Introduction
In this essay, I suggest that the term wellness would not be widely recognized today, nor would it be sponsored so universally (by universities, destination spa resorts, hospitals, etc.) if it had not be adopted and advanced by businesses large, moderate and small. This adoption commenced around the start of the 80s. One overlooked consequence of this leadership is that business has defined the wellness movement.
Let's give credit where it's due - corporate worksite wellness has popularized, legitimized and shaped wellness. This happened in good measure because companies provided a sizable job market for doctors, nurses, exercise and nutrition specialists and others, all of whom were expected to know what wellness was and how to make attractive to and work for company employees. It turned out that this was a big ask.
(A Rand Corporation study found that 92 percent of employers with 200 or more employees offered wellness programs in 2009. (See A Review of the U.S. Workplace Wellness Market, July 2012.)
In so many ways, the corporate sponsorship of wellness was a good thing. Unfortunately, the adoption process did not turn out so well for wellness enthusiasts familiar with the concept before bottom line managers took the helm. In worksite programming, wellness was implemented as a medicalized approach to moderating health insurance expenditures.
Those who learned about wellness and its possibilities before the concept fell under the control of the business world believed it would usher in a healthier society and far healthier individuals. That did not and could not happen, given the nature of worksite wellness.
Corporate wellness was dumbed down from the beginning, interpreted and shaped as yet another form of medical intervention. The focus was on finding ways to guide workers to live so as to reduce their likelihood of getting sick less. Nothing wrong with that, except of course that it was not wellness and should not have been billed as such. Approximately half the number of employees offered this kind of wellness, which rarely seemed like much fun at all, must have thought to themselves, Geez, if this is wellness, I can manage quite nicely without it. Programs sought to prevents health problems and manage illness conditions; few efforts were made to guide workers in thinking about and exploring what it means to be well - and how to become and remain so.
Evolution Versus Devolution
The unfortunate descent or degeneration of wellness to a lower state than envisioned in the original model was never a conscious act by evil-doers, corporate or otherwise. It happened because a preventive and treatment model of wellness was seen to be in the best interests of companies. Corporate executives did not embrace the elements of wellness that were positive or life-enriching. They were not thinking of wellness dimensions such as reason, exuberance or liberty). Maybe Halbert L. Dunn in the middle of the 20th century and several early adopters of his thinking decades later viewed wellness as a lifelong quest for added meaning and purpose, respect for all life and the environment - these were not the elements that company leaders found appealing about wellness. Few even knew that this concept began as a way to encourage love of learning and related qualities associated with a meaningful and humanistic existence, physically and mentally. Wellness was about choices that led well past a state of not being ill.
Alas, these notions of wellness were not embraced by promoters of corporate worksite wellness programs. It was never characterized as a pathway to exuberant states of happiness and joy. Business style never addressed what Robert Green Ingersoll in the last part of the 19th century described as desirable qualities of Improved Man.
A Little Perspective
In The Hitchhiker's Guide to the Galaxy (2001), Douglas Adams wrote this:
The fact that we live at the bottom of a deep gravity well, on the surface of a gas covered planet going around a nuclear fireball 90 million miles away and think this to be normal is obviously some indication of how skewed our perspective tends to be.
In some ways, those who have shaped the corporate wellness movement have dwelled in something of a deep gravity well by having the nerve to call what they offer worksite wellness. Those associated with these programs have for decades overlooked opportunities to advance positive wellbeing. They have found it normal to extoll the benefits of reducing, postponing or maybe even eliminating chronic illness while maintaining a silence about the joys of exceptional advances in physical and mental aliveness. In short, the tens of millions of dollars invested in worksite wellness have been poured into something akin to the bottom of a deep gravity well in order to appease the modern-era high priests of cost containment. In short, worksite wellness exists to minimize poor health-related attitudes and ill-advised behaviors that drive up company health insurance and other dysfunctional employee expenses.
What Wellness Is and How It's Different from Prevention and Other Approaches
It is probably clear at this point how wellness is viewed as different from prevention, health education, holistic health, medical self-care and other activity intended to avoid, treat or manage health problems or other issues that diminish the body or mind. Recognizing this fact is step one for understanding wellness; step two is understanding what wellness and wellness alone of all extant programs seeks to accomplish. There are as many definitions of wellness as there are religions, and some are better than others - just like religions. Some wellness definitions are much worse than others, also like religions. Only one wellness definition, however, is true, which is unlike religions. That, of course, would be MY definition.
Ha ha. Forgive this pause for a moment of sit-down comedy. Humor aside, let me offer a perspective on wellness different from what has been on offer at worksites and elsewhere for several decades.
Wellness is a mindset and a lifestyle intended to increase wellbeing in a positive way. Whether as a personal choice by an individual or an organized program offered for the benefit of others, wellness describes initiatives that promote improved human functioning. Wellness in this positive sense, looks beyond non-illness/absence of disease. Wellness in an affirmative context encourages attitudes and behaviors that enhance wellbeing. Wellness lifestyles and programs seek to increase happiness, meaning and purpose, joy, fun, love and similar qualities associated with physical and mental health. Wellness also values emotional and social wellbeing. In sum, wellness is an idea expressly intended to increase a person's capacity to reason effectively and to experience high levels of exuberance while supporting personal freedoms.
Wellness does address bodily states - primarily evidence-based health - promoting dietary choices and vigorous, regular exercise regimens that enable and sustain exceptional physical fitness. In summary, wellness is associated with thoughts, actions, programs and plans that are positive in nature, proactive and motivated by anticipation of attractive outcomes or states of being.
