The Amateurish Quality of Many Corporate Wellness Programs
Are employers really serious about employee health? If so, they need to move beyond giving employees generalized platitudes such as "get more exercise" and get down to scientific evidence (biometric screenings) supporting improved health. How many employers know the best test available to check their employees' risk of heart attack?
When we get down to that level, we can start making real progress. But all this talk about "setting goals," and "getting patients involved," seems to be missing the mark. People are naturally intelligent enough to opt for choices that will improve their health if they are given education about what to check and see proof that the interventions really work.
COMMENT: Improving the quality of people's health needs a broad education and information sharing approach. Such an approach worked very well for me thirty-two years ago when I was in a severe stress burnout. My first hair mineral analysis showed that I had a significant magnesium deficiency that put me at very high risk for diabetes and a fatal heart attack.
I was very fortunate that a Ph.D. educator friend and colleague knew more than my medical doctors about severe magnesium deficiency and its relationship to glucose regulation problems and heart attack risk. Gradually, the word is getting around to more people about the epidemic of magnesium deficiency. Magnesium and other supplements have worked very well for me for the past 32 years.
REPLY: Like you, I take magnesium supplements daily and have been doing so for years. In the past month, I switched from a magnesium oxide dominant ingredient supplement to one featuring exclusively magnesium citrate. The magnesium citrate is more expensive, but it creates a much higher bioavailability of magnesium than the oxide form. Again, how many employers are smart enough to have someone run their wellness program who understands, and can convince the average employee, to consider well known deficiencies in the American diet and take corrective action? In addition to magnesium, most (maybe 98%) Americans need Omega 3 fatty acid, Vitamin D, Vitamin E, Vitamin K, Vitamin B-12 sublingual, and folic acid supplements.
COMMENT: Whether corporations are serious about the quality of wellness is a very good question, and requires considerable soul-searching. A careful examination of the risk factors for disease shows that most are valid, yet some are based on beliefs that are hard to substantiate using 2012 measurement capabilities and understandings.
Scholars of the history of scientific thought are quick to point out how xenophobia can eradicate decades of quality research in an instant, replacing evidence with anecdotal descriptions of the beliefs of a home-grown expert.
I believe that most employers are serious about improving the quality of employee health, but the information that they receive through the popular press (or influenced by trade groups with a vested interest) may be so skewed that it interferes their ability to make data-driven decisions.
REPLY: The reason so many corporate wellness programs appear amateurish to a professional health outcomes researcher is that they provide general encouragement such as discounts on area fitness club memberships, but that does nothing by itself to reduce risk of diabetes, obesity, cardiovascular disease, stroke, or any of the other cluster of diseases known as the Metabolic Syndrome.
Instead, to improve cardiovascular disease risk, employees need to be educated about how to determine optimal cholesterol measures. Most employees know their "total cholesterol" number, but that number by itself tells us nothing about the employees' overall health. With a more sophisticated approach, all staff would be educated to measure and routinely monitor every 3 - 6 months (depending on whether medications are changing) the total cholesterol/HDL ratio or alternatively the LDL/HDL ratio.
Aside from calculating the ratio, employees need a target level, e.g., to drive Total Cholesterol/HDL to 3.2 or below. Most corporate wellness programs are clueless about these kind of sophisticated measures of wellness. Similarly, every staff member should get a high sensitivity C-reactive protein (CRP) blood test, because it represents the best measure of heart attack risk available at this time.
The corporation should pay for those tests (The C-Reactive Protein test is $15 or less), and then follow up by telling staff what scientific evidence shows about risk of heart attacks for various levels of CRP. Again, most corporate wellness programs seem clueless about CRP, and so they do little or nothing towards preventing the leading cause of death for both men and women in America.
COMMENT: You pose a great question. I would suggest that there are two answers. On the one hand there are employers who fall into the category of having some of the following criteria: they have large workforces, large pension funds, an aging workforce, a workforce that is firmly entrenched, unions. These companies are faced with high current and potential future costs involving health care.
They are facing both a real immediate cost issue and a mounting future cost issue, and to them employee wellness programs translate literally to long term cost cutting. So, yes, they will care about wellness programs that have the best disease prevention tactics included, but they do so from a financial sense. I highly doubt it is for the moral reason of truly caring for employee health.
The second group are businesses that fall into the category of being - small, younger, start-ups among others. These businesses I believe do not care about using the best possible information to prevent disease because - they cannot afford it, given the younger age of their workforce and the likelihood of 2-3 year turnover times, and various other reasons. They are more apt to do wellness programs as a value added, perhaps for retention and perception.
REPLY: My sense is that the employers with large workforces who adopt wellness programs for long term cost cutting think they have effective programs, but they are still amateurish in their approach. For example, how many of these wellness programs ever discuss the therapeutic benefits of high dose Vitamin D for the immune system and for prevention of certain cancers including colon cancer and breast cancer? Probably none.
If your doctor recommends you take 1,000 IU of Vitamin D daily, that dose is way too little. Most Americans will find they need 10,000 IU of Vitamin D daily in order to boost serum 25-hydroxy Vitamin D levels up to 50 ng/mL and above. Similarly, there is increasing evidence that systemic inflammation is the root cause of numerous diseases ranging from hypertension to certain cancers to Alzheimer's disease.
One of the best "drugs" we have available to combat systemic inflammation is Omega 3 Fatty Acids. If all employees and the general population would consume therapeutic doses of Omega 3s, we could cut the incidence of cardiovascular disease and other medical conditions in half.
