a giant bowl of candy was passed around, for reasons unknown to me. It reminded me of my orientation the day prior, when the facilitator did an ice-breaker by asking us trivia questions about the company, and if you answered correctly he threw you — threw you! — a packet of M&Ms.

Anyhow, after the candy-bowl meeting, I was taken to lunch at the company cafeteria, where I enjoyed a good-sized serving of pork tenderloin with a side of fries. For a beverage, I stuck with water — you know, to keep it all healthy.

Holiday feasting and food-sharing are wonderful and important social traditions. Little did I know back in those days that the feasting had little to do with the holidays, and would ebb and flow — but mostly flow — for the next 10 years.

It surprised and saddened me back then that, as I was introduced to co-workers as the new wellness manager, they sometimes felt the need to make an awkward joke about whatever food they had around at the time, assuming I was judging them for the muffin on their desk or the McDonald’s bag they were carrying.

But I wasn’t judging, and never have. I’ve observed an unbridled abundance of edible goodies pervasive in the workplace — my workplace and others — and I believe it’s a force in wellbeing that employees quietly contend with daily. But, indeed, it’s a force that challenges me — I like food, too — so far be it from me to judge anyone else.

Food at work. It’s a thing…for a lot of us. And that’s the topic of my new post over at LinkedIn, My Nine Assumptions About Workplace Food-Sharing — And Why They Matter to Employee Wellbeing. Please check it out. If you like it, click “Like.” And if you don’t like it, click “Like” anyway…because that helps get the post into other people’s LinkedIn feeds and encourages them to chew on it and chime in with their own point of view.

And…speaking of feeds, I sincerely hope you enjoy a magical holiday, feasts and all!

Arianna Huffington’s New Venture: Wellness Game Changer?

August 14, 2016 in Uncategorized, Commentary, Employee Wellness Programs

Arianna HuffingtonLast week, Arianna Huffington resigned from the Huffington Post to lead a new venture, Thrive Global. The new company will focus on both employee and consumer wellness.

Business Insider published what they say is Thrive Global’s investor pitch. A review of the document and Thrive Global’s public announcement suggest the company plans to be more than an old-school behavioral modification wellness vendor.

Here are some of my observations and thoughts — optimistic, skeptical, and neutral — about the promise of this new player on the employee wellness scene:

  • Giving a keynote presentation at a small conference last April, I speculated that burnout will be the next employee wellness trend — on the heels of mindfulness, sleep, and financial wellness.Thrive Global positions “burnout” front and center. Their announcement states,

Thrive Global’s mission is to change the way we work and live by ending the collective delusion that burnout is a necessary price for success

  • Thrive Global currently has seven employees. In light of recent consolidation in the wellness industry, we may expect that the company’s plans include significant partnership (possibly including acquisition or merger) with an existing wellness vendor.
  • Thrive Global already is partnering with basketball players Kobe Bryant and Andre Iguodala, and football coach Pete Carroll… (…because, when employees struggle with their physical and mental vitality as a result of working multiple jobs, being torn between the demands of their family and their employer, enduring long commutes to a workplace where they’re overwhelmed with responsibilities that aren’t clear or meaningful to them, being subjected to unfair or hostile environments where their efforts aren’t rewarded, feeling alienated, and/or being anxious about the possibility of losing their job altogether — the variables known to be drivers of employee wellbeing and burnout — who better to help than a pro basketball player and a football coach?)
  • A seat on Thrive’s Board of Directors is held by Aetna CEO Mark Bertolini, de facto czar of the mindfulness-industrial complex. Time will tell whether this relationship leads to Thrive Global having ready access to Aetna’s 23 million members or its 50,000 employees (who often serve as test subjects for the insurer’s innovations).
  • The announcement states that Thrive Global will partner with “thought leaders including Adam Grant… to measure the impact of its services on employee retention, well­being, and productivity, as well as organizational culture.” Grant is an organizational psychologist — a field conspicuously absent from the US wellness scene — with a track record of insightful research and a knack for contributing to marketable content. Possibly to Mark Bertolini’s chagrin, Grant authored the New York Times article “Can We Stop the Meditation Madness?
  • On the consumer side, Thrive Global is planning an e-commerce strategy that includes products like “sleep kits,” pillows, beds, candles, supplements, “food products” and “lines of product and subscription boxes specially curated by celebrities and athletes.” This is one of the biggest red flags. Is Thrive Global a serious company “aimed at changing the way we work and live’’ as they say in their announcement? Or a celebrity-fueled new-age bazaar “capitalizing on this growing market opportunity” (as the investor pitch explains)? Or both?
  • Arianna Huffington is a former feminist-bashing “Republican Revolutionary” metamorphized into a liberal self-help guru. The investor pitch says Thrive Global “leverages the brand and success of Arianna Huffington as the face of the platform to drive adoption.” For more about how the brand was built and about the twists and turns of Huffington’s activism, check out the 2008 New Yorker article, The Oracle: The Many Lives of Arianna Huffington
  • Abby Levy serves as the President of Thrive Global. In the Business Insider article, Levy offered this compelling comment:

We’ve had one of our [startup] partners say to us: ‘Everyone here does three jobs.’ There has been this hero mentality and sometimes in that culture companies want to change that so they can do right by their employees…

  • Levy has described Thrive Global’s corporate offering as a consultancy. The investor pitch envisions, “Organizational Design consulting to establish structures and systems that support Thrivers, eg. workspace design, (including nap and quiet rooms), healthy snack offerings, team communications design and more — all within an educational framework that encourages healthy choices.”

In an interview conducted by Benz Communications, published last week, I called for the convergence of independent wellness research with wellness product. Though it may be agonizing to see employee wellness take a turn toward celebrity-worship, health fads, and opportunism, Thrive Global may be just what this convergence inevitably looks like in real life.

What do you think? Visit the LinkedIn version of this post and chime in with your opinion.

“Health Shapes Work and Work Shapes Health”

July 16, 2016 in Uncategorized, Stress, job design
construction workers

Photo courtesy jaimebisbal

The Robert Wood Johnson Foundation, as well as the Harvard T.H. Chan School of Public Health and National Public Radio, may have given a boost last week to advocates of employee wellbeing. Here, I refer to what I consider authentic wellbeing — based on workers’ exposure to harmful job conditions and environments — not the store-bought imitation based on wellness websites, apps, incentives, and medicalized interventions.

To promote the findings of their Workplace Health poll of 1,601 workers, these sponsoring organizations waged a publicity blitz that brought the “healthy work” perspective to a broad new audience. A Health in the American Workplace panel, streamed live on the web, served as a centerpiece of the campaign.

Workers’ Views on Jobs and Health

Poll results, according to panelists, revealed that many workers view their jobs as impediments to their wellbeing.

  • 43% said their job has a negative impact on their stress level
  • 28% said their job undermines their eating habits
  • 27% reported that their job interfered with the ability to get a good night’s sleep
  • 22% said their job has a negative impact on their weight.

Panelist Marjorie Paloma, director of RWJF, explained how job stress and health are influenced by workplace policies:

If you think about the stress a person feels whether because of their day to day work routines, or the stress they feel because of caring for a loved one while working a full time job, or workers who feel as if they have to go into work despite being sick…These are all stressors that influence health.

Succinctly describing the relationship between behaviors and the environment, Paloma stated:

The choices we make are as good as the choices we have.

She summarized this position with the catchy phrase:

Health shapes work, and work shapes health.

“Human Resource Failures”

Harvard Business School professor John Quelch described how workforce management and the intensification of work have been shown to influence health. Quelch bemoaned…

…the sheer overload that comes from downsizing and outsourcing and asking someone to do two jobs when previously they had to do one.

He cited an often overlooked source of stress:

It can also come from job ambiguity — the requirements of the job are not being clearly articulated by supervisors.

Quelch characterized these workforce management patterns as “fundamental human resource failures.”

Gloria Sorensen, from Harvard Chan, cited her team’s studies of health care workers, whose job conditions have been linked to health problems:

Risk of injury or musculoskeletal pain or accidents on the job increase…when we look at harassment on the job, inadequate staffing, bullying at work, high job demands, lack of control, and poor supervisor support.

Sorensen went on to say that these job conditions also have been linked to fatigue, sleep problems, and risk of obesity. She concluded…

The point is these conditions of work are critical when we look at a range of health outcomes for workers.

The panelists’ remarks revealed mixed feelings about conventional worksite wellness programs that focus on behavior change. The poll results showed that only half of workers have access to wellness programs, which at times the panelists, such as Harvard’s Robert Blendon, seemed to cite as an indictment of employers:

Almost half of people who work are at a workplace that has no workplace health program.…People go to work every day, and this is something they read about in a magazine, but they don’t see in their own job.

On the other hand, Paloma remarked…

Worksite wellness is insufficient if it’s not going hand in hand with efforts to improve the health of communities.

Blendon, director of the poll, said that the findings changed his mind about stress. He led an uncomfortable laugh at the expense of conventional stress management strategies, and noted…

Employers should have some responsibility for lowering the level of stress.

NPR’s Joe Neel, the panel’s moderator, summarized…

It’s all about conditions of the workplace and stress.

Kudos to Harvard Chan’s Sorensen, who introduces the audience to the study of job stress in San Francisco transit operators, in which changing the work — such as modifying schedules, training, staffing changes, and equipment upgrades — succeeded in reducing worker stress, whereas, according to Sorensen, previous efforts to change the workers (for example, with stress management programs) failed. For the curious: The research Sorensen cited has been incorporated into an in-depth analysis of stress prevention for bus drivers, available from the International Labour Organization.

The disconnect between the “healthy work” approach and the behavior change emphasis in the panel’s videos, if anything, highlights the need for an acceleration of credible worker health research, which is exactly what NIOSH’s Total Worker Health initiative has set out to do .

In the interim, watch the full one-hour panel here:

 

Workplace Health, Injustice, and Your Mother

April 28, 2016 in Uncategorized

Be FairYour mother always told you life wasn’t fair. In few places did her words ring truer than workplaces where favoritism, bullying, discrimination, or broken promises rule the day.

But if life’s not fair, it may be no small consolation that, when facing an unjust and uncivil work environment day in and day out, life may not be very long either.

One study has shown that workers who felt they were treated unfairly at work — compared to well-treated workers — had a 55% greater risk of heart disease, even after controlling for other risk factors.

Organizational Injustice

Organizational unfairness, or injustice, refers to a pattern of exposure to inequitable conditions that undermine workers’ dignity and self-respect. It runs the gamut from being ignored… to being spoken to rudely… to being bullied… to being assaulted.

In addition to its link to heart disease, which includes documented cases of heart attack and angina — organizational injustice has been associated with a variety of physical and mental health problems.

In one study, 8% of workers reported being harassed within the previous 12 months. These workers were significantly more likely to be obese; sleep less; smoke more; and experience psychosocial distress, pain disorders, and lost work days.

