Cristina G. Banks, PhD


Many writers acknowledge that in the next decade or so, the U.S. will experience a “health tsunami” (Reich, 2012).  Several factors are driving us in that direction: the aging Baby Boomers, the toxic environment, a compromised food supply, the shortage of clean and abundant water, stressful work, growing substance abuse, lack of adequate and universal healthcare, and stagnant and declining wages, among other things.

There appear to be three major approaches to stemming the tide: (1) developing and selling more and different drugs and treatments; (2) making drugs and treatments more accessible and affordable through insurance; and (3) making people healthier.  This third approach is the Center’s sole focus.

How are we making people healthier?  There are four primary methods pursued today and one emerging method for making people healthier.  The first is educating and training people how to live and work safely and how to take care of themselves better to avoid illness, injury and disease.  The second is creating wellness programs and other stand-alone resources (e.g., EAP, smoking cessation, weight management) to treat existing health-related problems.  The third is changing how people live and work by creating and implementing guidelines, policies, processes, rules and regulations, which provide a structure for day-to-day behavior and decision-making.  The fourth is modifying the way people interact with the places they are in and the things they work with or use (e.g., machines, equipment, furniture, office structures, and spaces).  The fifth and I believe most promising method is changing the way people think about their lives and their relationships with others–what might be called “social engineering.”   This last method is the game changer.  It does not replace the other methods; rather, it enables the other methods to be utilized together more effectively and in a manner that complements a different way of living and working.

How much progress are we making with each of these methods?  Before this question can be answered, it should be noted that the research on the effectiveness of each method is scarce, poorly documented, and by and large unhelpful.  That is not to say researchers haven’t tried their best to do a good job evaluating factors that they believe will make a difference in the health and well-being of employees and the public in general.  The difficulty lies in the nature of the constructs they are trying to study; they don’t lend themselves to quick turnarounds, they are multi-faceted but only one or a few are studied at a time, and reliable and valid measurement is almost impossible.  It is no surprise that we are still at the beginning stages of knowing how to improve people’s health and well-being in significant and long-lasting ways.  A brief although incomplete summary of our progress can be captured as follows:

  • Quitting smoking will dramatically decrease a person’s chance of developing CVD and cancer.
  • Avoiding sugary drinks, saturated fats, fried food, high glycemic foods, excessive amounts of alcohol, and empty calorie foods AND eating nuts, seeds, fruits, vegetables, and good fats will decrease a person’s chance of developing CVD, diabetes, and cancer.
  • Increasing physical exercise on a daily and weekly basis lowers a person’s chance of developing CVD, diabetes, depression, illness and injury.
  • Lowering work-related stress and job strain will decrease a person’s chance of experiencing illness, injury, depression, insomnia, and other stress-related conditions.
  • Following safety procedures and wearing protective gear and equipment will lower a person’s chances of illness, injury and death.
  • Improving air quality, ventilation, natural light, and personal control of indoor temperature and noise lowers a person’s chance of developing illness and depression.
  • Increasing the ergonomic fit of people to equipment (e.g., furniture) lowers a person’s chance of developing repetitive motion injuries, back strain, other musculoskeletal problems, and metabolic problems.
  • Increasing wages and economic resources improves a person’s health status.

Very little research, if any, has been conducted examining the effect of multiple-factor interventions where applications of illness-reducing and health-promoting factors are combined and integrated into a total health strategy.  Part of the reason for this dearth of research may be that health and well-being experts from multiple disciplines don’t naturally work together.  In fact, they probably do not know much about each other’s research and therefore, don’t know how they can be knitted together to form a total health strategy.  There is a large variety of players in this game of health: doctors, nurses, occupational health experts, nutritionists, ergonomists, psychologists, business experts, sociologists, economists, engineers, designers, computer scientists, public health experts, public policy-makers, social welfare advocates, lawyers, and architects, among others.  They tend to stay in their own silos, and they tend to conduct research for their own kind.  This doesn’t make for much sharing or collaboration.

