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Many employers today are launching worksite wellness programs. But are these efforts truly wellness programs? Read on to see why they may not be.Within worksite wellness, I too often think we view issues as being either/or, rather than being inclusive. Most worksite wellness programs today are not about wellness at all, but rather improving the health status of individual employees. While our attention is focused on employee health status, this does not mean we can’t also start to deliver wellness type programming and interventions as well.So what is the difference?While there are a number of wellness definitions available to consider, I will use the definition and model put forth by the National Wellness Institute (NWI). NWI defines wellness as “an active process through which people become aware of and make choices toward a more successful existence.” The NWI model of wellness consists of six, interconnected dimensions:• Physical• Social• Intellectual• Spiritual• Emotional• OccupationalLike wellness, health is often described as being a multi-dimensional concept. Health is generally measured in terms of:• Physical conditions such as pain, disability or condition likely to cause death• Emotional conditions• Social functioningHealth status is a snapshot of health at any one particular point-in-time. Health status can be measured at both the individual and population levels. Individual health status can be measured objectively through:• The presence or absence of illness• The presence or absence of risk factors• The severity of any diseases present• Overall perception of healthIn the workplace, employee health status is generally measured through the use of health risk assessments and biometric screenings.As best as I can determine, there is no absolute measure of health status. And because the measure of health status also includes overall perception of health, health status is also somewhat subjective.By comparing the above definitions with the way worksite wellness is being practiced today, we can clearly see that what is being called wellness today is not really wellness, but really employee health status improvement (EHSI). So from my perspective, let’s stop calling what we do today worksite wellness and call it employee health status improvement or employee health improvement instead. Instead of creating phony worksite wellness programs, let’s instead focus on creating solid, effective EHSI programs instead.Given today’s worksite wellness program focus almost exclusively on physical health, many of the concepts and practices already in place can be readily applied in the EHSI program model. Since health status is a function of disease states, risk factors and overall health perception, let’s focus the attention of EHSI programs on risk reduction, chronic disease management, medical self-care and helping employees to better perceive and act on their health status.Since we are not faced with an either/or situation here, let’s also start to do wellness programs at the same time we are doing EHSI programs. EHSI programs will never equate to wellness because they are not designed to. At their best, EHSI programs are designed to avoid health problems. Prevention or avoidance alone will never yield wellness. Creating wellness requires the taking of deliberate actions to move beyond the point of prevention or no health risks. Prevention and avoidance are based on the pathogenesis model which will not, by itself, ever create wellness.Recall the definition of wellness. Wellness is about creating opportunities for “a more successful existence.” Wellness is a process where employee health status is a static snapshot at one specific point-in-time. Wellness is closely aligned with the concept of salutogenesis, or the creation of opportunities for health.Given that wellness is multi-dimensional, here are my present thoughts about what constitute wellness type programming in the workplace for each of the wellness dimensions:• Physical – This domain will be covered by the EHSI program• Social – Creating positive, supportive, employee first or employee centric organizational cultures and workplace climates; random acts of kindness; employee volunteer programs• Intellectual – Brain health and fitness• Spiritual – Helping employees find meaning and purpose in both work and life• Emotional – Workplace mental health promotion; stress management; building resilience• Occupational – Integration with employee safety; integration with employee training and developmentI believe pathogenesis and salutogenesis represent different segments of the health – wellness continuum and can successfully co-exist by building off each other’s core principles. Employers can and should deliver both EHSI and worksite wellness programs.

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A study by Blue Cross Blue Shield of Tennessee takes an in-depth assessment of the possible effects that national health care reform could mean for Tennessee residents. The study estimates that 683,000 Tennesseans will get new Tennessee health insurance coverage under health care reform. It also focuses on possible changes in access to medical care, as well as the shift from employer-provided TN health insurance to the state exchange.Dr. Steven Coulter, president of the Tennessee Health Institute, conducted the study entitled “National Health Care Reform: The Impact On Tennessee.” According to Coulter, the study explores how the expansion of Medicaid and the establishment of the TN health insurance exchange in 2014 will affect the residents of Tennessee.Coulter says that since the advent of Medicare in 1965, the Patient Protect and Affordable Care Act has been the largest expansion of entitlement programs. “With the expected increase in consumers eligible for Medicaid expansion coverage and an estimated 1.5 million qualifying for subsidies in 2014, there is a great deal that needs to be addressed to ensure a smooth transaction,” he says. Coutler also noted that people who already have access to health care might have to wait longer when more people can afford to see a doctor unless there are basic changes to the health care system.What’s Happening With The Shortage Of Doctors In Tennessee?Long before health care reform, an appalling shortage of doctors was noted in Tennessee, and the situation has improved dramatically in some counties. On October 26, 2011, The Jackson Sun reported that the situation had improved in rural West Tennessee. Specifically, the doctor-patient ratio in Hardeman County went from one doctor per 4,675 people to one doctor per 2,229 people from 1992 to 1999. Chester County saw similar improvement with the ratio of one doctor per to 6,409 people falling to one doctor per 2,505 people.What’s Happening to Tennessee Health Insurance Prices?Coulter also notes the possibility that young adults will have to pay more for Tennessee health insurance by 2014. That’s because health care reform tends to level the playing field, so to speak. Groups, like the long living, have been paying high premiums, while young people have been paying low premiums. To average out the price of TN health coverage for all residents, some will likely end up paying more, but those who have been paying high rates, will get a break.Who Stands To Gain The Most From Health Care Reform?Overall, the people with the greatest economical disadvantages stand to benefit most as access to health care is extended to more state citizens. People who have been barred from getting TN health care coverage based on medical conditions will also get greater access to health care when they can finally get coverage.Employers are also expected to have financial gains when they can encourage employees to get Tennessee health insurance through the exchange because not providing coverage will improve the company’s bottom line.Will Everyone Directly Benefit From Health Care Reform?It remains to be seen whether people who currently have TN health insurance will have longer wait times for health care, with more doctors and clinics coming to the state. For example, a federally-funded clinic opened in Hardeman county in 1993 and in Hardin county in 1995. In East Jackson, West Tennessee Healthcare opened a clinic in 1996, and federally-funded clinics have been operating in Fayette and Lake County since the 1970s.Tennessee health insurance companies will have to navigate new price regulations and could see their profit margins decreasing over time. Insurers selling individual TN health insurance plans are already required to spend 80 percent of the premiums they take in to pay for policyholders’ care. That reduces the amount of premiums they have been permitted to keep as profit. Group plans have been managing regulations that require they spend 85 percent of premiums for policyholders’ care, though.