Withholding earned pay for 2-week or 1-month “pay periods” is a vestige of days gone by, serving the funds-holder but penalizing the earner.
While some companies already have introduced on-time (on-time = real-time) payment as an opt-in service paid for by employees and/or their employers, it inevitably will become the standard. This is an important option to be considered by employers genuinely committed to their employees’ financial wellness. But it only makes sense if the employees incur no fees. Employers generally don’t charge employees for other payroll services, just as they don’t return dividends to employees when they’ve managed to realize savings (say, through increased payroll system efficiencies, contracting with more cost-effective providers, and so forth.)
There is a cost… in service provider fees and the loss of “float” (the interest employers earn on the money they’re withholding — big money, especially during periods of higher interest rates). This needs to be built into employers’ financial models.
A long-haul truck driver fell asleep during his shift in Sunbury, Pennsylvania, on Jan. 13. Heading north on Route 147, he drifted into the eastbound shoulder for almost 375 feet, struck the side of the road and flipped his rig. Thankfully, the driver only suffered a minor injury and nobody else was harmed.
8 lessons from the 2020Iowa caucuses… for Wellness, HR, and Employee Benefits Managers launching new apps/websites:
Conduct your due diligence with the vendor.Find and talk to the vendor’s ex-clients — not just the references provided to you. Visit the vendor’s offices (i.e. site visits), when possible.
Attach steep performance guarantees to implementation.Look for at least 10-15% of the first year’s total fees.You only get one chance for a smooth launch.If the vendor balks, they’re telling you they don’t have confidence in their capabilities. Consider metrics like launch-date readiness, uptime, loading speed, speed to answer help desk calls and to reply to emails, and participant satisfaction (measured by you, not the vendor) with the initial process. As usual,you don’t want to have to collect these performance guarantee fees. Youdowant the vendor to be motivated and accountable. Of course, you can only hold them accountable for things in their control.
Test, test, and test again.Test as many scenarios (different kinds of users; different ways of using the technology; etc.) as possible.
During implementation, require regular updates on your vendor’s quality assurance processes.
Have an experienced project manager on your team, and an IT specialist who has access to the vendor’s IT team.Include other experts, as needed, and work within your organization to assure selected team members are fully engaged in the project, and not just begrudgingly doing something they consider outside their job responsibilities.
Collaborate with your vendor on systematic pre-launch trainingof key managers, leaders, and team members in your organization.
Require your vendor to identify an executive sponsor for your account — a leader on their team with whom you can establish a relationship and who will make sure the vendor’s organizational barriers are torn down when you need them to mobilize for action on your organization’s behalf.
Don’t scapegoat your vendor.When things don’t go well, look at your own performance and your organization to identify opportunities for improvement. (When things do go well, give credit where credit is due.)
The vendor blog post “Why We Love Patty McCord” perpetuates the cult-like status of an HR exec who made a name for herself blurring the lines between leading with transparency and leading with fear. Early on, the blog post proclaims that great workplace culture “requires companies to show employees they care.”
Another worthwhile read, which lends insight into why the aforementioned exec was fired (falling victim to the consequences of the culture she fomented), is “Working at Netflix Sounds Absolutely Terrifying.” The exec, this article reports, left a legacy of a “harsh, hyper-competitive office culture.” This is the same exec the “great caring culture” vendor says “we love.”
Do the simplistic platitudes that permeate our discussions of corporate culture enable workplaces to cloak ruthlessness as transparency?
Is it enough for a job candidate to “show up” for an interview?
A prominent voice on LinkedIn recently garnered more than 17,000 likes with a post that read, in part:
We just hired a Gen-Z candidate with zero experience. Here’s why… They arrived 10 min early for their morning interview (respect ✊), pronounced my name correctly (major kudos), had a firm handshake, dressed sharp, and brought a hard copy of their resume (I didn’t need it). During the interview they smiled, made eye contact, and were honest about having zero experience (we value honesty). They asked me questions, they wanted to learn, they showed up! To all the hiring decision makers out there, don’t disqualify candidates because they don’t have “experience.”
By all means, don’t discriminate against Gen-Z or any other Gen, or against candidates who don’t have experience if the job doesn’t require it. But be smart about hiring, based on Continue reading »
In 2019, employees filed a class action lawsuit against a prominent employer for allegedly selling out its workers’ 401(k), costing the plan tens of millions of dollars in excess fees and underperformance, in exchange for mega-donations and lavish personal gifts. These shady dealings with employees’ savings were being finagled at the same time financial wellness program promotions admonished employees to “understand their values and get their finances in order.” (Learn more in myFinancialWhatness?article.)
On the other hand, Dan Price of Gravity Payments, who, in 2015 raised his company’s minimum wage to $70,000 per year while slashing his own salary, launched aplanin 2019 to establish the same healthy wage for employees of a new acquisition in Boise, Idaho. Mr. Price has his naysayers, but you’ll be convinced he understandshisvalues when it comes to employee wellbeing — financial and otherwise — after you listen to this interview:
Just when you were getting on board with a plant-based dietcomes a new, supposedly more rigorous analysis by 14 researchers,saying it’s fine (nutritionally) to eat red meat, even processed meats like bacon. The new analysis argued that previous studies were either biased by veggie-lovin’ diehards and food industry shills or simply weren’t rigorous enough.
Browse the nearly 100 blog posts I’ve published onmy websiteand you’ll find no mention ofmillennials— because generational stereotypes have limited validity and are just another way to pigeonhole folks. So, while I can understand the backlash that may have led to 2019’s patronizing #OKBoomermeme,it ultimately serves only to perpetuate polarization.
OKBoomer may lead to someage discrimination lawsuits, or it may just be a soon-to-be-forgotten fad. Either way, it can serve as a reminder for each of us to embrace diversity, inclusion, and connectedness, in all their forms.
In the early going, a typical employee wellness program doesn’t have much impact on healthcare costs, health, quality of life, or job performance. This, based on data from a cluster-randomized study of employee wellness at BJ’s Wholesale stores. (Clusterrandomization means the worksites, not the individual participants, were randomized.) Get the lowdown in my article,The 4 Factiest Facts Overlooked in the Latest Wellness Study Kerfuffle.
But rumors of wellbeing’s demise have been greatly exaggerated. A cluster-randomizedstudyof Gap stores showed thatstabilizing worker schedules led to increased sales and — while it’s no panacea — enhanced employee wellbeing, especially sleep. (Aseparate major studyconfirmed that unstable schedules are strongly linked — more strongly even than low wages — to workers’ psychological distress, sleep disruption, and unhappiness.) The contrasting results from these studies, building on previous research, surely will persuade business leaders to prioritize organizational strategies over health behavior modification products.
Japan’s #KuToo movement — from the words “kutsu” (shoes) and “kutsuu” (pain) — arose in response to dress codes requiring female workers to wear high heels, a workplace policy the Health and Labor Minister declared “occupationally necessary and appropriate.”
Similar requirements have ignited protests elsewhere.
Aside from the unabashed sexism these policies represent, even less woke old-school health promoters will be concerned about health risks linked to high heels. According to a report conducted for the UK Parliament, these include:
long-term changes to gait, which cause knee, hip and spine problems and osteoarthritis;
stress fractures in foot bones;
ankle sprains, fractures and breakages due to trips and accidents;
hallux valgus (bunions);
blisters and skin lesions;
enduring balance problems which persist into old age;
The report also cited psychological distress reported by female workers who were required to wear high heels against their will.
Meanwhile, in the US, HuffPostexposeda prominent professional services firm that set us all back with one of its women’s leadership trainings. The training’s handbook insisted that“the most important thing women can do is ‘signal fitness and wellness.’”🤮
It advised trainees to have a “good haircut, manicured nails, well-cut attire that complements your body type.” Then it warns:
“Don’t flaunt your body ― sexuality scrambles the mind (for men and women).”
Read the full HuffPo article and to view the employer’s “leaked” video response:
The National Institute of Mental Health reports that 20% of people live with a mental illness.
Mental and behavioral disorders are the 3rd-leading cause of disability in the U.S. That’s a lot and warrants special attention.
Not everyone recovers from mental illness. Many (here, I don’t have stats, but the 20% figure — and my own observations — suggests this is true), suffer their entire lives with mental illness, and an increasing number of people end their lives as a result. Suicide is the 10th leading cause of death in the U.S. We need to help these people.
Mental health and emotional wellbeing, unquestionably, are important for everyone. But in the wellness industry’s well-meaning enthusiasm for covering everyone under the mental health umbrella, we must be sure not to marginalize the large portion of people experiencing mental illness.
If we do communicate that there’s no difference between someone with a common disabling mental illness — like PTSD, bipolar disorder, and anorexia nervosa, as well as severe depression and anxiety — compared to anyone else who may be going through a tough stretch in an otherwise smooth-sailing life, we risk perpetuating mental health stigma rather than alleviating it.
Wellness thought leaders, under the guise of “wellness isn’t just about physical health,” brush physical health aside as if it’s no longer our concern. We’re all about connection, humanization, and collaboration.
You know those organizational inventories we recommend for other dimensions of wellbeing? Before launching a physical wellness program, for example, we conduct audits of workplace factors that influence physical health, like pretty stairwells, healthy food in vending machines, and so forth. Before launching a culture-of-health strategy, we assess the current state of the organization’s culture, using criteria like “Is wellness mentioned in the company’s mission statement?” and “Does the CEO visibly model wellness behaviors?”
