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3rd Key Observation – The Other 16 Hours (Part II)

Wellness in the Workplace 2.0

What Got Us Where We Are Today…Won’t Get us Where We Need to be Tomorrow

10 Key Observations from Thirty-Five Years in the Field


3rd Key Observation…

The Other 16 Hours – Health Promotion’s REAL Challenge (Part II)

presented for your intellectually driven consideration, your emotionally driven engagement, and — most important — your viscerally driven action


I applaud the effort that has gone into worksite health promotion and—at the same time—I am very frustrated by the lack of progress we’ve made over the past 30 years.  Certainly, there are exemplary programs throughout the country, usually led by a charismatic leader; however, the health promotion industry, in general, remains fragmented, stuck in silos, and in danger of making the next 30 years a mirror image of the past, just with newer leadership and better technology.  If we simply have fresh minds with new technology doing the same old stuff, well, Einstein’s definition of insanity comes racing to mind.

Researchers like Ron Goetzel, Jim Prochaska, and Dee Edington are doing a good job with data and, yes, employers like Volvo, MD Anderson, Healthwise and dozens more (notice I didn’t say hundreds more) are doing a good job of creating pockets of meaningful and replicable outcomes.  That said, the wide brush paints a nation whose overall health continues to slip and slide in converse proportion to the dollars we spend.

The lack of continuity, comprehension, measurement and standards at the worksite accounts for some of it but a closer look at the other four sectors may give us a clearer picture of why the US is the greatest place on earth to be when you get sick but far down the list when it comes to keeping you well.

The US Healthcare Community

It doesn’t work—our current healthcare system—it doesn’t work.  No secret, everyone is talking about it, our current healthcare system, it doesn’t work.  Given an annual bite of $2.8 trillion in 2010 on a pace to hit $4.3 trillion by 2012, the U.S. healthcare treatment model is economically unsustainable.  People are getting sicker earlier and staying that way longer, productivity at the worksite is down while employer healthcare costs are rising out of control.  Teen smoking is creeping back up, obesity is epidemic, and 10 year-old kids are being diagnosed with “adult onset” diabetes.  The current healthcare system isn’t just breaking, it’s broken.  So, whom do we blame and who’s going to fix it?  After all, finger pointing is a national sport, so let the blame begin (continue)!  Actually, when judicious identification, removal, and replacement nets positive change, seeking and finding blame is both logical and helpful.  In this case, however—our national healthcare crisis—who takes the rap?  Who do we kick out?  And, whom do we charge with solving the problem:  The employers?  The pharmaceutical companies?  The physicians?  The medical centers?  The schools, The health insurance companies?  The parents? The lawyers?  The government?  The answer is:  Yes!  Anyone else?  Did you say, “us, all of us?”  Well, if the plural is “us,” the singular must be… ME!  What?  Me?  Now, wait a minute, not me!  Sorry, but once again we realize that Pogo was right when he said to Porky, “Yep, son, we have met the enemy and he is us.” We did it and now, we (us, I) have to fix it.

What did I do?  Nothing.  And, that’s a big part of why we are now facing a crisis, a crisis that demands immediate and, some would argue, radical attention.  We, as a nation, do nothing or next to nothing on the prevention side of the wellness/sickness continuum while we continually and consistently support the supply side of the treatment industry.  We consciously made and make choices that created, sustain, and grow this $2.8 trillion business.

For most Americans, quality healthcare is a given, a birthright, an entitlement program where we are passive participants.  For decades we have chosen one role in the healthcare game:  To get sick.  Fixing and paying?  That’s someone else’s problem, someone else’s responsibility, and someone else’s dime.  It’s been that way since FDR, through Truman, Eisenhower, Kennedy, Johnson, and so on, right up to today.  No more.  Why?  Easy… no more money.  Besides, the current system is busted, broken, it doesn’t work.  Don’t believe it?  Take a look…

Follow the Money:  The Cost & Reward of Doing Business Right of Center

Ninety-eight percent of the annual $2.8 trillion (and growing) spent on U.S. healthcare kick-starts and grows dramatically as you move right of center on the above graph.  Certainly, everyone vested in the healthcare business espouses the value of keeping and/or driving people left of center toward optimal health (intellectually and morally, how could you not take this position?).  The reality, however, is that the status quo—the treatment model—is sustained and advanced due to the enormous power, money, and influence held by those who live and work in the treatment world.

Follow the money and you will find centers of excellence (cancer, diabetes, heart, arthritis, stroke, etc.), treatment-focused research grants, enormous malpractice judgments (and corresponding liability insurance rates), practitioner incentives skewed toward quantity vs. quality, medical device hardware and software, specialty pharmacy, and all things curative.

Where are the dollars for prevention?  Good question.  Here are four more good questions:  Where are the meaningful government policies that protect all citizens by advancing health literacy?  How do you shift the momentum of massive amounts of money, power, and influence to the left on the resource distribution continuum? Where are the parents and how do you get them to create a safe and healthy home and to understand the power they have as role models?  Where are the Schools and how do you get them to remove deep-fat fryers, sugar stacked vending machines and to promote student health with the same intensity as math, science and english?

Answer these questions and take action!

So, when it comes to the other “16 hours,” how ARE we doing?

Again, I’m a pretty easy grader so I’ll give equal weight to both effort and execution.

C-/D = D+

This means with the C- for Wellness at the Worksite along with a D+ for Wellness Outside the Worksite I give the US Health Promotion effort a very generous “D+” as an overall grade.  And, you can thank tobacco control efforts for the positive swing bump.

I Give Health Promotion in The US a Very Generous “D+” as an Overall Grade

Okay, I do so with — believe it or not — great optimism!  We can push this grade up IF, if, if…we pull our heads out of the sand, learn from the past, avoid gratuitous pats on the back for mediocre results, create meaningful success standards, and get very active in our schools as well as our local, state, and national policy debates.

More on this subject at a latter time…


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