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The Effects of Wellness Incentives

Workplace wellness programs were once a benefit that provided employees health education resources along with skill building activities and opportunities to engage in better health behaviors.  They typically existed in organizations with a healthy culture and positive work environment.  Leadership genuinely cared about the health and wellbeing of their employees.  As a result, morale in these organizations was high.  Occasionally an incentive, such as a cool T-Shirt, would be given to participants in the programs.

Fast forward to 2014 and workplace wellness programs have essentially morphed into wellness incentive programs.  The wellness incentive program is primary and wellness programming is secondary.  Because of the widespread use of incentives with wellness programs, I find it hard to use the terminology "wellness program" because people think I am talking about a reward or penalty program.  In fact, the recent reports questioning the value of employee wellness programs refers to these types of incentive programs, not well designed, evidence based comprehensive programs. 

Wellness incentives are promoted by many as the magic bullet for building better health. But the research is very clear on this subject - incentives do not work.  For simple tasks such as completing a survey or sitting passively through a short health coaching session, incentives can work to get participation.  However, this does not mean the individual is engaged in the activity.  And the underlying message you are sending by offering incentives is that this is not something you should want to do on your own volition and that is why I am bribing you to do it. When behaviors become more complex (and changing one's behavior towards a healthier lifestyle is very, very complex), incentives, at best, will not improve your chances and, at worst, completely derail your chances.  [Kohn, A. (1999). Punished by Rewards, Pink, D. H. (2009). Drive: The Surprising Truth about What Motivates Us.]

Whenever you pay someone for health improvement, you change the dynamic from this is something I want to do for myself to this is something I should do for the money.  And while incentives may work in the short-term, they will not work in the long-term.  Individuals must be intrinsically motivated to adopt habits that contribute to their health and wellbeing.  Intrinsic motivation is defined as acting out of genuine interest instead of rewards, goals, or outcomes.  Example: I'll sign up for the fitness challenge because it sounds like fun and I want to see if I can do it.  Extrinsic motivation is defined as doing something for a tangible reward, such as money, prizes, additional time off, or avoiding penalties.  Example: I'll sign up for the fitness challenge because I want to get a discount on my health insurance premiums.

There are a host of unintended consequences from using incentives such as unreported job injuries for fear of losing a safety reward, dysfunctional methods of weight loss to win a competition, or more importantly, discrimination against low-income people or racial and ethnic minorities.  These people are more likely to have the health conditions that wellness programs target and also may face more difficult barriers to healthy living.  These barriers may be work related, such as having higher levels of job stress, job insecurity, and work scheduling issues.  Barriers outside of work may include personal issues, such as not having access to healthy, affordable foods, or safe spaces to be physically active in their communities, or they are overwhelmed with child care or elder care. 

Additionally, health is impacted by factors that are sometimes beyond lifestyle behaviors, such as genetics, family history, gender, and age.  Penalizing employees for their health status by increasing premiums or deductibles if employees cannot reach certain health metrics can deny them access to the very care they need.

On another level, employees who are penalized for their health status are likely to end up resenting their employers.  So these wellness incentive programs intended to improve health and productivity could actually backfire and have the opposite effect.

When individuals decide to improve their health on their own terms, for their own reasons, they are far more likely to be successful.  If you tell people eat this and don't eat that, or don't smokeÃÂ they immediately want to do the opposite; it's just human nature.  Nobody wants to feel controlled or treated like a child.  And a constant focus on risk factors is not a good way to motivate behavior change.  Focusing on the joy of living is a much better motivator than fear of dying.  [Ornish, D. (2008). The Spectrum.]

The recent suits brought forth by the EEOC are a great opportunity to leverage what we do know about improving health and move beyond the belief that we can pay people to get healthy.  Since physical health can ebb and flow based on a variety of factors, a more appropriate term to capture the holistic nature of health is wellbeing.  Our wellbeing is so much more than our physical health.  So to truly create a life worthwhile (that captures the joy of living) we need to engage in meaningful work that provides us a sense of purpose; we need to invest time in strengthening our relationships with the people we love; we need to manage our finances to reduce stress; we need to adopt healthy lifestyles that provide us with good physical health and energy; and we need to develop a sense of community focused on giving of our talents and time to others.  Focusing on any of these elements in isolation will compromise our overall wellbeing. [Rath, T. & Harter, J. (2010). Wellbeing: The Five Essential Elements].  And we can create these keys to good health and happiness without the use of incentives.  By focusing more on improving our workplaces and fostering a culture of empathy, we can provide the best opportunities for employees to improve their health.

Posted December 03, 2014

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