We should do the same with our ever-popular financial wellbeing strategies. Before launching strategies to promote savings, budgeting, debt management, and retirement planning, let’s assess Continue reading »
This week, CBS News, CNN, and other major outlets blared headlines and articles — most accompanied by photos of office workers collapsed face-down on their desks — claiming that burnout had officially been recognized as a disease. The news spread like wildfire but was almost completely unfounded. Continue reading »
This is based on a response I wrote to an astute new leader of a wellness industry organization who was asking, “What should be next for the organization to move wellness forward?”
Broaden the base. Reach out to professionals trained in fields other than exercise, nutrition, and HR. Especially, bring in folks trained in the relatively fast-growing field of I/O Psychology, who have a deeper, evidence-based understanding of wellbeing and also tend to be well trained in analytics. Speaking of which…
Train wellness professionals in analytics. HR finally seems to be getting serious about data, and wellness will be left behind if we don’t have stronger competency in this area. We don’t need to be data scientists, but we should be able to direct analytical work and speak the language. I’ve been studying statistics, business analytics, and advanced Excel, and it’s already added value for my clients.
Help us understand the wellness needs of employees. Because wellness in the US has been market driven, we give most of our attention to what purchasers (employers) will buy, rather than what employees want. Unfortunately, these are rarely the same thing.
Help identify and then advocate for where wellness fits in an organization. As long as we’re tucked away in benefits departments, we’ll be undervalued and weighed-down by healthcare cost-reduction fantasies.
The BJ’s Wholesale Club study wasn’t the most important employee wellness research published last month. Let’s look at the Workplace Health in America Survey conducted by the Centers for Disease Control and Prevention.
The CDC asked about companies’ employee health promotion programs. 2,843 respondents completed surveys — targeting whoever in the company was most knowledgeable about its wellness offerings — from a variety of employers.
Not to be missed: Bruce Daisley’s brilliant interview with William Kahn, widely credited with coining the concepts of psychological safety and personal engagement at work. To whet your appetite for the entire interview, here’s a taste: Continue reading »
When skillfully incorporated into a broader strategy, external recognition for wellness programs has the potential to be a win-win, serving both the employer and the employees.
In keeping with my recent theme of providing practical tools and tips for wellness managers who do the hard work of creating and operating employee wellness programs in complex corporate environments, I’m pleased to share this post I wrote for one of my clients.
I’m pleased to provide these practical tips for wellness vendor management, one of the most demanding roles of employee wellness managers. Some of these — six tips for implementation and oversight, eight for selection and contracting — may be more relevant to larger corporations, but many are applicable to a spectrum of organizations and a variety of non-wellness vendors. They can help make a manager’s job easier, while eliciting higher levels of performance from vendors. Continue reading »
I agree with the position paper, Behaviour-Based Safety Programs, recently published by The International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF). An employer’s primary role in employee wellbeing is to protect employees from Continue reading »
A new year, a new opportunity for an employee benefits trade publication to randomly drop into an article a chart that makes less sense than a child’s finger-painting. (For legit. A finger-painting can’t be wrong. The chart is blatantly wrong.) Continue reading »
In 2018 aHuffington Post article,Everything You Know About Obesity Is Wrong, went viral, debunking myths about obesity and weight loss. It argued that the “war against obesity” has really been a war against obese people, fostering a culture that encourages fat shaming and alienates overweight people.
2 Slices of Bacon Daily Shortens Life by a Decade?
Ioannidis illustrates his point by describing the real-life implications were we to assume studies of individual foods are legit:
…eating 12 hazelnuts daily would prolong life by 12 years (ie, 1 year per hazelnut), drinking 3 cups of coffee daily would achieve a gain of 12 years, and eating a single mandarin orange daily would add 5 years of life. Conversely, consuming 1 egg daily would reduce life expectancy by 6 years, and eating 2 slices of bacon daily would shorten life by a decade, an effect worse than smoking. Could these results possibly be true?
Ioannidis blames researchers’ failure to properly account for confounding factors:
Relatively uncommon chemicals within food…may be influential. Risk-conferring nutritional combinations may vary by an individual’s genetic background, metabolic profile, age, or environmental exposures. Disentangling the potential influence on health outcomes of a single dietary component from these other variables is challenging, if not impossible.
He also blames selective publication of studies that proclaim a correlation between a food and a health outcome over studies that show no correlation. And he throws shade on nutrition advocates…
Expert-driven guidelines shaped by advocates dictate what primary studiesshouldreport.
Ioannidis didn’t even dig into the type of academic misconduct described in the first story on my Top 10 list, Mindless Cheating.
The Good News
But there’s a valuable learning — making this Number 9 on my list of Top 10 Wellness Stories of the year — we can take from all these stories. The lessons from Ioannidis’ article and Huffpo’s obesity article are essentially the same.
Pursuit of continuous improvement in the promotion of employee well-being demands skepticism.
We have to maintain idealism to believe we can do better. My New Year’s resolution is to cultivate even more optimism in the pursuit of measurable progress, knowledge, and improvement.
This is the 5th in my Top 10 Wellness Stories of 2018.
Not long ago, I attended a panel discussion in which an audience member asked the panelists what their organizations were doing to address mental health. No one had anything to say other than, “We offer an EAP.” A wave of ick swept over the room as the tragedy of this truth dawned upon us — the panelists and the audience.
These readily make clear that countries like Canada, European Union members, and Australia are far ahead of the US in their action planning, and I’ve previously written about Japan’s aggressive approach.
Will the US learn from other countries and develop an evidence-based agenda to address mental health in the workplace (and beyond)?
I’m optimistic and predict that evidence-based solutions prevail.
I’ve writtenad nauseamabout the University of Illinois Workplace Wellness Study, so allow me to just explain why I’m optimistic about where it’s heading.
This evaluation of an employer’s fledgling wellness program gave wellness critics a rationale to declare employee wellness a failure. The evaluation data, which showed almost no positive outcomes during the program’s startup, is only preliminary anddoesn’t say what critics say it says.
Even if you’ve never heard of Brian Wansink, you’ve probably been affected by his research.His studies,cited more than 20,000 times, are about how our environment shapes how we think about food, and what we end up consuming. He’s one of the reasons Big Food companies started offering smaller snack packaging, in 100 calorie portions. —Vox
Wansink led many headline-grabbing studies of eating behavior, showing, for example, that people eat less when food is served on smaller plates and that pre-ordering lunch leads to healthier choices. His work unleashed many employers’ nutritional wellness strategies, especially “making the healthy choice the easy choice.” Continue reading »
A New York Timesarticle recently revealed that the company has protected, arguably even rewarded, executives accused of sexual misconduct. It described one exec who “often berated subordinates as stupid or incompetent.” The company “did little to curb that behavior.”
A screenshot the exec’s ex-wife included in a lawsuit, according to the Times, showed an email he sent to another woman: “You will be happy being taken care of,” he wrote. “Being owned is kinda like you are my property, and I can loan you to other people.”
In our quest for a psychological-safety poster child, we may need to conduct a better search.
Does your Employee Assistance Program proactively address workplace mental health? Are they reaching out and screening employees — like those out on disability, or who have recently given birth, or are dealing with grief, or who have a chronic disease — who are at risk for mental health problems?
In 2013, Carol Harnett and Fran Melmed interviewed Bob Merberg for their CoHealth CheckUp podcast (which is no longer in production). They asked him to discuss a “great idea that didn’t work out.” In this 2-minute answer, he talks about a positive psychology intervention designed to help employees cultivate happiness.
A lot of questions remain about if and how these programs work. We have observed results for only the first year of our intervention. We are continuing to collect data to evaluate effects in the second and third years.
The University of Illinois study rolls on as the researchers demonstrate they are eager to uncover the truth and not just confirm over-simplified pre-existing notions about whether wellnessworksordoesn’t work. Notice that they called their paper, “What Do Workplace Wellness Programs Do?” rather than using a title that declares the issue put to rest, like, say, “Workplace Wellness Doesn’t Work.”
Ultimately, they may very well find that the Illinois programdoesn’tyield the desired outcomes (potentially a real kick in the pants for Aetna, one of the researchers’ “collaborators”). Or that it does. If we knew for sure, there’d be no point in the study.
Personally, I’ve never had any reason to believe a wellness program would reduce an employer’s health care costs. But,so far, there isn’t anything in this study I’d cite to support that opinion.
Randomized Controlled Trials vs. Observational Studies
One of the most interesting things about the study is its design. It’s a randomized controlled trial (RCT) — a rare sighting in the world of wellness — and the researchers compared their findings to what they would’ve concluded if their data came from a an observational study (the kind that almost all our healthy lifestyle guidance is based on — from “physical activity is good for you” to “don’t inhale too much asbestos”), potentially explaining, as Aaron Carroll argues in his column, why some wellness studies show that wellnessdoeswork. Or, as one of the Illinois study’s principal investigators wrote to me in a private correspondence, “Methodology matters.”
Even when methods are about as good as can be, we probably should never trust a single study with high confidence…Take, for example, the randomized controlled trial (RCT). It’s reasonably considered the gold standard of social science methods. When you read the results of a well-conducted RCT, does that mean you can take them and run with it? Not so fast. They may not apply outside the population studied.
