Your personal habits are your own business, right? Not exactly. Personal habits have social – and financial – impacts, especially in matters of health care. In a developing trend, doctors, the media and employers are pressing Americans to take more.

Employers who provide health care coverage realize they can save money if employees take better care of themselves. Citing data that show that much of the increase in health care costs results from obesity, tobacco, sedentary lifestyle, poor food choices and stress, employers want workers and their families to improve their personal behaviors. Over the last two decades, employers have avidly promoted health and wellness agendas among employees.

However, encouraging healthy behavior is a long way from actually changing unhealthy behavior, and, generally, Americans have avoided recommended changes. Breaking lifestyle habits is difficult, and the lack of direct financial incentives to change (as when health care is employer-paid) does not help. As the health status of the workforce continues its decline, many employers who provide coverage are more aggressively pursuing behavioral changes.

Carrots and Sticks

In more positive settings, employers have installed on-site workout facilities or provided more healthy food choices in company cafeterias. Others have instituted in-house wellness programs which begin with voluntary “health risk assessments,” completed by employees. With the assessment, individually-tailored wellness and disease management programs – sometimes with a personal wellness “coach” — can be instituted for employees that are striving to improve their health. Many employers offer discounts, rewards and other positive incentives to encourage reluctant employees to complete health assessments and embrace health management programs.

In a rising trend, however, other employers are adopting more coercive measures aimed at forcing workers to change behaviors. Smoking is the most common target and efforts are intensifying. Most state governments now ban smoking in indoor settings, including workplaces, and some employers have added their own obstacles by eliminating outdoor designated smoking areas and requiring workers to leave the grounds to smoke.   While some employers fund voluntary tobacco cessation programs, others are increasing insurance co-pays for workers who smoke. Some will no longer hire new employees that smoke. In the most striking example, a Michigan health benefits management company, WEYCO, Inc., terminated several employees who refused or were unable to quit smoking 15 months after a company-wide, “smoke or your job” policy was announced.

More recently, employers are pushing workers to lose weight, citing new data that connect increased employer costs to employee obesity. In an extreme example, an Indiana hospital system, Clarian Health, announced last summer that, effective in 2009, employees with high body mass indexes (BMIs) would suffer payroll deductions to cover the company’s weight-related losses. Though that company later backpedaled, others – Scotts Miracle-Gro, for instance – now require a health-risk assessment under penalty of an insurance premium surcharge. Scotts’ employees with high BMIs must work with a coach to improve their health or accept an additional paycheck deduction.

Social Debate Unfolds

While the advisability of various ways to stiffen worker responsibility for personal health behaviors remains a topic for cultural and legal resolution, there is no doubt that a trend toward greater individual accountability has emerged.

Drugs, alcohol, tobacco, junk food, oversize portions, laying around on the couch…it is increasingly apparent that our individual choices can drive up health care costs which are then incorporated into the cost of everything else we buy and consume. Accountability for personal lifestyle choices is becoming an important component of the struggle to control costs and improve health.

[Steve Clark]