Another study showed that men who felt their workplaces had a high level of justice had a 25% lower risk of developing metabolic syndrome than those working in unfair conditions.  And a review of several studies revealed a consistent association between organizational justice and mental health.

The exact definitions may differ depending on which expert you talk to, but generally workers experience unfairness via four categories of organizational injustice:

  • Procedural injustice — Processes for the employer to interact with employees aren’t created or conducted in an equitable manner. For example, effective systems are absent to assure that workers in comparable circumstances are treated equally when decisions are being made about job performance issues, schedules, promotions, and transfers.
  • Interactional injustice — Workers aren’t treated respectfully and their value isn’t recognized. Bullying and hostile work environments are examples of interactional (also called relational) injustice.
  • Distributive injustice — Benefits, compensation, and other rewards aren’t extended equally to employees doing comparable work, or generally aren’t appropriate for the demands and expectations of the job. Workers who earn less due to discrimination based on race, gender, or religion experience distributive injustice.
  • Psychological breach — Promises are broken. This includes the expectations the organization sets — including those related to pay, responsibilities, job demands, opportunity, and job security — when workers are hired or assume a new role. This category isn’t always included in classical definitions of organizational injustice, but is a process that may amplify the other categories.

Failure to communicate accurate, timely information to workers and to offer conduits for meaningful input are common denominators of organizational injustice.

Manage Fairness for Better Health

A 2011 meta-analysis confirmed that organizational injustice is associated with physical health problems and mental health problems, especially depression, anxiety, and burnout. Interestingly, the study also found that the strength of the association with specific kinds of health problems depended largely on the type of organizational injustice:

  • Workers experiencing procedural injustice were most likely to have physical health issues
  • Those encountering distributive injustice mostly reported mental health problems.
  • Psychological contract breach was associated with burnout.

Reviewing the meta-analysis, the online publication I/O At Work proposed strategies employers can consider if they genuinely want to promote worker health:

Organizations have a great deal of control managing fairness (and unfairness) perceptions. To increase feelings of distributive justice, organizations should strive to make policies with outcomes that are the same for all employees regardless of gender, race, and tenure. Increasing perceptions of procedural justice can be accomplished by insuring that decision-making processes treat all employees equally. Finally, to increase perceptions of a sturdy psychological contract, openly and clearly communicate to employees, provide them with information, direction, and support in times of change, and treat employees with respect.

Your mother may have been right: Life’s not fair. But that doesn’t mean the workplace can’t be.

Our society of hard knocks may scoff at the notion of fairness at work — dismissing it as the product of a self-entitled workforce. And it may be hard for traditionalists to believe that justice and other organizational strategies are an avenue toward improved workforce health.

But sometimes it’s the employer that feels entitled or plays the victim. And the observational evidence that connects the dots from fairness to health is no less solid than that cited by the wellness industry to sell behavioral change.

Ultimately, organizational change and individual change are likely to complement each other in cultivating a healthier workforce. Of the various solutions to choose from, a combination of organizational and behavioral strategies may be the fairest of them all.

Beware of Running with the Wellness Herd

March 9, 2016 in Uncategorized, Commentary

Like many industries, we in the wellness biz tend to run with the herd. A few years ago, all we could talk about was mindfulness. Then we veered toward resilience. Last year, financial wellness was the buzzword. This year, the herd must be getting tired, as we switch direction toward…sleep.

Sleep loss and its cost to business are hot topics these days. Employee Benefit News recently published an article titled, Companies Can’t Afford to Ignore Sleep in Wellness Offerings. Fast Company published Your Employees’ Sleep Problems Are Costing Your Business Time And Money. The Institute of Health and Productivity Management created its Sleep Health and Wellness division, to be introduced with a day-long conference. And a book, Work and Sleep, will be published next month and will draw additional attention to workers’ sleep loss.

New sleep program providers are cropping up, and existing wellness vendors are waking up to the opportunity to hop on the bandwagon.

Don’t get me wrong. Mindfulness, resilience, financial wellness, and sleep are important.

herd

And I’m not saying that none of us have run against the herd by addressing these topics before they got trendy or supporting employee wellbeing in innovative ways. But, in general, our industry flits from one topic to another, from one tactic to another, falling in line with our herd’s stampede. The risk is that workers get trampled in the process.

One key to sustaining established wellness efforts, rather than letting the sun set on last year’s program as dawn breaks on this year’s, is to strategically scale up the size of the team that operationalizes these efforts. In other words — to use the term HR has eerily adapted from cattle ranchers — “add headcount.” Expand resources in proportion to demands? What a concept.

Despite my earlier acknowledgment  that our herd mentality is comparable to other industries’, there is a difference: Other industries — especially those that are consumer-oriented — respond to changes in demand: Cold-pressed juice with chia one day, probiotics the next. Fuel-efficient cars one year, technology packages the next.

What drives our wellness herd?

As our newfound devotion to employee sleep takes hold this year, I suspect our herders may be revealed to us if we  keep an eye on who is sponsoring the events, the publications, and the research that promotes it. There, the presence of vendors and pharmaceutical companies, for example, wouldn’t invalidate sleep as an important issue for employees, but it seems unlikely to serve as a sustainable driver of a successful long-term employee wellbeing strategy.

Waking Up To How Sleep and Work REALLY Interact

March 8, 2016 in Uncategorized
Awake

Photo by Aaron Edwards

 

By this time, most of us are well-versed in how sleep — more accurately, the lack of it — affects work. Injuries, errors, accidents, and health care costs have all been linked to sleep loss and shown to affect business results.

What’s more, as reported by McKinsey in the article “The Organizational Cost of Insufficient Sleep,” there’s a host of psychosocial and cognitive problems that have been linked to sleep loss, including impaired attention, concentration, creativity, learning and memory, decision making, and relationship formation. Some studies have even shown that lack of sleep is associated with unethical behavior and have proposed specific pathways in the brain that may explain the connection.

Just as important, however, as how sleep affects work — maybe more important — is how work affects sleep, points out Canadian researcher Julian Barling, author of the forthcoming book Work and Sleep.

Chronic overtime, excessive workloads, shift work, expectations to be “always on,” and a culture that diminishes sleep all have been shown to contribute to the widespread problem of worker sleep loss.

Researchers from the University of Washington and University of Michigan recently published a whitepaper, Why it Pays to Ensure Adequate Sleep for Your Employees. The authors point to the prevalence of the problem:

The average person needs 7-9 hours of sleep per night. When surveyed, about 29.9% of Americans stated that they had gotten less than 6 hours of sleep the previous night.

Okay, we get it. Lack of sleep is widespread and undermines the wellbeing of workers and organizations. What can we do about it?

Typically, well-meaning employers wheel out their usual wellness strategies to get employees to change their sleep habits:

  • Education about sleep hygiene, with tips like
    • Don’t eat large meals before bed
    • Establish a consistent schedule for going to bed and getting up
    • Limit nighttime use of lit devices, like phones and computers
    • Use your bedroom exclusively for sleeping and sex
  • Apps and web-based modules, like the cognitive behavioral therapy-based Sleep.io
  • Behavioral change programs that include goal setting, tracking, and rewards

But employers should first look at themselves, and how they create or facilitate the conditions that lead to sleep loss. These are the factors the employer can control, and only once they’ve committed to organizational changes as a primary solution can the benefit of behavioral change strategies be fully realized.

What changes should employers consider? The McKinsey authors also published an article in Harvard Business Review, in which they suggest some ideas for starters:

Evaluate and rework company policies to ensure that they encourage — or at least don’t discourage — a good night’s sleep. Look at policies covering travel, email (e.g., blackout time on email, after which no emails can be sent), team working (creating tag teams that enable employees to hand work to each other across time zones), work-time limits (setting limits on hours or creating blackout periods), mandatory work-free vacations, predictable time off, napping rooms, and smart technology that improves sleep management.

Flexible schedules might seem like a slam-dunk solution, but University of Washington researcher Christopher Barnes found they often backfire, according to a BBC article. Due to cultural biases that favor early risers, flexible schedules prompt workers to start their days too early for their own natural sleep and wakefulness rhythms. One of the sources cited in the article estimates that 70% of workers typically wake up too early to achieve optimal performance during their work day.

Multiple studies, the BBC reported, have found “that workers who adjusted their work schedule to their individual biological clocks were more productive, healthier and less tired both at work and in their free time.”

Nominal, short-term sleep loss — like the kind many of us experience in the days following the switch to Daylight Savings Time — can lead to big problems. According to one study, for example, workers sleep on average 40 minutes less, compared to  other days, on the Monday after turning clocks an hour forward. An accompanying study found  3.6 more mining injuries each year on these Mondays, with absenteeism data indicating that these injuries tended to be especially severe.

How much sleep did you get last night? How alert and well rested do you feel right now?

Unemployment Makes Health Worse. Recession Makes It Better?

February 23, 2016 in Uncategorized

Arrows -- unemployment harms health, recession improves it

Getting laid off, job insecurity, and long-term unemployment are hazardous to your health. So why do health measures for statewide populations tend to improve during economic downturns?

Job loss is associated with a 73 percent increase in mortality risk — the equivalent of adding 10 years to a person’s age, according to a 2014 study from Drexel University. Yet the same study found that  each percentage-point increase in state unemployment rate reduced the mortality risk of a resident of that state by 9 percent, about the equivalent of being one year younger.

In other words…

Joblessness strongly increases the health risk for people who are jobless.

But…

Periods of higher unemployment rates, such as recessions, moderately decrease health risk among the entire population.

What at first seems paradoxical may not be. The significant increase in mortality risk for the jobless is limited to a relatively small population — say, 9% in a typical recession. The improvement in mortality for the population is based on a small improvement spread across a much larger population, which can easily be misinterpreted, if someone were to oversimplify it, to mean that everyone’s health is getting better. (In fact, there undoubtedly are other subpopulations for whom health deteriorates during economic downturns. These may include those living in poverty, people with less access to health care, senior citizens, and less educated people.)

The researchers did not investigate the question of why risk improves for employed people during economic downturns, but they offered a hypothesis:

During economic expansions, work is done at a faster pace, more employees are commuting, workers have less average sleep, and so on — all of which can be linked to higher risk of heart attacks, vehicle crashes, industrial injuries and enhanced circulation of germs. All of this reverses in recessions.

Of course, this leaves us with a damned-if-you-do-damned-if-you-don’t scenario. Joblessness is harmful to your health — but hard work is also harmful and less work is the cure? This wouldn’t even begin to explain the bi-directional changes in mortality risk for the employed and the unemployed. And it neglects to factor in how job insecurity — which presumably increases across a wide swath of the population when unemployment rates spike — factors into population health shifts.

We still have a lot to learn about where the sweet spot lies for employment, productivity, and worker health. Ultimately, we get on the right track by asking the right questions.

