The problem with "wellness"

I just got a brochure in the mail from my health insurance company today telling me about all of their "wellness" initiatives. Some of which--like smoking cessation--are no doubt a good thing. Yet all of this focus on wellness makes me feel more than just a bit uneasy, and I finally figured out why.

It's a way to blame the patient for their illness. Get the flu? Obviously you didn't wash your hands enough, stood by a sick person, didn't get the flu shot, etc. Now I'm not saying that washing your hands is bad- I do have OCD, after all. The same thing with cancer prevention: you didn't get your mammogram/colonoscopy/prostate exam frequently enough, you ate too much of the wrong foods, you didn't eat enough of the right foods, you didn't exercise enough, blah blah blah.

Promoting health is good, but the understanding that people are going to get sick anyways sort of gets lost in translation. Humans want to avoid bad things; it's good for the gene pool, if nothing else. I'm not saying that people should say screw it and ignore that rectal bleeding and inhale flu-laced sneezes. But even if you do everything "right," you still might get sick.

And even if you don't- even if you buck the advice and just try and live your life- and you still get sick, that's okay.

We can't prevent everything. In our zeal, I think we forget that. Even with eating disorders, 100% is essentially impossible. People will say that of course, we don't think we will ever have a world with no eating disorders. But then I see ads that say "Until eating disorders are history..." and I have to wonder.

Obesity gets the lion's share of "wellness" initiatives directed at it and is pretty much the most stigmatized medical condition I can think of. If you'd only eat fewer calories than you burn, you'd be thin. Right? Except it's a little more complicated than that. Instead of addition and subtraction, think path integrals.

Patients get blamed enough. Many medical professionals unwittingly assume that something you did led to you're being in their office. Maybe that's true, maybe it isn't. But no matter how much money we pour into "prevention" and "wellness" efforts, people are still going to get cancer, they're still going to get diabetes, and they're still going to be fat.

And you know what? That's okay.

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Libby said...

Thank you for this. It definitely needed to be said.

Anonymous said...

It makes me uneasy because it could be a way to deny people care in the future. Maybe your insurer doesn't know that you have some of the risk factors their initiatives aim to help with ... until you sign up for help with them. Then, if you switch jobs or insurance coverage changes, you might be denied benefits ... either entirely, or as a pre-existing condition. I'm not even sure how, but it really seems like it's only very partially in the health-care consumer's interest to raise their hands for these "benefits."

Kim said...

I work for a health insurance company and write brochures for these "wellness" initiatives (ugh). Their real goal is to try to prevent spending money on claims. They figure if they can get people to "be healthy," they will be sick less. They don't really care about people with chronic conditions. It's really sad.

Carrie Arnold said...


Good point. Having wrangled with my insurance company over coverage, I have no illusions that they give a shit about my health. They care about their bottom line. The thing is that there's no evidence these initiatives ultimately decrease illness- though they do make the insurance companies look better ("We care about you!" *cough bullshit cough*). And I know for sure they will use this to deny coverage at some point, if they haven't already.

Kim said...

Yep, unfortunately, it's all about the bottom line. I have first hand knowledge of this. They give bonuses to people who find ways to deny coverage (especially expensive coverage, like ed treatment). The "wellness initiatives" are put in place to counteract the fact that they are paying less and less on claims. The message is, "Yes, your plan sucks more, but WE CARE." Right. Don't even get me started on health insurance.

Gaining Back My Life said...

Wow. Very interesting post. Point well made.

And Kim, it's so sad but true. Patients need a personal advocate these days to receive any sort of sound care.

Special K said...

I also wrote about this...
what is health? Balance! It is about not ALWAYS feeling pressured to work out at lunch versus sitting down and having the soup at the cafeteria, even though you know it's loaded with sodium. Some of us need less rules and more intuition. If you get the time, check out my site!

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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