is your employees’ health their private matter?

May 20, 2010

in wellness

my health’s my affair, right? if i decide to stuff my face, never get off the couch, and chew tobacco until the cows come home, whose business is that but mine and maybe my family’s?

you’ll hear that response if you conduct focus groups about health and wellness.

is it a fair position? do companies have a place in their employees’ health? or is employee health a private matter?

i’m going with the classic consultant answer: it depends.

do companies have a right to see each individual’s medical and prescription history? to know that i’m personally popping enough lexapro to keep a small country ebullient for a lifetime? no, companies don’t have that right—in my opinion, and legally.

do they have the right to know that their employees are collectively under enough stress to collapse the GW bridge? and the phone’s been ringin’ off the hook at the EAP about it? yup.

do they have the right to alter what’s on offer at the cafeteria and in the vending machine and to provide incentives to alter what their employees eat? whether they smoke? and to help get their butts moving on a regular basis? you betcha.

can they say i’ll give you benefits when you complete our health risk assessment? and can their insurance partner reach out to you if that assessment shows significant health risks that personal health coaching could lower? what do you think? bingo!

and i’ll tell you why. because they’re on the hook for the outcome.

on average, employers pay 75%–80% of employees’ and their families’ premium, which also allows for the $25 copay, 20% coinsurance, and free diabetic prescriptions. that’s not factoring in the lost revenue from absenteeism, disability, lowered productivity, and presenteeism. (realistically, we all pay through increased health care costs and suppressed wages, but try telling your employees that joe in accounting wants them to put down that donut.) for a very long time, companies have shied away from talking about the true cost of health care—to their employees, to the business, and to their combined fate. because of this, it’s a very difficult conversation when all of a sudden an employer’s buttin’ their nose into what’s typically considered a very private matter: our health and health habits.

like your mom and dad presuming that they get a say in the invite list, the seating arrangements, and the spread when they’re footing the bill for your wedding, companies have an active interest in their employees’ health. as with mom and dad, we may not like it, but it’s justifiable. and if we really don’t like it, the other option’s to just foot the bill ourselves.

f

more reading:

employers miffed at employees’ lack of health engagement? get real.

employers should stress wellness, butt out of private lives

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{ 18 comments… read them below or add one }

Frank Roche May 20, 2010 at 11:21 am

“…and if we really don’t like it, the other option’s to just foot the bill ourselves.”

Wow…that is an awesome conclusion. Really awesome. You’re really on the leading edge with this. Speaking truth to power…and to people who feel powerless. Nice.

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Mark Stelzner May 20, 2010 at 12:11 pm

Great post and conversation started Fran. This is such a critically important discussion that I don’t think most employees are thinking about.

I’ve just returned from several days in Washington, DC at the annual Mercer Benefits Conference and the topic of health and healthcare reform were top of mind for the 100+ senior human resource officers in attendance. One comment from a representative of Halliburton really caught my attention, namely that “employees think health is their business”.

Your conclusion that it depends is dead-on. So long as employers are footing the bill for a disproportionate share of medical costs, your health is their business. The first time you get a sense of the employer’s cost is when you get the bill for COBRA after you’ve been laid off. Many employers are now starting to itemize their financial match in the annual open enrollment process so that employees have a sense of just how expensive this is to fixed costs.

But there’s a bigger issue at play. Employers are worried about absenteeism, productivity loss and retention/longevity and one’s health directly correlates to each one of those issues. An economist at the conference shared that we are going to be facing a talent crisis simply by virtue of our lack of procreation. We literally aren’t going to replace Americans fast enough. That means we need to be productive longer, which means living longer, which means taking care of ourselves. This is a hidden part of the discussion (in my opinion).

I could write pages on this but I wanted to thank you for stimulating this discussion!

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fran May 20, 2010 at 5:49 pm

frank, it’s so true — we’re never as powerless as we think. we just might not like what taking the power involves.

mark, that tweet about the halliburton rep inspired this post. great point about how our longevity adds to this equation, and in so many ways. many are looking to their employer for help with retirement financial planning — and that’s not even considering planning for health care costs in retirement! i hope you’ll be writing about your experience at the conference.

