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The California commute and its adverse implications for health status

Lancaster is also hoping to make its communities more pedestrian-friendly. Last month, the City Council revised its residential zoning ordinance to provide incentives for infill development and to require developers to include pedestrian and bicycle connections to nearby amenities.

Lancaster Mayor R. Rex Parris said residents’ long commutes concern him, adding that he knows hundreds of families who endure debilitating treks to the office.

“The mother and father spend most of their productive hours on the freeway,” Parris said. “It’s just not a good way to live.”

via After a long fall, Antelope Valley is back on upswing – latimes.com.

Parris is right.  It’s not only not a good way to live, research indicates the daily commute has adverse health implications.  The Antelope Valley is located in California, an automobile-driven state noted for having some of the longest and most congested commutes in the United States, with the San Francisco Bay Area and Silicon Valley leading the nation in so-called “super commutes.”

The state recently formed a Let’s Get Healthy California task force made up of the Golden State’s top health experts.  Inexplicably given that commuting is such a big part of Californians’ daily lives, the role of commuting and its adverse affect on health is not discussed anywhere in the task force’s final report.  As Mayor Parris implies, if residents are spending all their daily hours working and commuting, once they get home they aren’t going to have time or energy to get the exercise they need for maintaining good health on the pedestrian and bike trails that his city envisions.

Ironically, while Silicon Valley companies produce some of the longest and worst commutes, they have also innovated much of today’s modern information and communications technology that allows those who perform knowledge and information work to get their work done from their communities.  It’s absurd Californians would jeopardize their health to drive hours each day to use a computer and telephone in some distant centralized office.  And it’s a major oversight this was not addressed by the Let’s Get Healthy California task force.

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Survey suggests lack of schedule control limits participation in wellness programs

Organizations are struggling with the transition from a commute-to-the-cubicle, 20th century Industrial Age environment where work is performed during set times in centralized locations to one that affords more control over when and where work is performed.  As a result, many are also struggling with wellness programs, finding that staff lack the time in their daily schedules for sustained physical activity, as shown by the recently released 2013 Global Workplace Health and Wellness Report.  The findings of the survey 378 organizations in various industries and a link to the report can be found in this Forbes article, Employees Don’t Have Time for Wellness Initiatives.

The survey’s finding that lack of time for exercise is a major obstacle for wellness programs is hardly surprising.  The Industrial Age work style consumes most of people’s waking hours and energies in minimum 8-hour-long “shifts” and time sucking, stressful commutes.  All involving prolonged sitting that studies show adversely affect health status.  Then when they get home mentally exhausted, it’s more inactivity and collapsing onto the couch, often with take-out food.  And we wonder why as a society we’re getting fatter and sicker.

Achieving wellness requires exercise.  And sustained exercise done at least daily takes time.  The implication to be drawn from the Global Workplace Health and Wellness Report is wellness isn’t so much as a “workplace” issue as a personal time management and lifestyle issue.

The good news is organizations have 21st century Information and Communications Technology (ICT) at their disposal to help alleviate the time crunch.  ICT allows staff to work most any place and time, affording them more control over their personal schedules to engage in exercise programs in their own communities chosen by them and their health care professionals.  While organizations clearly have a stake in the health of their members, health is ultimately an individual lifestyle choice.  Making the right choice for health requires organizations provide their members sufficient control over their work schedules to exercise that choice.

California coalition’s report calls for overhaul to rein in health care costs – Health and Medicine – The Sacramento Bee

February 26, 2013 Leave a comment

Simply put, participants said Californians should “collectively” create a health culture.

A critical part of this involves creating environments where people are eating healthier foods in smaller portions and getting exercise, especially walking.

“We need to reduce the burden of illness on the health care system,” said Shortell. “It’s important that we design communities and schools to increase and encourage physical activity.

via California coalition’s report calls for overhaul to rein in health care costs – Health and Medicine – The Sacramento Bee.

I would add that how people work should not be overlooked as it was in the Berkeley Forum report.  We should rethink how knowledge work is done in the 21st Century and develop more modern ways of performing it rather than adhering to the outmoded 20th Century paradigm of sitting in a commute to go sit another 8 hours in a centralized office.

Is the sedendary commuter/cubicle treadmill that also wastes time that could be spent engaged in sustained exercise really worth the price to our health?  I say it is not, especially when most information and knowledge work can be accomplished outside of a central office location.   If Californians are properly to be expected to take more responsibility for their health status and prevention, they must also be afforded the fullest possible degree of freedom and time to exercise — literally– that responsibility.

Time for sustained exercise to bend the healthcare cost curve — and promote better thinking

January 1, 2013 2 comments

Knowledge workers earn their livings analyzing, abstracting and communicating.  In today’s Information/Internet economy, all too many knowledge workers needlessly do so working under legacy Industrial Age 8-5 office schedules, spending even more time each day relatively immobile than sleeping.  Add to that another 1-3 hours spent sitting in a daily commute to a central office location.  Month after month, year after year of this occupational lifestyle sets the stage for the development of preventable chronic conditions such as diabetes, hypertension and obesity that drive the health cost curve and the health insurance crisis.

But that’s not all.  Lack of physical movement can also dull the knowledge worker’s most important tool: their brain.  This Sacramento Bee article cites research linking physical activity to the brain’s ability to perform learning and memory tasks.

