GET healthy, and save money. That’s the promise of the corporate culture of wellness taking hold in the business world.
Until now, most companies’ efforts to keep their employees healthy have been limited to the likes of courses to quit smoking and cheap gym passes. Now, in the US, schemes are becoming personally tailored, high-tech and rich in worker data including steps taken, calories consumed and even genetic information.
At computing giant IBM, software company Autodesk and retailer Target, bosses encourage employees to don Fitbit fitness trackers and compete to rack up their steps. At Visa and the messaging service Slack, people can take in Burlingame, California, which screens for mutations linked to breast and ovarian cancer. Pathway Genomics in San Diego, another genetic testing company, offers a that, among other things, looks for clues in DNA to tell people if they have a “Fat gene” or “Sweet Tooth gene”.
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Meanwhile, a crop of start-up firms offer to use your health data to make recommendations or compare health providers for you, and also provide bosses with a bird’s-eye view of workers’ health. For example, on the basis of insurance claims and health-related searches on its app. Employers get aggregated, anonymised updates if more than 40 of their workers sign up to ensure the data can’t be traced back to an individual.
It’s no surprise these schemes are getting popular; they promise healthier employees, a more productive workplace, lower insurance premiums for staff and more on the company’s bottom line (see “The company dime“). Everyone wins.
“Touted health scheme advantages are more productive staff and more on the firm’s bottom line”
Or do they? Some health experts argue that the benefits aren’t so clear cut – and that the wellness trend, if left unchecked, has uneasy implications for what workplaces of the future will know about your health.
Wellness programmes have been around for years, yo-yoing in popularity. The trend revved back up in 2010 in the US, after the country passed the Affordable Care Act, or Obamacare. The act shook up the health insurance system and carved out incentives to encourage firms to keep their staff healthy. When employees join such a scheme, employers can now get government money to cover up to 50 per cent of the cost of the person’s health insurance.
“There’s clearly potential value to people having access to information about their health or themselves,” says Brian Zikmund-Fisher at the University of Michigan School of Public 91ɫƬ in Ann Arbor. But “it’s not always that more information is better. What matters from an employee standpoint is: is this something I’m going to be able to use?”
The jury is still out on the effectiveness of devices like activity trackers. Keeping tabs on daily activity has undoubtedly helped some people lose weight, but that weight might not stay off. and throw them in a drawer.
In addition, the notion of a weight-loss programme that takes DNA into account has raised eyebrows. There’s very little a genetic test can tell you about this that’s actionable, says Hank Greely of the Center for Law and the Biosciences at Stanford University in California. With a handful of medical conditions, such as colorectal cancer or some forms of breast cancer, there are one or two genes that are well understood and accepted indicators of risk. For obesity, the genetics is “completely confused”, and the interplay of genetics, behaviour and environmental factors that causes weight gain is less clear than these services make it out to be, he says.
When it comes to most conditions, “genetic testing is about as useful as a horoscope, but costs more”, says Greely, and the idea that it will inspire people to change their lifestyle is overblown. “People who believe in testing say it will increase your motivation if you know that it’s genetic, but there’s no good evidence for that.”
Attractive package
Currently the genetic tests subsidised by companies focus on weight loss or check for genes that are linked to cancers shown to have a strong genetic component. But as companies vie for the best personnel by enticing them with the , there’s a worry that it won’t be long before firms begin using more extensive screening tests. One US test from 23&Me in Mountain View, California, for instance, .
Being pressurised or even gently pushed in the direction of taking such a test is something that makes some people uncomfortable. The results won’t relate only to your health, they also give clues to that of your relatives. Plus there are lingering worries over the accuracy of tests – in 2013, a study found that .
