Beating the Biometric dead horse or getting in the Biomechanical buggy
When I was in graduate school my anatomy professor, Dr. Moncur, had several taglines she would use to keep us on task. One of her favorites was, “Get in the buggy!” Basically meaning to pay attention, focus and more forward; not to dwell on the small details and miss the big picture. This was her common response when we would focus too much on one small anatomical quandary. She could tell we were missing the main concept of the lecture and we needed to be brought back to a better understanding of what we needed to know. In the current corporate wellness communities we need her statement just as much. We need to get off the bandwagon and “in the buggy”.
One of the corporate bandwagons I want to point out is biometric health screenings. The new buggy I want to present sounds similar, what I call biomechanical health screenings. I will get to those in a moment.
Why would I say biometric screens are the bandwagon? They have become something that companies continue to do with no real improvement and little evidence they help change what they measure. I am sure there are examples where some employees improve their numbers. However, I have yet to see convincing evidence of lasting result from the screens, especially on a national scale. In addition, more companies provide them and some even require them (or have increased insurance premiums or other pressure tacticts). Corporate wellness personnel hear about the grand, flagship companies that have huge gyms, onsite salad bars, yoga retreats, walking programs, nap time, granola Fridays, and of course biometric screening. They see the claims that other programs are exemplary and are great investments for the company. So they want to follow suit. Unfortunately, many of the current concepts in corporate wellness are not showing the returned benefit once thought. Biometrics is right in the middle of it.
Here is a scenario to think about. You work for a large company in an office setting. Your company has been making some changes over the past few years in an effort to “get everyone healthy”. Your insurance premiums have steadily increased each year as well. You now get a newsletter in your email every week that gives tips on keeping you healthy; you have read maybe 2.5 of them. You have been invited to a yoga class 3 times, a cooking demonstration 2 times, a walk-a-thon 2 times; you have not been able to attend any as they are either after work and you have a family waiting at home or during work but you barely get your work done by the end of the day. How can you take time off? You get to work and open your email and a new one pops up. If you get a simple biometric health screen you can get a discount to your health premium (starting next cycle, those that do not complete screening may have a rate increase). “What? Now my company wants to know my blood pressure, cholesterol, triglycerides, glucose, medications, cancer risk, liver function and how many BM’s in a day? Why? Didn’t I just hear in the news that we were wrong about cholesterol and it is mostly genetic? Similar for blood pressure and many other things they want to measure for me? Don’t I have enough to worry about? My rates are going to increase? This is not fair!”
This is an exact scenario my personal friend and millions of Americans deal with regularly. I remember talking to my friend the day he got his email about getting tested. We were actually at the gym together and he asked my opinion on it. He said they are basically required to do the screen or their premiums will go up. Of course, he ended up doing the test along with the many other requirements being asked by his employer. Why? Fear of his premium going up. Not to be healthier.
The corporate wellness climate has become one of pressure and scare tactics to push change. When has that ever gone well? As a business owner, I don’t blame a company for trying to reduce costs. I also hope those with wellness programs are doing it to help employees and their families and not just to cut costs. However, the data is just not as promising as it was once believed. Numbers of 6-10% of return on investment in only a few years for initiating wellness programs were once claimed. Now studies are finding little evidence that current wellness programs actually change behavior or bring a return on investment. Some show small returns of 2-3% over 5 years of more. Companies are starting to see a need to changing the corporate climate; not just placing more programs and restrictions.
So, are screenings bad? In reality, no. They might even prolong a life when used at the right time by the right professional. Are blanket screenings of everything for everyone bad? Yes, I think so. I recently attended a conference in which my states leading healthcare company (Intermountain Health Care) had collected data over several years about wellness screens and was presenting the information. In a nut shell they explained, according to their data, that biometric screens don’t create a return on investment. Also that showing people their “numbers” from a screen does not change their behavior. Most biometric markers were meant more for population comparison and not individual study. Without a health professional to help someone understand their numbers it can almost be useless information. They questioned several tests now commonly performed and I agree with their concern:
· Blood pressure – reliability of how it is done, genetic predisposition, whitecoat syndrome
· Body Mass Index – can be unfair depending on body type
· Body Fat Impendence – inconsistent reliability with current technology
· Cholesterol – does not need to be screened every year, genetic predisposition
· Diabetes – only in those at risk (40 and overweight)
· Cancers – only those at risk (40 and over)
· Risk of complications or injury outweigh doing the test, or findings can lead to false positives/negatives that need more follow-up – Carotid Artery Screen (can cause heart arrhythmia), EKG, Liver Function, Metabolic panel, Oximetry, peripheral DEXA)
The most highly recommended screens were for physical activity, nutrition habits, sleep and possibility drug/substance use. Another concern was the level of understanding by the wellness staff of what they were screening for and if it was really their place to discuss findings with an employee. A company could actually be placing itself at risk by having screens that bring back data that really should be discussed with a medical professional without having one available.