The point is that including a "program of wellness and prevention" in an employee benefits packages turns out to be rather meaningless unless it takes advantage of ongoing research on prevention of diseases. For example, look across the vast universe of employee wellness programs. How many of these programs pay for employees to learn through a blood test their precise risk of developing diabetes?
Diabetes is described as an epidemic, and surely it poses a risk to employees as well as the general population. The Center for Disease Control estimates that 75 million Americans are prediabetic, and that 90% of the 75 million have no idea they are prediabetic, because they have never been tested. So what is the correct test to use to check for diabetes risk?
It is the same test used to define diabetes clinically. If you think it is the fasting serum glucose test, you would be wrong. The fact that 99% of so-called "wellness and prevention programs" do not even offer the basic correct test for diabetes makes these programs look amateurish. The same could be said for stroke risk, heart disease, and all the other leading causes of (premature) death for men and women.
COMMENT: It is good to learn that there are corporate wellness programs that break from the common "amateurish" wellness strategy that are virtually of little value and pursue true preventative health. I applaud the belief of the author that individuals need to take responsibility and initiative to achieve their own well being.
Corporate employee health needs to be there to support these endeavors. One element of concern is motivating the individual to take responsibility, and do the work, to achieve their own well being. Also, how do we motivate senior management over corporate health to move away from 'amateurish' programs to a solid health and wellness offering?
ANSWER: You asked some great questions. Concerning motivating patients to take responsibility for their own health, I had this same question come up at a Continuing Legal Education seminar on the Affordable Care Act. The room was filled with lawyers, and they said their clients are not going to take the time to read about prescription drugs or learn the best treatments for some illness.
Against this pessimistic view, we know that more and more consumers are using the Internet to research medical conditions and treatments. In fact, doctors sometimes exclaim "Everyone is a doctor now," meaning their patients come to them with their own diagnoses based on symptoms and have researched drug treatments and blood tests.
Motivating people to proactively manage their health will be difficult if health topics in general are foreign to them. I am cautiously optimistic that the Internet will equalize information and make health outcomes research more readily available to the general public. Your second question was how to motivate senior management to move away from an amateurish approach.
Firms are always trying to gain an advantage over their competitors. If one firm would stand out from the crowd and offer a first-rate wellness program complete with tests for hemoglobin A1C (everyone should know his or her A1C number, and hopefully within 10 years people will know it the same way they now memorize their last cholesterol result), C-reactive protein, and others, then it would serve as a model against which other corporate wellness programs might be compared.
Surprisingly, I have yet to find even one single firm with this approach. Even when I looked at the wellness program of a corporation that runs one or two large hospitals and ten smaller hospitals in central Texas, this hospital management company did not sponsor any of these blood tests for its thousands of staff. If a health system company that employs hundreds of doctors and thousands of nurses is not doing wellness correctly, what hope is there for firms in other industries?
COMMENT: One thing that I have found is that employers, who do initiate wellness programs, see results. I previously worked at a company that had instituted many different wellness initiatives into the employee's schedules, whether it is a smoking cessation course, weight watchers, even zumba classes!
By giving the individuals a short amount of time whether it is 30 minutes on the clock to go weigh in for weight watchers or an hour off the clock to participate in zumba class, the participants realize their company and their executives care. It is not a forced wellness program, because people will not change if they do not want to change.
I agree with you that it is hard to change when there are hospitals that do not incorporate a proper wellness program into their businesses. The way I see it, the companies who are instituting and have instituted these wellness programs are gaining an upper hand as we discuss this issue. Employers who have instituted true wellness and preventative care programs should begin to see results that affect the levels of absenteeism among employees participating.
All this will also affect their levels of productivity while at work and results are typically seen within the first 12-18 months, sometimes sooner depending on the size of the company. For so long we have lived in an environment that turns the other way while employees are off the clock. As long as you showed up to work on time, that was good enough. Those days are slowly coming to an end, because we now are seeing how the choices we make outside the office affect how much we get done in the office.
REPLY: You indirectly raised a question that I have been struggling to answer. You mentioned that employers need to see results, also called a return on investment (ROI), for wellness programs. Most of what I call "wellness" involves looking for disease conditions that show the first signs of onset around middle age and looking for ways to prevent them.
Essentially, we intervene and take steps now in the life of an employee at age 45 to prevent an early death at age 80. Similarly, reversing the course of diabetes so that an employee now tests in the normal range for three-month average serum glucose can be expected to add years to that person's longevity, maybe even a decade. But most employers have no pecuniary interest in seeing that the employee is healthy and robust during his or her retirement years.
In one sense, wellness might be called age management medicine, but the benefits often are so long term that they cannot be captured as financial rewards by employers. I would like all employers to take steps to improve the quality of health of their employees, because it is the right thing to do.
For example, employees should be encouraged to take a therapeutic dose of Vitamin D, because it not only boosts the immune system, but it is also a key element of prevention of osteoporosis, and clinical studies have shown patients with a therapeutic dose of Vitamin D cut their risk of colon cancer by 30%.
Most employees would feel loyalty to a company that demonstrated it was looking out for their long-term health, even beyond the period of employment.We frequently see corporations making charitable donations, and they do not make these donations with the expectation of getting increased profits in return.
Instead, these donations are based on the corporation's altruism and desire to be a good neighbor in their community. That same philosophy of altruism and helping others without expecting anything in return would justify the investment in a quality wellness program for employees focused on achieving compression of morbidity into as short a period as possible at the end of one's life.
