Friday, August 31, 2012

Employees: Insist on Quality of Life Opportunities, Not Medical Interventions Disguised As Wellness

Scholarly evaluations of worksite wellness show modest health-related returns for modest investments. What is not mentioned is that expectations of such programs are also modest. Such programs in most companies are low on the priority lists for management; most employees with mediocre to hazardous lifestyles either do not participate or do so reluctantly and with little enthusiasm or follow-up.

A recent analysis of 33 assessment studies of worksite wellness suggests investments in such endeavors yield mixed results. The meta-analysis focused on changes in physical activity, diet, body mass index/weight, mental health, tobacco use and alcohol abuse, absenteeism and healthcare costs. The best face put on the body of such programs was mixed impact on health-related behaviors and cost, with insufficient evidence for effects on absenteeism and mental health. (See Karen Chan Osilla et al, American Journal of Managed Care, 2012;18-2-e68-e81.)

I'd like to see dramatic changes in worksite wellness. Almost the entirety of such efforts should be more properly be identified as employee assistance and focused on workers at risk. What exists now as wellness are in fact medical interventions. I favor new endeavors oriented at introducing REAL wellness educational programming. Such teachings would engage workers to think in terms of quality of life.

At present, company wellness consists of risk assessments, medical management, smoking cessation, weight loss classes, stress management lectures and the like. REAL wellness educational opportunities would include principles for effective thinking and decision making, for the enjoyment of life, for lifelong athleticism, high performance nutrition and teachings that explore what it means to be free. Worksite wellness would be less clinical resembling outpatient clinics and more philosophical akin to university life.

The current agenda is medical in nature and largely managed by professionals in the disease treatment and prevention sciences. Nurses and doctors, hospital administrators and other professionals from the healing arts are trained in medicine; worksite wellness would be more suitable for promoting quality of life if companies hired philosophers and others trained in positive psychology. The menu of worksite wellness services that exists today should be rebranded and given over entirely to the medical establishment. A new initiative dedicated to introducing and promoting REAL wellness is needed. Current worksite resources should be shifted to company employee assistance and medical departments. Why continue to give workers the impression that wellness is on offer when the available programming is nothing of the kind?

Real wellness education would guide employees to assess goals that render life not just healthier but also qualitatively better and more enjoyable.

A start in the process needed to bring about a shift in consciousness from risk reduction to quality of life enhancement might start with recognizing and eliminating oxymoronic programming.

Consider the extent to which the current range of worksite wellness is marked by oxymorons. An oxymoron is a word with Latin and Greek derivations. The literal meaning would be pointedly foolish. In modern English, an oxymoron is a combination of contradictory or incongruous words, such as jumbo shrimp. Worksite wellness has taken on this veneer.

Among my favorite oxymorons in the public domain are friendly fire, awfully nice, act naturally and negative growth. Oxymorons usually surprise and sometimes delight. George Santayana offered this take on the matter: The world is a perpetual caricature of itself; at every moment it is the mockery of what it is pretending to be.

Worksite wellness employs oxymorons. One I often hear is preventive mental health! Why prevent mental health? Wouldn't it be more appropriate to encourage it? There's not a lot of it out there anywhere in America these days, but what there is should be nurtured, supported and treated like an endangered species, not prevented. I wrote the director of a program so titled after I read a speech he delivered about his company's commitment to preventive mental health. I asked if he did not think the phrase a bit odd, explaining my reasoning. I thought the response I got was quite gracious: Don, obviously you paid attention to my talk... and picked up on the inappropriate use of that phrase. You are absolutely correct that we do not want to prevent mental health but rather promote it. In fact, a better term would be 'mental health promotion' or even 'mental fitness.' Mental health has a negative connotation whereas mental fitness is a more positive and upbeat term... I do not take offense that you pointed out the error of my ways. This could be 34 seconds of the fifteen minutes of fame I am entitled to in this lifetime.

At different times over the years I have asked well-known wellness personalities to identify favorite health-related oxymorons. Jack Travis mentioned, wellness care. That's a good one, since who can provide wellness care for someone else? It's a personal thing -- if you don't care, who will? Travis added that he once had wellness medicine listed on his (first) business card when fresh out of med school. Before long, he decided that wellness medicine was an oxymoron. There is nothing medicinal about wellness.

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