In 1978, when wellness was still a strange term that few people understood, I was hired to direct one of the first hospital based health promotion/wellness programs in the country.

Samaritan Health System (SHS, now known as Banner Health), the largest hospital system in Arizona, started this innovative program because health care costs were escalating and consuming a continuously increasing percentage of GDP. The Center for Disease Control had just completed a study showing that over 50% of morbidity and mortality could be attributed to lifestyle related behaviors, but only 3% of health care spending went to prevention. SHS founded Lifewise to increase its focus on prevention, address the health care cost issue, and establish itself as the leader in comprehensive health care management. Now, wellness facilities are ubiquitous and the word has become part of our common parlance. Smart-watches are even being sold to monitor our exercise and nutritional habits. The following graph shows the results of this movement.

1978 2014
Total Health Care Costs $200 Billion $3 Trillion
Percentage of GDP 8% 18%
Percentage of health care spending allocated to prevention
3% 8%
Percentage of disease and premature death attributable to lifestyle related behaviors
>50% >50%

What does this chart tell us? In the last 36 years, health care costs have increased 15x, spending on health care as a percentage of GDP has more than doubled, and spending on preventive health services/wellness has increased significantly. For this enormous investment in health care, there has been absolutely no impact on our health, our behaviors, or disease prevention. In fact, obesity rates are still climbing. Clearly, many individuals have become much healthier as a result of many of these programs, but for the population as a whole, obesity has increased, stress has increased, and our health care system – the most expensive in the world – ranks very low compared with other countries on indicators such as infant mortality. Affordable health care represents a step in the right direction, but Republicans are doing their best to snatch defeat from the jaws of victory.

What happened?

Basically, when we think of health promotion we need to take into account not only individual health, but also organizational health. Yes, there are more marathon runners, tri-athletes, vegetarians, and people who get massages and go to Yoga classes; but unfortunately, most organizations are still soul-sucking, health-depleting places with toxic managers and abusive working conditions. And the American culture of greed and gluttony doesn’t exactly support positive health practices. Income inequality has exacerbated the stress. While the top 1% can afford their health clubs, massage therapists, and high performance gadgetry, the lower 90% not only find it harder to make ends meet, but also to find affordable fresh fruits and vegetables in their neighborhood markets. It may be that wellness will turn out to be one more perk for the privileged.

What can be done to re-draw this rather dismal picture?

First, individual health and wellness needs to be seen as more than physical fitness. Second, we need to create environments that support positive health practice and well-being. I believe there are four critical areas that require different approaches: purpose, context, content, and process.

Step One: Change the PURPOSE of wellness from bicep building to performance improvement.

A recent New York Times article, “Why You Hate Work,” was based on a study conducted by the Harvard Business Review along with consulting firm The Energy Project, and it begins by simply stating:

“The way we’re working isn’t working.”

The article continues:

“Even if you’re lucky enough to have a job, you’re probably not very excited to get to the office in the morning, you don’t feel much appreciated while you’re there, you find it difficult to get your most important work accomplished, amid all the distractions, and you don’t believe that what you’re doing makes much of a difference anyway. By the time you get home, you’re pretty much running on empty, and yet still answering emails until you fall asleep.”

For most of us, in short, work is a depleting, dispiriting experience, and in some obvious ways, it’s getting worse.

“Employees are vastly more satisfied and productive, it turns out, when four of their core needs are met: physical, through opportunities to regularly renew and recharge at work; emotional, by feeling valued and appreciated for their contributions; mental, when they have the opportunity to focus in an absorbed way on their most important tasks and define when and where they get their work done; and spiritual, by doing more of what they do best and enjoy most, and by feeling connected to a higher purpose at work.

The more effectively leaders and organizations support employees in meeting these core needs, the more likely the employees are to experience engagement, loyalty, job satisfaction and positive energy at work, and the lower their perceived levels of stress. According to the Harvard study, when employees have one need met, compared with none, all of their performance variables improve. The more needs met, the more positive the impact. …

