Below is the submitted text of an article I wrote for the Sunday Business Post - link to the final slightly tidier article behind a pay wall here. There have been several recent articles particularly in the US context questioning the efficacy of corporate well-being programmes (e.g. here and here with thanks to Brendan Kennelly for suggestions). RAND Europe recently produced a report looking at how various programmes were being implemented in the UK, pointing to a relatively positive view of how they are received by workers but also pointing to the dearth of any effectiveness evidence. In Ireland, the main employers group IBEC have launched a new initiative to promote well-being in the workplace - the Keepwell Mark. I spoke at their launch that also included speakers from companies such as Microsoft Ireland and was attended by hundreds of company representatives. The seeming failure of the tested initiatives in the US to convert into improvements in company productivity and the extent to which many of the initiatives in the US even seem to have backfired and in cases reduced employee morale (e.g compulsory drug testing initiatives reducing trust) should give us pause in the Irish context. Should IBEC be successful in bringing many of the country's employers on board such an initiative, it would provide the opportunity for a serious and structured way of evaluating the impact of various features of well-being initiatives and hopefully the potential to avoid rolling out ones that are going to have harmful effects to both productivity and morale, and ultimately to develop an evidence base on the extent to which well-designed initiatives could have potential benefits and the extent of these benefits.
The declines in infant mortality in Ireland in the 1950s still represent one of the state's major achievements. Improvements in sanitation, in particular, led to healthier maternal, infant, and childhood conditions, setting the foundation both for reducing mortality and improving the health of people as they grew up. At least some of the health improvements we are seeing in our aging populations can be traced to this period. Furthermore, while people have spoken about our health system as being a "black hole", the improvements in life expectancy in the last 30 years have been remarkable, fuelled in part by reductions in smoking and improved nutrition but also by health services, however still flawed, that have substantially improved with the investments made in them by successive governments.
There is increasing evidence for the interplay between health and economic productivity. As might be expected, economists disagree on the precise relationships, but an increasing body of work has related health to economic productivity at both individual and national levels. In the context of aging populations, it seems obvious that improving health will act at least partly as a bulwark against rising dependency ratios, allowing people to work healthily longer into life. One key element of this is the extent to which mental health and chronic pain influence economic outcomes. Depression and chronic pain have dramatic effects on probabilities of unemployment, lost days at work, and life-time wealth accumulation. Mental health might well be the biggest economic concern for the Irish economy in terms of the scope and severity of the effects. Scholars such as Richard Layard have called for major and transformative levels of investments in mental health across countries to understand conditions more and develop and scale-up effective treatments. More broadly, developing workplaces and health services that break the link between mental health and economic deprivation is one of the major tasks of the 21st century.
As well as the implications for economic productivity, there has been an increasing emphasis on how to incorporate health and well-being into policy making as a goal and indicator of progress. A range of high-level reports have asked about how to construct measures that go beyond GDP and economic measures. The incorporation of factors such as literacy, life expectancy, economic inequality and other measures of welfare provides a more rounded account of the progress of nations and has a long history. More recently, the incorporation of measures of subjective welfare and of mental health has become the focus of attention.
The development of workplace programmes to improve health and well-being should be seen in this context, both in relation to their potential role in productivity and as contributing to well-being as an end in itself. So far, such programmes are in their relative infancy. The evidence on the links between well-being and work is very strong but that is different to saying we know how to influence those links. The internet is replete with examples of over-claims about the benefits of introducing health and well-being programmes in work settings. So far, the evidence is slight that productivity can be directly improved by such programmes. There are certainly many studies showing that employees will engage with many of them and enjoy aspects of them etc., But whether investment in worker health and well-being driven by programmatic activity of firms can be part of a major societal shift in well-being and productivity is still an open question.
There are clearly many plausible reasons why providing access to healthier food at work, exercise facilities, health screening, and related services might impact on both well-being and productivity. But there are also pitfalls. Such facilities might only be used by people who are already doing fine in terms of health and well-being. Framed badly, corporate well-being programmes might come across as intrusive or patronising, an attempt to distract from wider issues, or even a subtle hint that worker dissatisfaction is due to their own fitness or mental health issues. Encouraging people to disclose mental health issues to their employer often ignores the fact that many companies have very little idea what to do with such a disclosure and there are risks that people could end up being tacitly discriminated against. Recent reviews of the literature make it clear that there are not simple off-the-shelf models for intervening in worker well-being that will also raise productivity. If this is to be achieved, it will require iteration and commitment to testing, and a willingness to measure and acknowledge failure.
Even with all the above in mind, accumulating evidence on work-place programmes that genuinely have a causal impact on worker well-being and productivity would be a substantial advance for both business and policy in Ireland. Adopting a hard-headed approach to evaluating these programmes will be key.
Liam Delaney is Professor of Economics at UCD and directs the MSc in Behavioural Economics.
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