Frederick Taylor, the so-called “father of scientific management,” created the first bureaucratic system for measuring and constituting effort standards for work. His system for organizing work, which came to be called “Taylorism,” began with the conviction that “the natural instinct and tendency of men is to take it easy.” In order to overcome this lethargy and realize maximum worker efficiency and organizational calculability, Taylor designed a control structure over work performance that included scientific tests to ascertain the best of which a worker was capable and an incentive system to induce him or her to attain it.
The principles of Taylorism have had an enduring effect on job design practices. Something very like them is now being applied to the job of health.
Health, increasingly conceived as a kind of commodity that can be engineered, is work. And the new norms for the management of this health bears all the marks of the old Protestant work ethic. We are enjoined to scrupulously monitor ourselves, to be aware of and manage our susceptibility to illness, stay informed of the latest developments, and adjust our conduct, diet, and lifestyle as recommended by the experts. If we get sick, it’s quite likely our own fault; we should have eaten better, exercised more, drunk less, had that screening, and taken all other possible preventive actions, the scope of which is rapidly expanding. Medical illiteracy or a resigned attitude toward the future are not valid excuses; they are ethical failings.
Here’s the rub. What if we don’t work at this “health” hard enough? If much of our illness is thus self-inflicted, what is to be done? What about the impact on our effort at work? What about the potential costs?
A case in point. My university recently completed its open enrollment period, that time in the year when employers allow employees to make changes to their employer-sponsored benefit coverage. We have long received the occasional email encouraging participation in a wellness program or to sign up for a gym membership. But this year brought a new system of surveillance. Every employee was asked to take a health risk assessment and participate in a biometric screening. If you did both, you would be charged lower monthly medical premiums over the following year. A non-negligible savings for answering a few questions and letting them take some blood.
With the new surveillance, the university is following a growing trend to drive employees into health programs. According to a survey of nearly 800 companies conducted last spring by Aon Hewitt, the human resources consulting firm, some 83 percent of large and mid-size employers now offer “incentives” to employees for participating in programs that encourage them to “become more aware of their health status” and “take actions to improve their health.” In the HR-speak of the Aon news release about the survey findings, there are no penalties, only “incentives,” and no coercion, only “healthier personal decisions.” But the force behind the programs is unmistakable, and it is ratcheting upward.
Of the companies offering an “incentive,” most (79 percent) do so “in the form of a reward.” The rest either offer the incentive “in the form of a consequence” (5 percent)—read “financial penalty”—or in the form of “a mix of both rewards and consequences” (16 percent). But the “reward” talk may be misleading. My employer first raised the premium rates by roughly the amount of the reward, so the real effect was to financially penalize those unwilling to be measured.
Further, at 80 percent of the companies, the reward carrot comes with a compliance stick. More than half (56 percent) require employees to “actively participate in health programs, comply with medications or participate in activities like health coaching.” The other quarter (24 percent) link their incentives to “progress toward or attainment of acceptable ranges for biometric measures” like blood pressure and cholesterol levels.
Apparently these efforts to hold people responsible for the state of their health are not working, or not working well enough. According to the survey, more sticks are coming. Most of the employers are planning to “impose consequences” on employees who do not take “appropriate actions for improving their health,” or are considering “tying incentives to program designs that require a focus on health 365 days a year.” With the arrival of an extraordinary array of new tracking devices in recent years, such as wearable digital sensors of biometric data, the body is becoming more transparent. Individuals can measure and monitor themselves all the time, giving employers new ways to measure and monitor employee progress.
The goal, it seems, of these reward-and-consequence schemes is the Taylorian one. Our health is work and we need expert supervision to determine and sticks/carrots to boost our effort levels to produce more of it. Taylor saw his system as promising both greater material wealth and social harmony. A win-win, as both employers and employees enjoyed the benefits of best-fit job placement and maximum daily output. The same cheery, no-conflict self-confidence infuses the deployment of the new schemes. Yes, there is the hope of cost-savings and greater productivity, but if our health is in our own hands, then surely only the indolent would resist the solicitude on offer.