Corporate Wellness
January 2, 2024
17 minutes
I imagine most people, like myself, think of their health as something they manage in spite of the demands and pressures of their work. Sadly, most of us are not managing. As we briefly touched on last time, health care costs in the U.S. are skyrocketing, and premiums for employer-sponsored health insurance are set to rise almost 7% (mostly to cover the costs of new weight loss drugs such as Ozempic and Wegovy), leaving employees and employers in an increasingly tight financial situation. It is widely known that health insurance premiums have risen faster than inflation or wage growth over the past decade, and many employers are starting to become concerned that employees are already strapped for health care expenses and can't afford more [1].
Given this context, I've recently been thinking of the following inversion: what if, instead, work was a place you went to in order to get healthy? What if the health and wellbeing of employees were managed as explicitly and intentionally as meeting a project deadline or satisfying a high-value client? The idea, of course, is that this wellness would result in higher productivity, less lost time due to illness, less turnover, and of course, less health care costs. This post will be part rant on the ways I wish employers would do more to facilitate the health of their workforce, and part riff on some future possibilities.
In my experience, most workplaces are not architected with employer health as an intended outcome. Most companies I've worked for are ambitious startups. As such, there are a lot of demands, and the pace and stress are kept consistently high, and employers do not arm their staff with protocols or knowledge to manage that stress. The most "corporate wellness-y" thing that's been offered in any of these environments is have a massage therapist visit once every two weeks. In practice, the only discretionary work activities that don't involve doing or discussing actual work typically feature alcohol or desserts. Don't get me wrong, I like those things every now and then, but it seems that companies, especially the ambitious ones, are leaving a lot of gains on the table by not cultivating a culture of workplace wellness.
@JosephJacks_ tweets: "Highly ambitious startups should pretty much always incorporate Olympic Athlete-Level team cultures and execution.
Those who don’t are simple not highly ambitious."https://twitter.com/JosephJacks_/status/1729235645233860795
I agree. Think of how Olympic or professional athletes are managed: of course, they are on a training plan that ensures they are performing and progressing in the obvious work to increase their specific skill performance. But other aspects of their lives that support their specific skill are also managed such as diet, motivation, and mental health. The NBA, for example, has required all teams to have a mental health practitioner on staff since the 2019-2020 season, and many teams go above and beyond that requirement because they see it as a potential source of competitive edge [2].
Meanwhile, in the corporate world, the idea of acknowledging and covering mental health treatment, much less investing in mental wellbeing to improve performance, has yet to gain much significant traction. Many employees face difficulties with accessing adequate coverage for mental health treatment; only 13% of employers who offer coverage for mental health through their insurance plans consider their coverage to be sufficient, and 13.4% of employees cited an unmet need for treatment due to cost [3]. Even the companies out there that just want to save on cost, rather than proactively invest in performance would do well to invest more in mental health coverage. It is estimated that "people with both behavior and physical health conditions incurred an additional $406 billion in health-care costs", which indicates that employers would likely save on cost by providing coverage for behavioral health issues [4]. The lack of sufficient mental health coverage is not all on employers, health insurers and providers also play a critical role, but employers could certainly elevate the importance mental health services when choosing insurers and negotiating plans.
It's worth noting that a small sliver of corporate employers, the most profit-minded ones, have embraced the idea of investing in the holistic wellness of their employees in order to improve performance. Hedge funds are known to employ board-certified psychiatrists to work with their traders to help them manage the emotional burden that can sometimes lead to irrational and suboptimal trading performance [5]. But these demands, and financial stakes, are not unique to hedge fund traders. In my world of tech, I can think of numerous types of employees who work in high stakes settings who would benefit from mental health coaching and counseling beyond what their direct manager could offer them:
- A salesperson navigating the long and complex rollercoaster of an enterprise sales cycle.
- A software architect designing a complex distributed system.
- A product manager crafting a roadmap that incorporates feedback from an array of stakeholders (clients, sales, engineers, senior leadership).What tools and meta-skills do we give these people to manage the intense pressures and demands of their job? In my experience, not a lot.
