the world of work in 2018

The latest edition of Workforce Management has a feature on experts' predictions for what the world of HR will look like ten years from now. (The story isn't available online yet.)

Here's what caught my eye.

Top predictions for 2018 regarding the structure of work:

#1

There will be an increased focus on infrastructures-- such as social networks and wikis-- to support building strong relationships and collaboration.

#2

The structure of work will become more adaptive, more informal and less focused on formal structure and static design solutions.

#3 [a five-way tie!]

"Agile" organizations will have survived rampant aggregation and consolidation, and all organizations will be developing greater agility.

There will be greater demands on HR professionals to be businesspeople, with competencies in finding and retaining talent and in managing contract and freelance workers.

Organizations will have the ability to personalize the employee value proposition, helping employees find value in the work they do based on how they interact with the company. Some employees will be full time and long term. Others will be short term and part time.

Flexibility will no longer be optional. Employees will expect to utlize both short- and long-term flexibility options to meet their needs.

The most successful organizations will have a performance culture or meritocracy and will demand extraordinary effort from those who wish to achieve leadership positions.

Top predicitions for 2018 regarding work and society:

#1

Societies throughout the world will focus on work as a more important crucible for social progress and values. The memory of today's financial crisis will leave a legacy of greater scrutiny and regulation of issues such as fairness, pay diffefrentials and wthics, particularly in traditional Western economies.

#2

Millennials will redefine work, doing work at home and taking home to work. This means blurring the boundaries of life and work. More workforce mobility will allow people to work from home and at different hours.

#3

There will be more emphasis on collaboration and using technology to support it.

stress, fear, action, relief

Great post in Steve Roesler's All Things Workplace blog.

"Do something now. Feel the relief that follows. You and I have more control over our stress than we sometimes care to acknowledge."

too much information....

At the Freakonomics blog, Stephen Dubner asks "what to do about too much data."

The problem is ... reading and research is so much fun that it is really hard to limit yourself. Especially in this age of Google (and Google Books) and Amazon and even Wikipedia (yes, I was an early detractor but have come around on certain subjects), I am constantly trying to take a little sip from a firehose, and it’s nearly impossible. Reading too much inevitably turns into wanting to write too much; in this case, shorter will be better, but it takes a lot of effort and a long time to get the right three paragraphs (as opposed to a much easier but, to my mind, less effective 12 paragraphs).

The problem is that the more I’ve read — and the more data I’ve consumed ... — the better those three paragraphs will be in the end. It reminds me of making maple syrup, which we did every winter as kids. You’d run around collecting all this sap, gallons and gallons of it from the trees you’d tapped, and then stay up all night boiling it down on an open fire — all to produce one little jar of syrup.

Nice metaphor. Unfortunately, nowadays we're often unwilling to invest the time and effort to tend that boiling maple=syrup kettle....

Meanwhile, in the WSJ's Juggle blog, Rachel Silverman asks whether "documenting" your family (i.e., photos, scrapbooks, etc) can take too much time.

I’m ... overwhelmed by the sheer volume of photos that digital photography makes possible. We literally have hundreds of pictures of our son, only 10 months old .... Looking through all the pictures and organizing them can sap up more time and energy than the events that we’ve documented.

Is it worth it? I wonder if it’s possible to take too many pictures, to spend too much time documenting, to focus too hard on capturing an event in an image or video, to rely too much on photos for memory, rather than really living and experiencing a moment and trying to imprint it in our brains. Sometimes, when my husband and I forget the camera we even get bummed out, at least for a moment, because we can’t capture whatever adorable expression or gesture our baby makes, rather than just truly enjoying the experience as is.

So true. Makes me think of the opening of Choruses From The Rock by T. S. Eliot:

The endless cycle of idea and action,

Endless invention, endless experiment,

Brings knowledge of motion, but not of stillness;

Knowledge of speech, but not of silence;

Knowledge of words, and ignorance of the Word.

All our knowledge brings us nearer to our ignorance,

All our ignorance brings us nearer to death,

But nearness to death no nearer to GOD.

Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

Info Buffet

Tasty tidbits I’ve been sampling from the “info buffet” 12/9/08 – 12/11/08:

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HR Capitalist blog has a good story illustrating how “the behavioral DNA that defines a company's culture” manifests itself in telling ways.

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The Freakonomics blog. Introduces us the concept of a “buycott.” Unlike the negatively-focused boycott (where you choose not to patronize a business whose practices you don’t agree with), the “boycott” is a more affirmative measure: You promise to patronize a business if it implements certain practices you’d like to see in place. According to the Freakonomics gang,, “buycotts” have potentially more economic leverage than boycotts.