So now, back in the buggy! What is the big picture with corporate wellness? Are we focusing on details and missing what is important? I have stated my educated opinion on the use of biometric screens. There will be many that will want to stay in the bandwagon and just keep doing what they have always done. The climate of corporate wellness is changing. It is very slow, but it is here. A movement towards empowering employees and creating a corporate climate of big picture wellness. Not just guilt trips about the details.
Just like the motorized “buggy” eventually replaced the horse drawn “wagon”, I am suggesting it is time to replace biometrics (or at least the parts that should be left to your doctor) and introduce a new wellness buggy. Biomechanics. In actuality, this is not a new concept. They have been used in the hard labor industry for decades working in reduce injury and improve ergonomics. Anything that can done to improve the mechanical efficiency of a process will increase productivity or reduce cost. What is the one machine that just about every company needs to stay in production? Yep, people. Some need far less than they did. Computers have changed the workforce forever. However, most large and small companies are driven by people. Isn’t that the basis of the wellness movement? If the people in a company are unhealthy, then productivity falls and so does the company. Not to dehumanize people, but we are the machines that run companies. As with machines, we break down, get pushed to our limit, fall apart, get rusty, get bugs, etc. What if we could better predict when a machine will fail or break? Isn’t that why many production companies have a maintenance team? Could we do the same for people? If we knew that employees were more likely to get injured and not be able to perform would it be worth it to a company to have that knowledge? Could this be used across the board and not just with hard labor companies? Yes, am suggesting it can.
Just recently in the journal Applied Ergonomics (Moakip et al 2016) it was shown that 93% of Malaysian office workers will have work related discomfort in a 6 month time period. That could suggest that almost every office worker will have work related pain up to twice a year. How is that going to affect productivity and absenteeism? In the American Journal of Preventative Medicine in 2016, Carr identified an inverse correlation between general physical activity increase at work and decrease of cardiometabolic risk by giving some employees sit to stand desks. What if we empowered the ability of people to move instead of focusing on biomarkers? In 2014 Gorg et al completed a study (J of Human Factors) looking at factors that could predict low back pain in a variety of working locations. They studied people from 30 different facilities over 4.5 years. Over that time 75% of people reported low back pain associated to work. The most predictive factors being exposure to peak lifting and a previous history of back pain. Further study found 32% sought medical care. Those that did had higher exposure to lifting, history of back pain, were older and were female. Could this type of information, applied to any company, be helpful in identifying real issues that hurt employees and keep them from producing well?
Muscle and skeletal related problems have been reported to be the most common causes of sickness absence from work. Yet, there is very little that a biometric screen does to identify muscle and skeletal problems or risk. This is my proposal. Use a type of system that has been used for decades in the heavy labor industry to help keep workers safe and reduce their risk of injury and adapt it to office and light labor companies. A biomechanical screen that could combine some basic health assessment information and physical activity assessment with information that could identify potential bodily injury from work. A screen with actual hands on testing of how someone moves, that identifies weaknesses, injury risk, general fitness and provides education by a health care professional. Even office workers deal with aches and pain. Sometimes they help another department and end up hurting their back or shoulder. Maybe their desk, chair or other equipment is not right. Maybe they have been dealing with headaches for months. If a company could help their employee identify areas where they are most likely to get hurt and what might cause the injury, could it be prevented? I believe it can.
There is one detail: this needs to be done by a qualified health professional that can also educate and empower the individual about the information from the screen. There is one professional most qualified to do this, most of them do it every day. Physical Therapists, the movement experts. As a physical therapist I want to bridge the corporate wellness and injury/safety worlds. Why not? If you are sick or unhealthy you are at greater risk of hurting yourself of others. If you are injured you are not well. I am not saying this is the only solution to reducing companies’ health concerns or it is the only way to investment their wellness money. However, incorporating these two areas with the help of biomechanical screens instead of biometric screens, companies will get more useful information; and no useless information. Information that they could use to make changes without making employees feel pressured. Changes that can help employees physically feel better at work and home. Changes that can lead to increased productivity and job satisfaction. Employees will know they are supported when the company makes choices to help them feel better at work; not just pressure them to lose weight, workout more and eat better. The only thing to loose is the number of injuries and sick days a company has. Plus, you will have a great health care professional in your corner that could be used for other wellness solutions such as education days, specific injury screens or even treatments to prevent major injury.
If you or your company are interested in hearing more about how biomechanical screens can improve and compliment both your wellness and safety programs I would love to talk with you. Don’t hesitate to email. Let us help you get back in the buggy.