The Illinois Wellness study is and will continue to be important. It has the potential to deliver actionable insights into the value of incentives; the profile of employees who tend to engage in wellness programs; the types of programs that are and aren’t effective; and, ultimately, the behavioral, health, financial, and productivity outcomes we can expect from comparable programs.
For the university, theiThriveprogram is a good start — more thoroughly thought-out than most new programs. (Thanks to the study’s transparency, a large employer seeking to launch a wellness program could use the study’s published material to develop a program template — though I’d recommend skipping the incentives and the screenings, and adding longer-range plans for a more comprehensive strategy.) But that’s what it is — a start.
In a non-study situation, smart leaders of a “comprehensive” program, seeing that Year 1 activities had no effect on anything, would undertake a quality improvement process and make adjustments accordingly. After all, if there aren’t any behavior changes in Year 1 — and environment, culture, and work design aren’t even on the radar — there’s no reason to expect health, financial, or productivity improvements in the following years.
I admire the researchers’ refraining from sensational conclusions based on their Year 1 data. Now, it’s up to thought leaders with a media platform, and up to us — those responsible for applying research findings to our programs — to exercise the same restraint.
We all need to educate ourselves and stretch our creative muscles regarding blockchain and, maybe, cryptocurrency. It’s a bummer blockchain is so hard to understand, but that’s no reason to dismiss it.
Blockchain will be used to store medical records and also to accelerate the advancement of medical research. Cryptocurrency could be incorporated into employees’ Total Rewards packages. And, if the will is there, it may be used to advance more participatory workplace practices — representing real progress for employee wellbeing.
Civil, an application of blockchain and cryptocurrency, is focused on democratizing journalism (not workplaces or employment — though they do say their own employees have “equity/token opportunity”). Still, Civil’s model, in which currency represents not nothing — the accusation commonly and rightly leveled against, say, Bitcoin — but influence.
Imagine influence issued as an employee benefit. At first blush, it may seem unlikely — but not if viewed as a future iteration of employee ownership, co-ops, or even stock options and other equity awards.
You’ve probably read dozens of Blockchain-for-Dummies explainers and still don’t get it. Here’s one I’ve found helpful:
There’s been a lot of talk lately about how to take wellness past well-being and into the future. Specifically, how can we expand beyond physical health and, as wellness professionals, deliver maximum value to our organizations.
Check out the milestone 100th episode of Jen Arnold‘s Redesigning Wellness podcast.
As a result of all the interviews she’s conducted, combined with her own experience and insight, Jen has her finger on the pulse of employee wellness more than just about anyone.
In this solo episode, Jen — with her characteristic candor — systematically lays out a case for a new vision of wellness and previews exciting opportunities she’s creating for wellness professionals who want to make good things happen.
Listen to “Celebrating 100 Episodes” on the Redesigning Wellness podcast wherever you usually get podcasts, or stream it here…
Big thanks to the folks at Lumity, Inc. for inviting me to present the webinar “Wellness, Wellbeing, and Workforce Sustainability: 3 Routes to Employee Wellness and Optimal Performance.” If you missed it, check out the recording.
In this orderly mash-up, I present about 40 years of work in 33 minutes (plus Q&A). It has something for everyone — from the HR generalist who’s been assigned to wellness but may not know much about it, to veteran managers of comprehensive programs trying to figure out what does and doesn’t work. I cover
the premise of health risk costs and risk reduction;
the distinctions between wellness and wellbeing;
ROI vs. VOI;
typical wellness program components;
work, stress, and health;
Without being overly prescriptive, I offer my own interpretations of evidence and practices, some of which you’ll find immediately applicable and some of which will irk you to no end. This link, exclusively for my blog readers, takes you directly to the recording.
The article argues that Maslow never conceptualized the pyramid commonly used to illustrate his Hierarchy of Needs. The figure was developed by a consultant seeking to simplify Maslow’s theory for corporate clients, and it distorted Maslow’s work in the process.
Maslow’s theory aside, we can find a broader learning here. The phrases “some consultant,” “distorted,” and “overly simplistic,” remind me that consultants and other practitioners do, indeed, habitually oversimplify and distort theories of employee wellbeing.
In the employee benefits and wellness spheres, a couple of examples of oversimplification come to mind:
Consultants and other practitioners increasingly cite Self-Determination Theory, which says that autonomy, competence, and relatedness are prerequisites for human flourishing. But many present the theory as a simple explanation of behavioral motivation and are hard-pressed to explain what relatedness is or how it fits in.
Behavioral economics is a trendy framework consistently misrepresented. Wellness consultants have described it as a theory of intrinsic motivation. Behavioral economists, however, will assert that there is no such thing as intrinsic motivation. If behavioral economics had to be bucketed as one or the other, it could only be considered — with its warm embrace of incentives and other manipulative techniques — a framework for extrinsic motivation.
Scholars resent such oversimplification. But I’d be cautious about one-sidedly indicting consultants.
Perhaps scholars should endeavor to communicate their theories and findings in a manner more accessible to lay practitioners. Were relatedness and competence really the best terms to communicate what’s intended in Self-Determination Theory? Indeed, delve into the details of Self-Determination Theory, and you’re likely to find it nearly incomprehensible to non-psychologists. The theory picked up steam outside psychology circles mostly after Daniel Pink simplified it in his bestseller, Drive.
Similarly, behavioral economics has repeatedly been distorted by TED-talk superstars who have little or no training in either behavior, economics, or any combination of the two.
We wellness professionals would benefit by reading fewer bestsellers and more journal articles. I might also suggest that scholars — in order to learn how to reach an audience of practitioners with minimal distortion before TED talkers and bestselling authors pull the rug out from under them — study fewer journal articles and more bestsellers.
Perhaps a consultant would not have created Maslow’s pyramid, and it would not have taken hold to the extent it has, if Maslow or another scholar had more effectively illustrated his ideas.
[Hat tip to Kuldeep Singh, who shared the “Who Built Maslow’s Pyramid” article on LinkedIn, and Rob Briner, who shared the video in the lively discussion that ensued. This blog post is adapted from comments I contributed to that discussion.]
On a snowy winter day, as I listened on a conference call with a client, I watched through the window of my cozy home office as the curbside recycling truck lurched to a halt.
A burly guy jumped off the truck, where he’d been clinging in the blasting snow and arctic wind. In his orange reflector-striped parker, snow-dusted cap, and humongo gloves, he lifted my recycling bin out of the snow bank where it’d been half-buried by the city plow and in one swift move heaved the clinking and clanking contents into the backend of the truck.
He tossed the emptied bin onto my snow-covered driveway and stepped back onto the rear of the truck as it grinded away. With its amber caution lights flashing and sparkling in the icicles that hung off its rim like a damaged chandelier, the truck — its passenger clutching the back and ducking his head out of the wind — vanished into the whiteout.
“What kind of wellbeing program would appeal to this guy?” I thought. “What would be useful to him?”
On my conference call, the client was chatting about placing fruit-infused water stations in break rooms.
Would the recycling worker want a fitness challenge to track his steps? Would he like a health coach to call that evening to “nudge” him to eat fewer carbs? A work-life balance lunch-and-learn?
In the latest iteration of employee wellbeing, where all the buzz is about purpose, authentic self, mindfulness, and gratitude, would the recycling worker pick up what we’re throwing out there?
I don’t know what this individual worker wants and I won’t make assumptions. I haven’t spoken to him yet, but, like you, I chat with blue collar employees, manual laborers, and lower-wage workers every day. Some I meet in the course of my daily business, some are friends, some are family members. And I do ask what they want and how their workplace can support their wellbeing.
The above was originally the preamble to my LinkedIn post, “How My Dad Proved Steve Jobs Wrong About Loving What You Do…”, but I cut it because of length, relevance, and tone. Still, I’d love to hear from you. How can we serve employees in job classes like this recycling worker? How can we best support their wellbeing?
In previous posts about the transition from wellness to wellbeing, I neglected to address the studies of wellbeing — including many attempts to define it — that were done before corporate America appropriated the term.
As legendary occupational psychologist Sir Cary Cooper says, “Define wellbeing? We can’t even agree on how to spell it Hyphen or no hyphen?” (I’ve paraphrased Sir Cary.)
“Wellness programs focus on physical health while well-being addresses ‘all things that are stressors in an employee’s life.’”
So far, so good.
Then they wrote:
“ Improving employee health was the most frequently mentioned (82%) reason for offering well-being programs, followed by: decrease medical premiums and claim costs…”
If those two quotes don’t have you scratching your head, you’re reading too fast. Please back up and keep rereading until you’re appropriately distressed.)
Gallup’s Essential Elements of Wellbeing
In recent years, Gallup describes wellbeing, based on their massive surveys, as consisting of (these are verbatim):
Purpose*: liking what you do each day and being motivated to achieve your goals
Social: having supportive relationships and love in your life
Financial: managing your economic life to reduce stress and increase security
Community: liking where you live, feeling safe, and having pride in your community
Physical: having good health and enough energy to get things done daily
In 2010, Gallup’s Tom Rath and James Harter published “Wellbeing: The Five Essential Elements.” The book served up the same five elements that Gallup advocates today, except the book used the label “Career,” whereas Gallup now calls the same element “Purpose.” Hmmm.
Gallup, with their partner Healthways (which eventually was acquired by Sharecare — creating the Gallup-Sharecare pair) argues that employers should address all five elements of wellbeing. For a price, they offer consulting services to help.