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Now that we have a recession, there's never been a better time for defining health as human capital. That’s the message of the latest entry in the Health as Human Capital Foundation’s research blog. Wendy Lynch and Hank Gardner have a refreshingly different view of the value of good health. For a more detailed description of their “health as human capital paradigm,” go here. The key point for me is that health is one of the three key assets (along with skills and motivation) that people bring with them to their jobs.

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And speaking of health and jobs, here’s a recent WSJ op-ed by Dr Ezekiel Emanuel (he was co-author of the WaPo piece on the myths of healthcare that recently caught my attention) and Senator Ron Wyden (D-OR) arguing in favor of severing the link between employment and health insurance. One way or another, I think, the employment/health insurance link will be severed over the next several years—if not because of developments “on the left” (i.e., a national single-payer program), then because of developments “on the right” (i.e., a move to portable, defined-contribution type health accounts)…. For some more commentary on the Emanuel-Wyden op-ed, as well as socialized versus market-based approaches to health insurance, there’s this post by Matthew Holt in The Health Care Blog.

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I find myself reading a lot of materials about “market-based” approaches to health. Here’s one of them, courtesy of the WSJ Health Blog. Evidently, a study in the current issue of the Journal of the American Medical Association suggests that if we paid people to lose weight, we could curb the obesity epidemic.

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Jane Sarasohn-Kahn is a healthcare economist whose work I’ve been following for the last half-year. I think she’s outstanding. One of her latest contributions is an article on how the economic downturn has been affecting people’s health behaviors. Bad economy leads to poor health behaviors. Jane combines insights from National Center for Health Statistics data about gender/age patterns in ambulatory visits to doctors with results of a recent AARP survey of how age 45+ Americans have altered healthcare behaviors due to the economic downturn and concludes that women's health outcomes in particular could decline in concert with the economy. Read the whole thing.

Jane also has another post about a recent National Research Corporation survey of “online health functions” that American households have been engaged in over the last year. The bottom line is that more and more people are doing a broader variety of health-related tasks online. In her “Hot Points” assessment, Jane sees evidence of what she calls the “Craigslistification” of health searching.

And be sure to check out Jane’s assessment of the NIH’s National Center for Complementary and Alternative Medicine’s latest report on use of complementary and alternative medicine (CAM) in the United States. "Economics plays a role in the adoption of CAM. In both 2002 and 2007, when people delayed conventional health care due to cost, the use of CAM increased." Nutritional supplements (fish oil, glucosamine, and the like) were the most commonly used therapies; and musculoskeletal disorders (back issues, neck issues, joint disorders, etc) were the most common reason for using CAM.

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I spent yesterday morning at a decidedly non-CAM facility—a local gastroenterology center (I was waiting to pick someone up after a diagnostic procedure). While I was in the waiting room, I read the latest issue of Business Week, which had this highly informative article about how patients are using Web-based social networking to take charge of their own care. We’re going to be hearing a lot more about “Health 2.0” (especially if the “management gurus” get behind it, as this item indicates). And check out the end of the Business Week article—Jane’s everywhere these days!

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One my way home from the gastroenterology center yesterday, I stopped at Dunkin Donuts to pick up a late breakfast. Fast food places like DD are notorious for high employee turnover. Which leads me to the next item: An article on the kinds of “hard-knock turnover situations where [any HR professional] would have a hard time getting annualized turnover under 100 percent.” How many businesses in these five categories would appear on this list? Not many, I suppose.

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And finally: The WSJ Juggle blog asks readers how their families are using texting. I’m sorry, I just don’t get what the advantage of texting is (yeah, I know-- I’m old. I don’t get it.)

a tech bleg

For any readers (and I have no idea if I have any at this point!) who might be knowledgeable about HTML stuff: I just slightly modified my blog template, and many of my earlier posts seem to have gotten messed up. (The last couple seemed to be OK-- but I initially composed them in MS Word, then pasted into Blogger's composition window and tweaked from there.) Any advice on what to do?

selections from today's info buffet

• America’s Health Rankings—a collaborative venture between United Health Foundation, the American Public Health Association, and the Partnership for Prevention—are available for 2008. (These rankings use the World Health Organization's more expansive definition of health, and consequently incorporate socioeconomic quality of life measures as well as the more traditional physical-health measures.) Check out the interactive map. There’s a clear geographic pattern to distribution of most- and least-healthy states. I’m wondering when someone will make comparisons between that map and this one.