Getting Axed Is Hazardous To Your Health

February 4, 2016 in Uncategorized, Stress, job strain

You look to your job not only for income and benefits, but also for purpose, social interaction, and daily routine. These influence your health, and the loss of them — or the threat of losing them — can suck the life right out of you.

Every day, millions of Americans either look for work or go to work. Their success at finding and/or maintaining a decent job with good benefits will, to a large degree, determine their current and future health.

Robert Wood Johnson Foundation

Job loss, long periods of unemployment, and job insecurity have all been linked to deteriorating health. Yet, even companies that profess to support employee well-being have been known to contradict themselves by executing mass layoffs as a first line of financial defense rather than a last resort.

Netflix Do-or-Die Culture Deck

The Netflix exec who masterminded the vaunted slide deck about the company’s do-or-die culture boasted about the workers she’d laid off and fired. After being let go in 2015, she “doesn’t like to talk about it.”

As a business strategy, layoffs are a proven fail, a formulaic tactic executed by complacent executives in the absence of genuine leadership skills. Though frequently assumed to be a desperate measure, corporations often lay off workers when business is booming.

Of course, layoffs aren’t the only source of unemployment and job insecurity…

  • Workers get fired due to performance problems.
  • Businesses go belly-up.
  • Some employers foster job insecurity as an ill-fated method to drive productivity.

But mass layoffs — regardless of whether they are euphemistically called reductions-in-force, redundancies, right-sizing, down-sizing, or all-around-the-town-sizing — are responsible for the majority of job loss that is out of workers’ control.

Job Loss and Health

Compared to employed workers, people who have recently lost a job are…

Unemployment and Health

According to Gallup, Americans who have been unemployed for a year or more are more likely to be obese than those unemployed for a shorter time. The obesity rate rises from 22.8%, among those who have been jobless for less than three weeks, to 32.7% among those unemployed for a year or more. Those who have been jobless for more than 26 weeks are twice as likely to have high blood pressure and high cholesterol compared to people who have been unemployed for shorter periods.

Gallup also found that 20% of people unemployed for a year or more suffer from depression — about twice the prevalence compared to people unemployed for less than six weeks.

The Robert Wood Johnson Foundation points to several pathways from unemployment to deteriorating health:

  • Reduced income, which leads to inadequate nutrition, shelter, and health care.
  • Increased stress and limited access to the physical, mental, and social activity that are underpinnings of well-being.
  • Increased likelihood of engaging in unhealthy behaviors, like alcohol consumption, smoking, and drug use.

Job Insecurity and Health

The jury is still out on whether job insecurity — the threat of involuntary job loss — causes measurable declines in health status, but plenty of studies suggest a connection.

Job insecurity harms health, even more than unemployment.

The World Health Organization

One of the largest investigations of job insecurity and health analyzed data from more than 174,000 workers who were studied for nearly 10 years. It found that workers with job insecurity were 20% more likely to experience life-threatening heart disease compared to others who felt their jobs were a lock.

Research also has found that chronic job insecurity is a strong predictor of deteriorating health, even stronger than smoking or high blood pressure.

Job insecurity can lead to unhealthful behaviors like smoking, a Canadian analysis concluded, and avoidance of healthy behaviors like exercise and taking needed vacation and sick time off. It may even increase the risk of work-related injury and illness.

The relationship between job insecurity and health may depend on job type, economic conditions — how readily a laid off worker can land a new job — and workers’ attitudes about their employment and health. Case studies suggest that availability of social support and services for laid off workers may be differentiators for wellbeing.

Real Leaders Lead: Alternatives to Layoffs

Honeywell CEO Dave Cote doesn’t have a perfect record when it comes to worker well-being,  but his decision to favor furloughs over layoffs during the Great Recession serves as a Harvard Business School case study on how to maintain competitive edge during economic downturns and recoveries. Cote’s process should be required reading for execs who succumb to arguments that layoffs are inevitable.

The benefits of using layoffs to manage costs during a recession didn’t make economic sense…

Harvard Business School

The Wall Street Journal offers a tip sheet suggesting alternatives to layoffs.

Lessons about support for laid off workers also can be learned from the Unnatural Causes video comparing Electrolux layoffs in the US and Sweden and the Nokia Bridge program that granted seed money to laid off workers in Finland.

For workers in America, if you worked at a company like General Electric it’s more like you get a month’s salary and go. They lock the doors on the day you are fired. At Nokia there were people who knew they were going to be laid off in six months and  were able to stay at Nokia with a Nokia email address with the Nokia laptop and spend time applying for new things, and Nokia helped them.

— Ari Tulla, laid off Nokia employee, now co-founder and CEO of BetterDoctor (quoted by BBC)

In a separate post, we’ll explore what we know about the relationship of health and on-demand or “gig” economy jobs, like Uber drivers, Airbnb hosts, Postmates couriers, and TaskRabbit taskers.

 

[If you’d like to comment on this post, please head on over to the LinkedIn version.]

Job Stress Is In Your Head. Literally.

January 12, 2016 in Uncategorized, Stress, job strain

Or…

Half of What I Know About Employee Health
I Learned from Concussion

Concussion is a movie about employee health as much as it’s about anything.

In the movie, the National Football League goes to great lengths to cover up the harm it allows to be inflicted on its players. The league is motivated by fear of liability and its unquenchable thirst for ever-increasing revenue.

Medical examiner Bennett Omalu, MD, a trained neuropathologist played in the movie by Will Smith, determines that several ex-players who died of unnatural causes suffered from chronic traumatic encephalopathy — CTE. The disease is characterized by long-term damage to specific sections of the brain, where tau proteins surround and choke off brain cells. The damage affects memory, agitation, and anger, and leads to dementia and, reportedly, Alzheimer’s disease. Brain studies were conducted on numerous players who died, including several who committed suicide. Ann McKee, a neuropathologist at Boston University’s CTE Center, reported in 2013 that she’d examined the brains of 46 former football players and found CTE in 45 of them.

Professional football players are employees of their respective teams, and the NFL serves as a sort of trade association for its member teams. For years, the NFL deflected blame for CTE, sometimes onto the players themselves. They pointed their finger to substance abuse (including steroids and alcohol), past history of concussion, and genetics. They downplayed the role of concussion, insisting that “mild traumatic brain injuries are not serious” and that players could safely return to the same game after suffering a concussion.

Ultimately, the NFL agreed to pay $765 million dollars in a settlement with more than 4,500 retired players who sued the league for concealing the issue.  Speaking about the settlement, NFL Commissioner Roger Goodell said, “There was no admission of guilt. There was no recognition that anything was caused by football.”

The settlement included a provision that the NFL would never again compensate players or their families for CTE, which is why, as one example, the family of hall of famer Frank Gifford, diagnosed with CTE post-mortem in November 2015, cannot take action against the NFL.

Football players are an elite group. What does their plight have to do with your job stress?

In another post, Half of What I Know About Wellness I Learned in the First Six Minutes of Joe Vs. the Volcano, I recounted a dialog between Joe and his boss. Joe, it turns out, suffers from “a brain cloud” caused by a black mass running down the center of his brain. His boss insists that Joe stay in the game: “So what!” the boss shouts. “Do you think I feel good? Nobody feels good. I don’t let it interfere with my job!”

Joe’s brain cloud and black brain mass, which viewers are led to believe result from job strain, are the stuff of satire. But is there really a chance that average workers exposed to prolonged job stress suffer brain damage — structural changes in brain tissue with accompanying symptoms?

Yes, there is.

Occupational stress affects signals from the amygdala to the prefrontal cortex

Repetitive stimulation of the amygdala — a result of prolonged job stress — releases chemicals to the medial prefrontal cortex and may cause thinning of the cortex, enlargement of the amygdala and, consequently, a cycle of deteriorating stress modulation, cognitive symptoms, and impaired fine motor function.

In 2014, Ivanka Savic, MD, PhD of Sweden’s Karolinska Institute, published a study that used brain MRIs and showed that prolonged job stress — which included chronic overtime and a cycle of distorted perceptions regarding job demands, abilities, and control — leads to structural changes in the brain.

Compared to the MRIs of demographically matched control subjects, the patients who reported debilitating job stress — and exhibited burnout symptoms like impaired memory and concentration, sleeplessness, achiness, fatigue, and emotional exhaustion — showed abnormalities in the parts of the brain involved with the processing and perception of stress, specifically the prefrontal cortex and the cortex (which were abnormally thin) and the amygdala (abnormally large). These findings were consistent with Savic’s hypothesis that “repeated, chronic stress could lead to damage of the brain areas which modulate stress perception, leading to a vicious cycle with impaired ability to cope with stress.” The MRI findings were supported by documentation of reduced fine-motor skills and emotional regulation in the stressed group compared to the control subjects.

Finally, Dr. Savic concluded, “This condition needs to be considered as a stress illness, whose sufferers deserve proper and swift treatment.”

Dr. Savic summarized her study in her blog post Does Chronic Occupational Stress Cause Brain Damage? (The complete findings were published in the journal Cerebral Cortex.)

While a worker suffering from stress-related ailments may feel, as they go about their business, like they  metaphorically are banging their head against a wall, the analogy between job-stress and football concussions is somewhat tenuous. Here are some ways the two phenomena differ:

  • The research on job-stress-related brain damage is still preliminary.
  • CTE is a result of smashed brains. Job-stress-related brain damage is more subtle, resulting from interactions between an individual’s job and their perceptions, and the resulting chemical activity in the brain.
  • There is no “cover-up” of job-stress-related brain damage that we know of — if for no other reason than most employers don’t know about it.
  • Job-stress-related brain damage has not been linked to behaviors that are as aberrant as those linked to repeated football concussions, nor has it been linked to death (though job stress has been found to be a significant risk factor for cardiovascular disease and death).

But there are some similarities, too:

  • Football concussions cause brain damage. Prolonged job stress also appears — based on preliminary research — to cause brain damage.
  • Just as football’s CTE was originally blamed on players (their drug use, history of previous head injury, or genetics), job stress in the United States has commonly been accepted to be solely a consequence of employee perception and coping skills, with employers turning a blind eye to their own role in creating job conditions that cause stress. Instead of empowering you with more control over your workflow, your employer adds a resilience program to your to-do list. In the absence of a broader preventive strategy, resilience programs are for job stress what football helmets are for concussions: Tools to help you endure more pain.
  • NFL players and everyday workers — as well as the enterprises that employ them — will benefit from having these neurological conditions identified and treated as early and effectively as possible.

Ultimately, symptoms of job-stress-related brain damage may prove to be less severe than CTE. But its burden to society — in terms of economics, well-being, and productivity — may be far greater simply due to the vastly larger population at risk.

 


[In addition to the film Concussion, much of the data and quotes for the CTE section of this post were derived from the episode of PBS’s Frontline: League of Denial — The NFL’s Concussion Crisis.]


