Time & Attendance
By Rebecca Vesely
Jul. 18, 2012
The 1980s marked the rise of the “yuppies”—a new generation of ambitious young men and women entering the workforce seeking wealth and status. With it came the glamorization of corporate culture by the likes of Donald Trump and Michael Milken, later dramatized in the 1987 movie Wall Street, starring Michael Douglas, whose corporate-raider character Gordon Gekko coined the phrase, “Greed is good.”
By the end of the decade, the country was in recession and Milken was in jail. The Cold War ended and the Berlin Wall fell. The country as a whole ended up rejecting much of what came out of the ’80s—from big hair and dyed mohawks to the synthesizer rock found on the new cable station MTV.
But some things were here to stay—not just MTV, but a new awareness about fitness and health. C. Everett Koop, who served as U.S. surgeon general under Presidents Ronald Reagan and George H.W. Bush, was one of the first to sound the call. Early in his term, Koop wrote a scathing report on tobacco that likened the addictive properties in nicotine to those found in heroin and cocaine. Koop challenged Americans to “create a smoke-free society in the United States by the year 2000.”
In April 1984, Boeing Co. took up that challenge and became the largest U.S. corporation to ban smoking in the workplace.
A Personnel Journal feature story titled “No Smoking,” which was written by William L. Weis, an associate professor at Seattle University, covered the news. In the article, Boeing’s then-president Malcolm Stamper ushered in the workplace wellness movement declaring that it is a company’s responsibility “to provide the cleanest, safest and most healthful environment possible for its employees.”
The Boeing campaign started with select buildings. By 1994, smoking was effectively banned in all Boeing facilities, though other forms of tobacco were allowed, a company spokesman says. In 2004, smoking was only allowed in designated areas on campuses, and by 2009, Boeing’s entire workplace was tobacco-free. Today, Boeing invests about $30 million annually on wellness programs for workers, and works in partnership with the American Cancer Society to encourage employees and their spouses and domestic partners to quit tobacco.
Employer intervention in the health and wellness of workers has over the past 35 years evolved from a hunch that a healthier population could lower health care costs to a science of studies and sophisticated data-based research. What started as a single program aimed at a specific group (like smokers) has become, for many U.S. employers, a philosophy that adopting a culture of health is a pillar of overall corporate success.
David Anderson, senior vice president and chief health officer at StayWell Health Management in Minneapolis, recalls that when he started working on wellness programs in the late 1970s, it was still commonplace to see ashtrays atop conference-room tables. “Smoking was the first major shift we saw at the work site,” Anderson says, calling the Boeing announcement in 1984 a “pretty big step at the time.”
The first workplace wellness interventions involved building on-site gyms for top corporate executives in the 1970s. This coincided with Congress creating in 1976 the Office of Disease Prevention and Health Promotion, which set benchmark goals for improving the health of U.S. citizens through programs such as the Healthy People 2000 and 2020 campaigns, science-based national objectives to improve the health of all Americans, and has raised national awareness about population health.
Some early corporate adopters in the late 1960s and 1970s began ordering full physicals on employees, including chest X-rays. DuPont Co., Kimberly-Clark Corp. and several major life insurance companies led this trend, veterans of that era say.
“But that was recognized as probably overkill in terms of costs and predicting disease,” says Steven Noeldner, partner and senior consultant at Mercer, who entered the workplace wellness field in the 1970s.
Early efforts to instill a culture of health at work were typically driven by a single corporate executive who had a personal interest in fitness, experts say.
But by the time of Boeing’s announcement, a larger fitness craze had seized the nation, spurred in part by Jane Fonda’s blockbuster 1982 exercise video Jane Fonda’s Workout. Employers caught this wave by building on-site fitness centers for all employees and implementing health promotion programs.
“It was about encouraging people to become more involved and engaged in their physical health,” Anderson says. “That was characteristic of the programs at the time.”
Also driving enthusiasm for workplace wellness campaigns in the 1980s was the rising cost of health benefits. This accelerated in the late 1980s and early 1990s when the nation’s employers saw double-digit premium increases. In 1988, for instance, the average cost of employer-based health coverage jumped 18.6 percent over the previous year, Noeldner says.
“This ushered in an era of more rigor in the science” of studying and assessing the quality and effectiveness of wellness programs, he says. “There was more retrospective review of the effectiveness of programs.”
In 1987, StayWell, along with actuarial firm Milliman & Robertson (now called Milliman Inc.), released a study showing for the first time that common health-risk factors such as smoking, obesity and not wearing seat belts were strongly linked to higher health care costs. Subsequent studies backed those findings.
“It got employers very interested in costs,” Anderson says.
Prior to that, fitness centers and wellness programs were just perks. “There was no compelling data that fitness centers could attract and retain employees,” Anderson says. “It was a kind of free-for-all.”
Johnson & Johnson also published one of the first comprehensive studies on employer health and associated costs, tracking employees from the late 1970s to the early 1980s. By intervening and encouraging workers to adopt healthier habits, Johnson & Johnson was able to show annual health care cost savings, grabbing other large employers’ attention. Johnson & Johnson then packaged their health promotion strategies into a product to sell to other companies under the Live for Life brand, still in existence today.
“It was a breakthrough,” says Ron Goetzel, research professor and director of the Institute for Health and Productivity Studies at Emory University.
In the 1980s, research on wellness programs was very basic, but gradually more sophisticated researchers got into the field and started conducting studies that controlled for outside factors, Goetzel says.
For instance, some early studies showed that wellness programs saved employers money when comparing the health care costs of participants vs. nonparticipants because participants spent fewer health care dollars. However, these studies didn’t control for other factors. Typically, participants in health interventions are healthier and more motivated to begin with, so they cost less even without wellness programs, Goetzel says.