• “Time is money,” says Daniel Hamermesh in The New York Times’ Freakonomics blog, as he provides us a fascinating glimpse into the newest form of multi-tasking. (Seems to me like the opening refrain of this Chumbawamba video would be an appropriate accompaniment!)

• I like the premise behind The New York Times Tierney Lab blog:

  John Tierney always wanted to be a scientist but went into journalism because its peer-review process was a great deal easier to sneak through. Now a columnist for the Science Times section, Tierney previously wrote columns for the Op-Ed page, the Metro section and the Times Magazine. Before that he covered science for magazines like Discover, Hippocrates and Science 86.

  With your help, he's using TierneyLab to check out new research and rethink conventional wisdom about science and society. The Lab's work is guided by two founding principles:

  1. Just because an idea appeals to a lot of people doesn't mean it's wrong.

  2. But that's a good working theory.

  
  Check out the TL’s most recent supersizing experiment. I have to find out if they’ve linked up with Brian Wansink and company, who specialize in research about “mindless eating.”

• "Hey, Boss, I'm Not Sleeping I'm Learning." Steve Roesler’s All Things Workplace blog has some useful insights, based on neuroscience research, about the value of sleep to proper mental functioning. (Lots more related info at John Medina’s Brain Rules website. Check out video #7 on the main page, as well as the more detailed slideshow on sleep.)

Contagious Happiness

Maybe ten years ago, I was made aware of a book entitled Contagious Emotions, which was about the codependent nature of depression and how friends and relatives of someone suffering from depression could help the depressed person break free without themselves getting “infected.” Ever since then, I’ve enjoyed making reference to the concept of “contagious emotions” and watching peoples’ reaction when I did so.

And now, there’s this report in last Friday’s British Medical Journal demonstrating that emotions—at least to the extent they involve happiness-- are, well, contagious.

Co-authors James Fowler and Nicholas Christakis used records generated by the long-running Framingham Heart Study to do extensive social network analysis. Using responses to a subset of questions from the CES-D that were administered to participants several times throughout that study’s period, Fowler and Christakis were able to trace reported happiness levels of study participants and people in their social networks.

Here’s what they found:

• “Clusters of happy and unhappy people are visible in the network, and the relationship between people’s happiness extends up to three degrees of separation (for example, to the friends of one’s friends’ friends.)”
• Furthermore, people who are surrounded by lots of happy people, as well as people who are “central in the network” (a term of art in social network analysis that characterizes the type of person who in the old days would have been labeled as a BMOC), are more likely to have future happiness.
• And finally, Fowler and Christakis found that geographic proximity was a major factor in the “transmission” of happiness: The closer you’re physically located to a happy person, the greater the likelihood you’ll be happy, too. (But the big exception here is the workplace. “Effects were not seen between coworkers.” And there were some puzzling findings regarding “coresident spouses.” See below for more on these two points.)

Press accounts of this study include ringing endorsements by several big names in the area of behavioral research. The Washington Post quotes Martin Seligman, the “founding father” of positive psychology, (“pathfinding … totally original … the findings are striking”) and Ed Diener, co-author along with Sonja Lyubomirsky of many of the reports that form the underpinning of Lyubomirsky’s recent book The How of Happiness (“extremely exciting … interesting, provocative and important). The Harvard Crimson refers to an e-mailed statement (“stunning”) by Daniel Gilbert, author of Stumbling on Happiness and TED conference speaker. And finally, the Gray Lady reports the tempered approbation of Nobel laureate Daniel Kahneman, who calls the study an “extremely important and interesting work” but has some difficulty accepting (in the absence of independent replication) one of the study’s conclusions, namely that the “happiness effect” was not as strong for co-resident spouses as it was for next door neighbors (8% versus 34%).

So this study is a big deal. And as the authors point out, it has major relevance for public health

There is of course a tradition of community approaches to mental health, but this longstanding concern is now being coupled with a burgeoning interest in health and social networks. More generally, conceptions of health and concerns for the wellbeing of both individuals and populations are increasingly broadening to include diverse "quality of life" attributes, including happiness. Most important from our perspective is the recognition that people are embedded in social networks and that the health and wellbeing of one person affects the health and wellbeing of others. This fundamental fact of existence provides a conceptual justification for the specialty of public health. Human happiness is not merely the province of isolated individuals.

But before we all hop on the “happiness is contagious” bandwagon, we need to take note of some soft spots in the research.

