Financial Wellness

Employee Health Literacy Heats Up!

One of the enduring mysteries of "empowering" employees to spend their own money on purchasing healthcare is how employees can do that without understanding how to purchase healthcare. It turns out they can't. A study in JAMA Internal Medicine showed almost no one in a high-deductible plan is feeling "empowered." As the study's author said: "Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits."

One of the other enduring mysteries of employee health is why companies obsess with "achieving a culture of health" but have no interest in "achieving a culture of health literacy"? How can you have the former without the latter? It turns out you can't. For instance, a wellness program participant with metabolic syndrome sent me a letter from her employer's vendor (a letter which I have permission to forward, upon request -- and it has to be seen to be believed) which advised, among other things to:

  1. "Eat healthy foods"
  2. "Eat a healthy diet"
  3. "Eat healthy foods that are low in trans fats"
  4. "Include nonfat dairy in your diet"
  5. "Limit salt intake."

Absent some education in health literacy, how would an employee know what "healthy foods" are? How many employees know where trans fats are hidden? And absent health literacy, how would an employee know that the fourth and fifth recommendations from the employer's wellness vendor may very well be wrong? The funny thing is, this entire letter - all 3 single-spaced pages of it -- contained precisely two words of advice about preventing diabetes ("avoid sugar") even though the employee's screen had revealed metabolic syndrome.

For companies that have a sufficient budget and don't mind employees spending work time on the phone, coaching might fill the education gap, except that this employee's coach spent only literally two minutes on the phone, telling her to "keep doing what you're already doing."

What do we assume employees know?

Many wellness vendors apparently assume employees automatically know what to do once they are told what to do, meaning that they are walking encyclopedias of nutrition trivia. (Keep in mind these are the same vendors whose health risk assessments routinely alert employees to the presumably hitherto unrecognized importance of buckling their seat belts. My company, Quizzify, isn't the only company baffled about this dichotomy.

Medencentive, another employee health literacy company, is also flabbergasted at how much knowledge doctors and wellness vendors assume employees have.)Wellness vendors are wrong about this. There is plenty of valuable nutritional information that employees don't know. Consider sugar, for example. The food companies have developed myriad ways of hiding sugars.

One top-selling granola bar lists "organic brown rice syrup" as its first ingredient. On Quizzify quizzes, only 10% of employees successfully identified this as sugar. Another top granola bar has hidden ten different added sugars in its ingredients label, but most employees guessed only three.

And that misinformation covers just one category of food. Cereals are the mother lode of hidden sugar. The New York Times recently analyzed the top-selling cereal, Honey Nut Cheerios. General Mills does exactly the same thing as the granola bar companies: they divvy up their sugars so that "oats" would show up first on the ingredients list, with sugars being three of the next five.

It turns out that Honey Nut Cheerios has nine times the sugar of regular Cheerios. Who knew?Are employees supposed to know this about Honey Nut Cheerios just from being told to "avoid sugar"? If employees already knew this, it wouldn't be newsworthy and yet there it was, right in the New York Times.Likewise, consider the third piece of advice above: "avoid trans fats." Excellent advice, since these artificially created fats do cause heart disease.

Yet how many employees even know what a "trans fat" is? How to spot them? It turns out spotting these fats is very tricky because a food can contain trans fats and still list "0" trans fats on its label, due to the magic of rounding down. The only way to tell if a processed food contains artificial trans fats is by squinting through the ingredients label in search of the word "hydrogenated."Once again, who knew?

And, by the way, artificially added trans fats are all scheduled to be removed from the food supply in 2018, mooting this entire question.You guessed it. Who knew?And, as regards the fifth piece of advice, reducing salt intake turns out to be a bad idea for people at risk for diabetes without hypertension. You're a step ahead of us. Who knew?

Colorado Business Group on Health (CBGH) to the Rescue

Yet, until now, employers have refused to invest in employee health literacy, leading me to wonder whether there was an argument in favor of employee ignorance that I was simply unaware of. Fortunately, that turns out not to be the case. In response to demand from its members, the Colorado Business Group on Health, through its subsidiary Knowledge Benefits, has created the first-ever continuing education course for human resources executives focused on health literacy.

The Society for Human Resources Management confers an hour's credit. (And, no, you don't have to live in Colorado. You just need to have a credit card with a spending limit of at least $99.)The course and quiz cover a variety of topics that both you and your employees should know but likely don't. It's not just about the sugar in a granola bar or hydrogenated oils on an ingredients label.

There is a great deal of misuse of the healthcare system and harms to employees, caused by employees and employers failing to understand health and health care. This increases costs and can negatively impact health. For instance, consider one major operation performed 400,000 times a year. Yet 99 percent of the surgeons at a conference - the very same surgeons who perform these operations -- admitted they themselves would "absolutely not" get one.

Wouldn't you want your employees to be aware of this little factoid while deciding whether to spend $80,000 of your money on one of these surgeries? So as not to "cheat" on continuing education credits, we won't give away the answer here. Suffice it to say that this is one of many factoids, either in the CBGH curriculum and/or in health literacy in general, where more knowledge leads to better decision-making, and better decision-making saves money and improves outcomes. Or, put another way: "Is there any other expense category where you give your employees an unlimited budget but no training in how to spend it?" I didn't think so.

Learn about how you can become a Certified Corporate Wellness Specialist→