“You were really looking at two different populations,” he explains: the motivated and healthy and the less motivated and unhealthy.
By the 1990s, researchers were able to parse out some of those subtleties and give employers more nuanced information about programmatic success.
The ability to track changes in employee health status and costs also revolutionized the research, Goetzel says.
The use of health-risk assessments to evaluate and track employee health became commonplace in the 1990s. Today, annual health-risk assessments are routine at many companies, with 70 percent of large employers and 34 percent of small employers offering them in 2011, according to Mercer.
Health-risk assessments are a valuable tool to track behavior over time, but just one in the arsenal that today includes insurance claims data and other measurements that allow employers to get a clearer picture of their workforce’s total health over the years.
The more rigorous research grabbed the attention of employers. In 1998, a study of 50,000 employees published in the Journal of Occupational and Environmental Medicine indicated that a quarter of total employee medical costs were associated with three areas: tobacco use, diet and exercise, and stress. The study also found that behavioral issues such as stress, depression and anxiety have higher associated medical costs than traditional risk factors. Goetzel and StayWell’s Anderson were the study’s lead authors.
Known as the original HERO study, short for Health Enhancement Research Organization, it made waves among employers, and garnered front-page coverage in the Wall Street Journal.
But a shift happened in the 1990s that threw the burgeoning wellness industry onto the wrong track, Anderson says. Employers began using health-risk assessments to identify and target only the sickest and unhealthiest workers for interventions, putting all resources into this subset of employees. “I sort of liken it to bailing water from the Titanic,” he says.
Research has since shown that if employers zero in on only the 20 percent of the population costing the most, some of the 80 percent of healthy people will slip into the unhealthy category. “The learning from this was: You can get high-risk people to change, but unless you pay attention to the whole population, you are just going to get more high-risk people,” Anderson says. “You need to always be working upstream to keep the healthiest people healthy.”
Dee Edington, founder of the Health Management Research Center at the University of Michigan, couldn’t agree more.
“After 30 years, we know the real advantage is helping healthy people stay healthy,” Edington says.
Employers can do this by transforming the workplace into a culture of health, research shows. Edington points to smoking as an example.
“What really changed is that we made it an environmental issue. We started talking about second-hand smoke,” he says. Engaging the total population instead of just targeting the hard-core smokers helped shift the entire culture away from smoking, he says.
Boeing appeared to be trying to do that in 1984. The then-Seattle-based airplane manufacturer (it has since moved to Chicago) started in 1981 to pay for smoking-cessation programs, offer reduced gym memberships, on-site exercise classes, and softball and volleyball leagues. Boeing also gave $200 to every smoker who quit.
Edington says research shows that incentives should get into the hands of the healthiest. “Don’t give $100 to the smokers,” he says. “Give $100 to the nonsmokers.”
Companies are increasingly tying health care premiums to health status, where smokers pay more for coverage, Mercer’s Noeldner says.
This trend will likely accelerate with implementation of the Patient Protection and Affordable Care Act of 2010, experts say. The federal health care reform law, recently upheld by the Supreme Court, gives employers more leeway in terms of tying participation in wellness and disease-management programs with health care cost-sharing between employers and workers.
It’s a far cry from 20 years ago when Noeldner recalls observing smoking-cessation classes that showed participants a jar of used cigarette butts and pictures of patients with advanced throat cancer. Noeldner even remembers a class where participants were “smoking their brains out” while the instructor wore a gas mask.
Not only have the methods of interventions changed, but so have their delivery. Desktop computers and the Internet led to wellness programs in the cubicle with online coaching through chat rooms and instant messaging, computer games and social networking.
“As robust as the Internet has been, the health management arena is really just starting to pick up,” Noeldner says. “It’s only emerged in the past few years, not in the past 10 years.”
This is happening in the form of mobile apps especially, he says. “Everyone is trying to translate programs to portable devices,” he says.
Anderson agrees that the next decade will be about harnessing technological advances to engage and support employees in their health management.
“The last 10 years brought the strengths of the 1980s and 1990s together,” Anderson says.
In the ’80s, employers realized they needed to get involved in wellness. In the ’90s, they began using data to segment their workforce and target specific groups. By 2000, employers learned they had to work on total population health and target certain groups with appropriate programs, he says.
Interest in programs that aim to increase worker productivity has waxed and waned over time, Noeldner says. Today, there is renewed enthusiasm in productivity studies because of globalization. In countries where health care costs are fairly fixed or stable, multinationals are looking at productivity more closely.
“It’s still one of the tougher aspects to quantify,” Noeldner says.
What’s sure is, over the past three decades, workplace wellness has been embraced at the C-suite level.
“Thirty years ago, employers didn’t know what in the world we were talking about,” Anderson says, with some describing workplace wellness as “fluffy” or “New Age.”
But rising health care costs, tangible research results and sophisticated data-gathering techniques have changed their tune.
“Now wellness is integrated into the business strategy and mission statement,” Anderson says. “They are articulating wellness as shared accountability.”
In 2011, 87 percent of large employers described wellness as a leading corporate strategy, according to a Mercer report, Noeldner says. “It’s pretty much in the fabric of how employers deliver benefits today,” he says.
But the veterans interviewed for this article agree that workplace wellness still is evolving.
“Everyone needs to acknowledge that what we are trying to do is very, very hard,” Goetzel says. “Smoking is a great example. You can get the population to change. But look at the issue of obesity. We are going in the opposite direction. There are underlying factors driving all of this, and the employer plays an important role.”
Edington is more pessimistic when looking in the rearview mirror.
“We lost the 20th century in America,” he says, pointing to rising rates of diabetes and obesity. “We’re still No. 1 in terms of health care costs.”
Rebecca Vesely is a writer based in San Francisco. Comment below or email firstname.lastname@example.org.
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