Redefining Wellness: Giving workers more control over their day and rewards for a job well done. Entry 6 – 2010


Why do work bonuses influence exercise and smoking?
In this blog space, we have written many times about the connection between performance-based pay and positive outcomes, including higher productivity (1) and fewer absences (2). We’ve also seen examples where the structure of compensation seems to influence healthy behaviors (3). We often get questions about why or how pay and health might be connected.

Connecting a few more dots.

The standard answer: when good health translates into a greater opportunity for personal gain (incentive), workers value their health more. While our research shows this to be true from an economic perspective, I’ve always wondered: what is the psychological explanation? So, for those readers with a curious mind, a recent study connects the dots a little better.

Let’s start with Psych 101: Theory of Learned Helplessness.

If you took basic psychology, you probably remember the rat experiments where rodents were exposed to electric shocks on a random basis. For some rats, a particular behavior (e.g., touching a bar) would stop the shock. For others, there was nothing the rat could do to influence the occurrence of the shock, or how soon it stopped. The latter group learned that nothing they did mattered; they became passive and complacent (and perhaps fatalistic). Tests showed that rats with no way to control their environment actually changed brain chemistry and showed diminished response to subsequent stimuli. In other words, “Why try? Nothing I do matters anyway.”

It turns out that learned helplessness—the label applied to this phenomenon—happens when creatures have A) no control over when things happen to them (random shock) and B) no ability to change the outcome through actions they take (called contingency) (4). If the creature can, to some extent, control EITHER the timing or the intensity of the negative event, learned helplessness does not result. Believe it or not, the psychological pattern applies to people as well as rats.

What hopeless rats can teach us about the workplace.

In a study in 2006, researchers asked workers about the level of effort they put into their jobs and the extent to which they felt rewarded for their efforts (rewards included pay, recognition, and self-satisfaction) (5). Interestingly, workers who said they put high levels of effort into their work also reported putting effort into their health—they were less likely to smoke, be overweight, or inactive. However, when researchers created a ratio of effort to rewards, those who reported working the hardest but getting little reward actually had significantly higher rates of unhealthy habits. Workers experiencing the greatest imbalance in their efforts and rewards had a nearly 40% higher rate of multiple risk factors.

The authors hypothesize that when workers learn that their efforts at work do not result in positive outcomes, they develop a form of learned helplessness that extends to other parts of their lives. Feeling ineffective bleeds from one area to another.

Another recent study looked at changes in job control (control over job-related activities and tasks) to see if control correlated with changes in health behaviors (6). It did. Those who experienced an increase in job control over a four-year period were more likely to increase their exercise and report improved health status compared to those whose job control decreased. The reverse was NOT true—more exercise did not lead to higher job control four years later. Because this happened over time, it supports a causal connection between the two.

In summary:

1) Workers experiencing an increase in control over their job adopted healthy habits.

2) Workers who experience little connection between their effort and their rewards have worse health habits than those who work hard and see rewards.

Work and health come down to more than offering wellness programs. If you are like most people, you work because you want or need what you get in return. Sometimes we value the satisfaction that comes from personal accomplishment. Externally, we also value the rewards: pay, recognition, and promise of future opportunities. We work because we get something back.

But it appears that when efforts do not result in anticipated rewards, workers have a greater tendency not to care—at least when it comes to practicing healthy habits.

On the flip side, workers who are rewarded for their on-the-job efforts have a corresponding tendency to work to improve other aspects of life as well.

Applying these results to any workforce carries serious implications for workplace practices. Consider: is your workplace supporting personal control by giving people appropriate discretion over their work tasks? Are the people who get better results receiving better rewards? And perhaps as important: is there a clear pathway for those who are NOT doing well to improve and succeed?

If you cannot answer “yes” to these questions, your workplace may be detrimental to worker health, regardless of programs and messages encouraging healthy habits. In an environment where there is low control and high effort-reward imbalance, offering wellness programs or “coaching ”to correct lifestyle behavior is wasteful at best and perhaps even hypocritical.

Why this matters: The workplace has a powerful influence on behavior at and away from work. Whether business leaders realize it or not, that influence extends beyond specific work tasks into other aspects of life. By focusing on positive aspects of work, employers have a direct opportunity to improve individual health, without any wellness programs at all.


1. Lazear EP. Performance pay and productivity. Am Econ Rev 2000;90(5):1346-61.

2. Health as Human Capital Foundation.Aligning Incentives: What do bonuses have to do with reducing absence? More than you might think. Entry 2 – 2008. January 20, 2008; (accessed April 27, 2010).

3. Health as Human Capital Foundation. Money Matters. What do skinny people in big houses have to do with flu shots and bonus pay? Entry 11 – 2008. May 26, 2008; (accessed June 5, 2008).

4. Peterson C, Maier SF, Seligman MEP. Learned helplessness : a theory for the age of personal control. New York: Oxford University Press, 1993.

5. Kouvonen A, Kivimaki M, Virtanen M, Heponiemi T, Elovainio M, Pentti J, et al. Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees. BMC Public Health 2006;6(Feb 7):24-35; (accessed Apri 29, 2010).

6. Smith P, Frank J, Bondy S, Mustard C. Do changes in job control predict differences in health status? Results from a longitudinal national survey of Canadians. Psychosom Med 2008 Jan;70(1):85-91; (accessed April 29, 2010).


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