It's not just mental health that is lacking investment, I think there is significant return on investment to be realized in investing in employees' physical health. Here are a few ideas:
- Standing desks. At this point, everyone knows the harms of sitting. The average desk worker spends 6.5 and 8 hours per day sitting, typically with poor posture and biomechanics, which leads to a lack of activity and the ensuing slew of problems one might expect: various cancers, heart disease, etc. Many workplaces already have standing desks, but what about going a step further by invoking Pearson's Law (which every organization is aware of and tries to live by, though perhaps not by name): "That which is measured improves. That which is measured and reported improves exponentially" [6]. What would that look like? Perhaps a standing desk that measures how long an employee spends standing per day, but also reports on that information in a dashboard that's private to the employee? That information could optionally be shared with a wellness consultant, or other trusted third party source, and be part of an employee's quarterly wellness checkup to ensure a healthy balance of time is spent standing during the day. This is, in my view, what treating employee wellness as a first class concern alongside project deliverables and other "urgent" work priorities would look like.
- Diet. It's estimated that up to 20% of the population has some sort of food intolerance, and many people do not know what foods or ingredients cause them issues [7]. What if companies sponsored every employee to see a dietitian and come up with a personalized nutrition plan? Or, what if companies were able to bulk-buy Continuous Glucose Monitors for employees so they could learn what foods cause glucose spikes? Companies could ensure that lunch and snack choices at their offices had sufficient options for all kinds of dietary restrictions and intolerances. The more effort that goes into personalizing these options so that each employee can get a nutrient dense and healthy meal, the better. I don't think this is the type of thing that any employer (other than maybe the Googles of the world) could manage due to the administrative complexity, but I believe that when numerous entities face the same administrative burden, there must a company waiting to be born that can specialize in solving for that complexity. In any case, this is what "going to work to get healthy" would look like from the standpoint of diet.
- Breathing / Biofeedback. My (tragically) favorite example of workplace health gone awry is what is known as email apnea [8]. This is the phenomenon whereby people hold their breath while reading email. The breath is a person's most powerful tool for regulating their autonomic (subconscious / involuntary) nervous system, which governs whether a person feels safe or not. A feeling of safety triggers the parasympathetic nervous system (which controls the "rest and digest" response), whereas a feeling of danger triggers the sympathetic nervous system (which controls the "fight, flight, or freeze" response) Every day, multiple times a day, we experience erratic and irregular breathing which our body experiences as stress. What if employees wore a respiratory tracker whose data was shared with a biofeedback practitioner who coached them on healthy breathing patterns? Even better, what if this respiratory tracker could overlay data on top of the employees' calendar and email client so the employee, and the biofeedback coach, could see exactly what situations trigger a stress response?
I don't intend to convey that there are no options out there for corporate wellness. I actually think COVID-19 has catalyzed productive conversations about mental health and health monitoring, and a lot of the companies driving those initiatives forward are creating business-focused offerings (which feature population health metrics and reporting that respect individual member privacy). Here are a few examples:
- Noom offers expert-coaching for managing stress, losing weight, preventing diabetes, and obesity care designed for reporting on and improving population health [9].
- Oura makes a ring that is worn around one's finger (similar to the Whoop strap that is worn around one's wrist) that measures key biometric data such as sleep duration and quality, cardiovascular strain, respiratory rate, and heart rate variability (HRV) [10]. HRV is considered the gold-standard, "all-in-one" metric that captures how recovered one's nervous system is. I intend to do a more thorough deep dive on HRV in a future post.
- Calm makes an app that delivers audio content including guided meditations that are meant to help manage stress and anxiety, improve sleep quality, and build healthy habits [11].
It's exciting to see this emerging sector of consumer facing companies (as opposed to, say, a health insurer/payer) leading the charge on envisioning how to cater to the increasingly long list of employees health needs and wants in the work place. But, I think this is only the start. There are so many exciting possibilities for how to more proactively manage stress, fitness, and wellness in the workplace. Doing so would not only decrease the health care costs incurred by a workforce, but also improve productivity and cultivate a more enjoyable and sustainable working environment.
[1] https://www.americanprogress.org/article/health-insurance-costs-are-squeezing-workers-and-employers/
[2] https://theathletic.com/4384992/2023/04/18/nba-mental-health/
[4] https://www.washingtonpost.com/opinions/2023/07/21/mental-health-care-insurance/
[5] https://fortune.com/2016/02/04/showtime-billions-performance-coaches-therapists/
[6] https://www.amazon.com/Heart-beat-Business-Positioning-Variability-ebook/dp/B09VPC6LK7
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695393/
[8] https://www.mindful.org/email-apnea-is-real-heres-how-to-breathe-better-at-work/
[9] https://www.noom.com/for-work
