Tuesday, July 16, 2013

The New Eugenics--The Private Sector, the University, and Corporate Health and Wellness Initiatives

At least since the Enlightenment, people charged with the management of others, and especially those charged with the operation of states and large economic enterprises, have sought to apply the principles of animal husbandry to the perfection of the human herd from which they extract productive work, or using the more traditional if feudal terminology, compulsory service, in return for a wage (if to employer) or the varied benefits of citizenship (if to the state).  

(Pix (c) Larry Catá Backer 2013)

A more scientific set of efforts to improve the human condition was organized by public and private elements in the most civilized states of the time, including the United States. The science was crucial, of course, to the legitimacy of the policy decisions extracted therefrom. The idea was to help create a better, healthier and improved human, more fit for the occupations to which he or she appeared to be intended in emerging 20th century industrial society, one in which these individuals were also expected to have a modest role in political governance. Emblematic were three International Eugenics Conferences were organized and took place in Europe and the United States in 1912, 1921 and 1932. To further these scientific pronouncements, so indisputable at the time, it was only necessary for the captains of industry and the leaders of state to turn science into policy for the aggregate welfare of the state and the industries that enriched it and those fortunate enough to work within these forward looking industrial and social complexes. 

In its most extreme applications, eugenics has tempted states to engage in what is now considered horrific experimentation in social engineering to make its citizens better and to eliminate inferior individuals from the productive herd. Since the Second World War, overt efforts to advance the agenda of 20th century eugenics have been disapproved, especially in light of the experience in Germany between 1933-45 and later discarded practices of sterilization in the United States and other civilized states through the middle of the last century, as well as approaches to immigration policy.  (Edwin Black, The War Against the Weak: Eugenics and America's Campaign to Create a Master Race  ("To perpetuate the campaign, widespread academic fraud combined with almost unlimited corporate philanthropy to establish the biological rationales for persecution. Employing a hazy amalgam of guesswork, gossip, falsified information and polysyllabic academic arrogance, the eugenics movement slowly constructed a national bureaucratic and juridical infrastructure to cleanse America of its “unfit.”" Ibid., Introduction)). As a matter of state power, the most extreme aspects of eugenics have now been outlawed in many places (e.g., Convention on the Prevention and Punishment of the Crime of Genocide; Charter of Fundamental Rights of the European Union). 

But efforts to improve the human condition and to make individuals better and more useful have not entirely disappeared.  Rather, they have returned to the medical and corporate institutional organisms from which they emerged a century or more ago. They have been incorporated into the sensibilities of acceptable private sector conduct and more importantly, into the legitimate calculus of enterprises in the management of their productive forces--principally capital and labor.  The language and objectives of these projects are no doubt substantially different than their predecessors.  Modern efforts to deploy medicine, training, and life style choice programs to improve the human condition through management of behavior and the enhancement of the development of offspring in wholesome environments are also undoubtedly different, and avoid the worst excesses of their predecessor programs of related interventions.  More importantly, no doubt, the intentions of those who would impose these healthful regimes are far less subject to question, and the programs rely only on the best scientific developments, appropriately interpreted and naturalized within the social and political environments in which they will be imposed.  

Still, at bottom, these programs remind one of a long line of efforts to substitute individual discretion and choice for those of institutionally superior forces, bent on improvement  for the sake of those on whom these regimens are imposed, but also for the institutional advantage of those controlling the processes.  Where before 1945 the coercive power of the state was usually deployed to achieve these positive interventions, today, and  in harmony with the markets based structures of modern regulatory mechanisms, non-governmental organizations (usually some sort of momentarily legitimate expert grouping) and economic organizations have been at the forefront of these new programs of human development and welfare.  The rationales are also different.  No one speaks to the creation of master races anymore, no one proposes the elimination of individuals with mental or physical characteristics deemed inferior; but both public and private organizations speak to profit, the costs of providing health care, the need to take proactive steps to reduce costs and increase labor productivity, and (especially in the case of athletes) the need to maximize the physical utility of those purposed for sport.  Much of this is made possible both by the diffusion of notions of "efficiency" into virtually every aspect of social interaction, and by the increasing power of data (and those who mine and interpret it) to order policy and determine the structures and objectives of law (in the public sphere) and institutional policy (in the private sphere).  (e.g., Vaios Karavas, "The Force of Code: Law’s Transformation Under Information-Technological Conditions," German L.J. 10:463, 478-80 (2009); Larry Catá Backer, "Global Panopticism: Surveillance Lawmaking by Corporations, States, and Other Entities,"  Indiana Journal of Global Legal Studies 15(1):101-148 (2008)). Privatization has also embraced cultures of standardization and bureaucratization, founded in risk management and productive efficiency, that seek to blend public interest in health with private institutional welfare maximization (not just profits but the efficient management and conservation of useful inputs, especially labor inputs in ways that are culturally compatible within the society in which the institution operates).