For one, there’s the puzzling finding that’s left Daniel Kahneman scratching his head. How can it be that having a happy next door neighbor has a more powerful effect on your own happiness than having a happy spouse? (The authors hypothesize that this may be due to the fact that people are more likely to take “happiness cues” from people of their own gender—and they note that in their study sample all spouses were opposite-gender.) As Dr Kahneman has pointed out, unless another study independently replicates this finding, it will be tough to accept it as being valid.

In a similar vein, it’s difficult to make sense of the finding that there was no “happiness effect” in the workplace. Fowler and Christakis write in the paper that this “suggest[s] that the social context might moderate the flow of happiness from one person to another” In other words, if happiness is a contagion, then there’s something powerful in the immune system of the workplace that counteracts it there. But what might that be? The paper itself doesn’t say, but the New York Times article says “Professor Fowler believes inherent competition at work might cancel out a happy colleague’s positive vibe.” But there are no indications of any plans—by Fowler and Christakis or any other researchers—to test out that hypothesis. So, in the absence of further illuminative research into why the workplace—where millions of people spend at least a quarter of their time in close proximity to each other—is immune to the contagious spread of happiness, you can count me along with Daniel Kahneman as someone who needs a bit more convincing.

These two (non-trivial) issues aside, there’s the underlying question of whether and to what extent correlation implies causation when you use social network analysis as applied to health outcomes. In the same issue of the British Medical Journal as the Fowler-Christakis paper, there’s another paper, by Federal Reserve Bank of Boston economist Ethan Cohen-Cole and Yale professor Jason Fletcher, that addresses just that.

What they found: “Current empirical methods used to estimate causal social network effects might detect implausible network effects, including "contagion" in headaches, skin problems, and height between adolescent friends.” In other words, it’s possible to apply the social network analysis methodology used by Fowler and Christakis to other data sets and to conclude that, if your friends are tall, you’re more likely to be tall yourself—an implausible (to put it mildly) example of the “contagion” effect.

The Harvard Crimson does a nice job putting the Cohen-Cole and Fletcher study in context:

“Our study certainly does not refute their happiness paper, but it just suggests some caution that if you don’t take care to control for other factors, that you might be finding contagion where none exists,” said Jason M. Fletcher, a professor of public health at Yale.

Fletcher co-authored a study suggesting that perceived network effects could be erroneous. Using the same statistical methods as the happiness study, his study found that characteristics like acne, headaches, and height are contagious among adolescents, indicating that the methods used in the happiness study can produce spurious results.

“There’s no such thing as a social contagion in height,” Fletcher said.

Fletcher and his co-author, B. Cohen-Cole ’95, an economist at the Federal Reserve Bank of Boston, suggested that the happiness study could be biased because happy people are often friends and that their good moods are not necessarily influenced by each other.

“Friends select people to be their friends based on similar characteristics,” said Fletcher, “and potentially happy people choose to be friends with other happy people.”

He added that friends are often exposed to the same environment, including similar levels of crime, risk, and weather, and that those external variables could influence happiness more than a friend’s mood.

In light of these criticisms, both research groups plan to continue probing into the field of happiness with future studies.

“The whole point of science is that you want to capture a great idea but then retain healthy skepticism,” Fowler said.

“Capture a great idea, but retain healthy skepticism”—It sounds a lot like another wise maxim that got a lot of play a quarter of a century ago….

knowing what healthcare is really costing you

Great op-ed piece in today's WaPo ("5 Myths About Our Ailing Health-Care System," by Shannon Brownlee and Ezekiel Emanuel). WSJ's Health Blog also does a good commentary on it.

What speaks to me is Myth #2 (somebody else is paying for your insurance). Brownlee and Emanuel make an eminently sensible point:

Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.

And of course, your taxes are what fund the likes of Medicare, Medicaid, VA healthcare, and other public programs.

All told, the average family of four is coughing up $29,000 a year for health care through taxes, lower wages and out-of-pocket medical expenses.

So, maybe we should be paying more attention to increasing the salience of healthcare costs. This is something Congressional Budget Office Director Peter Orszag has argued in favor of (see the section starting at page 6 of this document), and given his likely next assignment, we'll probably be hearing more along these lines in 2009 and beyond.

good reads from recent issue of Fortune

The gym where I exercise has a magazine rack. For me, that's an essential piece of equipment-- right up there with the elliptical, stair stepper, weight machines, free weights, etc. I have to have something to read while I'm cranking out the MET's on my aerobic equipment du jour; otherwise I get frightfully bored.

Today I happened to be reading the latest (11/24/08) issue of Fortune. Great series of articles by Jennifer Reingold in the "Leadership" section:

Meet Your New Leader: How the fallout from the financial crisis could breed a new type of corporate leader-- the "Lifeguard Leader," who's more skilled at negotiating with different constituencies (especially government) and more willing to ask questions and acknowledge what he/she doesn't know than the "Lone Ranger Leader" celebrated in the business and popular press over the last few decades.