 

 

 

My “Tell-All” Interview about Employee Wellness

November 12, 2015 in Uncategorized, Employee Wellness Programs

NewspaperWow. I’m super appreciative of Dean Witherspoon from Health Enhancement Systems letting me be me in a “tell-all” Well-Being Practitioner interview.

[READ THE FULL INTERVIEW (page 4 of the pdf)]

You’ll find the interview to be a light-hearted and quick read (I called it a “tell-all,” but I’m stopping short of calling it a “romp”!). In it, I offer my offbeat musings on employee wellness:

  • The common culprit that induces stress in all industries
  • The underpinnings of employee wellness program success
  • Challenges that lie ahead for the industry
  • My numero uno best practice.

But I also get personal, sharing…

  • How I achieve balance in my own life and work
  • My wellness pet peeves
  • The book that transformed my take on work and health
  • Why I’m optimistic about wellness

There’s more fun crammed into this quick read… About banishing jesters; Dean’s offer to grant me unlimited funding; and how employers can really get their wellness on.

Check it out, if you have a chance. And let me know if you like it. 🙂

[READ THE FULL INTERVIEW (page 4 of the pdf)]

Sitting is the New Smoking. Smoking is the Old Standing. The Old Standing is the New Sitting.

November 9, 2015 in Uncategorized

Warning: Do Not Sit or Stand HereIn 2013 the LA Times quoted Dr. Anup Kanodia serving up the catchphrase, “Sitting is the new smoking.” Ever since, you’d have to be an epidemiologist to separate the fact from hype. And you and I are no epidemiologists.

Personally, I’ve resisted the phrase “sitting is the new smoking,” except to use it mockingly. In equating sitting and smoking we diminish the 50 years of investigation, social change, and sacrifice committed to understanding and addressing an insidious chemical dependency — tobacco use — that remains the world’s leading preventable cause of death.

But I get it. Prolonged sitting puts us at risk for future disease and premature death, inducing harm that can’t be undone even by regular exercise. The research suggests that interrupting prolonged periods of sitting is essential to health.

No one is surprised to hear that lack of physical activity is a health risk factor. The unique finding in the sitting research is that there is something deadly specifically in the act of prolonged sitting — the position itself — and that standing (or breaking up periods of sitting with standing) has health benefits. The recommendation from a landmark study in 2010 was:

Public health messages should include both being physically active and reducing time spent sitting.

[emphasis added.]

A group of international experts commissioned by Public Health England recently obliged, publishing a consensus statement that recommends:

seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks.

For starters, the panel advised sedentary workers to accumulate two hours of standing or light activity (such as the type of low-speed walking you do on treadmill workstations, which usually have top speeds of 2.0 mph).

A workstation for standing

Sit-stand workstation. Photo: John M

The 2010 study and others like it catapulted the popularity of standing workstations, which already were on the rise as a potential solution to ergonomic back pain. In my experience, however, enthusiasm for standing workstations was quickly eclipsed by a preference for sit-stand workstations, which offer workers the option to change position at will.

“Sitting Is No Worse Than Standing”

In recent weeks, however, we’ve seen a slew of studies that offered new perspectives — some refuting previous research about standing, some expanding on it:

First: An analysis of the Whitehall II study data (which I’ve described elsewhere) determined that sitting is no worse than standing. Reporting in the International Journal of Epidemiology in October 2015, the researchers found no association between sitting time and mortality. Their recommendation:

be cautious about placing emphasis on sitting behaviour as a risk factor for mortality

Next… Hold the phone. Acknowledging that there’s “insufficient evidence specifically focusing on the public health and medical implications of increasing daily standing,” researchers set out to identify the relationship between standing, metabolic syndrome (a cluster of risk factors), and obesity. They found that people who spend 25% of their day standing are less likely to be obese compared to more sedentary counterparts.

The plot thickens: Much of the earlier research was based on subjects’ total time spent standing or sitting. An employer may well question why they should invest in a sit-stand workstation if Joe-The-Knowledge-Worker goes home and spends hours on the couch at home. Why not encourage people to stand while watching TV or eating? Is the idea of a standing dining room table or a raised counter in front of the TV really so far-fetched?

Sitting at Home Is the New Sitting at Work

Along comes a small study that evaluated the outcomes of workers outfitted with sit-stand workstations. Data was collected via self-report and via instruments that monitored the workers’ position. The conclusion: Workers using sit-stand workstations spent significantly less time sitting at work…but significantly more time sitting while they were home. (Interestingly, previous work showed that workers with sit-stand workstations spend more time standing at work, but was not able to correlate this difference to health outcomes.)

That employees with sit-stands spend more time sitting at home is entirely plausible. Consider our tendency to overcompensate for a workout by overeating afterward. Another explanation may be that people standing more during the day experience fatigue that leads them to sit more at home.

Speaking of fatigue from standing, read on…

Standing Is Linked to Problems with Pain, Cardio Health, Pregnancy

For me, an irony of our newfound penchant for standing is the long and hard-fought battle workers previously waged to sit more. This came to my attention when I researched my blog post about the workers who ultimately perished in the Triangle factory fire. Seamstress jobs at the Triangle factory were considered cushy at the time, because the workers sat all day, in contrast to the more common manufacturing jobs in which workers toiled on their feet for hours on end.

The UK’s Hazard Magazine, which covers health and safety issues — from a decidedly pro-labor perspective — chronicles the history of European workers seeking the right to sit at work. But let’s not dismiss the right to sit as a relic of European history… In 2014, AT&T Mobility settled a complaint by workers and agreed to redesign stores with “learning tables” that gave retail staff the option to sit if customers also chose to do so. (The settlement also required AT&T to pay approximately $250 per eligible retail employee.)  In 2007, Safeway — self-anointed prophet of all that is righteous about employee wellness — was unmoved when a customer took sympathy and gifted stools to cashiers.

Prolonged standing was identified as an epidemic health risk long before cigarette packages even existed to put warnings on.  In the 17th century, Bernardino Ramazzini, the “father of occupational medicine,” called for shorter periods of standing and more frequent breaks during work.

A recent analysis confirmed that prolonged standing at work increases risk of low back pain, fatigue, cardiovascular problems, and adverse pregnancy outcomes. Most modern-day experts favor a mix of sitting and standing rather than prolonged periods of either.

A treadmill workstation.

Treadmill desk. Photo: Wicker Paradise

At this point, the body of evidence remains a labyrinth, with important variables — sitting at work vs. away from work; the role of standing vs. physical activity — not fully teased out. In the interim, we need to be wary of the “sitting is the new smoking” hype and learn more about the problem and the solutions.

In my opinion, pending further research, sit-stand workstations are a reasonable solution to attenuate problems associated with prolonged sitting at workstation desks. They give the worker more control over the work, which, all things being equal, is always a good thing for employee well-being.

I also have come around to supporting treadmill workstations, though I sacrifice a piece of my soul in doing so. Some physical activity is better than no physical activity, just as shifting positions is better than prolonged sitting or standing. But treadmill workstations seem just a step away from succumbing entirely to absurdity and putting workers in a hamster wheel.

There’s another approach that may be more sensible, well articulated in the quasi-satirical New Republic piece, “Screw Your Standing Desk!

Of course the long, stationary workdays of most Americans are unhealthy. The solution should not be to sit less, but to work less. If sitting is as bad as the doctors say—and I’m sure it is!—then why not prescribe longer lunch breaks, shorter hours, and more vacation? You can still be chained to a standing desk.

[Feel free to comment on the LinkedIn version of this post.]

For further reading:

Sitting Is the Smoking of Our GenerationHarvard Business Review article by Nilofer Merchant

Taking A Stand at WorkWall Street Journal interview with Dr. Anup Kanodia

Calorie Burner: How Much Better is Standing Up than Sitting? — BBC

NICE! Good Work Is the Key to Good Employee Health

October 27, 2015 in Uncategorized, job design
Good Work Is Key to Good Employee Health

Photo courtesy @prospectunion

On June 19, 2015, while the U.S. federal government was determining how much employers should be allowed to fine workers for high blood pressure and cholesterol, the United Kingdom’s quasi-governmental National Institute for Health and Care Excellence (NICE) was doing something beneficial for employee wellness. NICE issued evidence-based guidelines for management practices and policies that support employee health.

In the U.S., where we lean on behavioral programs and medicalized approaches to try to manipulate worker health, NICE’s focus on workforce management and policy may seem…um…foreign. But as often mentioned in this blog, much of the rest of the economically advanced world long ago realized that management practices — especially those relating to job design and work environment —  are the foundation of employee health. Voluntary behavioral programs play a potentially important but supporting role.

In fact, a recent Stanford study, described in a previous post here, determined that low job control, unemployment, long work hours, and work-family conflict had a greater affect on mortality than second hand smoke. And more than 120,000 deaths per year and approximately 5% to 8% of annual healthcare costs may be attributable to how U.S. companies manage their workforce.

The NICE guidance includes recommendations like…

  • “Encourage employees to be involved in the design of their role to achieve a balance in the work demanded of them. Allow them to have a degree of control, appropriate to their role, over when and how work is completed.”
  • “Value and acknowledge employees’ contribution across the organisation. If practical, act on their input and explain why this action was taken.”
  • “Create a supportive environment that enables employees to be proactive to protect and enhance their own health and wellbeing.”
  • “Ensure any unfair treatment of employees is addressed as a matter of priority.”
  • “Proactively challenge behaviour and actions that may adversely affect employee health and wellbeing.”
  • “If possible and within the needs of the organisation be flexible about work scheduling, giving employees control and flexibility over their own time.”

These are just a few examples. Visit the NICE website to read the full Workplace Health: Management Practices guidance and the evidence upon which it’s based.

In the U.S., we seek “disruption” in the form of new wellness programs, gizmos, and websites. But these aren’t disruptive and in some cases they aren’t even improvements. They’re just new tricks for old dogs.

Even if behavior is the underpinning of health, as we insist on believing, employers have  little influence over it, and may do some damage in the process of trying.

Employers do influence the workplace and the work, and that’s where they can have the most impact on wellness. Hence the tagline of this Health Shifting blog…

Change the work. Not the worker.

Partnering with Community Supported Agriculture May Be the Best Wellness Thing an Employer Can Do

June 4, 2015 in Uncategorized, Commentary, Employee Wellness Programs

Farm fresh vegetablesLast summer, I offered up my family as guinea pigs for a local Community Supported Agriculture program (CSA). As the leader of an employee wellness program, I was considering creating a partnership with the CSA to have shares of their harvest delivered to employees directly at work, and I wanted to check it out myself, first. If you’re not familiar with how CSAs bring together residents and farmers to support local agriculture and promote fresh food, find out more about them here.

My family started getting our weekly deliveries of vegetables and fruit — eagerly checking-in with the earthy young workers at the local pick-up spot and collecting our garlic scapes, bok choy, berries, broccoli, peas, greens, corn, chard, melon, and so forth.