Most interesting has been the way these trends have produced a new language of eugenics bound up in corporate health initiatives, one that blends public policy and private advantage.  It has been presented in an innocuous way--as part of efforts at the core of traditional human resources operations.  However, both the objectives and reach of this initiative are far more profound. These have tended, as public policy before it last century, to abstract the individual, reduce her to a factor in the production of institutional objective.  So abstracted, the individual can then be improved and managed, like any other tool, but managed in a way that (thanks to science and the interpretative magic of the social sciences) assures managers that the objects of this social engineering will be better off, and no doubt happier, for the effort. These are nicely brought out by the IBM statement on health initiatives for that enterprise:

At IBM, we have long understood that investing in prevention and well-being makes sense for both our employees and our business. The company has identified employee health risk reduction and maintenance of low health risk as a key requirement under IBM's Well-being Management System.

Wellness and healthy living are considered a company norm and employees are supported in this endeavor through IBM's wellness programs. The reasons are simple: Healthy employees tend to experience a better quality of life and higher personal productivity, and those who discover health problems early tend to get well faster and spend less on medical care.

The intent of IBM's global wellness strategy is to create a "culture of health" that fosters a long-term commitment to healthy lifestyles and the reduction of health risks among our employees and their families. (IBM Global Wellness Initiatives)
Of course, none of these programs are constructed with substantial input from the object of improvement.  Eugenics does not seem to recognize the possibility of a legitimate engagement by individuals whose failures are the precipitating cause of the need to improve in the first place. Consider this excerpt from NAMA, the National Automatic Merchandising Association, "Balanced for Life" initiative (2005):
Corporate Health Initiatives: An Overlooked HR Tool
Health Care Costs to Employers
Employers have been hit hard by the soaring costs of providing employees with health care benefits. Recent studies indicate that almost 50 percent of corporate profits now go for health care costs versus only 7 percent three decades ago.
PricewatershouseCoopers has just released a study commissioned by America’s Health Insurance Plans that found the overall increase in health insurance premiums was 8.8 percent between 2004 and 2005. The study attributes 27 percent of the increase to general inflation, 43 percent to increased utilization and 30 percent to health care price increases in excess of inflation.
The non-medical costs to a company of an unhealthy lifestyle can include:
• High absenteeism
• High worker’s compensation
• High disability claims
• Unnecessary health service use
• Excessive medical leave
• Early medical retirements
• High life insurance costs
• Significant productivity loss
• Excess worker conflict
• Family disruption
• Social disruption
Changing Behavior
Employers are actively seeking new ways to reduce health care costs without jeopardizing their ability to attract and retain workers and one significant way to approach this problem is through an employee campaign that may decrease healthcare costs (health insurance premiums, medical claims), reduce absenteeism and increase productivity.
According to Larry Chapman, chairman and co-founder of Summex Health Management, illness and injury in the workplace can be reduced by changing the behaviors associated with “modifiable” risk factors. Mr. Chapman says some modifiable “risk factors” targeted by most worksite wellness programs include:
Heart Disease: high cholesterol, cigarette smoking, high blood pressure, overweight and obesity, lack of exercise.
Automobile Accidents and Injury: non use of seat belts and child restraints, speeding, drinking while driving, cigarette smoking, long distance driving.
Pulmonary or Respiratory Diseases: cigarette smoking, occupational exposures, air pollution exposure, second hand smoke exposure, pollen exposure.
Selected Cancers: cigarette smoking, obesity, low fiber diet, high animal fat intake, lack of self-examination practices, use of smokeless tobacco products, excessive alcohol consumption, promiscuous sexual behavior.
In a recent study, Dr. Marilyn M. Helms, Professor at Dalton State College, found that corporate programs designed to improve the healthcare of employees improved employee morale and productivity and reduced employee turnover.
Dr. Helms pointed to a study by the U.S. Office of Disease Prevention and Health Promotion suggesting the average cost-to-benefit impact of these programs was a $2 healthcare cost saving for every $1 spent on the programs.
 The context are the compulsions of economic markets in which enterprises exist. The value determinations are substantially financial--compelling change in individual behavior is warranted when the benefits (to the enterprise) of the modifications are less expensive than the costs of the programs. Individuals, of course, like capital, are abstracted and reduced to a fungible factor in the production of economic value to the enterprise.  The programs are limited only by the social parameters within which the bundle of desired behaviors fall (they violate no legal, religious or social taboos).  The additional benefit, reducing the social costs of individual engagement in society is indirect beneficial to the company--increasing potential consumers and reducing tax exposure for otherwise necessary public social programs.