Recently, innovations in technology have stimulated a variety of new applications especially in the field of healthcare.  Some of these innovations are already familiar: wearable tech (e.g., FitBit), personalized apps for healthcare instructions, electronic sensors in buildings measuring temperature and other indoor air quality factors, and computer programs that shut down operating systems to control when people work.  There is also an entirely new line of technology developments for which we are just beginning to understand their potential application such as chips embedded in clothes, skin, glasses, and food.  Analyses of billions of health and work-related information records now available (Big Data) may generate new insights into the relationships between human behavior, living and working conditions, and health and wellness consequences.  Healthcare and wellness will be a key target for technology innovation, and these innovations are likely to change our lives (and work lives) dramatically particularly in the areas of personalized healthcare, self-care and coordination of care.  We need to keep our eyes on these developments in order to anticipate how they might be integrated into the design of healthy workplaces.

Although we can say that we haven’t made much progress because there isn’t enough money to do the kind of research we need to do or there are too many organizational barriers to creating and then evaluating a variety of interventions–and we would be right, but there are other reasons that I believe are the real reasons we haven’t made much progress.  They are:

  • We don’t take the time to think through the problem in enough depth and with the most expansive, creative, innovative and forward-looking experts;
  • Doing so would mean un-doing what methods have worked in the past and what people are satisfied with today;
  • It requires overcoming the need to personally profit from doing so in favor of joining together for the public good (although all players will personally profit by participating and being a contributor); and
  • It requires overcoming the drive for self-promotion in favor of seeing how each of us is a part of a much larger design.

Given the above, where and how can we make the greatest gains?  My recommendations for moving forward are outlined below:

  1. Collect better and more extensive data to build-out the knowledge base. This is required because we need to know what to do.  It answers the question, “What do we need to know?”
  2. Share knowledge across multi-disciplinary teams to gain new insights into how the pieces fit together. This is required in order to learn how a multi-pronged and integrated approach may be greater than the sum of the parts.  It answers the question, “How do we knit discipline-specific knowledges together?”
  3. Work with “builders” (engineers, designers) to share the accumulated knowledge and its integration to gain new insights into how people might live and work in the future. This is required in order to translate this knowledge into visions of new forms of workplaces, living spaces, and communities.  It answers the question, “What new things are possible?”
  4. Work with organizations of all kinds to share new possibilities of workplaces, living spaces and communities and explore ways work and workplaces can change fundamentally. This is required to determine how organizations might accept different ways of thinking about how they exist and operate, freeing up more ideas for how health and well-being design and interventions may be introduced into the workplace.  It answers the question, “What changes can organizations make?”
  5. Work with consultants, educators, change agents, facilitators, policy makers, and other deliverers of change to learn how to best implement new solutions in organizations. This is required in order to develop the right platforms to transition organizations from old ways of doing things to entirely new ways–which people will resist and fear.  It answers the question, “What are the best ways to make these changes?”


What is needed to get this done?  A list of activities for facilitating this work is suggested below:

  1. Develop new measures by bringing the best minds together to create the necessary content and formats.
  2. Harvest existing data through targeted Big Data projects.
  3. Expand the content of existing data collection efforts.
  4. Implement new data collections through new data projects.
  5. Convene working groups of top experts to gather subject matter knowledge.
  6. Convene multi-disciplinary teams to begin knowledge sharing and documenting insights.
  7. Produce articles, papers, briefings on knowledge to date.
  8. Initiate interviews with top developers and designers in the world to gather information on emerging science, design, and practice.
  9. Convene multiple-developer teams to begin knowledge sharing and producing insights into new possibilities for workers and organizations.
  10. Write articles, papers and briefings capturing new possibilities in design and operation.
  11. Convene groups of organization thought leaders for sharing the new possibilities in design and operation to gain insights into how work and organizations might change to promote employee health and well-being.
  12. Convene business experts, organizational experts and consultants to share new ways people might work and determine how to best facilitate introduction of these changes.
  13. Convene policy makers to share new possibilities of work and organizations to see what policies are needed to support new ways of working.