This past week I spent time cleaning my office at work, recycling (shredding) the detritus of an academic life: tenure and promotion materials, teaching evaluations, student papers, and my own papers. I do this periodically to ensure there is never too much of me—of my identity—at work, not from a pathological paranoia, but rather from a desire to maintain healthy boundaries. Or at least that is what I tell myself.
But during the cleaning and sorting I found a hand-written draft of a prose poem that I wrote many years ago during a workshop I taught on narrative medicine. It was in response to a close read and discussion of Jane Kenyon’s poem “The Sick Wife” and her husband Donald Hall’s poem “The Ship Pounding.” As Carol Levine writes in “Two Poets: One Illness,” the poems “…offer a rare view of the same illness from the perspective of the patient (Jane Kenyon) and her husband and caregiver (Donald Hall), both distinguished poets.” (Journal of General Internal Medicine, March 2010, 25(3): 275-275.)
In Hall’s poem he uses the metaphor of a ship to describe his experience in the hospital when his wife was sick. He concludes with describing the hospital as “the huge vessel that heaves water month after month, without leaving port, without moving a knot, without arrival or destination, its great engines pounding.” I used as an accompanying writing prompt for workshop participants to write a description of their own metaphor for their particular work site. What is your metaphor for your own work site? Here is what I wrote (and found while cleaning my office—and have now shredded):
Dusty, moldering storage closet
door with stuff behind
old files labeled for people and departments and programs that died long ago
textbooks for subjects that are no longer taught
a ceramic statue of Florence Nightingale holding her lamp
beside a bowl of nectaries
people who have retired but won’t leave
people who should retire
computer parts, old landline phones, stenographic paper
An increasing number of U.S. companies are ratcheting up their employee wellness programs in order to reduce their cost of health care coverage and payout in employee sick days (thus, of course, increasing their profit for shareholders and executive salaries). They call these wellness programs by all sorts of cute names like Healthy Journey, Move It Program, and Health Counts. They entice employees with rewards programs including cash ‘refunds’ and free membership to health clubs, weight-loss, and smoking cessation classes. Their advertising materials are sprinkled with fairy dust photographs of smiling, fit people munching apples and carrots and bowls of granola. What’s not to love? Wellness is a good thing that everyone wants, right?
This week I received a welcome letter from my medical insurance company, thanking me for continuing with them in 2014, and encouraging me to participate in their wellness program. The letter included a two page ‘notice of privacy’ about how they supposedly protect (and can use under all sorts of ‘exceptions’) my medical information. It has a reading level of post-graduate school, but at least it does have a clearly marked section ‘For questions or complaints’ with a (non-toll-free) phone number to call.
On the wellness program informational brochure they sent me there’s a chart ‘how to earn points and rewards’ that resembles those annoying frequent flyer ‘miles’ offers. They list eight of their top point-earning activities, including diabetes prevention and smoking cessation classes. At the top of their list is an online ‘General Health Assessment’ which they say takes 15 minutes, completion of which qualifies me for a $30 gift card. Beside the chart is a photograph of a bearded, smiling, white coat and black stethoscope wearing Marcus Welby, MD look-alike, inviting me to sit down and tell him all about my health problems. Who can resist?
OK, yes, those pesky ‘accurate, reliable, error-free’ things are too much to ask of a medical insurance company, right? Their GHA begins with the profound question, “Are you living your life to the fullest?” The correct answer happens to be ‘No, not if you are bothering to take this silly test.”
To begin with, their ‘gender-specific health’ questions are woefully out-of-date, sticking with the annual pap smear no matter what your HPV status or age, as well as the out-of-date annual mammogram ‘requirement.’ But then I got to the nutrition section and my (normally low) blood pressure really went up. Here is their first nutrition question: “How often do you eat at least six servings of bread, cereal, rice, or pasta?” Choices are: “1) Daily, 2) Several times a week, 3) Few times a month, 4) rarely.” Their fitness and well-being (as in anxiety and depression) questions, were equally imbecilic. I made it through the silly questionnaire, scored a 100/100, but was told I needed to stop eating a high fat diet (I don’t–I was munching on kale at the time) and I need to follow current guidelines on preventive health screens like for mammograms.