For all the effort, private efforts over the last decade have not been all that successful.  "According to a newly published report, 86% of employees don’t participate in wellness initiatives because they just don’t have the time. Not finding the initiatives fun or engaging was the distant second most common reason given for not taking, at 45% (yes, multiple answers were possible)." (Karsten Strauss, "Employees Don't Have Time for Wellness Initiatives--REPORT, Forbes, April 2, 2013).  The 2013 Global Corporate Challenge, Global Workplace Health and Wellness Report (2013) included a focus on the behaving changing techniques at the heart of these initiatives: "Whilst 99% of organisations report having fun as of medium to high importance for wellness initiatives, only 10% actually report their initiatives achieving very high levels of fun. The ability to create an initiative that is viewed as enjoyable is critical for both increasing participation rates and also supporting completion rates: two prerequisites for achieving long-term behavioural change amongst employees." (Ibid., 2).  Moreover, "According to GCC, lack of implementation may be the culprit here, as well as the drag of not feeling there’s enough time to feel good. Budget constraints are the real pull, according to the organization’s report, as are sufficient resources to promote and execute the initiatives." (Karsten Strauss, "Employees Don't Have Time for Wellness Initiatives--REPORT, Forbes, April 2, 2013). 

Now some institutions are trying to overcome the participation challenge in the management of  "improved" individuals as factors in the production of enterprise product by moving from discretionary to mandatory wellness programs.  No longer crudely designed as commands, these coercive programs are now designed  to give participants a "choice", though one embedded with consequences that function as coercion. This appears to be the case with certain university programs that have recently been announced. ("Get Rewarded! Not only will you feel better knowing your health risks, you will avoid paying $100 more per month in a health insurance surcharge, AND you will be entered automatically into a raffle for one of six $500 cash prizes." See HERE). These highlight the importance of "lifestyle choices" for both personal fulfillment and the economic needs of the employing institution.  See HERE.  The referent for these "lifestyle choices" appear to be neutral--nicely enveloped in the language of medicine and well interpreted data--no human discretion or policy choices appear on the surface.  These include standard biometric data, but also body mass index, waist circumference.  These are provided to suggest steps necessary to lower risk.  And  looks can be deceiving.  Body mass indices, for example, are not only controversial, their use in interpreting data for pronouncements about necessary courses to maximize health are also controversial.  See, e.g.,  Harvard School of Public Health, Obesity Controversy.  None of that is taken into account by those whose health is to be managed thereby. More interesting are the data mining potential of these initiatives.  For example, one institution also requires completion of a wellness profile that generate substantial data about personal habits (all of which arguably affect health--but then what doesn't?) and some of which might actually embed value judgments (drinking alcohol, for example) that may then factor into personnel decisions. An example--the Food Guide Pyramid illustrates a governmentally developed food guidance system was recently replaced by the nutrition plate, a now authoritative basis for determining the legitimacy of food consumption habits as against a certified standard (see HERE). It would not be hard to see the guidelines of these efforts move from suggestion to requirement, deviation from which might indicate the sort of anti social behavior that could trigger job related effects for "unhealthy" behavior by reference to the guide rather than to the individual.  More importantly, the data generated from these surveys and other medical records are used by the university for managing its health policies and ultimately setting health parameters and expectations.  In one case, data is harvested by a third party provider that also 
analyzes data and produces reports for [the University, but only using data collected from large populations of users. Such aggregate data cannot be used to identify any individuals. [The University] uses aggregate data to better understand the needs of our organization and design appropriate health improvement programs, such as lunch and learns, and physical activity opportunities, to meet those needs. Health information that specifically identifies you is never shared with [the University] in its role as an employer. (See HERE).
Part of this can be explained by the way in which these initiatives are developed, especially in U.S. universities. Eugenics continue to be constructed as a cluster of premises and choices privileging a particular cluster of norms and behaviors that are chosen by regulators (including university administrators) for a regulated and subordinate community (labor). The hierarchical and top down description is not accidental.  It is unusual for such programs to include any substantial engagement in their formation or any effort to seek buy in by faculty or staff at institutions where these programs are imposed. How that choice of imposition conforms to traditional university cultures of shared governance remains a mystery, but where too much opposition might jeopardize careers, it is unlikely to be raised. But however one considers this, what remains true is that, for reasons of productive efficiency, and to increase profit margins, institutions, including universities, have committed more aggressively to the eugenics  goal of improving individuals, the human factors in the production of institutional value (and reduction of the tax costs of public social programs affecting the institution or its stakeholders). At one university it was put this way
It is a program promoting a culture of employee responsibility and well-being. The steps the University is taking are the first in helping employees and dependents understand how individual behaviors affect the cost of health care for all of the [University] population. The University is self-insured, which means the claims costs come directly from the central University budget and employee payroll contributions. If the health of the entire employee/dependent population improves, the rates for our health insurance can be maintained at current levels or even reduced. (See HERE)