This interpretation and pursuit makes wellness unique. Wellness initiatives naturally have side-effects, highly fortunate and welcomed anticipated consequences, namely, a strong preventive component. But this is a side-effect, not the goal. Wellness activities are not pursued primarily to prevent or avoid anything - they are always about seeking positive outcomes. By positive outcomes, I mean results or states desirable in their own right, not because of negative possibilities avoided (e.g., sickness or problem situations). The latter, such as avoiding or mitigating a weight problem, is a welcome consequence of the attractive outcome sought (e.g., the fitness level needed to run a race or dance the night away) that provides the highest, most compelling motive for any wellness initiative.
A Shift from Harm Reduction to Positive, Proactive Initiatives Worthy on Their Own Merits
To understand wellness as just described is to appreciate that it is fundamentally different from but complementary to programming for the prevention of disease, the reduction of health risks and the treatment of medical conditions. The latter forms of programming pass for worksite wellness today. All are worthwhile when done properly. They can be valuable, and are not inconsistent with REAL wellness offerings that focus on life-enriching outcomes aimed at positive wellbeing. Worksite wellness has always been about harm reduction. The time has come for a shift to benefit enhancement. Enough is already on offer devoted to problem areas, to managing stress and pain, to modifying dysfunctions and to allying worries. Let's promote the re-envisioning of wellness as initiatives for pleasure that add strength and endurance. Let wellness, as when Dr. Dunn used the term, refer to positive endeavors that add to the richness of life.
Antagonistic Pleiotropy
Some genes serve us well in youth but bring us grief and woe in later life. This phenomenon, discovered by American geneticist George Williams in 1957, is called antagonistic pleiotropy. An example is the gene variant in pale or fair-skinned Caucasians that gives resistance to damage from the sun's UV rays by temporarily darkening (tanning) the skin. However, there's a price to pay - it increases the risk of testicular damage in later life.
An even more dramatic example is a gene that predisposes for hemochronatosis, which means high levels of toxic iron in the blood.
Scientists discovered that this gene afforded protection from bubonic plague during the Middle Ages. Yet, while it increased the odds of surviving the plague, it did so at the cost of poor health later in life.
Antagonistic pleiotropy could be in play affecting phenomena outside the realm of genes. I'm thinking of worksite wellness. As explained above, these programs have provided life support for the inchoate wellness concept. In a basic way, these worksite offerings have given wellness a foot-in-the-corporate door with recognition well beyond that. Worksite wellness probably would not have happened if wellness had not been interpreted to mean harm reduction, medical management, cost containment and other initiatives focused on health risk and health problems. REAL wellness would not have gained support from corporate leadership, for the state of the art and science of positive wellbeing promotion was and still is unlikely to be convincingly linked with cost containment.
Therefore, wellness as harm reduction was great for the early years of wellness. However, now it's a detriment. And the worst of it is that the medical model of worksite wellness is so well established that REAL wellness has not had air to breathe, evolve or prosper.
Antagonistic pleiotropy might, from a REAL wellness perspective, be seen as antagonistic foot-in-the-door pleiotropy.
Other Voices Calling for Change
Several experienced professionals involved in worksite wellness want companies to break out of harm reduction. There is an appreciation of the fact that worksite wellness has overlooked the core notion of a positive wellbeing advance, as life-enriching or enhancing.
There is risk in speaking out, opposing the prevailing model. Companies have invested significant resources in prevention and the medical minutiae of weight loss programming, risk analyses, etc. Yet, the need for a transition to positive offerings is becoming more evident. Events and trends encourage a return to the original REAL wellness perspective.
Here are a few examples of what the band Scorpions in 1991 identified as a wind of change blowing at the back of REAL wellness.
- In a timely article entitled, In Search of an Elegant Well-Being Strategy in the Benefits section of Human Resource Executive Online (May 6, 2015), Carol Harnett claimed that HR and employee-benefit leaders want to move beyond debates about physical wellness to discussions around a host of underlying issues. These include whole-person wellbeing. The wider term also encompasses financial well-being, mindfulness and skills aimed at improved cross-cultural understanding.
- In How to Build a Thriving Culture at Work - The 7 Points of Transformation, Rosie Ward and Jon Robinson describe worksite wellness as stuck in traditional biomedical risk factors. (Their book on such a transformation is available from Salveo Partners.)
- A report called Final Recommendations issued by worksite wellness leaders at the 2014 National Wellness Conference Worksite Academy identified growing evidence that medicalizing the workplace and coercing people into change is ineffective, unethical and iatrogenic. One member called for a worksite wellness paradigm that would move wellness promotion at the worksite into the 21st century. I wasn't there but I'm going to surmise that, fourteen years into the new century, few on hand insisted on keeping the focus on the 20th - or earlier, centuries. (See Jon Robinson paper entitled Re-Thinking Health...Re-Shaping Wellness.)
- Positive wellbeing as consistent with REAL wellness was mentioned by one of the Academy authors, Evin Faulhauber- Cole, who said, Don't be afraid to move away from the common elements of a wellness program to innovate ... to expand the concept of wellness. Consider terms like workforce wellbeing ... and what people want and need to be successful and happy ... joy, gratitude, authenticity and connectedness...When we feel happy and relaxed, we are at our best.
This is one of the most universal and basic notions regarding the human experience. Create systems and environments that support a positive and balanced human experience. (See How WE Can Shift the Wellness Paradigm.)
Summary
Can it happen? Might wellness professionals support a shift over time to REAL wellness, by one name or another, the kind of educational message that informs about and inspires positive wellbeing? If so, can the fixation on cost containment and medicalization of health be overcome, at last?
I'll recuse myself from advancing an opinion, which must be too obvious in any event. In any event, the more important question is, What do you think?
All good wishes - the future lies ahead, as it did in the past and will again, forevermore.