Shouldn’t employee wellness programs be required to at least follow accurate, up-to-date medical information and guidelines? Otherwise it seems they do more harm than good. The federal government, as a part of ACA/Obamacare, stepped in this year to issue guidelines for “Incentives for Nondisciminatory Wellness Programs.” (Because besides being inaccurate, many wellness programs are also discriminatory, coercive, etc. See my previous blog post Corporate Employee Wellness Wants You from 10-29-13, as well as links to resources below). Their new guidelines go into effect January 1, 2014.
Reading through the Federal Register on these guidelines I see that people did raise the same questions I have about following national guidelines for screening and prevention. But they decided to stick with the vague ‘reasonable design’ clause and only: “…require that health-contingent wellness programs be reasonably designed to promote health or prevent disease…” The successful argument against requiring evidence-based clinical guidelines and national standards is the oh so American excuse that it would “inhibit innovation.” Inhibit innovation of poorly constructed, out-of-date, misleading, inaccurate, thoroughly frustrating ‘wellness’ screenings and interventions? I will be avoiding all wellness programs in the New Year.
At least it seems to want me. A corporate/university wellness program is stirring to life at the University of Washington: Whole U. An unfortunate title since a simple Google search of the name brings up numerous spa and ‘body aesthetics’ businesses offering laser treatments and ‘body composition improvement’ (aka: “We’ll take fat from your butt and inject it into your face”).
We already have a university employee wellness program (of sorts) called UWellness (a much better name than Whole U). The stated purpose of UWellness is “balancing the emotional, intellectual, occupational, social, and physical components of health.” Makes sense, except for the intellectual part. Did they just throw that in because we’re a university and should be doing scholarly and intellectual pursuits? What the heck is intellectual health? Avoidance of all writing by French philosophers?
UWellness currently offers the following wellness services: 1) free annual flu shots, 2) referrals to Weight Watchers for weight loss, 3) links to a student-run group promoting bicycle and walking safety (including selling low-cost bike helmets), and 4) free annual ‘routine mammography’ for all women ages 40 and above at an on-campus mobile mammography van (a mammobile?). The first three offerings make sense to me and would earn an A or B according to the U.S. Preventive Services Task Force (USPSTF), an independent panel of non-federal experts in prevention and evidence-based medicine. However, the mammography offering surprised me since the USPSTF changed their breast cancer screening guidelines in 2009 to recommend biennial routine mammography for women aged 50-75 only (biennial screening for women ages 40-50 is optional/not routinely recommended). UWellness contracts with Seattle Cancer Care Alliance to provide the mobile mammography services, so I suppose they are stubbornly following the old guidelines (that the equally stubborn American Cancer Society still follows). There are, of course, intriguing political and economic self-interest issues there that I won’t touch on here…
The Whole U program is a “holistic employee engagement initiative which emphasizes community building, appreciation of the diverse lifestyles and interests of our faculty and staff and participation in programs that promote healthy lifestyles. Establishes a point system that encourages participation through prizes and engages a network of program ambassadors within departments to serve as key communicators in helping direct employees to the Whole U.” Sounds more than a bit Orwellian to me.
Penn State faculty recently staged a successful protest over the roll-out of their university/corporate wellness program Take Care of Your Healththat required faculty and staff to fill out a questionnaire asking about workplace stress, marital problems and women’s pregnancy plans–or pay a $100 a month penalty. (Good NYT article on it here.) A recent RAND Corporation report Workplace Wellness Programs Study found that half of all U.S. employers offer some sort of employee wellness program, many of which include individual health risk assessments and the use of incentives for participation. The most popular employee wellness programs include support programs for weight loss and smoking cessation. Rigorous cost-benefit analyses of these employee wellness programs are lacking, but the RAND researchers estimate the programs should be cost neutral within five years of implementation.
Starting in January 2014 the ACA allows employers to offer incentives of up to 30% of health coverage costs to employees who participate in the wellness programs, including completion of the health risk assessments (and biometric assessments like body-fat percentage measurements, blood pressure readings, and blood glucose measurements). So get ready to be queried at work on your health behaviors, to have your candy vending machines taken away, and to have your waist and hips measured by ‘program ambassadors.’
Meanwhile, my version of corporate/university employee wellness includes avoidance of French philosophers. I’ve also bought a bouncy exercise ball to use as a desk chair–mainly because someone stole my corporate-issued office chair. And it may come in handy to fend off the Whole U program ambassadors when they come knocking on my door.