A “Culture of Health” – It’s more than a checklist. Entry 12 – 2009.


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Every year, a new catch phrase becomes THE focus of corporate health. This year that phrase seems to be the “Culture of Health.” At almost every conference and corporate benefit presentation, a ‘culture of health’ is the gold standard all employers must strive to achieve. And why wouldn’t everyone want to?

But by what measure?
Disappointingly, more often than not, ‘culture of health’ is a term used to justify existing programs or sell new health-related activities. This thinking implies that how many health-focused activities a company sponsors, or how many health-conducive facilities they have determines whether there is a “culture of health.” I saw one presentation that defined it as a list of programs and facilities (everything from a fitness center, to healthy options in a cafeteria, to well-lighted stairwells, to weight-loss counseling), without mention of participation rates, results, or return on investment. This company is regarded as an industry leader, which means if other employers want to keep up, they’re going to need more checks on their list of health programs and activities.

Two things bother me about this year’s catch phrase: One, we’ve reduced the concept of culture to a single dimension (and coincidentally, only the dimension a company can buy). Two, it is a distraction from the real goal: productive employees and company success.

While external environment and supportive resources play roles in health promotion, can we really equate activities and facilities with culture? A definition of the term from Webster’s Dictionary:

Culture: The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group; and that members use to cope with their world and with one another.

Scholars who study culture point out that culture itself is not observable, and can only be studied indirectly. It’s not simply WHAT people do, but WHY they do it, and what they BELIEVE about it. It’s not the items they own, but what those items signify. Culture is much more about the meaning of what we do, than about doing.

A “culture” that truly values human capital is one that rewards work achievement, shares savings when efficiencies are achieved, and provides significant opportunity for employee advancement. It values all human capital assets and encourages growth through aligned incentives. Employers can make SKILLS, MOTIVATION and HEALTH all more valuable by making sure that employees receive clear rewards for good work and clear savings from protecting their human capital, and never purchase a single health program!

It is a mistake to isolate health—as if it operates separately from skills and motivation—or to make it the end, instead of a means for a successful career and life. (There is a wonderful World Health Organization statement that describes health as: “a resource for everyday life, not the objective of living.”(1))

When we reduce discussions about adopting a ‘culture of health’ to a checklist, we miss the point. In fact, companies cannot buy culture with things and programs. Can we buy a “culture of learning” simply by building more schools and offering more classes? Can we buy a “culture of economic responsibility” by training everyone to understand interest rates and budgets? Of course not. These activities provide tools and opportunity, but they do not MAKE culture.

No, culture comes from continuous reinforcement, encouragement, acceptance, and rewards that confirm what is (or should be) of collective value to the individual and the organization. Interestingly, the same company that presented the extensive list of health programs and activities also has overarching policies that discourage wellness, such as:

Extensive pressures on leisure time of employees. Leisure time is a significant predictor of participation in healthy behaviors. Severe infringement on personal time—or implying that a defined work day shows a lack of dedication—while asking people to prepare healthy foods and exercise, is not a culture of health.

Limited opportunity and dead-end jobs. Motivation in one’s job carries over into life. Without optimism for a better future, self-improvement has less meaning. Under-investing in skills and capacity, while asking employees to improve their management of disease, is somewhat incongruous.

Keeping instead of sharing savings. Employees understand that health improvement efforts are often driven by a company’s desire to save money. Will employees share in any of those savings? If there is no shared economic return—bigger bonuses or bigger health savings account deposits—is this a culture of health? Or is it simply a thinly-disguised cost-saving effort benefiting only the firm’s owners and management?

Do we send mixed messages?
Too often, I see executive support for health expressed in an unrealistic way. A CEO will say, “We care about you and want you to take care of yourself,” while also reminding workers that he works at least 80 hours per week and STILL does a five-mile run every day. He does not mention that he has hired assistance at home to do his shopping, fix healthy meals, care for his children, and keep his household running smoothly. He also has ultimate flexibility in his schedule.

Today more than ever, the currency of healthy living may be time. And the best encouragement may be an obvious, regular practice of healthy behaviors by leadership. Having convenient tools, facilities, and resources will not add another hour to a person’s day. Nor will it change unwritten rules about getting in early or staying late.

Which brings me to concern number two. Distractions from the end-game: productive employees and a successful business.

The usual goal of a business is to deliver quality products and services and make money doing it. Companies hire workers to help accomplish this goal. Ideally, those hired are maximally productive and able to generate more value than they are paid (a requirement to make a profit).
The primary purpose of business is NOT to keep employees healthy. Sure, it’s a means to an end, but really, when you think about why businesses are created—to make and serve tasty meals, to deliver landscaping services, to design graphic artwork, whatever—we shouldn’t expect that worker health improvement is the reason for being in business. Secondarily, as a part of a human capital-building environment, employers want employees to grow their skills and abilities not because it is employees’ duty or mission, but because human capital assets contribute to business success.

Before you jump on the “Culture of Health” bandwagon, ask the following:

  • Can employees earn significantly more for high achievement?
  • When health care and work absence spending go down, do employees share the savings?
  • Do employees have proven and visible opportunities for significant career advancement?
  • Is there significant investment in training?
  • Is the work day clearly defined to allow schedule flexibility and leisure time for healthy activity?

THESE elements reflect a true culture of well-being and respect for human capital, not whether a company has a program for every disease or risk factor an employee might experience.
If workers don’t gain from better performance and lower costs, why should they believe the company truly values their well-being (as opposed to simply wanting to make more money by cost cutting)?

Re-think the checklist.
If you look, you will see that those advocating most loudly for a ‘culture of health’ are those trying to sell more services. You will also see that the ever-lengthening checklists focus on more programs and services rather than on taking a hard look at how workers are rewarded, trained or treated.

Human capital growth, rewards for achievement, shared savings, respect for individual needs, and recognition for accomplishment are all proven to produce both improved health, and business results too…without a checklist.

Why this matters: Not every well-intended trend is a worthwhile investment. Remember, every dollar spent adding programs (health-focused or otherwise) is a dollar NOT spent on salary, bonus, or training. Make sure it is a dollar that truly encourages and rewards achievement and capacity growth, for the benefit of company and worker alike.

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References
1. World Health Organization, Regional Office for Europe. Ottowa Charter for Health Promotion, 1986. Last updated April 1, 2006. Accessed June 5, 2009.


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2 Responses to A “Culture of Health” – It’s more than a checklist. Entry 12 – 2009.

  1. >In my 25+ years of consulting with companies, I echo Wendy's comments that the companies that were the most successful, with the most productive and results-producing employees at the lowest possible cost, were those org's that did the hard work of building a true set of shared beliefs about how to attain company results in a health-enhancing culture and environment. It wasn't about the number of programs, it was about all the harder things to build…health-enhancing management styles, decision-making practices, communications, etc.

  2. >In my company, and especially my department we have a saying: "Culture is free." It comes in really handy in an economic recession.

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