10 New Gurus You Should Know: The "next generation" of management experts. Here are the ones that intrigued me: Patrick Lencioni (his focus is on "organizational health" and he's now turning his attention to working with "overwhelmed families"); Rakesh Khurana (his big idea is "charismatic CEO's don't work," and he believes management needs to become a profession-- with licensing requirements, a code of ethics, and a "stated commitment to improving the well-being of stakeholders and society"); Don Sull (his big ideas are that businesses should forget about developing a grand vision and should instead embrace uncertainty); and Joel Podolny (when he was at Yale School of Management, he developed courses on customers and invention that looked at problems holistically, and now he's heading up Apple's in-house "university").

Secrets of Their Success: Interview with Malcolm Gladwell about his latest book. What grabbed my attention: The 10,000-hours rule and the relationship between wet-rice farming and academic success. (Read the whole thing.)

"aging slackers"

Workforce Management magazine recently ran an article about how the recent market crash-- coming on top of the elimination of many defined-benefit pension plans and the inability of many middle-aged workers to save enough money on their own to be able to fund a comfortable retirements-- may mean larger numbers of workers staying in the workforce "well past the traditional retirement age of 65."

At the very least, that could cause bottlenecks in companies’ plans to move people up the corporate ladders. But it might also mean something else: Firms could find themselves with a population of aging slackers—older workers who are doing just the bare minimum to get a paycheck without getting fired, warns Teresa Ghilarducci, the Bernard L. and Irene Schwartz chair in economic policy analysis at the New School for Social Research in New York.

Even worse, disgruntled older workers could resort to litigation or work sabotage over their lack of retirement savings, experts say.

"At the very least, employers may be facing employee disaffection," Ghilarducci says. "Employee revenge often comes in the form of work slowdown. It’s not so hard to do just enough to get by without getting fired."

C'mon, now. Is that a realistic picture? What about all the 50+ people who are redefining retirement and pursuing encore careers?

It's interesting to note that Prof. Ghilarducci recently testified at a House Education and Labor Commitee hearing on behalf of a proposal to eliminate the 401(k) "tax subsidy" and to implement a system of government-administered "guaranteed retirement accounts." Sounds like she's exploring a novel way of selling business on the advantages of "guaranteed retirement."

What Do Hans Selye and Potter Stewart Have in Common?

Going back to the American Institute of Stress' page on definition of stress, we find the following reminiscence about Dr Hans Selye, the "father" of stress theory:

In his later years, when asked to define stress, he told reporters, "Everyone knows what stress is, but nobody really knows."

This is in many respects quite similar to Supreme Court Justice Potter Stewart's famous concurring opinion in Jacobellis v Ohio, 378 U.S. 184 (1964), where he wrote:

I have reached the conclusion ... that under the First and Fourteenth Amendments criminal laws in this area are constitutionally limited to hard-core pornography. I sall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.

Stress, then, is like pornography: hard to define, but people "know it when they see it." And let's take it one step further: people's interpretations may vary-- what one person may find harmful, another may find beneficial.

Good Stress, Bad Stress (cont): Does "Crisis" Really = "Opportunity" + Danger"?

The American Institute of Stress has a nice biographical essay on Hans Selye, the "father" of stress theory and research. If you scroll about halfway down, you'll see a little blurb about how the closest Chinese word to signify stress is a composite of the characters for "danger" and "opportunity" which can be translated as "crisis." (Interestingly enough, it runs immediately to the right of a photo of a postcard that Hans Selye sent to Paul Rosch in-- well, you can't tell what year it was, but it was likely before 1963, because there's no ZIP code on the destination address-- and the text is "In Japan the word for stress is..." followed by a kanji character. Japanese, Chinese-- whatever.)

Now this concept of stress = crisis = (danger + opportunity) is kinda neat, isn't? (In fact, I distinctly remember, in the mid 1980's, how an Atlanta-based consultancy marketed materials around technology and organizational change that incorporated the logograph for "crisis" (wēijī) and made extensive reference to things like "opportunity ratings" and "danger ratings." Heck, a couple of years later, I even worked a reference to this into a paper I wrote for an advisory committee I was on at the time.)

Well, it may be neat, but is it accurate? Evidently not, according to these articles (here and here) originating either directly or indirectly from the UPenn Chinese language faculty.

Too bad. Don't you hate it when facts get in the way of nifty constructs?