The clear conclusion to be drawn is sustained exercise could produce dividends for organizations by not only lowering their healthcare and insurance costs, but also the added bonus of better and more creative thinking.  For knowledge organizations, affording workers control over their schedules and time for sustained exercise probably is likely the most cost effective “workplace wellness” program going.  A key program component is ditching outmoded Industrial Age commuting and office hours and becoming a more virtual organization and maximizing the use of Information and Communications Technology (ICT).  Knowledge work can be done anywhere, and some of the most creative thinking happens during and after sustained exercise.  That requires freeing up time for it every work day by getting people out of their cars and cubicles.

Schedule control necessary if contingent wellness programs are to achieve meaningful results

December 23, 2012 Leave a comment

In November, the U.S. Department of Health and Human Services (HHS) issued a proposed rule governing wellness programs offered as part of employer-sponsored health plans for plan years beginning January 1, 2014.  The proposed rule is aimed at boosting incentive for large employers to increase the health status of their employees since large employers will be continue to be regarded as discrete risk pools under the Patient Protection and Affordable Care Act, whereas small employers will be collectively treated as a single risk pool.

In addition to the traditional participatory wellness programs such as discounts on fitness club memberships, health assessments and seminars, the proposed rules create an enhanced incentive for employers to offer health contingent wellness programs.  The contingency?  Employees must adopt a lifestyle changes and health improvement plans designed to help them reach target biometric goals such reducing weight, body mass index (BMI), blood pressure, or cholesterol levels.  If they hit the prescribed targets, the proposed rule would allow employers to reward the employee with a payout of up to 30 percent of the cost of the employee’s health coverage for the plan year, an increase over the current 20 percent permitted under rules adopted in 2006.

The rulemaking’s preamble suggests HHS believes the increase in the maximum reward is necessary to boost participation in contingent wellness programs. It cites a 2010 survey by NBGH and TowersWatson in which just four percent of responding employers reported offering financial incentives for maintaining a BMI within target levels.  Only three percent did so for maintaining targets for blood pressure and cholesterol levels.  Based on these numbers, increasing the maximum award level alone isn’t likely to produce a significant increase in the number of employers and employees participating in contingent wellness programs.

However, if such programs were joined with affording employees greater control over when and where they work, participation could increase substantially and employers would see a potentially large payoff in improved employee health status and reduced medical utilization.  Schedule control eliminates the “I don’t have time” excuse for not engaging in health promoting behaviors such as regular exercise and getting sufficient amounts of sleep.  If employers want employees to take responsibility for their health, they must give them the means to adopt healthy lifestyles and avoid the daily sedentary (and hardly health promoting) routine of commuting to and from and sitting in a centralized office.  Plus they would likely enjoy the added bonus of crisper and more creative thinking and better ideas from employees getting plenty of sleep and exercise thanks to having more control over their work schedules.

Lack of exercise kills roughly as many as smoking, study says – latimes.com

People across the world are falling so far short on exercise that the problem has become a global pandemic, causing nearly a tenth of deaths worldwide and killing roughly as many people as smoking, researchers warned this week as an alarming series of studies was published in the Lancet.

via Lack of exercise kills roughly as many as smoking, study says – latimes.com.

What the article doesn’t discuss — and should have — is the role the Internet plays in contributing to inactivity. People are wired 24/7.  Rather than computers, tablets and smartphones being a yoke around peoples’ necks, they should instead be used as tools to alleviate the daily commute to the office.  That would free up more time for exercise given that a top reason people aren’t more active is lack of time.

Don’t bribe employees with wellness incentives; give them more control over their schedules

Aon Hewitt’s survey shows a growing number of employers are beginning to link incentives to a result, as opposed to simply participating in a program. Of companies that offer incentives, 58 percent offer some form of incentive for completing lifestyle modification programs, such as quitting smoking or losing weight. About one-quarter offer incentives for progress or attainment made towards meeting acceptable ranges for biometric measures such as blood pressure, body mass index, blood sugar and cholesterol.

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“Employers know that eight health behaviors, including risks such as lack of physical activity and failure to complete recommended preventive screenings, drive 15 chronic conditions that lead to higher medical costs and increased absence from work. An effective incentive strategy rewarding those who take action to improve their health is fundamental for improving health and reducing cost,” said Stephanie Pronk, clinical health improvement leader for Health & Benefits at Aon Hewitt.

via Aon Hewitt Survey Shows Use of Incentives Grows as U.S. Employers Look to Improve Workforce Health and Productivity – Aug 8, 2012.

Rather than offer incentives for healthy lifestyle choices, employers seeking measurable gains in the health status of their workforces and decreased medical utilization for preventable conditions should afford employees more control over their schedules in order to free up time for exercise and adequate sleep.  One of the biggest reasons employees don’t exercise is lack of time — largely due to the outdated expectation that they must commute to an office five days a week in order to perform their jobs.  It effectively chains workers to their cars and their desks most of their waking hours and is a prescription for employee sickness, not wellness.  This situation cannot be rectified with any amount of “wellness” incentives.  Instead of trying to bribe workers to take better care of themselves, employers should treat them as adults and give them more responsibility and control over their schedules as long as they get their work done.  How?  By adopting a Results Only Work Environment (ROWE).

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