Last month, I made the case that health risk assessments are a poor tool for measuring the health of a population or a single individual, and the data they produce are not necessary for the design of good wellness programs. ("No more master key: Health risk assessments unnecessary for wellness plan design," EBN March)
Many people agree that HRAs are not a very good measurement tool but go on to argue that they can be a good engagement tool.
They think that HRAs can help get people to adopt new health habits and get them on the path to wellness. "It's not the HRA that changes habits," goes the thinking, "but what you do with the results that matters."
The key question is whether or not completing an HRA is a good start to changing habits, and if the reports that come from the process are useful in getting people to make lifestyle changes.
The vast majority of people who complete an HRA do so as quickly as possible (often simply to qualify for an incentive), spend between five and 20 minutes skimming their summary report and then they forget about the experience and go back to living their lives.
Except they do so with a slightly changed, and not improved, view of their own health. In fact, they leave the HRA experience with a license to continue behaving badly from a health habit point of view. Why is this?
Being human means that we predictably lie to ourselves when remembering our health habits. We're overgenerous (if you find the word "lie" too harsh) to ourselves and under-report our poor habits.
This is natural, even mentally healthy, but becomes exaggerated when incentives are involved, or trust of an employer's motive for asking is low. (For a contrary view on the usefulness of HRAs, read Contributing Editor Christy Yaccarino's column on page 32.)
When white lies become the new truth
The problem is that these white lies become our new truth when we commit them to paper or online during an HRA. We leave the experience believing we're healthier than we are, and that although we could stand to improve a few things, there is not much to worry about.
Add to this the fact that your peer group, to whom you may be compared in an HRA report, is getting less healthy by the year, and you can leave an HRA believing that you are much healthier than others, too.
Consider that as many as 80% of American adults suffer from a chronic disease or are overweight or obese, yet fewer than seven out of 10 think that they are overweight or in poor health!
Much of the problem lies in the way that we think about health. For most of us, when asked, "How's your health?" our response is, "Fine, thanks," on the logic that we're not feeling sick today, and therefore our health is good.
Health is a binary notion for most people (we are either sick or healthy), and there is no scale of how healthy we are. The reality is that there is a big difference between someone who is merely "unsick" compared with someone who is vitally healthy.
This is especially true when one compares productivity levels. Most of the gain in productivity that comes from improvements in health comes not from reducing health risk factors, but from improving positive health drivers such as exercise, hours slept each night and the quality of food eaten each day.
Not to mention the fact that positive health habits are often the best way to reduce or remove health risks like obesity, hypertension, high cholesterol and heart disease risk. So focusing on risk factors, rather than health habits, means we are aiming too low.
HRAs keep us preoccupied with health risks, or health failures, when we should really be focused on those aspects of health that directly improve our productivity.
After all, if improved productivity is not the main goal of wellness programs, they will continue to be used as a tactic to reduce health care costs only and enjoy the same level of support that other expense-control initiatives get in any company; that is to say, not much.
However, there is a second type of experience that some people have when completing an HRA.
It's more often seen with a blood draw or biometric screen: the person who truly does learn some news about their health habits and risks and who is frightened into action by the implications of this new awareness.
They turn their lives around on a dime, and within six months become the poster child for healthy living. Stories of these experiences are the stock in trade for HRA vendors and salespeople.
The truth is that for most people, the galvanizing power of fear is short-lived, and a few weeks later, people mostly revert to their former habits. For every poster child, there are hundreds of disillusioned people with failed attempts to adopt new habits.
This is because education and self-awareness, while important, are far from the critical success factors that lead to sustained healthy lifestyles.
For employers hoping to see reduced health care costs, HRAs (and biometric screenings even more so) often backfire, as the new information simply leads employees to visit their doctors, collect a prescription and start taking drugs to deal with their new-found health risks.
A spike in prescription costs is a common phenomenon following the first use of HRAs and biometric screens, supporting the case that most people choose to treat their health risks, rather than reverse them with a change in lifestyle.
You might argue that preventing a health risk with drugs is better than doing nothing, and from a cost and long-term health point of view, that may be true. But for most employers, the real metric that matters is employee productivity.
When the root cause of poor productivity is a lack of exercise, poor sleep and nutrition, treating the symptoms of these problems (such as high blood pressure) does not solve the productivity problems.
Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care and wellness. He can be reached at firstname.lastname@example.org. Follow EBN on: Twitter | Facebook | LinkedIn | Podcasts
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