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Correction to This Article
A Feb. 20 article on companies offering incentives to keep their employees healthy reported an outdated number for estimates of deaths attributed to poor diet and physical inactivity. Researchers for the Centers for Disease Control and Prevention had estimated 400,000 deaths each year, but they published a clarification in the January issue of the Journal of the American Medical Association changing the figure to 365,000.

Firms Make It Their Business To Push Health

Incentives, Monitoring Aimed at Cutting Costs

By Ariana Eunjung Cha
Washington Post Staff Writer
Sunday, February 20, 2005; Page A01

CYPRESS, Calif. -- At age 45, Rick Graham was 5-foot-8 and 235 pounds. His blood pressure was soaring, and he didn't have as much energy as he did when he was younger. The business analyst tried every diet in the book, but the weight kept coming back. Finally his employer decided to do something about it.

If Graham would try to eat better and exercise, PacifiCare Health Systems Inc. offered a novel reward: cash.


Jennifer Horn, chief of staff at PacifiCare Health Systems' corporate health services group, warms up with fellow workers during a company-sponsored yoga class Wednesday at PacifiCare's offices in Cypress, Calif. The company offers financial incentives for healthy living. (Steven Lewis For The Washington Post)

So now, once every 24 hours or so, Graham logs on to a computer system managed by his company and types in everything he has eaten: packet of instant oatmeal (104 calories), can of V-8 juice (35 calories), mini box of raisins (42 calories), Mandarin chicken (280 calories), wedge of banana cream pie (300 calories), pepperoni pizza (560 calories), eight cups of water (0 calories) and so forth. He then inputs any exercise he has done, which on this particular day happened to be nothing but is usually 25 minutes on a treadmill and 20 minutes on a stationary bike.

For keeping track of his food intake and his fitness routine, PacifiCare pays him about $15 every other week, or $390 a year.

The monetary incentives are part of unconventional new programs being rolled out by PacifiCare and other corporations around the country to try to coax, push -- or even force -- workers to become healthier.

The move is driven, the companies say, by soaring health insurance costs. They say that the fitter their workers are, the fewer claims they are likely to file. But some workers rights groups worry that these programs, while well intentioned, set a precedent for allowing employers to get involved in private aspects of people's lives.

"Do we really want employers conducting an extensive survey of employees' every unhealthy lifestyle choice? Do you really want your boss asking you what you eat and what you do for recreation?" said Lewis Maltby, president of the National Workrights Institute, a spinoff of the American Civil Liberties Union.

PacifiCare is among the more ambitious in its incentives. In addition to cash, the health management company offers its 9,100 employees rewards for participating in classes to stop smoking or to manage their diabetes or asthma. Workers can also earn credit for non-health-related activities, such as trying to manage their personal finances better, learning about art or music, washing their car or teaching their children not to play so many video games. The credits can be converted into iPods, spa certificates, water noodle toys for the pool and other goodies.

A number of other companies are trying similar approaches on a smaller scale. Many efforts focus on smokers, and some are not voluntary.

A Florida sheriff's office is requiring some applicants to take a polygraph test with questions about their smoking habits. Omaha-based Union Pacific Corp. last fall stopped hiring smokers in seven states. And Navistar International Corp., a Warrenville, Ill., truck manufacturer, is introducing an extra charge of $50 per month for health care coverage for those who smoke.

The question of how far companies should go was raised recently when seven employees resigned from Weyco Inc. of Okemos, Mich., in January rather than submit to a nicotine test.

The degree to which companies can impose health-related requirements on employees varies across the country. Thirty states, including Virginia, plus the District of Columbia have laws preventing discrimination against smokers, while others, such as Maryland, do not. Thirteen states prohibit employers from regulating alcohol use during non-work hours. But only four states -- California, Colorado, New York and North Dakota -- have passed broader privacy laws protecting people's activities away from the job.

The question of how deeply employers should get involved in their workers' health arises as half of all deaths in the United States continue to be attributed to a limited set of largely preventable behaviors. The Centers for Disease Control estimates that each year there are 440,000 deaths from tobacco use, 400,000 deaths from poor diet and physical inactivity, and 85,000 deaths due to alcohol consumption.

PacifiCare's incentives program is the brainchild of Sam Ho, the company's chief medical officer and executive vice president. Ho is a self-proclaimed health nut who practices yoga religiously, is a vegetarian and prides himself on needing only three to four hours of sleep a night.


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