My epiphany occurred around week two of the 14-week summer season. We’d received a bunch of green peas in that week’s harvest. The pods were plump and firm and seemed ready to burst. Like I said, I’m no foodie, and I wasn’t sure whether to eat the pods. So I did. Raw. I had about six or seven, and soon felt like I was digesting an electric sander. The next night, we cooked them, which I thought might soften them up but instead just seemed to toughen the fibers. So I went to the CSA’s Facebook page and asked whether the pods were edible.

“All that hot weather,” they wrote back, “followed by the thunderstorms made those peas really GROW in the last week. So, although typically delicious and tender. if you don’t enjoy the shells a bit more fibrous, the peas themselves are still delicious…”

That muggy weather. Those storms! I remembered them from just five or six days earlier. As I held a plump pea pod in my hand, I was thunderstruck by how it had been affected by the same storm clouds that had flash flooded the roads during my commute and overflowed the roof gutters of my house. There was a direct line from the weather into the ground through the pea and into my body. We were connected.

Of course, this realization isn’t that novel — even for a city kid like me. After all, I’d planted gardens that were influenced by the environment. But something about this direct experience of it in my core food supply brought it home and made it real. And I related to those pea pods, and all the veggies that came after, in a way that I’d never related to food before.

At work, we went on to pilot delivery from the CSA to employees at four worksites. One hundred co-workers out of about 2500 participated. That may not sound like a lot, but we chose not to set participation goals and didn’t push the pilot aggressively. We weren’t trying to change anyone; we were providing employees with a convenience they’d been asking for.

I considered subsidizing employees’ purchases. In today’s world of wellness, however, a subsidy functions like an incentive — and health incentives are deadly to the success of employee wellness programs. But I may rethink this.

The primary objectives of the program were:

  • To support employees who seek convenient access to whole, fresh food.
  • To support local agriculture.

But what I hope may be a bonus, and the reason this small program might be the most important wellness program I’ve ever offered, is because it has the potential to help employees experience their relationship with food in a whole new way — just like I did with the peas (Caution, however: n=1!).

Most healthy eating promotions used today — calorie labeling and nutrition education, merchandising tactics like those promoted by the Cornell Food and Brand Lab, and behavioral interventions like Weight Watchers— haven’t been a match for the proliferation of unhealthful food, oversized portions, and appetites that, for whatever reason, are insatiable. Conventional approaches have their place, but none have achieved good results on their own. And, with the possible exception of mindful eating strategies, none get to the root of the matter by a change in folks’ relationship to food, potential that exists with a CSA partnership.

I believe we also experienced an unintended consequence: A social effect that stands to bolster an employee community that rallies around well-being. Not only do some participants choose to split their shares, teaming up to divvy their bounty and exchange recipes, but on the day the large boxes filled with each week’s share were delivered, there was a heightened level of energy, curiosity, and camaraderie amongst co-workers.

We expect participation to double this year. Our next step is to source some of our employee cafeteria menu items from the CSA. This will, of course, support local agriculture in an even bigger way. More importantly, it will make high quality food available to a larger population, and it will integrate with our CSA purchase program — cross promoting and allowing prospective participants to experience how local crops can be transformed into delicious meals.

And a little transformation can go a long way.


(My wellness colleagues needn’t fret about the usual… ROI, outcomes, and definitions of terms. We’re helping get fresh veggies onto the tables of employees and their families. No vendors, no registration, no incentives, no behavior change, no contracts. The simplicity makes it sublime.)

A version of this post first appeared on Medium.com on May 25 and on LinkedIn on May 26.

Mapping Workplace Demons to Health, Costs, and Mortality

May 12, 2015 in Uncategorized, Stress, job design, job strain
Desk worker stressed with long working hours

Photo courtesy of Adam Foster. http://ow.ly/MKMke

The workplace demons that threaten employee health include long work hours, job insecurity, low job control, high job demands, shift work, effort/reward imbalances, role ambiguity, work-family conflict, inadequate workplace social support, and unfair treatment. These can be bucketed in various ways, but whatever you call them, they are the work conditions — controllable by employers — that research has consistently shown to influence employee health and well-being.

Now, along comes a study out of Stanford University that not only endeavors to quantify the burden — in terms of health outcomes, cost, and mortality — of these demons (what the researchers called “stressors” and I sometimes refer to as the workplace determinants of health), but also puts it into context relative to other, more commonly recognized, health issues.

Spoiler alert: More than 120,000 deaths per year and approximately 5% to 8% of annual healthcare costs may be attributable to how U.S. companies manage their workforce, according to this analysis. The mortality rate for these stressors, plus another the researchers found to have significant impact — lack of health insurance — was on par with the fourth and fifth largest causes of death in the U.S.: heart disease and accidents. It was greater than mortality resulting from diabetes, Alzheimer’s, or influenza.

Exposure to the following stressors was found to be more harmful than secondhand tobacco smoke:

  • Lack of health insurance
  • Low organizational justice (fairness)
  • High job demands
  • Shift work
  • Unemployment

And — again, using secondhand smoke as a benchmark — the conditions that had a greater affect on mortality are:

  • Low job control
  • Unemployment
  • Long work hours
  • Lack of health insurance
  • Work-family conflict

The Stanford researchers concluded,

Employers may not make appropriate decisions concerning workplace management if they are unaware of the link between management decisions and employee health and healthcare costs. Our analysis suggests that for such organizations, paying attention to the structure of the workplace and the associated job stressors experienced by their employees may be a fruitful way to reduce unnecessary healthcare costs.

But they acknowledge that employers may have limited motivation to address these issues if, indeed, they’re not on the hook for the costs of health care — for example, in the cases of employees who have been laid off or who are not offered health insurance. The study didn’t delve into associations between stress and productivity.

The analysis was conducted by Joel Goh, Jeffrey Pfeffer, and Stefanos A. Zenios and published in Management Science. Goh is now on the faculty of Harvard Business School.

The researchers are conservative yet insightful in their expectations regarding the implications of their work:

While we stop short of claiming that employer decisions have a definite effect on these outcomes and costs, denying the possibility of an effect is not prudent either. Analyzing how employers affect health outcomes and costs through the workplace decisions they make is incredibly important if we are to more fully understand the landscape of health and well-being.

And what of our current approach to employee well-being, with its slaphappy embrace of screenings, health risk assessments, health coaching, apps, wearables and incentives? How does it jibe with the real determinants of worker health? Not very well, according to study co-author Jeffrey Pfeffer. In his YouTube interview for the Stanford Graduate School of Business, he says,

Employers worry mostly about individual decisions: eating, exercise, smoking, drinking…things like that. Or about policy issues like how we pay for health care. A lot of their excess health care costs come from what happens to people every day in the work environment… Things that employers could fix, if they wanted to.

Read Dr. Pfeffer’s summary of this research in the Fortune article, “Is Your Employer Killing You?


[This post was originally published on Bob Merberg’s Health Shifting blog on May 12, 2015. Edited on March 21, 2018 — minor word changes — for clarity.]

15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza

April 5, 2015 in Commentary, Employee Wellness Programs
Strawberries and workers

Photo by JD Hancock

Only about half of employers evaluate their employee wellness program’s effectiveness, so it may be time to own up to the possibility that you have no idea whether your program is helping or hurting, or whether anyone even knows you have a program. Or whether your company even knows it has you. That’s okay. You’re okay.

Here are 15 Do’s and Don’ts to help you rise out of the abyss of employee wellness mediocrity:

  1. Don’t:  Start with changing employees’ behaviors.
    Do: 
    Focus on changing your organization. Healthy employees require reasonable job demands, input regarding job demands, appropriate rewards, reasonable work schedules, fair treatment, empowerment, less work-life conflict, and more social support.
  2. Don’t: Expect your program to reduce health care costs. Most likely, it won’t.
    Do: Strive to support your employees’ wellness aspirations. Positive outcomes originate with your good intentions.
  3. Don’t: Encourage your employees to get annual screenings.  Screenings are probably one of the least cost-effective components of your program.
    Do: Offer your employees paid time off and good health insurance so they can get the care they need, when they need it.
  4. Don’t: Invest heavily in health incentives. Incentives don’t support behavior change, and may stand in the way.
    Do: Offer wellness programs and opportunities employees want.
  5. Don’t:  Get caught up in language: “Wellness” vs. “well-being”; “return-on-investment” vs. “value-on-investment”; “health risk appraisal” vs. “health assessment.” Not only are these sideshows, but in most of these debates, the wellness industry is settling for the less specific — hence, less measurable — option. That said…
    Do:  Distinguish between “participation” and “engagement.” To use them synonymously is downright fraudulent. Especially: If you have incentives, you have unengaged participation.
  6. Don’t:  Call your health surveillance program an “outcomes-based wellness program.” It gives a bad name to those of us, and those employers, who truly care about worker wellness.
    Do:  Speak out — in professional networks, on social media, at conferences, in journals, and in your company — against the scourge of “outcomes-based wellness.” If you don’t stand up to protect employees from mercenaries trying to pass off discriminatory tactics as “wellness,” who will?
  7. Don’t:  Try to address all the dimensions of wellness.
    Do:  Pursue those dimensions of wellness that employees want addressed, that they will respond to, and that are actionable by and meaningful to your organization. (The dimensions of wellness — physical health, emotional health, spiritual health, financial health, occupational health, environmental health, relationship health, and so forth — are interdependent. When you influence one, you’ll influence others.)
  8. Don’t:  Rely on wellness committees to do the work. You don’t use committees to run your other employee benefits or your total rewards programs, do you?
    Do:  Hire qualified professionals to do the work.
  9. Don’t:  Do something just because you heard about it at a conference.
    Do:  Avoid insularity by attending wellness conferences and conferences focusing on unrelated industries.
  10. Don’t:  Limit yourself to the conventional American perspective on wellness.
    Do:  Read the World Health Organization Healthy Workplace Framework and also RWJF’s Work, Workplaces and Health. (They make scant mention of biometric screenings, health risk assessments, incentives, coaching, apps, portals, or wearables.)
  11. Don’t:  Fret about what external critics think.
    Do:  Define a clear goal and measure progress toward achieving it. Satisfy the needs of the organization.
  12. Don’t:  Expect much from your health risk assessment. It’s outdated and was never an effective catalyst for behavioral change.
    Do:  Leverage your aggregate health risk assessment data as a tool to assess how you’re doing and how you can most effectively serve employees.
  13. Don’t:  Obsess over obesity in the absence of population-based solutions.
    Do:  Provide employees with delicious, fresh, whole food, when it’s necessary to provide food, and with opportunities to move.
  14. Don’t:  Get preoccupied with employees’ families. They don’t want you messing in their business.
    Do:  Get preoccupied with the health of the community you are in. They do want you messing in their business, and you’ll stand to affect employees and their families in the process.
  15. Don’t:  Take it from me…
    Do:  Seek diverse sources of evidence and opinion, and draw your own conclusions.
    ……

[15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza was originally published on the InTEWN blog, April 2015. Some of the links have been updated]

Napo Lovably Spotlights the Causes of Worker Stress

January 26, 2015 in Uncategorized
Napo spotlights the causes of workplace stress

Napo raises awareness of the drivers of workplace stress.