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Steve Boese May 20, 2010 at 3:01 pm

Interesting post, Fran. How many organizations are already screening (in an unspoken manner) for ‘healthier’ seeming people in the recruiting process? Managing people and performance is a hard enough job for most managers and companies. Trying to get employees to eat their veggies and get off the couch may be a bridge to far. Heck, I struggle getting my 9 year old to do those things and I have all the power in the relationship.

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Ben Alabaster May 20, 2010 at 3:54 pm

Get your kids to watch the Ted Talk by Jamie Oliver

http://www.ted.com/talks/jamie_oliver.html

Kids want inspiration, not dictation… the same as employees. What makes you want to do your job? You want to believe in what you’re doing and you want to be believed in. It’s the same for everyone around you. If your employees don’t believe in what they’re doing, no amount of motivation will help. As a manager, it’s your job to inspire that belief. If an employee believes in what they’re doing, you won’t need to give them any motivation, they’ll motivate themselves.

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fran May 20, 2010 at 7:01 pm

ben, great point — and great video. i’ve watched it. i also, to my surprise, found jamie oliver’s food revolution inspiring. we watched it with our kids and they were shocked by what they saw. now, they haven’t changed their eating habits so much, but ….

yesterday i read an article that spoke to how we’re more likely to stick with hard changes when we think about the why we’re doing it over the what. there’s the motivation. what role do you think managers can play in motivating this particular type of behavior change, given your really well-stated argument below? and where do you see the line of privacy ending? can an employer tell me to quit smoking in my own home? to not go to mcdonald’s? can they fire me for these actions? or “merely” charge me more? how does this relate to things beyond my control that cause me weight gain?

for the record, next time i’m sending you my ideas and having you write. then you can write in upper case and not get twitchy! i’ll give you that. ;)

f

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Ben Alabaster May 20, 2010 at 8:34 pm

I think the line isn’t really drawn between what an employer can tell an employee to do or not do inside their own home, but rather a line between which of an employee’s actions can and will directly affect their ability to meet the obligation of their contract.

If their contract specifies that they are to be (within reason) in the office from 9am-5pm and their actions are causing them more often than not to fail that obligation, then are they meeting the terms of their contract? No.

If their health is directly affected by their smoking, then yes, I think that whether or not they smoke should be able to be dictated by the employer. What if I were to say:

“I will only hire non-smokers on the grounds that it is statistically proven that smokers drive up the cost of the company healthcare plan and I don’t feel that everyone should pay the price for our smoking brethren; smokers have statistically been proven to take more time off work due to health reasons causing a loss of productivity due to absenteeism; every day they take more breaks than non-smokers and on company time no less; To top that, it has been proven that third hand smoke (that’s the stuff that makes your clothes stink and your curtains yellow), is a known carcinogen. I cannot knowingly put my non-smoking employees in harm’s way by hiring you, sorry.”

Of course I would expect to hauled up in front of a tribunal pretty swiftly for discrimination – after all addiction is a disease don’t you know and we can’t discriminate against someone on the grounds they have a disease! But that withstanding – shouldn’t my argument stand?

Isn’t it my duty to provide a safe and productive work environment for all of my staff?

As for McDonalds, don’t even get me started on the garbage they sell in that place – I *love* sausage & egg McMuffins, LOVE them… but I know they’re incredibly bad for me so I take moderation. I avoid McDonalds for the large majority of my life…it’s a treat I allow myself once every week or two.

I *do* think that employers should do what they can to inspire better behaviour for their employees. I think we should all try and inspire everyone around us.

I don’t criticize weakness in others, everyone has weakness in some areas. Mine is definitely food – I’m on my way down from 280lbs. I just got below 250 lbs today for the first time in 5 years. My target weight is 200lbs and I’m doing everything I can to get back in the kind of shape I was in when I was at university when I was swimming 6 times a week and riding my mountain bike 20 miles per day. It’s bloody hard work when you see everyone around you indulging in things you’d love to be taking part in.

