🔒 WORLDVIEW: Should your boss know your weight?

By Felicity Duncan 

Would you let the company you work for monitor your weight? Your exercise habits? What about whether you’re considering having a baby? In the future, you may have little choice.

As health technology evolves and medical costs rise, companies around the world are turning to health tracking and incentives to encourage their workers to be healthier.
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In places where employers cover medical costs, like the US and South Africa, plans like Discovery’s Vitality program are being integrated into the workplace. Some US companies offer workers cash incentives to hit certain weight targets, for example. Why is this happening, and what are the implications?

Costs

The drivers behind this are clear: health care is expensive. Most countries around the world have seen their health care bill rising sharply over the last few years.

According to data from the OECD, a group of rich countries saw their average per capita medical costs rising from about $215 a person in 1971 to over $4150 in 2017. That’s a compound annual growth rate of 6.7% – global GDP grew by an average of 3.5% in the same period. Between 2000 and 2015, the OECD reports, South Africa’s health spending per capita doubled from about $500 to over $1000.

Why is spending rising? After all, a lot of basic healthcare stuff is not very expensive. Immunization, for example, saves millions of children’s lives at a very small cost. Similarly, basic pre- and post-natal care for women saves millions of lives at a relatively low cost. And things like paracetamol to lower fevers, antibiotics for septic wounds, and medications like oral rehydration solutions are both cheap and lifesaving

A lot of basic, life-saving healthcare can thus be delivered at a pretty low cost. The products involved are cheap (they aren’t the subject of live patents or predatory drug pricing) and the care can be administered by people with just a couple of years of health training – no need for expensive doctors with 10 years of university education.

However, things get more complicated when we’re trying to fix something more complex than an infected cut. We have fantastic technologies available, from MRIs to stents to advanced drugs that work genetic magic. But those things are pricey. We can cure hepatitis C – a life-threatening liver disease associated with medical issues ranging from cirrhosis to liver cancer that kills more people in the USA than AIDS – but the drug treatment regime costs $84,000 (or $95,000, depending on various factors).

Beyond the costs associated with technology, so-called lifestyle diseases like diabetes, heart disease, and certain cancers are chronic, complex, long-term, and difficult conditions. They require multiple drugs over many months or years and the intervention of highly trained specialists, including surgeons. Those don’t come cheap, and lifestyle diseases are becoming vastly more prevalent thanks to a combination of increasingly sedentary lifestyles (desk jobs and weekends in front of the TV), bad diets (lots of meat and sugar, no veggies), and population ageing (lifestyle disease prevalence rises with age).

Experts also attribute a lot of the increase in health costs to rising life expectancy. This chart shows the average per capita spending for rich countries and global life expectancy. As you can see, health spending and longevity go hand-in-hand.

Now, there’s a bit of a chicken/egg problem here. Are we spending more because we’re living longer, or are we living longer because we spend more? The answer seems to be the former – most of a person’s lifetime health spending happens in the last years of their life, with spending starting to rise in the 60s. This chart shows the proportion of Americans in each age group and the proportion of health spending they account for. As you can see, the over 55s and over 65s spend more than their share.

Implications

So, rising healthcare costs are associated with two things: aging and lifestyle. Companies can’t do much about the fact that humans get older every year, but they can do something about lifestyle. We know what a healthy lifestyle looks like: a plant-heavy, low-junk diet, plenty of exercise, no smoking, and no stress.

Much of this behaviour is within our control. We can choose not to eat pizza and sweets and to spend our free time taking walks or playing a sport. We can choose not to smoke. But often, we don’t make those wise choices. And that’s where corporate tracking comes in. Companies are issuing step-counting watches and smart scales to their staff, keeping tabs on their weight and exercise patterns. They’re monitoring what groceries employees buy and giving them points for smart choices. They’re giving medical aid discounts to people who stick to a healthy weight and don’t smoke.

The problem with this, of course, is that it means an extraordinary amount of very private information will be collected. And who’s to say that this information won’t form part of corporate decisions like who to promote. Women could find themselves especially hard hit – pregnancy discrimination is already rife in workplaces, and employers with access to huge volumes of private data may take a woman’s decision to stop drinking as evidence of pregnancy plans and grounds for retrenchment. As with all things data-related, we are forging ahead without careful consideration of the implications of our actions.