Put simply, the way people feel at work profoundly influences how they perform. What the study revealed is just how much impact companies can have when they meet each of the four core needs of their employees.
Renewal: Employees who take a break every 90 minutes report a 30 percent higher level of focus than those who take no breaks or just one during the day. They also report a nearly 50 percent greater capacity to think creatively and a 46 percent higher level of health and well-being. The more hours people work beyond 40 — and the more continuously they work — the worse they feel, and the less engaged they become. By contrast, feeling encouraged by one’s supervisor to take breaks increases by nearly 100 percent people’s likelihood to stay with any given company, and also doubles their sense of health and well-being.
Value: Feeling cared for by one’s supervisor has a more significant impact on people’s sense of trust and safety than any other behavior by a leader. Employees who say they have more supportive supervisors are 1.3 times as likely to stay with the organization and are 67 percent more engaged.
Focus: Only 20 percent of respondents said they were able to focus on one task at a time at work, but those who could were 50 percent more engaged. Similarly, only one-third of respondents said they were able to effectively prioritize their tasks, but those who did were 1.6 times better able to focus on one thing at a time.
Purpose: Employees who derive meaning and significance from their work were more than three times as likely to stay with their organizations — the highest single impact of any variable in our survey. These employees also reported 1.7 times higher job satisfaction and they were 1.4 times more engaged at work.”

Step 2: Change the CONTEXT of wellness from the gym to the work environment i.e. from reducing medical risk factors to improving the norms and values of the workplace.

In 1982, AT&T hired me as a consultant to design a culture-based wellness program for its one million employees. At the time, Total Life Concept was the first corporate wellness program that focused on creating a healthier work environment. Even though we didn’t have the benefit of the Harvard study cited above, the program concentrated on renewal, value, focus, and purpose. The timing was fortuitous. We implemented this program just before the divestiture of Ma Bell into seven regional operating companies, many of which have now merged. The purpose of the program was to help employees manage change during one of the most tumultuous upheavals in corporate history.

What made Total Life Concept unique was its emphasis on culture and leadership behavior. Instead of initiating the program with a health risk appraisal, it was first introduced to all leaders through a Managing for Health and Productivity workshop. In that workshop, we discussed how management behaviors influenced employee health, engagement, and productivity. Each manager received feedback on how his or her behaviors could make or break this program. An extensive evaluation of Total Life Concept after two years projected a decrease of $300 million in health care costs over a 10 year period. More importantly, the results showed that employee engagement and sense of well-being significantly increased.

Step 3: Broaden the CONTENT to include health enhancement as well as risk reduction.

In 2003, based on the work at Samaritan Health Service, AT&T, and many other clients, Barry Cohen and I published The Complete Guide to Wellness. This book includes 7 chapters on risk reduction and 9 chapters on health enhancement as well as a Lifestyle Possibilities Assessment. Here are the 16 areas:

Risk Reduction:

  • Stop Smoking
  • Weight Control
  • Cholesterol Reduction
  • Blood Pressure Control
  • Stress Management
  • Present Moment Thinking
  • Lower Back Care

Health Enhancement:

  • Fitness
  • Nutrition
  • Interpersonal Communication
  • Self Esteem
  • Managing Change
  • Creative Thinking
  • Job Satisfaction
  • Healthy Home
  • Connectedness

As you can see, there are chapters addressing the physical, emotional, intellectual and spiritual dimensions of wellness.

Step 4: Use the 5D PROCESS to implement the wellness program.

With a clear purpose (performance improvement), the right focus (cultural norms and values), and the right content (lifestyle possibilities), the last step is to use a systematic process to implement the program. For the past 30 years, we have used the 5D process to achieve significant results: Design, Diagnosis, Development, Delivery, and Determination. In 2001, Julie Meek and I published the book Spiritual Leadership in which we documented the process and profiled “Soul Models” who had successfully implemented 5D. Here is a brief definition of each D:

• Design: Creating the vision and possibilities for the future
• Diagnosis: Identifying solutions required to achieve the vision and the challenges that need to be addressed
• Development: Creating the programs and processes required to implement the solutions
• Delivery: Implementing the solutions
• Determination: Evaluating the results

With comprehensive content and a systematic process, the chances of achieving high level wellness are greatly enhanced.

The purposes of this post are to shed light on the history and evolution of wellness in America, to suggest some ideas for improving the impact of our health care and wellness spending, and to stimulate thinking on what it would take to make it easy for people to answer the question, Why I Love My Job?” When we are able to pass that simple test, we may be on the right road to wellness.

Also published on Medium.

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Mafe Rodriguez
Mafe Rodriguez

Hi Rick!!
Thank you so much for sharing.
And that is a beautiful picture!!
big big hug!!


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