As an employee I would dearly love to see my employer rip out the snack and pop machines and replace them with something healthy it would make my life far easier. The closest places to eat on break are Burger King, McDonalds, A greasy diner with frigging fantastic food. That doesn’t make dieting easy.

I think my advice to employers is to help employees kick the habit, pay for their zyban, install healthy food options, pay for gym membership, start up gym groups, set up a yoga class for your team to take on Friday afternoon… help make it easy and fun for employees to participate in a healthy lifestyle.

I truly believe that:
- Nobody *wants* to be unhealthy.
- People *want* to eat healthy nutritious food, but it’s gotta be interesting and tasty.
- People *want* to have fun and feel like they belong to something great.
- People *want* their life to be easy.

Give them an incentive to be healthier, give them options to make being healthier more accessible, more fun and less boring, give them options to make their life easier.

If you do those things, I’m sure employees will jump at the opportunity.

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Ben Alabaster May 20, 2010 at 8:43 pm

All that said though, I still don’t think it’s fair to ask an employer for them to pay for things blindly without giving them fair disclosure of your activities that directly affect what you’re asking them to pay for. One thing being health insurance, the other being your salary.

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fran May 20, 2010 at 8:55 pm

ben, check out the links below in the reply to steve. the not hiring of smokers? it’s happening. yesterday in our monthly @co_health wellness tweet chat we spoke about the “value exchange” for my sharing my personal health data with my employer — what would i get in return? here you outline the perfect value exchange regarding my employer asking (requiring?) me to be healthy: make it possible. make it free. make it easy. make it fun.

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Jean Christensen January 13, 2011 at 3:06 pm

Just wanted to mention … you can eat quite healthfully at McDonald’s. I eat there pretty much every work day and remain as healthy and lithe as ever.

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fran May 20, 2010 at 6:58 pm

steve, there are a number of companies who won’t hire smokers and alabama was in the media for its approach to overweight workers: lose weight or pay more (http://www.msnbc.msn.com/id/26337794/). your 9 year old ain’t seen nothing yet (and you only think you have all the power!).

f

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Ben Alabaster May 20, 2010 at 9:09 pm

The value exchange is this:

If you help me to help you be healthier, you will be healthier, live a longer, more active life. You won’t smell like crap, people will be able to talk to you without cringing about your smokers breath and smelly clothes, you won’t be carrying around an extra 50lbs and you’ll be happier about your self image.

If that’s not enough:

I’ll pay a more favourable amount of your health insurance for you and I’ll look out for better healthcare options for you that suit your needs better than just covering my own ass.

Perhaps as an employer, I should not only pay for gym membership, but I should require that all employees take part in the fitness class I provide on Friday afternoons in lieu of actual work…

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Ben Alabaster May 20, 2010 at 3:43 pm

Okay, seeing as you badgered me for my input…here it is, my opinion is somewhat complicated, but it falls fairly favourably with the employer based on these facts (and I think in agreement with your blog post):

1. The employer hired you to do a job and is paying you to do that job.
2. If you cannot do that job, for whatever reason, why should you be paid for that job?
3. A company selling a service only gets paid once that service has been provided.
4. A company’s overall costs are far more for an employee which is paid to that employee (NET pay)
5. When an you are hired by a company, you sign a contract. Part of that contract either implicitly or explicitly states your responsibilities for the job you’re being hired to do and agrees that by providing that service, you will be paid an agreed amount.
6. Part of that contract may include healthcare costs which are directly affected by the communal health of its employees. When the average health of the company’s employees declines, the insurance rate goes up, when the average health of the company’s employees gets better, the insurance rate goes down. Thus this directly affects the company’s costs for healthcare.

So, given these facts, why would you think an employer isn’t entitled to know these things?

They are signing a legally binding contract with you to pay you for a service which you’re providing – that service is the provision of your responsibilities and obligations laid out in that contract.