Good Stress, Bad Stress

I came across this press release ("Well-Being of Workforce Influenced by Employers, Job Duties. Something to Think about on Labor Day: Research Shows a Good Boss Can Help Make Weekdays Feel Like Weekends, but a Bad Boss May Lower Employees' Well-Being") last week on the Healthways website. (Healthways partners with Gallup on the Gallup-Healthways Well-Being Index, which I'll be writing more about over the next few days).

There's a lot of good material here, but for now I'd like to pick out one paragraph that particularly resonated with me:

Research from the Well-Being Index also reveals that people in a negative work environment are less psychologically resilient and are more vulnerable to stress from economic downturns. Some stress in life is good stress, necessary to motivate through deadlines and often a driver of success. However, people in negative work environments report a high percentage of stress and worry without happiness and enjoyment, a feeling that negatively affects overall well-being.

There are several meaty themes in that paragraph-- pyschological resilience, the concept of "good stress," the role of the work environment in mediating (or aggravating) psychological distress, the measurement of "happiness"-- and I'd like to deal with all of them at some point, but for now (drip, drip, drip), let's stick with just one: the notion that some stress in life is good stress.

There's a great article ("Stress, Definition of Stress, Stressor, What is Stress?, Eustress?") on the website of the American Institue of Stress(AIS) that addresses the notion of "eustress" (good stress). The article's author (who I assume is AIS president Dr Paul Rosch) makes reference to the Human Function Curve, which was first articulated by cardiologist Dr Peter Nixon at least 25 years ago. Unfortunately, I haven't figured out how to paste images into my blog post, so I'll have to ask you to look at the graphic as it exists on the AIS website (I'm sure Dr Rosch will appreciate the increased click-thru traffic ;-)

The main idea of the Human Function Curve is that a certain amount of stress is beneficial and leads to improved performance and productivity-- but only up to a point. Beyond that point, stress becomes negative and leads to decreased performance and productivity (and increased wear and tear on a person's body, mind, and spirit). So, the challenge is to make sure you stay on the right-hand side of the curve. And the way you do that is by (a) modulating your environment or your response to it, or-- actually: and/or-- (b) improving your capacity-- your resilience, if you will-- and moving the "hump" on the curve further to the right. This latter approach really resonates with me, and in future points I'll elaborate some more on how and why that's the case.

Is it Really a "Fat Tax"?

A couple of days after I put up my last post on this blog, one of my work colleagues circulated a link to this Fox News article about the proposed change to Alabama's state-employee health insurance plan that could require certain obese employees to pay more for their coverage.

I have to admit, there's something catchy about the concept of a "fat tax," especially if it's associated with the state that ranked #2 in obesity prevalence in 2007. But are Fox News and scads of other commentators using this term accurately describing what's being proposed?

Well, let's take a look at the actual proposal by the Alabama State Employee Insurance Board.

• What they (the state) say they are doing is charging (for the first time,apparently) for health insurance-- to the tune of $25/month, beginning 1/1/10.
• At the same time, they're offering a $25/month "wellness premium discount." What do employees have to do to get the discount? Submit baseline readings for blood pressure, cholesterol, glucose, and BMI. Employees have until 11/30/09 to submit the baseline data. They can do so either through participating in a state screening program or they can get their own physician to certify the info.
• Starting in 2011, employees deemed not at risk based on baseline data (remember, this includes blood pressure, cholesterol, and glucose as well as BMI) continue to receive the credit. Those deemed at risk can also continue to get the credit if they do one of three things: (1) get their physician to state that they've been counseled (that's all; nothing about treatment) regarding their health risk factor or else has a medical condition preventing them from improving the health risk factor (whatever that means); (2) "participated [in] and/or completed" a state-approved wellness program (the "and/or" is key); (3) "reported acceptable improvement in the health risk factor(s)" (whatever that means).
• Not sure exactly what's meant by this statement: "At risk employees are eligible for a physician referral waiving the copay." I haven't researched plan details, but I'm guessing that (a) employees always (or at least for several years now) have had a copay (even though they haven't had to pay premiums), and (b) this traditional copay is going to be waived for at-risk employees, to remove a dis-incentive for receiving care

Bottom line, this seems to be a fairly benign and not totally unreasonable proposal. And in fact, that's how some news coverage-- see Birmighmam News here or Wall Street Journal here-- has presented it. Using the term "Fat Tax" may make for spectacular headlines, but it doesn't really help us make sober assessments of programs based on the merits.