Employers faithfully adopted the five elements, depicting their wellbeing program goals with circles perfectly divided into equal parts — each representing one of the five elements — sometimes shoehorning in another element or two, like “emotional,” “environmental,” or “spiritual.”
But employers have not been well-served by their simplistic pie diagrams, which are used as virtual checklists to perfunctorily confirm that each element is addressed…
A fragmented effort to address what is in wellbeing, rather than a cohesive strategy to support what wellbeing is, may be one reason why, in practice, nothing but the name has changed.
Since his groundbreaking review, “Subjective Wellbeing,” first appeared in 1984, psychologist Ed Diener has probably published more wellbeing research than anyone. Though Diener evaluated the elements of what he calls “subjective wellbeing,” he defined it not by its elements but by the experience. To Diener, wellbeing is…
“…how people evaluate their lives — both at the moment and for longer periods… These evaluations include people’s emotional reactions to events, their moods, and judgments they form about their life satisfaction, fulfillment, and satisfaction with domains such as marriage and work. Thus, subjective wellbeing concerns the study of what lay people might call happiness or satisfaction.”
“Happiness or satisfaction.” Isn’t that what we always knew wellbeing to be, before we picked it apart?
I Feel Good!
With the various definitions of wellbeing circulating helter skelter, Uncle Sam (in the form of the CDC) played peacekeeper:
“There is no consensus around a single definition of well-being, but there is general agreement that at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good.”
Rath and Harter’s description of wellbeing and other definitions of wellbeing emphasizes how you get there — the road to wellbeing. Diener and other psychologists emphasize how you are when you arrive.
Wellbeing and Burnout
Diener mentioned marriage and work, referring to domain-specific wellbeing. Here’s where that comes into play…
In job crafting research — as with a lot of organizational development research — “wellbeing” often is measured in the work domain only. Work wellbeing doesn’t just mean job satisfaction; it goes deeper to how employees are.
How do you measure how employees are at work?
For perspective, consider the symptoms of burnout:
A feeling of not making a difference
It’s not unreasonable to say that the opposite of burnout is work wellbeing — having energy, purpose, and optimism at work. This is why burnout metrics have, sometimes, been used to measure work wellbeing.
Focusing on work wellbeing — which, on the surface, seems to be just one domain — may be heresy to employee wellness leaders looking to check off their list each element of wellbeing.
But employee wellbeing programs risk getting in their own way if they try to do too much. Would it make sense to help employees thrive at work — the domain over which employers have most control — before trying to get them to thrive in, say, relationships, community, or even physical health?
On one hand, focusing on work wellbeing seems to contradict arguments against checking the elements off one-by-one. On the other hand, if the elements are interdependent, bolstering work wellbeing helps support the other elements. And if the others are supported at the appropriate time and place, work wellbeing will benefit.
If you can find some downtime (or some treadmill time?), listen to “Dealing With Burnout” the Wisconsin Public Radio Morning Show. One of the guests wasMonique Valcour PhD CPCC, who has a gift for articulating, in super-practical terms, the connection between work and wellbeing. Monique explains what burnout really is, and delivers keen insight when the first caller makes a reference to the role of autonomy in addressing his own burnout. She talks about burnout as an “interpersonal phenomenon” and notes the supportive effects of mindfulness and emotional intelligence. And she provides practical tips for workplace leaders.
By the way, not only is it essential for us wellness professionals to address the burnout that occurs amongst employees, but I’m observing that it’s increasingly common within HR, Employee Benefits, and Employee Wellness teams. So if you don’t feel the need to learn about burnout for your organization, learn about it as an act of compassion for yourself.
I’ve had the pleasure of co-presenting with Rajiv on several occasions, and the conversations always take a turn toward the unexpected. I elaborate on my latest passion, job crafting, and how it may surpass other popular solutions for health-related job stress, burnout, and disengagement.
Rajiv brings his unique perspective as a community-minded entrepreneur, physician, and vendor. I’m always enriched by our conversations, and I think you will be, too.
Last year, online media had a field day when a survey showed that one third of respondents who owned a “wearable” activity tracker stopped using their device within six months. The firm that conducted the survey referred to this as “the dirty secret of wearables.” But it’s premature to judge this disengagement rate, and there’s no secret to keep. Sixty-six percent adherence for wearables after six months may, in fact, be something to celebrate.
Is It Time to Disengage from Disengagement Rates?
We haven’t identified universally accepted goals for activity trackers (by “trackers,” we’re talking here about devices like Fitbits, Jawbone Ups, and the like). Is the purpose to increase activity? To lose weight? To (perish the thought) have fun? Without goals, there’s little we can say about effectiveness or the significance of disengagement rates.
The assumption behind the negative publicity for disengagement rates implies that users should wear their trackers indefinitely. But…Says who? Many consumers wearing a tracker for the first time will see, within a few days, that they aren’t as active as they thought. This may be a first step to modifying behavior, even if they ultimately rely on non-tracker strategies to make changes, and even if those strategies take place at a later date.
Business Insider writer Erin Brodwin recently published an article called, I Tried Fitbit for a Month, and Taking It Off Was the Best Decision I’ve Made. Judging from the title, we might think that Brodwin’s story is a testimonial to the transience of tracker engagement (or that she needs to make better decisions in her life). And it may be. But this observation she makes near the end of the piece may exemplify unexamined potential of wearables:
I still do some of the healthier things I learned to do with my Fitbit, like taking the stairs at work and going for a walk when I take a phone call.
In Brodwin’s case, sustainability of her Fitbit use would have been the wrong metric if her goal was to increase physical activity.
Do One Third of Users Disengage with Wearables after Six Months? Or Do Two Thirds Continue?
What benchmark are we using to judge sustainability of engagement with wearables? Do we compare it to the 20% of patients that drop out of psychotherapy early? Or to the attrition rate for Crossfit, physical therapy, yoga, walking groups, Weight Watchers, or gym attendance? What about mindfulness, our panacea du jour? What percentage of mindfulness practitioners sustain their efforts for more than six months?
I don’t have credible citations for disengagement rates on any of these potential benchmarks, because hardly anyone’s even asking the question. But, by most accounts, a 66% adherence rate after six months compares favorably to…well, just about anything that requires effort.
Previous research on pedometers and early-day accelerometer devices has shown they can be useful tools for increasing physical activity…when they’re integrated with a sound behavioral program. And this was the optimistic conclusion of the “dirty secret” survey — that use of wearables can be sustainable when integrated with behavioral approaches.
Through my job, I’ve overseen the distribution of thousands of pedometers and hundreds of modern tracking devices to people engaged in top-tier behavioral programs lasting several weeks, often offered periodically throughout the year. The pedometer users, I did indeed find, are usually eager to abandon their device in the junk drawer after a program ended. But those who stop wearing their pedometer after eight weeks tend to be perfectly happy to resume wearing it when the next program rolls around. And I’ve seen unpublished data showing that the effects of this intermittent participation on activity levels is sustainable for more than a year. Using it or not using it for the first six months of ownership doesn’t seem essential.
Our wearable technology is ahead of our research. Do we know what consumers expect from trackers? Not everyone wearing a tracker wants to change. Some may be quantified-self devotees. Some enjoy a tracker as an expensive toy.
As for me: I need to have an activity tracking device because I’m in the business, and I’m extra motivated to continue so that I can contribute my data as a subject in the Heart Study (which, I hope, may ultimately resolve some of our questions about wearables). If my job was unrelated, I doubt I’d pony up the bucks for a glorified pedometer.
Calorie-counting apps have come under similar criticism, but there’s no arguing that expectations of these apps are more clearly defined. Consumers come to these apps to lose weight, though research shows that attrition is high and that the apps, perhaps like wearables, are useful as a measurement tool and not a standalone strategy.
I use MyFitnessPal to track calories for 3 to 4 weeks each year. In the first three weeks I used it, I suffered the revelation that I consumed more daily calories in snacks than I did in meals. While I caution that n=1 — my experience may be irrelevant to anyone else’s — approximately three weeks was all it took to trigger a lasting change in my eating patterns. I consider that a win and, as of this moment, it’s no secret.
[This post was originally published on Medium.com on May 18, 2015]
I’ve compared, in a separate post, the terms health, wellness, and wellbeing.
But even “wellbeing” doesn’t go far enough. The term, as it’s typically used in employer circles, overlooks the interaction between an employee’s wellbeing and their work — the job conditions, the people they work with, the support they receive… indeed, all the way to the very way work is done. The consequences of a sustainable workforce are the very ones employers seek: work engagement, productivity, consistent attendance, and retention.
One of the best descriptions of workforce sustainability is offered by researchers Ellen Kossek, Monique Valcour, and Pamela Lirio in their chapter, The Sustainable Workforce: Organizational Strategies for Promoting Work–Life Balance and Wellbeing, published in the book Work and Wellbeing: A Complete Reference Guide:
“A sustainable workforce is one where the work environment is caring and supports employee wellbeing. Employees are not seen as primarily resources that can be deployed (and depleted) to serve employers’ economic ends. Their skills, talent, and energies are not overused or overly depleted. They are not faced with excessive workload nor with a relentless pace of work for weeks or years on end. During times of crisis (e.g., natural disasters, sickness), employees are given time to recover or seek the extra resources they need to be able to perform in the future. Burnout is avoided and workers are given time for renewal.
