June 28, 2023

In their Data & Society primer Wellness Capitalism: Employee Health, the Benefits Maze, and Worker Control, Labor Futures senior researcher Tamara K. Nopper and research analyst Eve Zelickson explore how employee wellness has been promoted in the US through public policies and government support, and how this has led to a rapidly expanding, data-collecting industry. The result is what they call “wellness capitalism,” a model of public health involving the state, employers, and a wellness industry in which worker behaviors are monitored to improve society’s health. We spoke to the authors about what’s at stake in the entanglement of wellness and work, the limits of privacy in health data, and the role of technology in wellness culture.

Read coverage of Nopper and Zelickson’s research from Marketplace and Fast Company.

You explain that the growth of the employee wellness industry in the United States is fueled by a win-win narrative. What is that narrative, and why does it have such a hold on us?

Tamara K. Nopper: “Win-win” is common corporate-speak — and as an employee survey we cite indicates, it’s a phrase workers find particularly annoying, which I found entertaining. What we did was identify how this corporate-speak is used to champion employee wellness programs and insulate them from critiques of unequal power relations and worker control. We also wanted to flesh out how the state promotes employee wellness by suggesting it is a win for both workers and employers in terms of improved health and cutting healthcare costs. In doing so, we wanted to draw attention to how the win-win narrative is a public health claim as well as a fiscal claim about how to reduce healthcare spending — while doing little to rein in the role of the insurance industry or the private sector in US healthcare access and delivery. A lot of research focuses on the efficacy of employee wellness in terms of determining the return on investment, which is valuable. But we wanted to underscore the political dimensions of the push for employee wellness. Corporate jargon like “win-win” suggests employee wellness is innovative, when it actually conceals power relations at work and diminishes the state’s role in providing access to quality and truly affordable healthcare.

More broadly, what is the role of technology in wellness capitalism? Are the two inextricable?

Eve Zelickson: Technology has helped solidify wellness capitalism as a model of public health because it makes collecting, monitoring, and sharing worker data much easier. The wellness industry builds products and services designed to track worker behaviors, conditions, and proclivities. The rise of digital benefits is also responsible for what we call the benefits maze: programs and offerings knit together by the collection of worker data and the transmission of that data between companies. For example, one Fortune 500 company might offer over ten different health and wellness benefits, and these vendors all have their own referral practices, data sharing processes, and privacy policies. This creates messy and camouflaged information flows, and workers often don’t know how their information is being collected, stored, or shared.

As we detail in the primer, many health and wellness start-ups advertise hyped technology like AI chatbots and prediction algorithms. It’s unclear to what extent companies are actually using these technologies, but it is certainly a way to get investor and employer attention. And one only has to visit company websites to see extravagant claims: for example, the website for Spring Health, a mental health benefit, reads, “The most successful experience for your employees starts with the best data. Our approach eliminates the trial-and-error in traditional care by leveraging the power of data, across every aspect of care delivery.” You can see how this language devalues human-first approaches to care, and inflates the value of worker information.

How do issues of surveillance and privacy figure in to these programs? What about employee consent?

Nopper: It helps to put employee wellness in perspective as an employee benefit, and part of a suite of benefits that an employer might offer. Employers are not required to provide employee wellness programs or employee assistance programs, per the Fair Labor Standards Act, so they are offered as a benefit. In this sense, employee wellness programming is already presented as a type of perk that presumably enhances our overall compensation package. There’s also the fact that healthcare is expensive, and that a large portion of the US population gets health insurance through their employer. We sign up for benefits and our unions fight over them in collective bargaining, so it’s hard to claim that benefits are being forced on us. This is why we wanted to focus on how employee wellness programming is incentivized by policies like the Affordable Care Act as well as the issue of penalties for non-participation, and how some workers are challenging the way they are being punished financially for not participating in these programs.

We also wanted to show how, just by using the benefits that are provided, you basically sign up to be part of a benefits maze and to provide more of your private data to your employer (as well as to a wellness industry, whose technology is not well regulated by the state). While you might agree to participate in wellness programming, you do so at great risk of having your data collected, having it travel, and possibly being used in ways that aren’t made clear to you before you sign up. What you have is a lack of substantial privacy protections for workers in general, and for health data in particular as more healthcare and mental health services go digital or are accessed via the workplace.

Among the apps and technological interventions you explore, were there any that stood out as being particularly disturbing or harmful — or that really exemplify the problems you write about?