The psychosocial and environmental interplay of stress at work are foregone conclusions among regulators, thought leaders, and many employers across the globe, especially in Europe. In the United States, with the exception of NIOSH’s Total Worker Health strategies, the drivers of stress at work remain largely ignored. In the US, we take the reactive viewpoint that an individual’s response to stress is more important than the causes of stress. In doing so, employers grant themselves license to put the onus for solutions on employees, too. Whereas the rest of the industrialized world endeavors to address stress by balancing employees’ job control and demands, offering scheduling flexibility, limiting overtime, addressing bullying, and so forth — even the most caring American employers take pride in addressing stress merely by offering stress management programs or uber-trendy resilience training. “Yes, we’ll stress you out,” we seem to be saying, “but we compensate by training you how to live with it.”

Reflecting their dedication to furthering employers’ understanding of workplace wellbeing and encouraging  action, a small group of European organizations commissioned French company Via Storia to develop a series of videos promoting employee health and safety. The result is a lighthearted collection of culturally non-specific, animated vignettes featuring an endearing main character, Napo. Consistent with the European viewpoint, these videos include — in addition to episodes about slips and falls, workplace transport safety, skin protection, noise control, and the rest — a full series about the psychosocial and environmental causes of stress at work.

The Napo videos aren’t intended to be scientific documentaries or instructional tools. They’e an intentionally simple means to raise awareness about worker health and safety and, in this case, the ingredients — like role ambiguity, untenable work schedules, and job strain — of workplace stress. I’ll share some of these Napo videos, as well as other invaluable resources readily available to European employers — here on the Health Shifting blog.

To complement my previous post, which addressed NIOSH research suggesting a connection between hostile work environments and obesity, I’m pleased to share the following Napo video — a segment from “When Stress Strikes.” In this 56-second video — probably the simplest of these episodes — Napo’s co-worker, Napette, is subject to repeated incidents of disrespect from a workplace bully. The Boss intervenes.

 

Unlocking the “Human Factor” in Employee Wellbeing

January 18, 2015 in Uncategorized
Asch building

The exterior of the Asch building remained intact after the fire (above). The Triangle Shirtwaist Factory occupied the top three floors. (Photo courtesy of the Kheel Center, Cornell University.)

Years ago, in lower Manhattan, flames burst through the windows of a skyscraper. Cornered by a fast-moving fire, employees clung to the window frames until the heat, the flames, and the terror became too much to bear. They leapt from the windows to their certain death, their burning hair and clothes leaving a smoky trail, and crashed smoldering to the ground with an unearthly thud.

This is not an account of a terrorist attack. This is the scene of what, for 90 years prior to 2001, had stood as the worst workplace disaster in New York City history.  Like 9/11, this tragedy changed the world — especially the world of work.

This is the story of the Triangle Shirtwaist factory fire, in which 146 employees — mostly young immigrant women — perished on March 25, 1911.

Shirtwaists were a kind of trendy women’s blouse, and the Triangle factory, which occupied the top three floors of the 10-story Asch building, could barely make them fast enough to keep up with demand. Each floor of the crowded Triangle factory had two exits. But the Greene Street exit, the one that workers were herded through at the end of each day so that bosses could search the workers’ handbags for stolen goods, was blocked by flames after the blaze exploded near the end of the workday that Saturday.

The only remaining exit, the Washington Place exit, was locked — a huddle of desperate workers burned to death trying to open it. Fire escapes led nowhere and eventually collapsed in a mangled mass of heat-compromised iron.  Workers jumped down the elevator shaft into a heap of corpses on top of the elevator, which had shuttled many panicked workers to safety until the heroic elevator operator, Joseph Zito, knew it could run no more.

The fire department responded quickly, but their ladders weren’t tall enough to reach any of the victims. The factory owners, Max Blanck and Isaac Harris, managed to escape the inferno. (Later, Blanck and Harris were found not-guilty of wrongdoing in a contrived court case, and had to escape the courthouse undercover as the families of the victims cried for justice. They went on to have additional scuffles with the law over suspicious fires and illegally locked factory doors).

Several days after the fire, a funeral procession of 120,000 workers marched in the pouring rain, as 300,000 grief stricken New Yorkers looked on in a demonstration of unity. Marchers pledged never to forget the fate of the young women and men of the Triangle Shirtwaist factory.

We need not sully the memory of this tragedy by comparing the plight of the Triangle workers to the work conditions that most Americans enjoy today. But nor should we dishonor the memory by neglecting to apply the lessons we can draw from it.

Bestowed with a broad charge and powers to investigate the Triangle fire and the work conditions of factory employees throughout the state, the New York Factory Investigating Commission in 1912 argued that the “human factor is practically neglected in our industrial system,” and reported that employers had “shown a terrible waste of human resources, of human health and life.”

Foreshadowing current events, in which government intercedes where employers fail to regulate themselves, the Commission spelled out the true significance of worker health:

Health is the principal asset of the working man and the working woman… Aside from the humanitarian aspect of the situation, economic considerations demand from the State the careful supervision and protection of its workers. Failure to perform this obligation will produce serious results in the workers of the future. It will affect the working capacity of the future generation.

The Commission recognized that worker health had implications for society as a whole, in the present and in years to come.

Indifference to these matters reflects grossly upon the present day civilization, and it is regrettable that our State and national legislation on the subject of industrial hygiene compares so unfavorably with that of other countries.

Other industrialized nations continue, more than 100 years later, to surpass the US in the protection of total worker health. They emphasize psychosocial health at the workplace, regulate limits on overtime, require paid sick time, and encourage workers to take needed leave to care for newborns and for ailing family members.

The work of the Commission set the tone for widespread changes in labor practices, without which the comfort many of us enjoy in today’s workplace likely would not exist. (Many of us enjoy comfort, but not all.)

And, yet, today, when employee health is discussed in journals, in lay media, and at conferences, we persistently neglect the “human factor,” which the Commission identified as the core of worker wellbeing.

The question, “Does employee wellness work?” is posed consistently with an assumption that “wellness working” is measured in employer cost savings or increased output. This commodification of human life stands in marked contrast to the social consciousness, the compassion, the empathy, and the vision that swept the nation after the Triangle fire.

Rosaria Maltese was 14 years old. Bettina Maiale and her sister, Frances, were 18 and 21, respectively. Ida Brodsky was 15. Fannie Rosen, an immigrant from Kiev who had worked at the Triangle factory for only two days and was one of the last six victims identified — a century later — was 21 years old. These girls were among the 146 employees who perished in the Triangle Shirtwaist factory fire on March 25, 1911.

Fannie Rosen, age 21

Fannie Rosen, age 21

With a unified voice, Americans pledged that we would never forget these girls and their courageous young coworkers who fought to be treated humanely, who suffered and endured, and left a legacy from which most of us now benefit every day of our lives. Just as we now pledge to always remember the victims of the 9/11 terrorist attacks, we once gave our word that we would remember the sacrifice represented by the charred remains of 146 Triangle factory workers.

But every time we argue, or simply assume, that the primary purpose of employee health is not the human factor but is, instead, simply to save an employer money…we harden ourselves against the memory of Rosaria, Bettina, Frances, Ida, Fannie, and the others.

As former Secretary of Labor Hilda L. Solis wrote in her commemoration of the 100-year anniversary of the Triangle Shirtwaist factory fire, “We must always be a nation that catches workers before they fall.”

Much of the information in this post was drawn from: Kheel Center, Cornell University. The 1911 Triangle Factory Fire, accessed January 15, 2015, http://trianglefire.ilr.cornell.edu/index.html.

Not Everyone’s Idea of Workplace Fun

May 19, 2014 in Wellbeing, Commentary
workplace slide

Every worker’s idea of fun?

Recently, I chatted with the Human Resources director from an employer known for encouraging “fun at work.” The company had the usual symbols of a fun workplace: foosball tables, slides, Xbox, pie-eating contests, and parties for every occasion. The HR director boasted about parades, in which employees construct floats, dress up in costumes, and march around the office to mark company milestones. I asked, “What if you don’t want to join the parade?” No problem. If you’re not the parading type, you can work on building a float. “Everyone is expected to participate in some way,” she told me. “Our employees know what kind of place this is when they accept a job.”

Fair enough. But count me out. When the data reconciles, when I have that eureka moment of identifying a creative solution to a work-related problem, when a team member rises to a new challenge or lights up when recognized for a job well done… That’s what I call fun. Some employees enjoy the fun of work, and don’t depend on adding fun to work.

Much of what passes for “fun at work” — parties, games, playground apparatus, contests, dress-up, etc. — represents little more than workplace tyranny of extroverts over introverts. And studies show, according to author Susan Cain, that one third to 50% of employees are introverts. So consider that half of your workforce may experience fun by setting their minds to their work, and they may be put off by someone else’s brightly colored and boisterous version of fun.

Lately, the social web has shone a light on “surface acting” in the workplace and the body of research, albeit thin, which suggests that being compelled to demonstrate positive emotions  — like when service workers are required to smile and chirp to customers, regardless of what they are actually feeling — leads to emotional exhaustion, stress, and reduced productivity.

(Surface acting occupies one end of a spectrum of emotional labor — in contrast to physical labor — opposite the more intrinsic deep acting. For more info about emotional labor, check out the pdf,  When The “Show Must Go On”: Surface Acting and Deep Acting as Determinants of Emotional Exhaustion and Peer-Rated Service Delivery,” which was published in the American Journal of Management).

While most research demonstrating the negative effects of surface acting is based on studies of frontline workers such as customer support reps, food servers, hair stylists, clinicians, and first responders, blogger Mike Pearce — in a post called Surface Acting: Bad for Business and Your Health — points to a study suggesting that expressing inauthentic emotion in meetings is linked to employee burnout and turnover. Indeed, it’s not unheard of for supervisors to warn office workers — even those who have no exposure to customers — to smile more, a directive that serves no purpose other than allowing the supervisor to perpetuate their own delusion of leading an energized team.

In a LinkedIn post called The High Cost of Acting Happy, Time magazine contributing writer Annie Murphy Paul proposed well-founded alternatives to forced happiness:

Train workers well, so that they satisfy their customers with good service. Offer them congenial working conditions, so that they’re glad to be at work. Allow them more personal control over how they do their jobs (research shows this can buffer the stress imposed by surface acting). And provide them with opportunities to develop genuinely warm relationships with managers, coworkers, and customers—so that employees have something real to smile about, and so that when they tell someone to “be well,” they mean it.

Paul’s advice is rooted in evidence that maps how employee well-being is a product of healthy organizations and job design rather than employee behavioral change.