Alabama 'Obesity Penalty' Stirs Debate

WebMD has a good story on Alabama's plan to do BMI (body mass index) screenings on state employees and require those classified as obese to pay an additional $25 per month on their health insurance-- a so-called "fat tax."

Count Dr Jeffrey Levi, executive director of the Trust for America's Health, as an opponent of the state's plan. "Just addressing this through the health care system is insufficient. What are we doing about the workplace environment? What's served in state cafeterias and hospitals? We need to do the voluntary things first for people to be able to make healthy choices before forcing punitive measures."

How punitive is the new measure? "Even with a $25 monthly bill, Alabama state workers boast a plum health care plan," notes the article. "Single state employees pay no insurance fees, [Deborah] Unger [clinical director for the Alabama State Employees Insurance Board] says, while family plans -- which can include a spouse and several children -- only cost $180 per month. Spouses and children of state workers will not be subject to the wellness screenings."

The implicit assumption behind the new program is that obesity correlates with poor health, which in turn correlates with higher health care costs. But, asks WebMD, "does thin and trim always equal fit and healthy?" Not necessarily. Citing a recently-published study on cardiometabolic risk factors and weight (which I noted in a previous post), WebMD concludes: "Lifestyle and activity levels certainly vary between individuals, but the link between weight and health doesn't appear to be absolute. And unlike many conditions which remain discrete, obesity is on full display."

So, the debate over Alabama's "fat tax" encapsulates two larger issues that invariably get raised in any discussion of ways to improve people's health (and thereby bring down costs of the healthcare system): first, whether a recommended intervention approach is adequately grounded in findings of empirical research; and second, what kinds of incentives are most effective at getting people to change their behaviors. These are two issues that I hope to be looking at in more detail over the next few months.

fat can be fit?

Yesterday's Washington Post carried an article about a recently-published analysis of data captured by the 1994-2000 National Health and Nutrition Examination Surveys (NHANES) which concluded, basically, that a) a lot of fat people are fit and b) a lot of thin people aren't. (Yes, I know, that's a crude way of saying "Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy.)

This comes shortly after studies by researchers from Michigan State University and Hope College "with findings tending to refute commonly held stereotypes about the personality traits of overweight employees" (those stereotypes being that overweight job applicants and employees are "less conscientiousness, less agreeable, less emotionally stable, and less extraverted than their "normal-weight" counterparts").

Are we starting to see a reassessment of the conventional wisdom of the last five to ten years regarding obesity (i.e., it's a major public health menace and must be fought with vigor on several fronts)? Or are these just some random research artifacts?

Habits- Alexander Technique

This past weekend, I attended a free introductory lecture on the Alexander Technique (A.T.) given by a delightful young couple who have been certified to teach the technique. I won't go into detail as to what drew me to the lecture-- other than to say that a) I've had life-long issues with poor posture and body mechanics, and at my current stage in life (late 50's) they're getting harder and harder to ignore, and b) unlike other "alternative therapies" such as yoga, reiki, etc, the A.T. tends to take a more cerebral approach, which I personally find more appealing. Towards the end of the lecture (which also included a hands-on demonstration of A.T. training), I had a little mini-insight.

That insight had to do with habits: Habits are the things we do unconsciously. They can be good or bad. You don't change habits so much as you un-learn old (or bad) habits and replace them with new (or good) ones. To un-learn ("break") habits, you first have to become aware of them. This requires consciously stepping outside of yourself and being able to see yourself from that perspective. You then have understand why you do what it is you're doing, and then based on that information consciously stop doing it. But that's not enough: You have to introduce the new habit. And there, you reverse the process: You begin with a series of conscious actions and you repeat them until they become unconscious.

(Yeah, I know-- this is nothing more than the Lewin model of change, applied on the personal level. But I finally "got" it!)

I mentioned this to the teacher, and he smiled and then pulled a framed quote from the wall, and then began to read the quote. It was from a 1918 book by F. M. Alexander, the originator of the Alexander Technique (Man's Supreme Inheritance: Conscious Guidance and Control in relation to Human Evolution in Civilization; see Google Books for more-- and note, btw, that the introduction was written by John Dewey):

Thus it will be seen that the difference between the new habit and the old is that the old was our master and ruled us, whilst the new is our servant ready to carry out our lightest wish without question, though always working quietly and unobtrusively on our behalf in accordance with the most recent orders given.

Nicely put.

