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Is it Our Fault We Get Sick? 

By Carl Finamore

Submitted to portside by the author
July 30, 2012 
Also on www.BeyondChron.org

Why do we get sick and how do we get well were the
enormously complex and controversial questions explored
by a gathering of labor and community activists, health
policy experts and academics attending a one-day
conference at the University of California Berkeley on
July 27, 2012.

In particular, speakers critically reviewed corporate
Wellness Programs that essentially blame personal
habits like smoking and excessive eating for poor
health and for ballooning medical costs.

Under the soothing, holistic rubric of "Wellness,"
these employer-sponsored programs are ostensibly
designed to improve health. For example, most programs
urge employees to stop smoking, lose weight, improve
cholesterol and lower blood pressure. These goals
appear quite laudable.

"Seems like a good idea, everyone wins. Employees get
healthier and companies save money on rising health
insurance costs." However, opening speaker Lewis
Maltby, president of the National Workrights Institute,
dryly observed, "It seems almost too good to be true.
Get my drift?"

It seems wellness programs are a mixed bag, some do
better than others. But they are most ineffectual when
following the uniform business model of faulting
workers, in this case, for causing steep increases in
health care costs.

There are several problems with this corporate blind
spot. To begin with, as speakers pointed out, a
genuinely comprehensive health care program must
involve more than changing personal behavior.

Katy Roemer, a registered nurse (RN) and member of the
California Nurses Association/National Nurses United
(CNA/NNU), sat next to me in the audience and agreed
that "health conditions often have broader social and
economic causes for which individuals have no control.
For example, obesity, high blood pressure, smoking and
elevated cholesterol result from complex factors
including poverty, stress and working conditions."

But corporate wellness programs, according to critics,
would rather place the blame solely on the plate of
individual workers. The worst plans actually infer
workers are unhealthy because of bad attitudes.

Jacqueline Hart, a sociologist at Sarah Lawrence
College, took the podium and acknowledged that "all of
us want people to take personal responsibility for
their health but most corporate wellness programs focus
on the mind, essentially abandoning the body."

Just Say No! to Your Body Disregarding crucial warning
signals generated by the body's defense system,
wellness staff of large businesses repeatedly told Hart
that "attitude is the biggest part of health."

"In other words," Hart explained, "it's all in the
mind, thus de-legitimatizing use of sick leave" when
the body just finally gives out and pleads for a break.

This is bad health policy. Contagious or physically
impaired employees should not be at work. This is only
one example of how corporate wellness programs,
primarily interested in lowering medical insurance
costs, often depart from appropriate standards of care.

In other examples cited, the worst of these programs
financially penalize employees who do not stop smoking,
do not reduce their weight, do not lower their
cholesterol or do not decrease their blood pressure.

Again, there are many factors that affect these
benchmarks that have nothing to do with personal
behavior, DeAnn McEwen, RN, MSN and vice president,
NNU, emphasized to me during the conference: "In
addition to socio-economic factors, genetic
predisposition plays a significant role in determining
many health factors including excess weight, high blood
pressure, blood sugar, and cholesterol levels."

"As a nurse," Roemer added, "I see the health problems
associated with stressful work environments, the
collapse of our economy and the pressure of increasing
workloads and I am concerned that wellness programs
that focus exclusively on individual unhealthy habits
are seen as separate from a discussion about these
larger issues."

This advice was echoed by panelist Dr. Jeff Ritterman,
a retired 30-year Kaiser Permanente cardiologist and
prominent community health activist:

"Anti-biotics and vaccines play a huge part improving
our health but social factors have by far the biggest
influence, much more than anything I do in my office.
For example, mortality and class are inextricably
linked. The poor die quicker and just like a step
ladder your health advantage keeps getting better by
degree of your wealth and education."

Dr. Ritterman described how this all works. More income
gives you more options and "more autonomy" to make
healthy lifestyle choices such as the kind of food you
eat. He gave a vivid example of Richmond, California
where he serves on the city council.

"Soda-drink companies target the poor communities and
those children suffer far higher rates of obesity and
diabetes because of its excessive availability." In
middle and upper class communities, Ritterman
explained, there are many more product alternatives,
People have more choices.