It could also be a slippery slope into workplace discrimination. In the US, federal laws provide some protection, but when it comes to wellness programmes, there are loopholes. Earlier this year, the US Equal Employment Opportunity Commission – which enforces employment discrimination laws – lost a case against plastics manufacturer Flambeau.
from its insurance plan after he failed to complete a biometric test and health risk assessment. The judge ruled that Flambeau’s actions were allowable because they fell within the boundaries of the Americans with Disabilities Act law, which is supposed to prohibit firms from demanding workers pass arbitrary medical tests. A similar case is pending.
Employees can’t be forced to participate, but opting out might mean missing out on insurance cover or other perks. That’s a distinction without much of a difference, says Nicolas Terry, of Indiana University’s Center for Law and 91ɫƬ in Indianapolis. “Essentially, you’re segmenting employees,” says Terry. “However you dress it up, I think this is discriminatory.”
“‘My boss will pay me $1000 if I sign up and I need the cash’ is not a good reason to get a genetic test”
“We’re talking about something that’s being done under the auspice of employee wellness,” says Zikmund-Fisher. “‘My boss is going to be mad at me if I don’t participate’, or, ‘My firm is going to pay me 1000 bucks and I really need money’ are not good reasons to be giving up your genetic data.”
And although it’s against US law for health insurance companies to deny coverage on the basis of someone’s genetic data, the law doesn’t extend to life insurance or long-term care insurance, says Marcy Darnovsky of the non-profit Centre for Genetics and Society in Berkeley, California.
This shouldn’t be an issue if wellness companies stick to their – which prevent them sharing individuals’ data – and only show employers aggregate information so they can see the effect the programme is having on their workforce.
Tighter laws
Not everyone is convinced the existing protections are enough. The Genetic Alliance, a non-profit organisation in Washington DC, is pushing back against legislation that lets employers offer monetary incentives for signing up to wellness programmes.
Tighter laws would help protect against a company slipping up, or if there’s a security breach, says Darnovsky. “If the information comes out, it’s obvious employers could consciously or subconsciously not want to hire, retain or promote people who may get sick.”
In March, Ifeoma Ajunwa of the University of the District of Columbia in Washington DC and her colleagues proposed a the relationship between employee and employer: the Employee 91ɫƬ Information Privacy Act. Such a law, she says, would prevent slipping into a world of “limitless worker surveillance”. It could clarify that medical data collected by a wellness programme or device is protected health information – a point not explicitly spelled out by current laws – and give employees control over whether a company tries to sell their data or keep it on file indefinitely.
“If left unregulated, wellness programmes could turn into a tool of surveillance,” says Ajunwa. “It can create a bad situation where workers have their privacy invaded, rather than really being helped to live a better life.”
The company dime
Does a healthy workforce mean more money? A few companies have taken it upon themselves to try to prove that it does. A study overseen by researchers at Harvard University on pharmaceutical distributor McKesson concluded that almost $12 million in medical and productivity costs in 2013 and 2014.
Another, by researchers at insurer Aetna, involved an experiment on its own employees. Workers were biometrically and genetically screened for metabolic syndrome and obesity, then those at risk spent a year working towards a healthier weight. Seventy six per cent of the people lost about 4.5 kilograms each, which meant the company’s medical costs went down by about $122 per person per month.
Such information should be , suggests a report by the research arm of health services company Vitality. The motivations are moral as well as financial. “A business is really a community,” write the authors. “So you want the community to be healthy and, from a moral standpoint, everybody who is in the community should be taken care of.”
They suggest that companies report on the management of wellness programmes – whether there is a role dedicated to running the programmes, for example, as well as employee metrics like body mass index, sleep patterns, blood pressure and alcohol use.
“Corporate health is a structure for influencing change,” says Eileen McNeely at Harvard’s School of Public 91ɫƬ, who worked on the report. She says public reporting could show a firm’s impact on health in much the same way as carbon emissions statements draw attention to a company’s environmental impact. “We’re hoping the same thing will happen when people start measuring their footprint on wellness.”
This article appeared in print under the headline “Fitter, more productive?”