Do employers’ attempts to foster fun at work actually promote surface acting and its unwelcome outcomes? Do employees really want fun at work? Does contrived fun serve any purpose whatsoever? We’ll need more evidence to know for sure. In the interim, here are six tips for keeping the fun fun, and for keeping the surface acting at bay:

  1. Genuine fun arises effortlessly. It may come organically to some workplaces whose culture is well suited for it. If you try to have fun, you’re not likely to.
  2. Allowing people to bring their individual authentic personalities to the workplace, to express them freely, and to socialize according to their own desires, may be more fun than so-called fun-at-work events, campaigns, or games.
  3. Not all employees seek fun in the workplace, and not every organization needs it. Tune in to employee demographics and organizational culture.
  4. Fun in the workplace efforts may not be the only employer contrivances that promote a culture of surface acting. Be on the lookout for unintended consequences of the increasingly popular resilience and positive psychology initiatives so that stress, sadness, depression and even everyday introversion are not stigmatized.
  5. What employees and employers sometimes perceive as a need for more fun may actually be a need for something else — gratification, camaraderie, satisfaction, purpose, hope, inspiration, or self-expression.
  6. Based on studies of surface acting, expecting employees to act like they are having fun may lead to burnout, job dissatisfaction, turnover, and absenteeism. And that’s no fun for anyone.

Arbejdsglaede: Happiness at Work

June 5, 2013 in Uncategorized, Commentary

I’ve previously mentioned that Scandinavia has pioneered research about job-related stress. Now, we learn that Scandinavian countries — specifically, Norway, Sweden, and Denmark — are the only ones that have a word for “happiness at work.” The word is arbejdsglaede. And, no, that’s not a typo.

Below is a video about arbejdsglaede.

The video is oodles of fun, but I have one beef with it: It advances the conventional American notion that employers are not responsible for employee happiness, and that your happiness is entirely in your hands.

Certainly, you have some accountability for your own state-of-mind. But Scandinavian research has shown repeatedly that organizational structure and job design are the primary drivers of employee well-being. So go ahead and grab yourself some arbejdsglaede — happiness at work — if you can find it. But don’t be too hard on yourself if you can’t.

Pedometer Programs: 10,000-Steps-Per-Day or Individualized Goals?

February 4, 2013 in Uncategorized, Employee Wellness Programs

pedometer

[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]

I don’t advise pedometer program participants to strive for 10,000 steps per day.

Having each individual aspire to an identical goal flies in the face of everything I’ve learned — or is it assumed?– about behavioral change. But participants have heard the 10,000-step mantra, and sometimes adopt it as a goal. Ultimately, many report getting discouraged when they clip on their pedometers and realize they only walk a baseline of 2,000 or 3,000 steps per day, at which point a 10,000-step goal can be a real motivation crusher.

Where did this 10,000-step goal come from? What are the alternatives? And what’s been shown to work? Pedometer programs are reasonably effective, but solving these mysteries may lead toeven greater effectiveness and may even influence how we think about goal-setting and self-tracking.

Back in the 1960s, a Japanese pedometer manufacturer dubbed one of its products manpo-kei, which translates to “ten thousand steps meter.” There was no known reason  the company settled on 10,000 for its product name, but shortly thereafter, Japanese researchers did determine that habitually active walkers typically accumulate something in the neighborhood of 10,000 steps per day.

Since then, evidence has shown that it takes approximately 3,000 steps over and above the average steps taken by typical sedentary people to meet the standard recommendation for physical activity — namely, getting at least 30 minutes of moderate-intensity activity each day. Anything less than 5,000 steps a day is considered sedentary. So a daily recommendation for physical activity — 3,000 steps over and above a baseline of 5,000 — would be 8,000 steps.

The Institutes of Medicine, however, advises that 60 minutes of daily activity is necessary to maintain a healthy weight. This would be equivalent to 6,000 steps, which, when added to the baseline 5,000, means participants should accumulate 11,000 or so steps per day to prevent weight gain.

This establishes that 8,000 to 11,000 steps, a guideline subject to individual variation, is equivalent to the minimum amount of physical activity people should get to maintain good health.  The question remains: How do you motivate sedentary employees to achieve this level?

An alternate to the 10,000-steps-per-day goal has been popularized by one of the first widescale pedometer programs, America On the Move, founded by obesity researchers James Hill and John Peters. AOM encouraged participants to wear their pedometers for three days prior to the program, then to set a goal 2,000 steps above their average for these three days. When they achieve this goal, they can set a goal 2,000 steps higher. It’s individualized and incremental.

But research has not shown individualized, incremental step goals to be more effective.

One randomized, controlled study compared participants who had 10,000-step goals to participants who had individualized goals. It found that, although previously sedentary participants rarely reached their goal of 10,000 steps per day, they increased their steps as much as those with the more modest, individualized goal.

Referring to this study, the authors of a 2007 meta-analysis concluded, “Given the relatively similar increases in physical activity among those pedometer users given the 10,000-step goal and users given other goals, we conclude that the relative benefits of setting different goals remains unclear.”

The specific goal didn’t make a difference. What about people who didn’t have any goal whatsoever? The authors of the meta-analysis reported:

“Pedometer users who were given a goal, whether the 10,000-step goal or an alternative personalized step goal, significantly increased their physical activity over baseline, whereas pedometer users who were not given a goal did not increase their physical activity.”

In 2011, Catrine Tudor-Locke and a team of distinguished researchers, in their comprehensive scientific review, “How Many Steps/Day Are Enough? for Adults,” added:

“…It may be premature to make firm conclusions about the efficacy, effectiveness, or appropriateness of any specific step-based goal in terms of behaviour change…Regardless of the number of steps per day, effective programs, informed by the best research on critical moderators and mediators of behaviour change (i.e., what works best for whom under what conditions and at what cost) remain implicitly necessary in terms of increasing individual and population levels of ambulatory activity.”

In the end, it may not be the ambitiousness of the goal, but the existence of the goal — any goal — and a behaviorally sound program, that make the difference.

The significance of this conclusion may go beyond employee pedometer programs. For example: with all the talk these days about the quantified self movement — and people strapping on accelerometers, body sensors, and all sorts of biometric devices — we should not assume that tracking organically leads to improved behavior.

We all know that goals don’t amount to much without measurement. Now we also know that measurement — in this case, step tracking — may not amount to much without goals.

Counting on Pedometers for Workplace Wellness

January 27, 2013 in Uncategorized, Employee Wellness Programs

Activity Trackers

[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]

With all the chatter these days about whiz-bang innovations in employee wellness — mobile apps, body sensors, social media, and such — overshadowed is the lowly pedometer program. But why? I’d venture to guess that most employers running robust wellness programs, and even smaller employers just getting started, are offering some sort of pedometer-based program.

What are we to make of these programs, in which employees — usually in teams —  wear a pedometer for several weeks and record the total number of steps they take each day? Are they little more than the minor league of more hi-tech solutions?

Given my penchant for evidence-based approaches, you may assume I’d balk at pedometer programs. Not so.

The great challenge of implementing evidence-based employee wellness solutions is that there aren’t many of them. After reviewing the evidence, we frequently have to go with where it is strongest — even if it’s not very strong — as we factor in what’s most feasible and the best fit for our purposes. The “best fit” analysis may include employees’ needs, employees’ wants, resource availability, occupational factors (Do employees have internet access? Are they working on a manufacturing line? Are they in vehicles all day? What’s their educational level?), our organization’s goals and, of course, cultural fit.

I categorize pedometer programs as low-resource/modest-impact. As such, I believe they have a place in many, if not most, employee wellness programs, certainly compared to many of the high-resource/low-impact programs that have grown popular.

Here are some things we know:

  • Evidence is mixed regarding the effectiveness of pedometer programs. A limited meta-analyses of programs conducted in various settings — published in the Journal of the American Medical Association (JAMA) — found “significant increases in physical activity and significant decreases in body mass index and blood pressure.” (A 2012 Finnish study concluded that a pedometer intervention “was able to affect only modestly some of the outcomes of walking,” but acknowledged, “The intervention seemed safe, inexpensive and highly adoptable in worksite setting.”)
  • Pedometers can be crude instruments. Their accuracy depends on the quality of the unit. It can vary based on participant age, weight, and walking speed. But, generally, they are sufficiently accurate to be effective in promoting physical activity.
  • Employees enjoy pedometer programs, and team-based challenges using pedometers may help foster camaraderie and a culture of health at the workplace.

Pedometer programs are affordable, scalable, well received by participants, and work about as well as anything else.

One of the more interesting, unresolved questions, about pedometer programs has to do with the goal — number of steps — recommended to participants. Employee wellness programs commonly implore participants to strive for 10,000 steps a day. Is this based on evidence? Does it work as a motivational strategy?

The question of pedometer programs’ “step goal” goes to the heart of our understanding of motivation and behavior change. We’ll get to some answers in my next blog post.

♦♦♦♦♦

Much to my surprise, these little devices were shown to increase physical activity by just over 2,000 steps, or about 1 mile of walking, per day.

— Dena Bravada, MD, lead researcher of a Stanford meta-analysis

Health Risk Assessments: The Baby and the Bath Water

July 11, 2012 in Uncategorized, Commentary, Employee Wellness Programs

 

There may be some employees whose health has benefited based on some feedback they got on an HRA, but not enough to warrant the investment you are making in the HRA (that investment includes your organization’s money; your time; and, perhaps most importantly, your participants’ time, energy, and goodwill). But don’t listen to me. Your employees will also tell you that your HRA doesn’t make much difference to their health. That’s why some employers pay employees up to $500 just to complete an HRA.You wouldn’t have to pay employees to complete a simple form if they actually saw any value in it to begin with.

A series of blog posts about HRAs  has deconstructed HRAs with an eye toward better understanding their value or lack of value. Here are the cliff notes:

  • The conventional framework of employee wellness programs is predicated on the principle that improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.
  • HRAs are techniques or processes of gathering information to develop health profiles, using the profiles to estimate future risks of adverse health outcomes.
  • HRAs are dependent on self-reported data, which is valid for effective use in population health management intervention, although its value at the individual level is questionable.
  • Importing clinical screening values — such as blood pressure and cholesterol — to an HRA does not add much validity to the HRA on an individual basis, but, like the self-reported data, should be sufficient to measure the health risk of a population.
  • HRAs may help steer individuals towards more intensive programs based on the position of the individual in the strata of the population’s health risk and predicted health care costs.

These findings point to the same thing: Health risk assessment is a population health tool. HRAs’ primary utility is in helping employers identify the health risks that deserve the most attention in order to achieve positive health and financial outcomes. The same tool can then be used to measure a program’s success in shifting the health risk of the population.

Unfortunately, employers have been using HRAs, a population health measurement instrument, as a behavioral intervention. No wonder you are disappointed. Be honest with yourself and with your employees: The HRA is for you — a potentially useful tool in the administration of your program. It’s not an employee benefit, and your employees know it.