If you are not able to meet the requirements of the contract because of something affecting your health then I would say it’s well within the rights of the employer to know why.

If you were to ask *me personally* to foot the cost of your medical care and for my support in times of illness, I’d like to think you’d do me the courtesy of being honest with me and providing me with a reasonable way of making an informed decision. Why should your employer be any different?

I think this culture of entitlement needs to be given a swift kick in the ass. You are entitled to earn what you get off your arse and earn, no more, no less. Privacy is due where it can be afforded, but when you’re asking for someone to provide a service or product that is directly affected by something you want to remain private, you cannot expect them to provide that product or service… there needs to be some realistic consideration here.

That’s like expecting to be given a credit card but expecting that my previous credit history is private. That’s retarded, why would I consider lending you money unless I can make an informed decision as to whether I’m going to be repaid?

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Greg Matthews May 20, 2010 at 3:48 pm

Fran, I LOVE the wedding analogy. Another thing that occurred to me as I was reading is that this “employer’s role in health” debate is a microcosm of the larger health reform debate … the American public (VERY generally speaking) want to be able to make whatever INDIVIDUAL decisions they want about their own health … but do NOT want to pay for the results! They’d much rather share that part with their friends and neighbors. Maybe if we can figure out a model that works in the employment context (in terms of promoting well-being), it’ll yield some valuable insights about how individual accountability could be structured into health reform. Hmmmm.

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fran May 20, 2010 at 7:03 pm

thanks, greg. i know from what i speak re: the wedding analogy. i learned on the first one and applied to the second!

once we take these insights and apply them to health reform, we can move onto poverty, community breakdown, education. where’s my tequila?!

f

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Ben Alabaster May 21, 2010 at 12:27 am

The wedding analogy only really works if the parents pay… my wife and I paid for all three of ours, that’s right, three… all within 3 months. One in B.C., one in Toronto, one in Colchester, England. Call us crazy but it just worked out that was the only option. All of our divorced and remarried parents… so that’s 4 sets of parents expected input on who was on the guest list, what food was served, what the decor should be like… 8 parents, 1 bride and groom, 3 locations, 2 countries, one convention centre, one hotel, one restaurant… it was crazy. Anyway, just saying the analogy doesn’t necessarily work, although it may have been good in your case ;)

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Thomas R Crown July 12, 2011 at 11:16 am

I like what you wrote. I would love to see the day we are all living healthy, require no healthcare and can put that cash back into my pocket for consumer spending.

That said, I work for a small company, 15 people and 10 years in business. The unwritten truth with my employer is that management cringes when they have to pay out for HC. They see it as overhead eating away at profit margins. They feel compelled to pay HC as it has become mainstream as a competitive hiring tool. Most companies in our sector pay 60-80% HC, we pay 100% Med/Dent/Vis. HC is just an upfront “bonus” paid to employees for retention.

We do nothing to promote better empl health, were to small a demographic – will 15 people really make a difference to profits with better health, I’m not sure?

Our stats – of 15 people we have:
- 2 smokers, 2 over weight (26% of group).
- 3 go to the gym and are in top physical shape (20% of group).
- The remainder are of avg health and generally eat good foods for lunch (54% of group).

Ironically, the “healthier 2 groups” are generally jacked up all day on Starbucks, Caffeine Power-shots, and are codependent on loads of Ambien (Zolpidem), Clonazepam, Diazapam as sleep aids and anti-stress. Are the physically health really healthy at all?

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fran July 18, 2011 at 9:54 am

thomas, thanks for reading and commenting. you seem to know a lot about the “healthier 2 groups” and their habits. i’ve had some interesting conversations with companies that are also smaller in size. clif bar is one. they are larger than you (250 people, roughly), yet they also feel like they have very little control over health care costs since one or two people can make their costs swing wildly. they’ve decided to invest in people’s health and well-being because of engagement reasons. other companies do it for retention, as you mention, or productivity or attraction. there’s more than one reason to “skin the cat,” i think.

f

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