“When human resources are used in a sustainable way, employees are not only able to perform in-role or requisite job demands, but also to flourish, be creative, and innovate. Sustainable human resource management practices develop positive social relationships at work, which enhances business performance, including greater cohesion among organizational members, commitment to common purpose, hope for success, resilience, knowledge sharing, and collaborative capacity.”
There’s no secret sauce to achieving a sustainable workforce. But it’s important to understand the essential elements of workforce sustainability when implementing a wellness program, so that program offerings are crafted through a sustainability lens.
I recently read an article about business’s revolutionary transition from employee wellness to wellbeing. “Historically speaking,” the author wrote, “wellness has been thought of as strictly pertaining to physical health, usually measured by biometrics.”
But, accurately speaking, this is not so.
Of course, there’s no single arbiter who can proclaim what exactly health, wellness, or wellbeing mean, but it’s worth understanding some of the ways these words have been interpreted in order to fully appreciate the implications, or lack thereof, of the “transition” from wellness to wellbeing
“Health” was defined by the World Health Organization (WHO) in 1946 as
a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
WHO’s definition, incorporated into its constitution, remains unchanged to this day. But in 1986 the organization held an International Conference on Health Promotion in Ottawa, which resulted in the famous Ottawa Charter for Health Promotion that elaborated on the definition, stating,
An individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
The Charter went on to list the conditions for health: peace, shelter, education, food, income, a stable eco-system, sustainable resources, and social justice. A far cry from biometrics.
In the late 1950s, the chief of the US Office of Vital Statistics — Halbert Dunn, MD — described a dynamic state-of-being he called “high-level wellness.” This is generally considered the founding of wellness, and Dr. Dunn’s sermon-like lectures reveal his concept to be anything but a simple embodiment of physical health. Dr. Dunn said…
The state of being well is…a fascinating and ever-changing panorama of life itself, inviting exploration of its every dimension.
I believe Dr. Dunn was amplifying — not refuting — WHO’s original definition, and the Ottawa Charter later adopted much of his take on wellness as a never-ending interaction with the environment.
But Dr. Dunn’s framework may have proven too cosmic for the mainstream. And many thought leaders have since distilled wellness into the sum of its various dimensions.
The National Wellness Institute adopted a model that incorporates six dimensions of wellness — occupational, physical, emotional, spiritual, intellectual, and social. Others have divvied wellness up into five, six, seven, or eight dimensions, sometimes tossing in a “relationship” dimension, sometimes “environmental,” “financial,” or “community.” A quick image search reveals a galaxy of multidimensional wellness models in the shape of pies, hexagons, prisms, Venn diagrams, concentric circles, and geodesic domes.
I don’t know exactly how “wellbeing,” in the last few years, worked its way into the hearts of employers and the wellness industry. But one catalyst probably was the bestselling book, The Five Elements of Wellbeing, by Tom Rath and Jim Harter. Both authors are workplace consultants with Gallup (a partner of wellness vendor Healthways) and entrepreneurial marketers with a track record of successfully persuading employers to their way of thinking.
Rath and Harter argue, based on Gallup findings, that wellbeing is more profound than health and wellness, incorporating career, social, financial, physical, and community wellbeing. Sound familiar?
In practice, employers are rallying around mindfulness programs and financial planning, and repackaging stress management as resilience, and using these incremental expansions of the status quo as markers to distinguish wellbeing from wellness. Ultimately, the transition amounts to little more than a name change.
I’m more than happy to dispose of the word “wellness.” I never cared for it — not because of its definition, but because it has failed to resonate with employees or the public at large. And I see no harm in calling it wellbeing instead of wellness. Certainly, while the employee wellness industry has been celebrating this “transition,” I doubt many employees have noticed a difference.
Besides, I’m open to the evolution of language, as long as it isn’t contrived to cover up a deception (like calling participation “engagement,” which I’m sure no self-respecting wellness professional would ever do).
Here’s my bottom line based on this incomplete and superficial exploration of the terms health, wellness, and wellbeing: Some people are inclined to see connections, whereas others are more drawn to compartmentalize. Maybe surgeons and benefits directors are more likely to see what’s tangible and quantifiable, while artists and farmers see the whole and the dynamics it contains. Both points of view probably deliver value.
Either way, I’m guessing that anyone who views health and wellness as only physical phenomena is likely to see wellbeing the same way. Others who view these concepts holistically are likely to do so regardless of the labels we attach to them.
Health, wellness, wellbeing: In the end, what we call it won’t matter as much as how we think of it…and how we act on it.
It may be too late for employee wellness professionals to adjust their plans for holiday-season programs this year, but now is an ideal time to rethink the holiday stress programs we typically offer.
Every December, wellness program managers promote programs about managing “holiday stress.” These commonly take the form of lunch-and-learns or communication campaigns. They have the usual catchy titles like Holiday Stress Less and Take the Hassle Out of the Holidays.
The holiday season is stressful for many employees — no doubt about it. And it’s distinct from other sources of stress in the workplace in that the conditions that cause holiday stress can, indeed, be modified with behavioral approaches.
But I suspect that our holiday stress programs add to employee stress. They contribute to a culture that considers stress the primary mental state in which we experience the holidays and, as such, comprise a self-fulfilling prophecy.
May I suggest a new approach to promoting mental health during the holidays, even if some of the content may be the same? Let’s offer programs that promote happiness and joy, rather than just trying to remediate stress. Next year, instead of teaching people to manage holiday stress, why not teach them how to nurture their holiday happiness? Why not publish newsletter articles like “How to Share Holiday Joy”?
Instead of “5 Tips for Managing Your Holiday To-Do List,” how about “101 Reasons to Enjoy a Holiday Vacation”? Rather than “Balancing the Burdens of Work/Life During the Holidays,” how about “Focus on Family this Holiday Season!”
[Originally posted by Bob Merberg in May 2010 on the In TEWN blog.]
Photo: The Teaching Kitchen Collaborative evolved out of the Healthy Kitchens, Healthy Lives® conference, shown here. Photo creative commons copyright courtesy Culinary Institute of America Leadership Programs. Acquired via Flickr.
A study investigating the feasibility of workplace teaching kitchens, and the outcomes that might result from integrating them with other types of health behavior interventions, may herald a new and important movement for employee wellbeing programs.
The Teaching Kitchen Collaborative — led by the Culinary Institute of America and Harvard TH Chan School of Public Health — endeavors to promote teaching kitchens as “catalysts of enhanced personal and public health” across a variety of settings, including workplaces.
The study — led by Dr. David Eisenberg, Director of Culinary Nutrition at Harvard TH Chan School of Public Health and published in the Journal of Lifestyle Medicine — set out to determine the feasibility of an interdisciplinary teaching kitchen curriculum that includes…
hands-on cooking instruction
encouragement and resources to promote physical activity
mindfulness training, and
personalized health coaching
… and to measure the program’s behavioral and health outcomes.
At the completion of 14- and 16-week interventions participants showed statistically significant decreases in body weight, body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol.
Participants who completed the program also were more likely to engage in positive behaviors, such as cooking meals from scratch at home more often, relying on ready-made meals less often, reading nutrition labels on purchased foods more often, and feeling more confident in cooking.
The study had several limitations, as the researchers noted in their published article. The number of participants was small (40 all told) and the pool of potential participants was comprised of (non-culinary) employees of the Culinary Institute of America, which meant they had state-of-the-art teaching kitchen facilities available to them. The intervention was expensive, and many of the results weren’t statistically significant or sustained over 12 months of follow-up.
Models for teaching kitchens, in the workplace and in other settings, will continue to be refined and studied. The pilot study described here represents an encouraging first step. As Harvard wrote in its summary of the findings:
With dramatic increases in obesity and diabetes, the search is on for innovative strategies to change the paths of those living with, or at risk for developing these and other lifestyle-related chronic diseases. In conjunction with good medical guidance, holistic strategies are needed.
Dr. David Eisenberg may have tapped into one winning strategy with Teaching Kitchens—a kind of cooking laboratory that combines culinary instruction using healthful whole ingredients, nutrition education, exercise, mindfulness, and personalized health coaching.
Summer’s here, and it’s time to unstrap the Fitbit and track some physical inactivity — the kind, for example, that takes place while reading. Pictured here is a pile of books that I’d recommend, or almost recommend, to wonky wellness professionals who have been at it for a while and are still searching.
You may think it weird that some of these books are old or even out-of-print. What good does an out-of-print book recommendation do you? Well, sometimes the story of a book is worth telling just as much as the story inside it.
Starting at the bottom of the pile…
Making Health Communication Programs Work.
Can you imagine there was a time — from 1989-2004, to be exact — when the US government gave this health communication book away for free? All you had to do was call and ask. This was the authoritative source on health communication — with more of a public health bent rather than employee wellness — affectionately known to health communicators as “The Pink Book.”
The good news is that you can get the final version of the book as a pdf. Who cares if it doesn’t include the last 13 years of developments? Who cares if the last entry in the glossary is a definition of “World Wide Web”? The book still covers an evidence-based approach to health communication theory and practice, with some behavioral change theory thrown in to boot. Get on it.
