By Donald Ardell
On May 26, 2020, the Journal of the American Medical Association (JAMA) published a research paper entitled, “Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical Use.” The article described a two-year randomized clinical trial of 4,834 employees at a large U.S. university.
The result was as follows:
Employees who joined the wellness program showed no significant differences in biometrics, medical diagnoses, or medical use relative to the control group. The intervention increased self-reports of having a primary care physician… but did not significantly affect clinical outcomes.
The JAMA edition also contained an invited commentary by Jean Marie Abraham entitled, “Taking Stock of Employer Wellness Program Effectiveness-Where Should Employers Invest?”The author prefaced her commentary with this overview:
Today, most large U.S. employers offer their workers access to wellness programs as part of their compensation. These programs typically include a coordinated set of activities for employees to assess their health risks and engage in lifestyle behavior modification. Historically, employer investments in these programs have been motivated by the prospect of an economic return in the form of lower employer medical costs for workers and increased worker productivity resulting from disease prevention or improved management of conditions, such as diabetes, heart disease, depression, and lower back pain.
Enthusiasts and nay sayers can’t agree on much, and they particularly disagree about:
- Whether worksite wellness benefits the sponsoring organization, that is, delivers positive returns on investments.
- Whether employees get healthier as a result of participation.
- What incentives, if any, are effective in motivating workers to engage in such offerings.
- Whether and to what extent productivity, morale and/or other factors are affected, for better or worse.
Naturally, wellness promoters, particularly those supported directly or indirectly by worksite wellness, are enthusiastic and think the programs, if done well, are gloriously wonderful and beneficial. Nearly all wellness promoters wax eloquent on the advantages to participants, companies, the community, the nation and even the planet. Detractors are not impressed; some go so far as to proclaim that worksite wellness does more harm than good.So, what is the reality?
Well, you’re come to the right place to find out. The short anwer is this: We don’t know.
But, you might ask, what about the JAMA study noted above, and the assessment of it? Don’t these recent scholarly research project answer these questions?
No, they don’t and I can explain why not.
For nearly fifty years, I’ve promoted the idea that wellness educational offerings at worksites should be entirely separate from medically-based, so-called wellness programming, which is almost always dominated by medical personnel conducting medical activities. The study and the report about it demonstrates that nothing has changed, though consideration is now focused on what kinds of goal posts to erect as measures of return.
The invited commentary notes that the CDC suggests wellness programs should be even further diluted, in homeopathic fashion, with other fringe benefits (e.g., health insurance, employee assistance programs). Doing so would only insure that there are no genuine wellness molecules left in any such offerings.
A REAL WELLNESS ASSESSMENT OF THE STUDIES
The JAMA article is a waste of words. The authors don’t know what they’re talking about. The study design is weak because their thinking about wellness is feeble. If public funds were used for this project, those responsible should be prosecuted.
While the study assessed programs with the name wellness attached, the programs described were almost entirely prevention, medical compliance and risk reduction, not health enhancement, not activities having much to do with enjoyment of life or otherwise focused on positive wellness education. The commentator claimed that 80+ percent of attempts at reform do not achieve lasting change. I’d be surprised if any such program as this faux worksite wellness endeavor ever enabled employees to understand and adopt REAL wellness commitments as part of their everyday lives.
It would be more than enough to offer education that enabled people to improve their reasoning powers. No such efforts were noted in the program surveyed. What about increasing the prospects for employees to enjoy more exuberant living off the job? None of that was noted. How about growing interest in and skills for exercising as part of daily life and even methods for selecting healthy meals? Some such efforts were included but were diluted by all the medical testing and disease avoidance training. No attention seems to have been devoted to teaching personal strategies for increasing freedoms to live more in accordance with how employees would like to live.
Worksite wellness leaders might consider the following reforms:
Keep the medical and prevention offerings that exist, but separate all of it from positive wellness education, defining REAL wellness in ways that removes the concept from the grab bag of risk reduction and omnibus health education offers.
Don’t expect near-term medical improvements regarding diseases, but rather focus on biometric measures of well-being, physical and mental.
- Don’t expect medical or economic outcomes, but give employees choices-and ensure the choices are of the kind that will appeal to workers. You won’t have to pay people to learn, practice and sustain attitudes and behaviors that provide quality of life, satisfying returns. Why continue efforts that only 32% of employees believe will boost their lifestyles or (40%) say will meet their needs?
Wellness programs should focus on reason (critical thinking skills), exuberance (happiness/meaning, etc.) athleticism (exercise and nutrition) and liberty or how to gain increased personal freedoms.Cultural and other supports are essential. Most of us who are enjoying effective lifestyles got started on those paths from splendid modeling by influentials in our early lives, and the environments (people and resources) that made flourishing easy and natural.
All this will require strong support from company leaders.Dr. Judd Allen commented on my critique of this study, suggesting thatwhen people become part of supportive environments and groups that exhibit healthy attitudes and behaviors, they are much more likely to value their wellbeing.
Let’s hear it for cultural support and REAL wellness. Medical and prevention programs disguised as wellness have no possibility of reaching the hearts and minds of employees.