That these are undertaken without the slightest nod to participation in their development by the people on whom this social engineering is to be imposed is regrettable, especially in institutions that appear to hold to traditions of stakeholder engagement and shared governance.  It suggests some of the structural problems of shifting authority from the academic to the financial side of university administration.  It suggests that it is as likely that the finance administrator will someday wield as much authority over university programs as the provost, fueled, in part, by the need for revenue and the construction of university programs to maximize profitability per student processed through the educational system. Indeed, it might be useful, when universities begin to consider wellness or other employee lifestyle management strategies to consider the following checklist for better management according to traditional principles of shared governance and to enhance buy in:

1. Process:
a. who drove the process from idea to implementation within the administration?
b.  To what extent was any administrative team consulted or engaged in the development of the program?
c. to what extent are faculty and staff involved in decision to undertake a wellness program?
d. to what extent did faculty and staff have input in the framework or the details of the program?
e. how was faculty and staff input acquired?
(Note: there is a substantial difference between outreach that appears to get input and outreach that is aimed at getting a real sense of opinion.  The former is the usual means adopted by administrators seeking the appearance of engagement and involving either the appointment of "safe" faculty to some sort of usually mixed stakeholder committee, sometimes with the connivance of institutional faculty or staff leaders heavily invested in university crony networks.  The later usually is evidenced by more open textured rank and file engagement and faculty and staff choice of representatives)
f. to what extent did any staff or faculty leaders engageme their constituencies in the decision
(Note: it is lamentable but not uncommon for faculty organizations to exhibit what social scientists sometimes refer to as "capture".  This might be evidenced by a tendency for faculty leaders to avoid much broad discussion of policies the approval of which requires institutional faculty action--this is sometimes accomplished by action through a small cadre of "leaders" or by action without much publicity in a standing committee of the faculty or staff organization)
g. To what extent were faculty and staff permitted to review and comment on the drafts of the policies before decisions to implement were made?
h.  Sometimes there are conflicts between financial officers and HR departments over both content and implementation; to what extent was there deference to HP views or explanations for disregarding them?

2. Substance
a.  What alternatives, if any, were considered to the objectives for which th wellness program was adopted?
b. what alternatives, if any, were considered to reach the objectives adopted?
c. did third party providers provide any input, and if so what?
d.  how muchg did the university pay for the services of these third party consultants?
e.  Will these third party consultants continue to provide services to implement the wellness program and how was this harmonized with any policy against conflicts of interest?
f. how will the university ensure that lifestyle choices that will affect pricing, or more basically a decision to forgo participation, will not affect personnel decisions (promotion, tenure, retention)?

These are the sorts of questions engaged administrators, bent on managing employee lifestyle choices, that mark the start of conversations over enterprise policies that seek to merge issue sof personal autonomy with those of the economic necessity of enterprises that rent employee services for a wage but do not purport to own the employee (perhaps merely only the services). 

For all this, one ought not to expect much; money is money, and factors of production--whether natural born or cash (and its equivalents) are instruments to be molded and refined to their highest and best use.  In a world in which merit is rewarded, social conformity that adds institutional value appears likely to help shape the model employee of the future.  And like her predecessor a century ago, in ways in which the individual molded will have little to say about the manner in which she is improved. 


  1. Yes!! Financial-compelling change in individual behavior is warranted when the benefits of the modifications are less expensive than the costs of the programs. Individuals, of course, like capital.

    Kopi Luwak

  2. Interesting article and its good time to read your blog, so i would like to thank for creating this interesting blog.