I’ve been studying the Hawthorne experiments for the last couple of years, and have assembled quite the collection of yellowed, musty, out-of-print books, this being one of the most important and, published in 1993, the most recent. At the heart of the matter is the field study of workers, supplemented with detailed interviews of 23,000 workers, under different conditions at Western Electric’s Hawthorne plant outside Chicago, in the 1920s and early 1930s. It stands as one of the most important studies of workers, management, and productivity ever.
While the Hawthorne researchers weren’t committed to worker wellbeing as we think of it, they did recognize wellbeing as relevant to productivity. And much of what we believe today about management styles, leadership, employee engagement, and teamwork was rooted in the Hawthorne research. Forget the fact that it started as a study of lighting, or that it had an entire category of bias named after it. Most experts today believe that if there is such a thing as the Hawthorne effect — in which research subjects change their behavior simply as a response to being observed — it didn’t occur at Hawthorne.
Let’s get real… You’re not going to read an old book about a 90-year-old study. So take 9 minutes to listen to this peppy BBC podcast on the topic. Regardless of the Freakonomics interviewee drawing an unfounded explanation of the Hawthorne findings, the podcast may start to give you a sense of how important the Hawthorne experiments are to our understanding of work, motivation, and even research design.
Yup, out-of-print — I don’t know why, as this is a seminal classic about the relationship between work and health, in which Robert Karasek, one of the most important worker health researchers of our time, lays out the case for the demand/control model of job strain.
Healthy Work may be too technical for a lot of people, but if you can get your hands on a copy, it’s great to keep around and skim through whenever you have a chance. Healthy Work changed how managers, health agencies, and labor organizations around the globe think about worker health.
Health Behavior and Health Education.
Get the 2015 version (5th edition), which is called Health Behavior: Theory, Research, and Practice. Health behaviors aren’t the foundation of employee wellbeing. (Exposures are.) But whether you agree with me or are convinced that, like people always say, “it all comes down to behavior,” isn’t it important to understand what makes health behavior tick?
This book was published in 2000 predominantly for clinicians and other wonks. It gets highly technical — so it’s not something you’ll want to read at the beach. But I keep it handy on my desk. It’s a collection of evidence documenting the relationship between work, psychosocial job stressors, and health, and suggesting a causal relationship — that is, bad jobs lead to poor health. The rigor of the studies contrasts with the vendor- and employer-fueled quasi-science to which wellness professionals are customarily subjected.
Amazon usually sells The Workplace and Cardiovascular Disease, used, for less than 10 bucks. If you want something cheaper and more current, you can try to access the article, “Globalization, Work, and Cardiovascular Disease,” published in 2016 in the International Journal of Health Services. Two of the article’s authors, distinguished researchers Peter Schnall and Paul Landsbergis, were among the editors of the book.
The only thing I find more painful than hearing our industry called the “ignorati” is noticing that we often do ignore criticism. Sure, we’ve all been paying the price for Al Lewis’s book ever since it was published, but we can be thankful that someone cast skepticism on the claims of the wellness industry. I don’t know if this is Al’s goal, but it is mine: To get better at supporting the wellbeing of the American workforce. In order to achieve this, we need to be able to assess our practices critically, and this book rallies us to do just that.
Former Washington Post reporter turned work-life balance hunter, Brigid Schulte, endeavors to wake up America to the mess we’ve gotten ourselves into by putting obsessive “busyness” and profits ahead of our kids, our spouses, and ourselves. Schulte deconstructs an American culture driven by a destructive sense of individualism and machismo that puts us on a never-ending treadmill — the unhealthy kind — as well as the policies and gender inequality that keep us there. She draws upon the experience of her own work and family life, and visits Denmark where the possibility of a better way reveals itself to her.
Health is influenced by social status — specifically, our position in the spectrum of autonomy and of full participation in society. The workplace is a microcosm for this “social gradient.” Epidemiologist and author Sir Michael Marmot, who has devoted his career to spotlighting the social determinants of health, led the Whitehall studies — investigations into the work lives and the health of thousands of British civil service workers. Whitehall II is among the most important studies of worker health, but — as with much of the excellent research from Europe and other countries around the globe — is noncommercial and, consequently, infrequently discussed at American wellness conferences. Sir Michael once wrote in Lancet,
Healthy behaviors should be encouraged across the whole of society. More attention should be paid to the social environments, job design, and the consequences of income inequality.
Of all the books in my pile, this is the one I most enjoyed reading. If it’s nothing else to you, it’s a heart-wrenching story well told. Triangle also is filled with historical detail about working life that, for many, will continue to resonate today. The importance of the Triangle Factory fire — along with the events that preceded it and those that ensued — remind us of the context for worker wellbeing, and how it represents something more profound than lower health care costs or even improved morale.
Worthwhile reading, but not in my pile:
Workplace Wellness That Works, by Laura Putnam. At this point in my career, I learn most by delving into topics that are unrelated or only somewhat related to wellness. I don’t own Laura’s book, but I flipped through a co-worker’s copy and found it to be thorough and well-researched. This is the book I’d recommend to someone who’s looking for wellness ideas or trying to assess the evidence basis for employee wellness.
Quiet: The Power of Introverts in a World That Can’t Stop Talking, by Susan Cain. Quiet raises consciousness about what life is like for the large segment — perhaps the majority — of employees who consider themselves introverts. This is relevant as we plan our wellness programs and events and target our communications. Quiet isn’t on my pile because I lent it to someone and never got it back. I’d like to think that’s some sort of endorsement.
Any text on occupational health psychology. I like The Handbook of Work and Health Psychology, but others will do. Just as we should understand health behavior if we want to influence employees’ exercise and eating habits, we need to learn the science behind stress, burnout, adjustment to change, resilience, depression, motivation, and engagement.
Even if we don’t always understand the science of worker health, we benefit from recognizing that there is science to worker health.
For those interested in evidence-based approaches to wellness, reading these or similar books will be a breeze this summer.
Resistance to offering healthy workplace food options — whether it’s raised by cafeteria operators, vending machine operators, or company leaders — is often based on a myth that assumes employees demand unhealthy food, and don’t want healthy unprocessed food.
A new survey provides some evidence that it’s time we toss this myth down the garbage disposal. According to the 2017 Food and Health Survey, conducted by the International Food Information Council Foundation:
73% of college educated consumers and 51% of non-college educated consumers use nutrition information when eating out.
76% are trying to avoid or limit sugars in their diet.
Healthfulness, along with taste and price, is a top driver of food purchasing decisions.
Women favor foods and beverages with no artificial ingredients.
60% of those who regularly use nutrition info when eating out say it’s important that their food contains only natural ingredients.
The length of an ingredient list affects the perceived healthfulness of nutritionally identical products.
Overall, Americans say they take steps to eat healthy and understand the importance of expert nutrition guidance.
Undoubtedly, the Foundation brings food-industry bias to its positions. But that doesn’t necessarily invalidate its findings about increasing consumer demand for healthy food.
Other market surveys have had similar findings. A 2015 Workplace Food Insights survey by Sodexo, for example, found that eating healthy is “extremely” or “very important” to nearly 80% of surveyed workers.
I brought this point home in an article just published by Carol Harnett — employee benefits visionary — in Human Resources Executive Online…
Good food isn’t something you’re trying to convert employees to eat. It’s a need you’re seeking to accommodate.
Check out the article to get a taste of how the need for whole, fresh, well-prepared food has been met by at least one employer.
As an employee wellness manager for a large company, I was given responsibility for dining services — cafeterias, catering, and vending machines — with the express goal of accelerating our commitment to providing healthier options.
Easier said than done.
A slew of challenges ensued, but most perplexing were those instances in which food service operations directly conflicted with wellness goals.
Converting Brown Baggers
We were hosting finalist meetings for food service vendors, and it came to light that our “participation rate”— the percentage of employees who regularly use our cafés for breakfast or lunch — wasn’t up to par. The standard in our region is about 35%, and we were well below that.
We attributed our low participation to our homebody culture and demographics that include a lot of likely “brown baggers” — employees who bring their lunch from home. Our facilities don’t have competition from nearby eateries that could’ve been drawing business away.
The vendor’s sales guy told us, “We can convert a lot of those brown baggers to café customers, so that they’re buying their lunch instead of bringing it.”
There was a long silence as our wellness-focused team conjured images of employees leaving their brown bags — with their simple sandwiches in zip-lock baggies, or leftover lasagna in Tupperware — sitting on their kitchen counter as they headed out to work in the morning with a pocketful of cash to spend at our café.
I looked at my boss and asked, “Do we want to convert brown baggers to café customers?”
The Other Side of “Nudging”
Our company needs to generate revenue in our cafés in order to keep them operating affordably for employees. On the other hand, research tells us that food prepared at home is likely to be more aligned with healthy eating compared to eating out (notwithstanding our efforts to offer plenty of healthy menu options). Eating home-cooked food is better for financial wellness, too.
We’ve faced other dilemmas: Several years ago, before it was fashionable, we started diverging the prices of “healthy” foods from the prices of foods considered unhealthy. The idea was to “nudge” customers to buy the more favorably priced healthier food. Each year, we raise prices, on average, according to the Consumer Price Index for Food (about 3% or 4% in recent years). We’d achieve the average increase by raising prices more for the so-called unhealthy food and less (or not at all) for the healthy food.
We were victims of our own success. Sales shifted from soda to bottled water, from fried food to salads, and from beef burgers to turkey burgers (this harkens back to a simpler time when experts agreed that lean meat was healthier than red meat).