Zelickson: In May, there were alarming headlines about the National Eating Disorder Association’s AI chatbot, which was giving people horrible and dangerous advice — encouraging them to count calories and lose weight. We also saw AI chatbots implemented in similar fields. We wrote about Twill Health, which uses an AI therapeutic assistant that is supposed to provide “reassurance through realistic conversations” that are intended to “listen and guide you towards greater understanding of your thoughts, actions, and behaviors.” Pretty plainly, it is irresponsible to hand over sensitive, high-stakes situations to a chatbot, especially a proprietary one where there is little transparency around its inputs and testing.

Another example worth mentioning is MoveSpring, which is concerning because of the visibility it gives bosses into workers’ movements. The benefit is intended to encourage physical activity, but the platform is impossible to use privately. This means that admins can view a user’s daily steps, active minutes, and overall activity level, allowing them to easily filter users and see who is reporting a low level of activity. With a benefit like MoveSpring, it is clear to see how workers could be concerned about lifestyle discrimination. Overall, the primer discusses a range of health and wellness benefits, including services that focus on fitness, mental health, and fertility.

How do you situate “employee wellness” within broader wellness culture? Where do they intersect, and where are there points of distinction?

Nopper: On a pop culture level, “wellness” can be associated with self-care, working out, or mindfulness. Celebrities, medical professionals, pundits, and personal trainers are all building platforms, brands, or content about wellness or self-care. In terms of health policy, wellness is treated more as a scientific project, to determine how to measure health and identify the factors that can produce it. What has contributed to the push for employee wellness is a debate about how we conceptualize and measure health, as well as how we prioritize prevention, particularly of chronic illnesses, rather than simply treatment.

We are also seeing efforts to destigmatize mental health issues, and to treat substance abuse and addiction as part of matters of public health and government priorities. Alcoholics Anonymous was key to efforts to destigmatize alcoholism, and is part of the cultural history of what eventually become employee assistance programs — benefits that provide services for addressing what get depicted as “personal” (individual or family) problems that hamper productivity.

A lot of this sounds good on the surface. We should want to prevent illness, and especially chronic illness, and to destigmatize mental health issues. Yet this debate about how to promote health is also a question about who and what are responsible for wellness, what our public health strategies should look like, and what the role of the state should be. In the mid-1900s scholar and organizer W.E.B. Du Bois talked about how people were overworked and didn’t get enough rest; he argued that the state has a major responsibility to create the structural conditions for better health, including planning for controlling pandemics, conducting medical research, and investing in healthcare workers as public workers. Today, instead of the vision of public health that Du Bois called for, we have with employee wellness a public health approach that acknowledges people might be struggling — which is an improvement in terms of treating health issues as something we shouldn’t have to hide — but for the most part doesn’t challenge structural arrangements or power relations or demand the existence of a humane and robust social welfare state. Employee wellness authorizes the boss to administer more of our health and wellness services without really challenging any of our labor conditions. Our primer situates employee wellness programs within a conversation about public health and the privatization of the social welfare state, which is not typically the context in which employee wellness is critiqued.

What are some of the broader implications of this entanglement of wellness and work?

Zelickson: With the entanglement of workers and employers when it comes to health care, and the prevalence of wellness capitalism, we are witnessing the growing privatization of social services and public goods. What’s more, employee wellness benefits put the onus on the worker to “get themselves healthy,” solidifying a logic that doesn’t treat good health and healthcare as a right, and ignores larger, structural conditions that are contributing to rising costs. With the employer at the helm of a data-intensive benefits maze — one that is not sufficiently regulated — we worry about the deterioration of worker agency, power, and rights.

Our goal in writing about the history and current state of wellness capitalism is to illustrate and critique the employer’s growing role in worker health. We wanted to begin to capture the contours of this model of public health, including its reliance on digital tools, data capture, messy informational flows, possible worker harms, and the broader logic of individualized, privatized health it moves us further towards.

You acknowledge that employers do have a role to play in public health — something the pandemic underscored — and that it can necessarily involve functions like data collection and contract tracing, and vaccination requirements. What might it look like for employers to be involved in safeguarding workers’ health and wellbeing without upholding wellness capitalism?

Nopper: This is a big political and logistical question that our primer seeks to raise more than answer, and a conversation that should involve the labor movement and public health. It is also a bigger issue to consider as we critique worker surveillance and data collection, whether we are talking about employee wellness or another labor issue. A lot of the discussion about workers and data collection point to negative aspects like surveillance, social control, and punishment. But we are also going to need data to implement good or life-saving things, like a viable public health strategy during a pandemic. We raised the issue in our primer to make clear that our critiques of employee wellness, data collection, and surveillance shouldn’t be confused with claiming that employers and companies should never play a role in public health, or that a critique of worker surveillance means never collect data. Protecting workers, the people they come into contact with, and the environment is going to require some data collection, and will require employers to work with the state and public health institutions in the process.