Part of the reason employers have mistaken HRAs with a full-fledged health intervention is that vendors have marketed them as such. As a measurement tool, you should reassess whether your HRA is worth what you are paying.

But don’t rush to throw the baby out with the bath water. If you decide that your HRA’s capacity to measure risk in your employee population justifies its use, your next step is to reconsider whether you truly need to have all your program participants complete an HRA every year. Your vendor doesn’t want to hear it, but you may be able to realize the measurement potential of your HRA more cost effectively by having a sample of your employee population complete it every two or three years.

I’m not making a case for or against health risk assessments, just encouraging you to make a well informed and critical decision. What do you want your HRA to do? What does your HRA do? Is your organization getting its money’s worth?

[This article was originally posted on the InTEWN blog July 11, 2012].

Are Health Risk Assessments Effective?

July 6, 2012 in Uncategorized, Employee Wellness Programs

Are health risk assessments effective? Three systematic reviews have sought to answer this question.

One of the most rigorous and most recent analyses, Health Risk Assessment: Technology Report, conducted by McMaster University Evidence-based Practice Center for Agency for the Healthcare Research and Quality, examined 118 studies of health outcomes associated with HRAs. The report concluded:

Many HRA programs demonstrated improvements on intermediate health outcomes such as blood pressure, cholesterol, physical activity, or fat intake. However, only one article considered hard health outcomes (i.e., freedom from any of the following after 24-month followup: death, myocardial infarction, stroke, Class II-IV angina, or severe asymptomatic ischemia ). Also, followup periods were often shorter than 24 months. Therefore, we were unable to assess whether HRA programs produced health benefits over the medium to long term.

A previous, similarly comprehensive, review was conducted by RAND Corporation. RAND’s study endeavored to evaluate the effectiveness of HRAs for Medicare populations, but in order to do that their study focused on the evidence of HRAs’ effectiveness in any setting, especially worksites. Rand’s conclusions foreshadowed the AHRQ study, stating, “Interventions that combine HRA feedback with health promotion programs are most likely to show beneficial effects… It is not known if these effects persist over the long term.” But Rand also examined cost-effectiveness — importantly for corporate wellness programs — and added:

Current literature is insufficient to accurately estimate the cost effectiveness of programs using HRA. Limited evidence suggests that a carefully designed program that uses a systematic approach to implement HRA and subsequent disease prevention/health promotion interventions has the potential to be cost-beneficial. Considerable effort is needed to optimize program design, implementation, and evaluation.

Yet another study, conducted by the Task Force on Community Preventive Services and published in the American Journal of Preventive Medicine in 2010, suggested more positive outcomes for HRAs, but still with qualifications. The study concluded that HRAs with feedback “has utility as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least one hour or being repeated multiple times during one year….Results of this review suggest that this intervention may be more effective for some outcomes (e.g., smoking behavior or cholesterol) than for others (e.g., change in body composition).”

(These three reviews, in addition to trying to measure the value of HRAs, also provide comprehensive background information about HRAs — their history, their intended purpose, their modes of delivery, their strengths and weaknesses. If you haven’t studied HRA methodology, I strongly recommend that you read at least one of these reviews.  Any of these three reviews will provide much-needed context. The AHQR review is the best place to start.)

Each of these reviews suggests that there is or may be some potential for HRAs in evoking positive health outcomes for individuals, but none of them are a ringing endorsement. In an upcoming post, I’ll offer my own opinion on why employers may want to hang in there with their HRAs.


[This post was originally published on the InTEWN blog on July 6, 2012]

The (Theoretical?) Framework of Employee Wellness

May 27, 2012 in Uncategorized, Employee Wellness Programs

tape measure, notebook, appleHow is employee wellness supposed to work?

For starters, here’s the prevailing rationale that serves as the framework of most employee wellness programs today:

  1. Most health problems, and their associated costs, are preventable.
  2. Modifiable health risk factors — such as tobacco use, sedentary lifestyle, and unhealthful eating habits — are precursors to many of these health problems.
  3. Many modifiable health risks are predictive of higher healthcare costs and decreased worker productivity.
  4. Employer sponsored wellness programs can reduce modifiable health risks.
  5. Improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.

Important to this understanding of employee wellness are a few other learnings about health risks and their impact on health and productivity:

  • The number of health risks an individual has may have greater impact on financial outcomes than the severity of any one health risk. This is especially true for clusters of health risks related to heart disease, stroke, or psychosocial disorders (such as depression and anxiety).
  • Keeping low-risk employees low-risk may be a more direct route to health care cost containment compared to trying to improve the risk profile of high-risk employees. This focus on the low-risk, advocated by Dee Edington, is counter to a commonly accepted approach in which high-risk employees are targeted — based on the theoretical efficiency of targeting the 20% highest risk individuals believed to incur 80% of health care costs.
  • While it is unsurprising that risk is an indicator of future health problems, risk also is correlated — via mechanisms not fully understood — to near-term health care costs. In other words, one might expect that someone with cardiac risk factors is likely to incur higher health care expenses when they have, say, a heart attack, studies by Goetzel, Anderson, et al have shown that risk factors are associated with higher health care costs even in the near term, before the emergence of full-blown disease.
  • In employee wellness, absenteeism and presenteeism are the most common productivity metrics.

The model described by Goetzel and Ozminkowski is not the only rationale for conducting employee wellness programs. It may not even be the best rationale. But as we move forward in the next few posts to understand health risk appraisals — what they do, what they don’t do, and how they are perceived by wellness managers — it is essential to understand modifiable health risk and its role in the proliferation of employee wellness programs.


This post originally was published on Bob Merberg’s InTewn blog on May 27, 2012.

Which is Better, Telephonic or Face-to-Face Health Coaching?

February 14, 2011 in Uncategorized, Commentary, Employee Wellness Programs

conversation

A recent Robert Wood Johnson Foundation study of workplace clinics included this:

“When it’s just a disembodied voice on a phone line in place of a face-to-face session, it’s not nearly as likely that [the employee] will form a connection with the health coach, or that the coach can figure out what makes [the employee] tick and what will drive behavior change that’s meaningful and lasting,” a benefits consultant said.

Certainly, when I’m seeking advice about human behavior, who better to ask than “a benefits consultant”?

What’s more, I’ve often heard decision-makers rush to judgement in favor of face-to-face coaching. One  benefits director, telling me about her new coaching vendor, gushed, “They only do in-person coaching, which we all know is the best!”

Well, we may all think it’s the best. It’s hard to argue with what appears to be a high-touch approach. But argue I will.

Here are 4 reasons why telephonic coaching may be at least as good as face-to-face coaching:

  1. Telephonic coaching overcomes one of the primary barriers to participation. Employees have limited time, and convenience is everything. With telephonic coaching, they can participate whenever and wherever they want.
  2. Telephone conversations are not “disembodied voices.” If you don’t believe people can communicate effectively via the phone, will you also stand in the way of work-from-home arrangements, mhealth and telemedicine, and even conference calls? To take full advantage of the technologies of the present and future, we’ll need to let go of our old ways of looking at them.
  3. Face-to-face coaching can be woefully expensive and inefficient. In most cases, face-to-face coaching simply is not feasible for employers that have employees dispersed over large geographical regions.
  4. Employees demand and deserve privacy. If you’re an employer with a lot of extra configurable space, you may be able to devise the level of privacy employees demand, in which they cannot be overheard by co-workers, nor will coworkers even see them enter or exit the coach’s workspace. But can you match the level of employees can establish when they call a coach from the comfort of their home or office?

I don’t want to go overboard and try to claim that telephonic coaching is better than face-to-face. Most likely, the situation differs depending on the organization and the individual employee, and the ideal is to offer multiple options to each. But, as employee wellness continues to drive most of its initiatives based on intuition and pseudoscience, I simply want to caution against assuming that telephonic coaching is in some way inferior to face-to-face coaching.

If you’re still not convinced, here are some studies that support the case:

Employee Wellness Programs: Beyond ROI

July 21, 2010 in Commentary

money puzzleWhen was the last time someone asked an insurer or an employer what their return-on-investment is for covering Viagra? Or back surgery? Prostatectomy? Probably never.

Yet we’re repeatedly asked to prove the ROI of wellness — partly because the role of wellness is misunderstood, and partly because we’ve oversold the ROI of wellness, as I outlined in a previous post.

Wellness is as much or more a part of health as those expensive medical procedures. It’s a double-standard to expect that wellness delivers a positive ROI when the same standard is not upheld for much more costly health expenditures.

Some may make the argument that CFOs will always demand ROI because their interests ultimately lie in the bottom line. But CFOs frequently approve expenditures that don’t have a documented ROI, including community service programs, facility maintenance, diversity initiatives, and go-green initiatives, not to mention numerous expenses more directly tied to business goals, such as those associated with creating a brand. All these activities, including wellness, may generate a positive ROI, but it hasn’t been well documented, in many cases because much of the “return” in “return on investment” is difficult or impossible to measure.

When your organization breaks free from what may be a misguided need to generate a numerical value — whether it’s 3:1 or 12:1 — to your wellness program, it will more readily see the full benefits of wellness, beyond the control of health care costs. These include:

  • Helping to keep employees healthy is the right thing to do. In fact, public health is dependent on having all sectors of society — employers as well as governments, schools, faith-based organizations, and so forth — working toward health improvement. Smoking cessation, reduced littering, and civil rights are just a few examples of how major changes in society require the broadest possible efforts. Ultimately, employee health is a component of an employer’s social consciousness.
  • Wellness programs may promote job engagement. A recent Well-Being survey showed that 40 percent of employees believe wellness benefits encourage them to work harder and perform better. Another survey, conducted by the World Economic Forum and Right Management, found that employees are eight times more likely to be engaged in their work when employers actively promote health and well being.
  • Wellness programs may enhance retention. The Well-Being survey cited above found that nearly half of Americans would stay at their jobs longer because of employer-sponsored wellness programs. The Right Management survey found that employers perceived as pro-wellness are 3.5 times more likely to be seen as encouraging creativity and innovation, and their employees are 4 times less likely to report that they plan to leave within the coming year (compared to employees who do not perceive their organizations as actively promoting wellness).

The United States is the only country where health care cost containment is the primary goal of wellness. “Keeping employees healthy and working” is the primary reason cited by most employers outside the U.S. and, notably, “improving workforce morale” is the primary objective in Asian countries, according to a survey by Buck Consultants.

Just as we all need to work on health improvement, we all do also neeed to work on a solution for spiraling health care costs, which requires strategies based on credible data that may include employee wellness ROI. But ROI is not the be-all-and-end-all of employee wellness, and the sooner we peek out from under the cloud of our single-minded focus on ROI, the sooner we can give our full attention to creating great programs that bring to fruition the full potential of employee wellness.