Seven Habits of Healthy People

When I saw this press release announcing the launch of The 7 Habits of Healthy People, a new employee wellness program that's the result of a partnership between Inspire Health and Franklin Covey, I thought "of course-- you could see this coming." I have to confess being ignorant about Inspire Health (at least until now), but Franklin Covey-- well, there's a marquee brand in the world of mainstream, business-oriented self-improvement resources. Given that, along with Dr Covey's Seventh Habit (Sharpen the Saw)-- with its emphasis on balanced self-renewal, including staying in good health-- and along with the heightened emphasis in recent years on employee wellness programs, it makes sense to see a 7 Habits of Healthy People program being offered.

So what are those seven habits? Well, the partners are being coy here. The press release directs you to a page on Inspire's website. Once you get there, you can click through to a video advertised as "Hear from Dr. Stephen Covey how living The 7 Habits can change your life." But the video is quite short (a minute or two at the most) and-- how can I say this without sounding snarky?-- full of generalized bromides about habits, character, and destiny-- but with no hint as to what the 7 Habits of Healthy People might be. You're also invited on Inspire's web page to "print our sales sheet," which I did-- and it, too, was very general and gave no clue as to what the 7 Habits of Healthy People might be.

OK, I guess they want to discourage frivolous browsers, the type of people who go into the bookstore and leaf through the books, noting whatever it is they want to note, and walk out not having made a purchase (or then go to the library to check it out). Fair enough.

But now I've got my curiosity piqued. What are those key habits and behaviors that, if I adopt them, will make me healthy? So I did a quick search to find references to "seven habits" and "healthy people" and, looking at only the first couple (after throwing out the ones that referred to press releases for this particular venture-- and there were a lot of those, btw), I came up with some interesting findings.

There was this article entitled "The 7 Habits of Highly Healthy People" posted in February 2007. The author, Adrian Adams, writes about these seven habits:

1. get regular exercise
2. drink water
3. eat right
4. take supplements
5. get a good amount of sleep each night
6. practice good hygiene (ncluding good oral hygiene)
7. have a good attitude

Another article, with a publication date of May 2007 references a "new" (actually, if you follow their link, you'll find it dates back to 2000, if not earlier) study by the UCLA School of Public Health which found a correlation between lower mortality (and lower rates of disability) and these seven health habits:

1. Don't smoke.
2. Drink moderately or don't drink at all.
3. Get a good night's sleep of seven or eight hours.
4. Exercise 30 minutes at a time, several times a week.
5. Eat moderately to maintain weight in relation to height.
6. Eat regularly, whether that's two meals a day, three or five.
7. Eat breakfast every day.

A June 2007 post with the title "7 Habits of Healthy People" offers the following "Seven Habits for Living Longer":

1. Water
2. Oxygen
3. Food
4. Spinal Balance
5. Exercise
6. Positive Thoughts
7. Rest

And then there's this July 2007 article on "The 7 Habits of Thin (Healthy) People." (Hmmm... "Thin" = "Healthy" .... I guess the author doesn't agree with this crowd.) What are they?

1. Carbs: know good from bad
2. Fat: ditto
3. Nutrition counts
4. Portions
5. Water
6. Exercise
7. Hormone balance

Finally, there's an actual book (imagine that! people still write books, not just blog posts) with the title 7 Habits of Highly Healthy People. Published in June of 2007, it's attained an Amazon sales rank of 704,980 (not exactly generating many royalties for its author, Curry Pikkaert, but given his bio and the book description-- the author pastors a Reformed Church in western Michigan and his book has a distinctly Christian emphasis-- it's safe to guess that he was motivated to write the book by something other than money). Unfortunately, you can't browse inside the book (nice feature that Amazon offers, btw) so here, too, you're left guessing as to what those 7 Habits might be.

But wait: There's a clue. "If there are 7 basic deadly sins," we read in the Product Description, "are there not also 7 basic life-producing virtues?" And further on, we read: "Since the object of our focus is what most frequently influences us, it is important to focus on the development of the habits that produce the 7 virtues." Aha! So the 7 Habits of Healthy People are probably linked to the 7 Contrary Virtues, i.e. those virtues that you cultivate in order to avoid falling prey to the 7 Deadly Sins (that is, you would cultivate humility to keep from falling into pride, kindness to keep from envy, abstinence to keep from gluttony, chastity to keep from lust, patience to keep from anger, liberality to keep from greed, and diligence to keep from sloth). In other words (my version here):

1. don't let things go to your head
2. be nice
3. go on periodic fasts
4. take cold showers
5. when someone pushes your buttons, count to ten before responding
6. share your stuff
7. have plenty of constructive hobbies

OK, readers, now it's your turn. What do you see as the seven habits of healthy people? (And btw, if you happen to have insight into what Franklin Covey & Inspire's list looks like, please let me know.)