I am a moderately lazy person who is also interested in living as long as possible, which makes me a complete sucker for health apps. I have alarms and alerts that remind me to drink water, an app that tells me to walk around every once in a while instead of sitting at my desk like a little internet gremlin, and push notifications that ask me about my mood or whether or not I ate a balanced lunch.
A growing number of employers have faith in the health nudge, too. But instead of just swapping snacks with less salt into the vending machine, companies like Walmart have started to contract with data-mining firms to monitor their employee’s health records—and report that data back in the aggregate—in an effort to keep insurance costs down.
More from The Wall Street Journal report on bosses getting into the business of wellness:
Employee wellness firms and insurers are working with companies to mine data about the prescription drugs workers use, how they shop and even whether they vote, to predict their individual health needs and recommend treatments.
Trying to stem rising health-care costs, some companies, including retailer Wal-Mart Stores Inc., are paying firms like Castlight Healthcare Inc. to collect and crunch employee data to identify, for example, which workers are at risk for diabetes, and target them with personalized messages nudging them toward a doctor or services such as weight-loss programs.
It’s like big data meets corporate surveillance meets the cult of wellness in late capitalism. What could possibly go wrong?
“People have a certain expectation of privacy,” Dania Palanker, senior counsel at the National Women’s Law Center, told me when I asked her about about these programs. “The expectation is that your employer does not know what medications you may be taking. The expectation is that your employer does not know your blood sugar or cholesterol levels. For very valid reasons, it makes people extremely nervous when that information starts coming out connected through their employer.”
According to federal law, employers are generally barred from looking at their employees’ personal health records, but security experts have echoed Palanker’s concerns when it comes to paying firms to collect information on prescriptions and hospital visits.
“There are enormous potential risks in these efforts, such as the exposure of personal health data to employers or others,” Frank Pasquale, a law professor at the University of Maryland who studies health privacy, told The Wall Street Journal.
And since it’s your boss paying to have your health records scrutinized, illegal access to medical records could lead to workplace discrimination against people with disabilities or chronic illnesses. Or, say, workers who may be trying to get pregnant, since these data-mining companies can also tell which employees have gone off their birth control based on insurance claims and prescription refills.
Nearly 40% of gender-based cases about discriminatory hiring are related to pregnancy, according to a 2014 analysis of employment discrimination cases, and nearly half of the women who filed complaints after being fired while pregnant were in service jobs.
But beyond the security risks and looming questions about employment discrimination, there’s a general invasiveness about these algorithms that could set off red flags when the messages are coming on behalf of your boss, Palanaker added. Instead of generic, health-related corporate emails or notices posted in a break room that are directed at everyone, the messages and alerts based on this data are sent to targeted individuals with potentially sensitive health needs.
“If someone were to stop taking birth control for a medical condition, receiving a message on your phone suggesting you are pregnant could be incredibly painful,” she said. “So if you stop taking birth control because you are having an oophorectomy because you have a BRCA gene and a high risk of ovarian cancer, then you may still be personally dealing with the loss of the ability to have children, and then your phone is suddenly suggesting you are pregnant. That data may not be shared with the employer, but it can still create a burden on the employee.”
There is also the matter of what kinds of health benefits are accessible to the employees getting these little nudges. This is where the idea of wellness—and what employers can do to support the health of their employees—becomes less about apps and medical histories and more about living wages, access to paid time off, and affordable insurance.
“I think you need to talk about creating an environment where people know that their overall wellbeing is important,” LaWanda Cook, extension faculty at Cornell University’s School of Industrial and Labor Relations who works on disability and employment issues, told me. “If the real intent [from the company] is to help workers, then maybe it’s looking at a culture of wellness: what are the consequences of my choosing to take care of myself? Am I going to then get less hours next week? Will I be considered less promotable? Particularly for folks with disabilities or chronic health conditions, these are real concerns.”
A reminder that a diet low in fat and high in fiber can help prevent or manage diabetes is a fine thing, but may not change much if the person getting the alert is earning minimum wage—or even a few dollars above it—and struggling to keep food on the table. “So in situations like this, people may feel pressure to do X, Y, or Z, and still not know how they can actually do it.”
The concept of wellness is having a moment in the United States. There are bike-sharing programs in major cities across the country. School cafeterias are getting marginally less disgusting. Michelle Obama has a cool garden. This is a good thing. Staving off illness and death are totally worthy goals.
But part of the reason that bosses micromanaging health choices feels so bizarre is because work culture in the United States, for a great many workers, is anything but healthy.
An estimated 44 million private sector workers—about 40% of the workforce—have no access to paid leave, which means they lose money when they get sick or have to take care of someone who does. (As you might have guessed, workers without paid leave tend to be concentrated in low-wage and part time jobs.) And according to the U.S. Census Bureau, about 60% of households with food-insecure children have at least one adult working full-time.
If employers like Walmart, a company that recently eliminated health insurance for thousands of its part-time workers, are interested in promoting health and wellness, there’s one indicator they may want to look at that doesn’t require monitoring prescription drug use or private medical histories: income. (Walmart did not return my request for comment.)
The wealthier you are, the less likely you are to be sleep deprived, according to the Centers for Disease Control and Prevention. There is a 13-year difference in life expectancy between women in the top 10% of earners and women in the bottom 10% of the income bracket. (That difference is 14 years for men.)
A recent analysis from the Brookings Institute rounded up other negative health outcomes associated with poverty:
So while big box companies may be nudging employees about skipping dessert and reconsidering that spinal surgery, workers may want to rig up a regularly scheduled push notification for their bosses: Being broke is bad for your health.