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Preeti Vissa Headshot

Your Job, Your Health -- and Fairness

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Sometimes an idea that seems perfectly fair and reasonable on the surface turns out to be nothing of the kind when you take a closer look.

Case in point: Certain types of workplace wellness programs start off with good intentions, but can have unplanned, highly negative consequences. This issue was discussed in a recent report, Health, Equity and the Bottom Line put together by The Greenlining Institute and Prevention Institute.

Through the Affordable Care Act, the federal government is encouraging businesses to create programs that help employees stay healthy -- generally a good thing. But some of these programs have a punitive aspect, and that's a problem. They offer rewards or penalties to employees for meeting -- or failing to meet -- certain benchmarks, such as losing weight or quitting smoking. For example, those who don't get down to a designated weight may be forced to pay significantly more to be covered by the company health plan.

On the surface, this carrot-and-stick approach has a certain appeal, and it seems fair. After all, the same rewards or penalties apply to everyone. But giving equal treatment to people in highly unequal situations produces the exact opposite of equity. This can have real consequences for people of color, for example, who often live in more polluted neighborhoods and suffer higher rates of chronic illnesses like diabetes or childhood asthma.

Consider two employees of a hypothetical company, Joan and Jane. Both are single moms with a school-age child. They're both on the company health plan, and both are a bit overweight. Under the company's new plan, both will get charged $50 more a month for health coverage if they fail to lose 20 pounds. Seems fair, right? After all, the two women are being treated just the same.

But there are differences.

Joan is an executive, making $300,000 a year plus a bonus that can get into six figures in a good year. While she frequently puts in more than 40 hours a week, she can often work from home if she needs to. And with her income, she can afford whatever child care she needs.

Jane is a cashier in one of the company's retail outlets, making $8.75 an hour - roughly $18,000 a year at 40 hours per week. To make ends meet, she works another 20-25 hours, mostly nights and weekends, at a fast-food restaurant, where she makes minimum wage.

That second job is a major source of stress: The hours are inconsistent, and because Jane can't afford to pay for child care, she constantly scrambles to find a relative or friend who can watch her little daughter while she's working. But she needs the money.

Because one of the few perks of fast-food employment is free food during her lunch break, Jane can spend a little less on groceries. She knows it's not the healthiest diet, but it's free - and it lets her devote her grocery money to better food for her daughter.

It's not hard to guess which of these two employees has a better chance at success in the company's new weight loss plan. Joan, because she has resources, has options. If she needs to take aerobics classes or adjust her diet, she has the means to do it.

Jane, on the other hand, has far fewer options. The monetary penalty she'll face if she doesn't lose 20 pounds won't help her buy healthier food or find an exercise class that fits her already frantic schedule, much less care for her daughter while she takes that class. But it might force her to drop out of the company's health plan, leaving her and her child more vulnerable to health problems than before the firm decided to "help" her lose weight.

If the company really wants to help, it needs a plan that addresses the actual circumstances of Jane's life.

Some politicians and pundits peddle a simplistic version of equality: Just treat everyone identically, and all will be fine. But a veneer of equality that ignores unequal circumstances simply perpetuates inequality.

Instead, fairness demands an approach based on equity. An equity approach recognizes those unequal circumstances and tries to compensate in order to produce a more equal result. It recognizes that punishing an employee for failing to lose weight is an exercise in futility if that employee can't afford healthier food or literally has no time to join an exercise class.

Policies based on equity are more complicated because they replace a simplistic, one-size-fits-all approach with an effort to examine particular circumstances and structural inequalities and then try to compensate. It's not the easy approach - but who ever said fairness was easy?