The problem was that our margins decreased. We were making less “profit” because we’d nudged people to buy the least profitable food menu items. Don’t get me wrong, we hold true to the belief that we are not in the business of making money from employee cafeterias. But we all have budgets to meet.
Advocating for the Opposite
One more example: We have trays in most of our cafeterias, but for some reason they’re rarely used. A consultant observed this, noting that it was unusual. More importantly, he advised us that we could increase our “check average” (the amount of revenue earned on each purchase of a meal) by encouraging the use of trays.
Customers are limited by what they can hold in their hands, and using trays would allow them to pile on the food well beyond what their hunger level actually demanded.
Did we want to encourage trays, so that employees would buy more food than they wanted or needed? In most companies, the wellness manager would advocate for the exact opposite: Making trays less convenient in order to “make the healthiest choice the easiest choice.”
I’m proud to report that we’ve consistently opted for whatever we determined to most effectively serve the best interests of employees. Sometimes it served their nutritional wellbeing and sometimes their financial wellbeing. And sometimes it served their career wellbeing by assuring sustainability of good food at work. Sometimes it was all of the above.
Organizations are complex. It’s easy for consultants, vendors, and academics to sit in their home offices hollering at you about what you should do. But real jobs have real people, with real goals, real pressures, real personalities, real challenges, and real conflicts.
Seeing the big picture, and recognizing that it can be viewed from different angles, sometimes is the first step to success.
Wellness experts emphasize the importance of sleep, and vendors promote sleep-tracking devices, apps, and programs. But little is said about the job conditions necessary to assure workers have the opportunity to get the sleep they need.
It’s hard to get eight hours of sleep if you’re only home for five or six hours between your evening shift and your morning shift. And that’s where “clopening” comes in. The term commonly applies to schedules in which part-time retail and fast food workers are required to close the store late in the evening and open early in the morning.
Clopening gained notoriety in a 2014 New York Times story about the life challenges a Starbucks employee faced as a result of “just in time” (last minute) scheduling that included clopening. In the minds of activists, unpredictable scheduling and insufficient rest periods between shifts have been linked ever since — appropriately so, as both practices tend to coincide and threaten employee wellbeing.
These scheduling practices also go hand-in-hand with schedule fluctuation (like working eight hours one week and 40 hours the next) and inflexibility. According to a report by the University of Chicago, unpredictable, fluctuating, and inflexible scheduling undermine almost every dimension of workers’ wellbeing, including the physical, mental, family, occupational, and financial realms. The report’s author, Susan Lambert, was quoted in a follow-up Times article as saying:
This particular form of scheduling — not enough rest time between shifts — is particularly harmful.
Through literature review, original data analysis, and focus groups, we find that the health and well-being of workers is undoubtedly compromised by unpredictable work schedules.
Even prior to the original New York Times exposé, and increasingly after it, municipalities have considered “secure scheduling” legislation to limit schedule unpredictability, fluctuation, and, yes, clopening.
In 2014, San Francisco enacted the Formula Retail [i.e “chain store”] Employee Bill of Rights, which requires covered employers to provide employees with two weeks’ notice of work schedules, advance notice of schedule changes, and additional pay for schedule changes made on less than seven days’ notice and unused on-call shifts.
Employers inevitably resist regulation. But if we are as committed to employee wellbeing as we say we are, we should evaluate and address scheduling practices proactively.
Leadership sometimes emerges where it’s least expected — in this case, Walmart. The mega-retailer recently phased in new processes — on the heels of improvements it made to compensation and occupational development — in order to make scheduling more flexible and predictable for workers. The Washington Post reported that, based on early results, workers with access to the new scheduling system experienced an 11% decline in absenteeism and a 14% drop in turnover, “which comports with what academic research has shown is possible with greater predictability and worker control.”
[This post is adapted from one originally posted by Bob Merberg on September 19, 2016 on the Healthshifting blog.]
As the article mentions at the end, community cookbooks are still alive…
Community cookbooks are worth flipping through if you come across a boxful at a garage or used book sale… You may find a current self-published book from a group connected to your own community.
Employee recipe books are a form of community cookbook. They help employees build community at the workplace and — in the context of the type of cookbooks Gig Goodies will produce, they help workplace health seekers rally around a more hospitable work environment.
Make-your-own fruit cones (photo, below) are the perfect fresh-food option for workplace meetings and events.
They’re easy to serve, and attendees will love the novelty, the choices, and the refreshing sensation. And, unlike what may be served at, say, an ice cream social, your attendees will feel energized and ready to go after this delicious treat.
But Berkowitz is more captivated by the social norms candy bowls reveal. Why do people have candy bowls? What’s the personality profile of those willing to snag the last morsel? Was Forrest Gump’s mama right about life?
Check out the Post article for life-changing answers to these and other questions about office candy bowls.
Employees at many workplaces have a big role in shaping their environment. Sometimes those environments can be harmful. Nowhere is this more clear-cut than in the environments employees — in many offices — shape via their nutritional and food-sharing practices.
I’m not talking about employee cafeterias and vending machines — food provided by employers. They’re important, but receive due attention.
This is about employee-provided grub — a harder nut to crack.
As wellness professionals, it’s tempting to overlook the less-than-wholesome food shared at workplace birthday celebrations, the candy passed around at meetings, the treats at trainings, the potlucks, the chocolate that co-workers sell for their kids’ fundraisers, the “food days,” the desktop candy bowls, munchable business gifts and giveaways, breakfast donuts for the staff, leftover halloween candy, Friday ice cream socials, and so on. In fact, with a wink and a nod, we may sometimes enable this culture in our desire to buddy-up to co-workers.
Speaking of buddying up, let’s not forget sugary rewards doled out by managers — a demeaning ploy applied to school-children, and no better with workers.
My awareness about shared-food has been raised after listening to employees’ complaints about it or overhearing those who indulge while engaging in self-talk about lack of willpower, excess body weight, or plans for self-punishment. Unhealthy eating environments foster a culture of guilt. And guilt is fundamentally incompatible with wellbeing.
As I’ve chatted with employees and employers, my mention of the overabundance of indulgent food at work is met with knowing groans.
As a manager responsible for cafés, catering, micro markets, and vending machines at my own workplace, I’m fully aware of the behavioral economics manipulations we can use to make the healthy choice the easiest choice and the policies we can create to support healthy eating via the food channels under an employer’s control.
But I also know these efforts are for naught if candy, pastries, soda, and pizza are dangled in front of workers in every break room, displayed on credenzas along every aisle of cubicles, served at every event because “people will always come for free food,” and generally tempt employees everywhere they turn.
I’ll post more on this topic in the coming days and weeks, and explore strategies to understand and influence the pervasive sharing of unhealthy food. Throughout, I’ll challenge some of my own assumptions — and perhaps some of yours. For now, mine include:
A lot of workers want to make healthier food choices.
Acting as “food police” always backfires.
No food is bad when consumed occasionally.
More choice is rarely a successful strategy to support healthy eating goals.
Employers aren’t obligated to provide unhealthy foods.
Workplace eating touches multiple dimensions of wellbeing.
Workers should never be shamed regarding their body weight, food choices, or anything else.
Different channels of food at work — cafeterias, vending machines, food brought from home to share, treats and celebrations, catered events, farmers’ markets or local produce delivery — interact to create a nutritional milieu.
Habits like desktop dining, skipping lunch, eating alone, and brown-bagging vs. buying are vital pieces of the workplace eating puzzle.
A couple of years ago, I wrote that partnering with local farmers — via community-supported agriculture — could be the best wellness thing an employer can do. Based on the experience of at least one employer with 10,000+ office workers nationwide, I may have found my next best thing.
A survey completed by employees at this firm showed “healthier food at meetings, in cafeterias, and in vending machines” to be the second most requested wellness offering (after gym membership discounts). And 30% of employees who reported having unhealthy eating habits said they were actively engaged in trying to improve them. Some employees want to eat healthier.
The employer had, years ago, dug into a bag of age-old merchandising tricks that had become trendy when some bestselling author dubbed them “behavioral economics”: pricing healthier food more attractively than unhealthy food and making the healthiest choices the easiest choice.
The behavioral economics nudges had some success, but there was another obstacle afoot for employees who wanted to make healthier food choices…
Eating healthy is not always easy for consumers during the work day, with a little over half finding it only “somewhat” to “not at all” easy…Most attempt to eat healthy, but encounter challenges along the way. Some backslide the rest of the day and continue to indulge and eat less healthy as a part of a more emotional cycle of guilt and reward.
Free food is everywhere in offices and call centers. Sometimes it’s provided by employers, like not-so-refreshing refreshments served at long meetings and special events, or sweet treats used to reward workers the way you might use Milk Bones to reward a paper-trained labradoodle.
But much of it is introduced and shared by co-workers. I’ve previously described workplaces flooded with cakes, candy, and other treats, and cited studies that coined the terms “food altars” (where leftovers and treats are reliably displayed) and “cake culture.”
Navigate around the 'food altars' & head to the water cooler – Avoiding the high calorie office snacks https://t.co/Yk3bXG7IR9
The challenge this employer faced was how to meet the needs of employees seeking healthier choices and a healthier environment — without taking on the role of “food police.”