Nurse McEwen agreed: "Low-income individuals or racial
and ethnic minorities are more likely to have the
health conditions that wellness programs target, and,
they often face more difficult barriers to achieving
better health. These include unsafe neighborhoods,
substandard/decaying housing, poor air quality, lack of
access to affordable healthy food, and little or no
access to public transportation."

Pay or Play Many wellness programs now charge employees
higher premiums if they refuse to participate or if
they fail to reach normally prescribed levels for
obesity, blood pressure, cholesterol and body mass. As
we have seen, these general goals must be interpreted
differently for each individual depending on their
genetics, physiology and depending where they work and
where they live.

Being treated as an individual is the original and
fundamental aspect of holistic, wellness care because
we actually are all different. But this principal is
clearly not sufficiently recognized by the broad brush
corporate wellness approach of establishing the same
standards for everyone.

Ignoring this genuine holistic method becomes extremely
problematic as companies like Wal-Mart begin charging
employees who fail to make the average grade up to
$2000 a year for health premiums. Legally, federal law
already allows companies to pass along 20 percent of
premiums to workers who fail to meet wellness
standards. This penalty increases to 30 percent in
2014.

Unfortunately, reproaching and targeting some employees
for higher health costs gets a hearing among co-workers
because of current abysmally low levels of solidarity
and class consciousness. This disunity suits the
business agenda just fine as it justifies shifting more
premium costs to those isolated workers who simply
don't fit the corporate health profile of weight, body
mass, blood pressure and cholesterol levels.

As we have seen, this burden generally falls on the
most vulnerable among us and it is those who need
healthcare the most. Just as bad, keeping the focus on
individual behavior avoids a discussion of more basic
social health problems caused by corporate
irresponsibility.

Labor journalist and experienced union negotiator Steve
Early was also at the conference and suggested very
effective negotiating tools to help get around these
problems: "In my union bargaining experience,
manufacturing employers wanted to get smokers to quit
so the company could save on its medical plan costs but
management never wanted to address job-related hazards
like chemical exposure or excessive noise levels that
have an equal or greater impact on workers' health.

"So, when employers try to push wellness programs,
unions should always be countering with proposals to
reduce forced overtime, to decrease workload or
line-speed, to lower related job stress and to
prioritize other occupational safety and health
problems" that should be part of the discussion.

Now What? Despite all the problems discussed, panelists
still believed wellness programs could actually improve
one's health and successfully convince employees to
make better health choices if enrollment is genuinely
voluntary, if privacy of their health status is
absolutely guaranteed and if healthy choices are
rewarded such as by employers subsidizing gym
memberships, lowering prices for healthy meals in the
employee cafeteria and paying for recommended physical
examinations.

It also helps, speakers advised, if administration of
the wellness program is by a third party and not
directly controlled by management. It was pointed out
how labor unions UNITE-HERE and SEIU 1199 administer
programs that have been extremely successful in
reducing costs while also actually markedly improving
the health of workers.

Workers trust the union and do not fear retaliation or
imposition of added premium costs if they fail to meet
certain goals. Professional counseling and group
encouragement, indeed, is a healthy environment where
one can better succeed.

The concept of wellness originally developed from a
critique of western medicine's primary reliance on
treatment, largely with drugs from big pharmaceutical
companies. Critics describe it this way: "How much can
we poison you to kill the thing that is ailing you
without actually killing you?"

On the contrary, traditional wellness philosophy
emphasizes proper nutrition, exercise, adequate rest
and emotional and spiritual balance. Its treats the
whole body and not just our various parts and it
prioritizes prevention.

If we can successfully introduce these concepts into
the wellness debate at the workplace, it will perhaps
open further a "healthy" examination within our society
of why major corporations pushing their version of
wellness are yet allowed to enormously profit from the
production and marketing of so many fatty foods, sugary
beverages and empty caloric snack products.

In the end, the one-day conference could not and did
not attempt to answer all our questions. But it did
provide, dare I say, good food for thought.

Full disclosure, Carl Finamore is no longer hooked on
his Italian childhood diet of pizza, pasta and bread.
He can be reached at [log in to unmask] and his
writings appear on http://carlfinamore.wordpress.com/

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