Maria G. Hernandez, PhD

The opportunity to reduce health care costs through employer sponsored programs is key to our health care crisis but wellness and lifestyle programs like the ones mentioned in todays WSJ story are only half of the equation. There is substantial research that points to several "social determinants of health" that can be addressed in the workplace. Sir Michael Marmot, head of the Department of Epidemiology and Public Health and Director of the International Center for Health and Society at University College London has documented that workers with the least control over their workday often suffer with the poorest health. It shouldn't be all that surprising that being in a job where a worker has little control over daily demands can be wearisome and debilitating. This has enormous implications for the way managers manage and the way work gets designed. If we want to get serious on promoting wellness in the workplace our focus cannot just be on the worker who needs to stop smoking or stop eating poorly. We have to be willing to ask what kind of stressful conditions exist around an employee that undermine her health. A recent documentary Unnatural Causes (available at http://www.unnaturalcauses.org) has summarized these issues and a large number of community organizations and public agencies are rethinking the true nature of our health care crisis. CIGNA has been inspired by this effort and has initiated a program focused on Communities of Health (www.communitiesofhealth.org). The examples in this story are indeed inspiring but let's not get confused with what wellness requires---its about the individual behavior, genetics AND their environment. Are we ready to tackle this? A true response to the nation's health care needs requires this comprehensive view. Maria