A pulse poll found that, when co-workers brought in treats, 23% of this company’s employees ignore them because they don’t fit into the respondents’ eating style, diet, or health concern; 9% sample some to be polite but “wish it wasn’t there”; 8% tend to overindulge and “feel gross after.”
Did I mention that some employees want to eat healthier?
When asked what type of foods they are most likely to bring to an office potluck, 32% of respondents from a separate poll of the same employees said they’d contribute an indulgent dessert; 15% said they’d bring “pizza and wings, or something like that”; only 16% said they’d bring a healthy dish; and 12% said it depended on their co-workers’ dietary concerns.
Not much can be concluded from informal poll data, but at first it may seem like there’s a reasonable match between employees that bring treats and those who consume treats. That’s not a problem if workers are only bringing in food, say, once every week or two.
But “cake culture” isn’t about what happens once every week or two. It’s about what happens every day. That’s what makes it cake culture… and not just…you know…cake.
If the majority want to have their next slice of cake within arms’ reach all day every day.…what about those who don’t?
Remember that “choice” thing? Does it only apply to those who fall into a narrow majority?
Some will argue, “Who cares?! It’s a matter of personal will. Employees who don’t want unhealthy food don’t have to eat it!”
Did I say “some will argue”? Nix that. Most will. But this stance reflects an unfounded belief in willpower, which has little to do with behavior (or obesity, in case you’re interested), a lesson even many wellness professionals have not yet learned.
Research has shown that people who demonstrate what might appear to be a high level of willpower generally are not exercising willpower at all, but in fact craft their environments in a way that supports specific behaviors. If anything, some researchers have said, naive faith in willpower reduces your chance of adopting a healthy behavior.
This employer endeavored to support the normalization of healthy food, so that the needs of employees seeking healthier choices, even if they weren’t a majority, were not drowned in a sea of cake, candy, cookies, pizza, and chips.
In an upcoming post, we’ll see how this employer leveraged a feel-good crowdsourced tactic to support employees when their own workplace food culture sometimes failed to do so.
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.
Congratulate 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.
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 AriannaHuffington
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.
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:
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.
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.
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.
In 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.
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).
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:
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.
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.
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.
It may be hard to get your brain around abstract models of stress, especially when they don’t line up with the usual fright-or-flight illustrations or seem remediable by the relaxation tips commonly sold as solutions. But if we care about workers, and how employers may be able to help them, we can’t ignore the harmful effects of effort-reward imbalance.
Think back to Psych 101 and you’ll remember that most human transactions are based on our expectation of an even exchange, or social reciprocity. It’s like an unwritten contract. We’re hard-wired for evenhandedness, and when we get — or believe we’ve gotten — a raw deal, we suffer from physical and emotional stress.
In the workplace, employees trade their currency — effort — for the employer’s currency, rewards, which include:
job security and prospects for promotion
respect and prestige within the organization
The balance — or imbalance — of effort and reward may be influenced by an employee’s motivational style, especially for employees who are intrinsically driven to overextend their effort independent of rewards, often to fulfill their underlying longing for approval. This surfaces as “overcommitment” in the effort-reward imbalance model.
When physical and or mental job effort outweigh the reward — or employees perceive the balance to be out of whack — the result is chronic stress and, over time, the physical and mental problems that stress can lead to.
This understanding of work stress was first conceptualized by medical sociologist Johannes Siegrist.
The model of effort rewards imbalance claims that lack of reciprocity between costs and gains (i.e., high-cost/low-gain conditions), define a state of emotional distress with special propensity to autonomic arousal and associated strain reactions.
Siegrist’s theory was put to the test in Britain’s classic “Whitehall II Study,” which followed more than 10,000 civil service workers for 11 years. Results showed that effort-reward imbalance led to increased risk of cardiovascular disease, as well as declines in overall physical and mental health. Study subjects who were lower on the organizational chart and those with less workplace social support had the highest levels of risk among those with effort-reward imbalance. Since then, research has shown even more pronounced effects of effort-reward imbalance, especially on the risk of heart disease and depression — based on rigorous studies of employees in a wide range of occupations working in countries across the globe.
The Whitehall researchers, led by social determinants of health pioneer Sir Michael Marmot, felt their results showed that cardiovascular disease and other stress-related illnesses could be prevented by improving work conditions. Their work led to a campaign to encourage employers to:
Improve rewards by recognizing good job performance
Encourage job-skill and professional development
Foster social support at the workplace
Siegrist has proposed additional solutions:
Leadership development among supervisors, emphasizing the importance of esteem, recognition and appropriate feedback.
Building upon non-monetary rewards, like flexible work options, more effectively matching job status to achievements, and fostering job security.
Effort-reward imbalance is one of the two most influential frameworks for understanding job stress, alongside the demand-control model of job strain. In fact — despite our preoccupation with other models that push accountability for stress solely on workers — regarding both demand-control and effort-reward imbalance, Siegrist wrote in 2014:
Empirical evidence on their health-adverse effects is far broader than is currently the case for any other stress-theoretical model related to work and employment.
Ultimately, most elements of the psychosocial work environment can be plugged into one or both of these models.
Whether effort-reward imbalance is a product of employee perception or actual work conditions remains a topic of debate. Most likely, both play a role. Certainly, job demands and job control have been validated as causes of cardiovascular disease and high blood pressure, in contrast to trendy notions that stress is a mindset or is a good thing and that employees are on their own to address it. The role of personal interventions is to help employees with problem-solving skills that can help them advocate for themselves, assess their level of effort as objectively as possible and, in some cases, moderate overcommitment. Stress management and resilience programs may play a supporting role.
Last 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.)
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
And — again, using secondhand smoke as a benchmark — the conditions that had a greater affect on mortality are:
Low job control
Long work hours
Lack of health insurance
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.
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
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.”
Job strain is a particularly insidious form of stress that goes far beyond overflowing inboxes or tight deadlines. It is characterized primarily by organizational environments and job structure in which employees have high levels of demands placed on them and limited control over those demands (that is, low “decisional latitude”). This is the demand-control model that was originally described and measured by Robert Karasek. Other organizational and job-related factors that contribute to unhealthy job-related stress are effort-rewards imbalances, long work hours (sometimes including long commutes), job insecurity, and lack of social support on the job. Some researchers have categorized all of these stressors as job strain, others differentiate them. But most agree that these stressors — all related to organizations and job design and not to individual behavior — lead to negative health outcomes.
How unhealthy is job strain?
Job strain has been linked to hypertension and to heart disease. This is not a simple matter of people who have other risk factors, like pre-existing hypertension or what used to be called Type A personality, being drawn to stressful jobs. Research suggests a causal relationship between job strain and both hypertension and cardiovascular disease. (Some studies also have linked job strain to depression, musculoskeletal disorders, dyslipidemia, physical inactivity, obesity, and adverse birth outcomes.)
Blue collar workers are more prone to the effects of job strain compared to white collar workers, but no one is immune.
Not every study of job strain has confirmed this relationship, but most have. A 10-year prospective study of 22,086 female health professionals, published in 2012, revealed that women with active jobs (high demand, high control) and high levels of job strain (high demand, low control) were 38% more likely to experience a cardiovascular disease event (such as heart attack or diagnosis of atherosclerosis) compared to women reporting low job strain. During the study, there were 170 myocardial infarctions, 163 ischemic strokes, 440 coronary revascularizations, and 52 cardiovascular-disease-related deaths, reaffirming that cardiovascular disease is a major concern for employers and for public health.
A Finnish study of 812 employees, followed for more than 25 years, found that employees with high demands at work and low job control had a 2.2-fold increased cardiovascular mortality risk — independent of other risk factors — compared to their colleagues with low job strain.
Earlier this year, an Israeli study confirmed a link between job burnout and coronary heart disease. Job burnout was defined as physical, cognitive, and emotional exhaustion that results from stress at work. Factors contributing to burnout included most of those typically associated with job strain or job stress: heavy workload, lack of control over job situations, lack of emotional support, and long work hours. Over the course of the study, 8,838 male and female employees were followed for an average of 3.4 years. Each subject was measured for burnout, which, as it turned out, was associated with a 40% increased risk of developing heart disease. Of greatest concern, the 20% of participants with the highest burnout scores had a 79% increased risk of heart disease.
A British study of 6,014 workers, followed for an average of 11 years, found that three to four hours of overtime per day is associated with a 1.6-fold increase in coronary heart disease risk, independent of other risk factors. (More about overtime in a future post.)
Countless research studies have demonstrated the relationship between job strain and health.
Unlike many other countries (again…especially Scandinavian countries), American employers continue to insist on offering employees behaviorally based stress management programs, such as relaxation programs and time management seminars, rather than trying to address the program where the employer actually has the most control: the structure of the organization and the jobs within it.
Even the National Institute for Occupational Safety and Health declares, “Working conditions play a primary role in causing job stress” and it advises,
As a general rule, actions to reduce job stress should give top priority to organizational change to improve working conditions.
Check out the NIOSH page for some ideas about the type of organizational change that is needed.
Emphasis on the organization’s role, rather than the employee’s role, may have applications beyond stress. Fitness challenges, biggest loser contests, tobacco-free campuses, incentives, health risk assessments, coaching, health screenings, yoga classes, and even culture-of-health have limited potential to evoke meaningful population health improvement…as long as the roots of the problem persist.
[A version of this post was first published on Bob Merberg’s Health Shifting blog on December 20, 2014]