by Jon Robison, PhD, MS
Like many people in this country, I have a chronic “pre-existing condition” which has me paying exorbitant rates for mediocre health insurance and prohibits me from looking around for a better option. As a health professional I have also, over the past two decades, been involved with worksite health promotion as a creating partner of a unique, holistic, HAES®-based employee wellness program entitled KAILO that has won awards in both the United States and Canada. Additionally, I regularly speak at Employee Health Conferences throughout North America. For all of these reasons, I have been watching the controversies over “Obamacare” with great interest. On the one hand, I am excited (and mildly hopeful) that I may qualify for more reasonable and effective health insurance in the not too distant future. With respect to employee wellness, you would think I would also be excited by the prospect of millions of dollars for workplace health—certainly many of my colleagues are. But I have issues with what is happening in the workplace around health and I am worried that this health care reform may actually make things worse.
Some of the responses to Lindo Bacon’s recent blog stimulated me to want to write more about my concerns. I agree wholeheartedly with Lindo’s assessment of what will happen in regards to weight at the workplace—it will not be good—it will not improve health—and there will be significant iatrogenic consequences.
Coincidentally, I had a recent email conversation with one of the leading Health Promotion experts in the country regarding weight loss programs at the worksite. He said that there was no need for me to harp on the failures of traditional weight loss programs because every health professional was already well aware of the complete lack of efficacy of these approaches. I realized that this statement might actually not be too far from the truth. As Dr. Dee Edington from the University of Michigan, one of the most seasoned and well-respected names in worksite health for as long as I can remember, put it:
Weight loss money is money down the toilet.
I thought a bit more about this and asked my colleague this question: “If health professionals all know about the failure of these programs, why are they all still promoting and implementing them at the workplace? Why are weight loss programs, contests and competitions still a mainstay of worksite health initiatives?” Perhaps not surprisingly, I never got an answer back from him on this one.
The response to Linda’s blog that really caught my eye was from Joanna. She commented that she believed that “a focus on health” [at the worksite] “would be just as destructive as a focus on weight.” She continued, explaining her reasoning for opposing such a focus by saying, “does anyone really think that governments and employers, in our deeply healthist culture, will not abuse the power given to them?” She continued on, decrying HAES for not speaking out on this issue. In fact, this is an issue I have been deeply concerned about, have written and spoken about for more than decade, and one that I believe warrants further exploration.
Our culture’s traditional approach to promoting health is based on a paradigm that developed some 400 years ago during the time of the Scientific Revolution in Europe. Often referred to as “The Mechanistic Worldview,” it sees everything within the universe, including living things as machines. Understanding any of these “machines” is accomplished through a “reductionist approach” which entails taking the thing apart and fixing or replacing the broken part.
The Mechanistic Worldview divides the entire universe of things into two; one universe includes everything that can be measured and quantified and the other contains all those things that cannot be. So blood pressure cholesterol and weight, etc. would be included in the first universe and feelings, thoughts, emotions and spirituality would be relegated to the latter. According to this worldview, nothing in the second universe (mind/spirit) can impact anything in the first (body) and therefore the former should not be considered appropriate topics for scientific study. Here we have the original separation of the body from the mind and the spirit. Finally, this worldview is decidedly patriarchal, valuing highly the masculine characteristics of aggression, competition and control.
For the health professions, the result of this worldview is our traditional biomedical model which views human beings as complicated machines whose diseases (diagnosed mostly using physical determinants) are caused by biological malfunctions that can be cured (fixed) by physicians (mostly male). Of course, we have moved off this worldview to varying degrees, but it still underlies much of what we do in the health fields. For instance, the idea that we can calculate how much someone needs to eat to lose a certain amount of weight, the use of BMI as a proxy for health, and the stubborn reliance on calories in/calories out calculations are clearly throwbacks to the “human being as machine” assumption. After all, these kinds of mechanistic calculations work pretty well with lawnmowers!
Our traditional approach to health promotion and health promotion at the workplace evolved directly out of this biomedical perspective. I will explore the approach and examine the associated problems in my next blog.