Building A Culture Of Health - John A. Quelch

The Role of Corporations in Addressing Public Health

Author: John Quelch

Creating A Culture of Health

All American companies are in the health business whether they like it or not. The private sector directly pays for one-fifth of the whopping 17.5% of GDP spent on healthcare in the United States. Rather than viewing health merely as an insurance expense to be controlled, every company needs to embrace building a culture of health as a business opportunity.

Forward thinking companies are doing just that. After CVS removed tobacco products from store shelves and renamed itself CVS Health, new revenues more than made up for lost sales. Johnson and Johnson has achieved a $4 return for every dollar invested in employee health and wellness programs over 30 years. Bath Iron Works in Maine has extended a successful in-house diabetes prevention initiative into the wider community. It expects to cut participants’ future healthcare costs over 5 years by 60% on average.

Recognizing both necessity and opportunity, companies are scrambling to assess and improve the health impact of their business strategies and operations. Last month 150 top executives from diverse industries met for two days at Harvard Business School to hammer out an agenda for building a culture of health in American businesses across four domains: Employee Health, which companies invest in to improve the wellness of current and future employees; Environmental Health, which connects companies’ environmental policies to the health of populations affected by their operations; Community Health, in which businesses boost the health of the local communities in which they operate; Consumer Health, which targets the healthfulness and safety of a company’s products and services for its consumers. “This was not charitable work,” the vice chairman of a large food and beverage company told peers about reducing sugar, salt, and saturated fat in its product portfolio, “It makes business sense.”

The business imperative for companies springs from past neglect and the traditional healthcare system’s ongoing inability to solve America’s health conundrum: poorer health outcomes than in other wealthy countries despite much higher spending on healthcare. How is it possible that American children and adolescents—the future of the U.S. workforce—rank last in health outcomes against wealthy country peers? Not only does this represent a lousy return on investment nationally, it has consequences for American business, including flagging worker productivity and weaker consumer demand for other products and services as consumers spend more on healthcare.

Relying solely on medical care to fix America’s health problem, is futile. Medical treatments influence total health outcomes far less than prevention—defined not just as better diet and exercise, but also in terms of good education, good jobs, good housing, etc. The Affordable Care Act starts to address this complex challenge, but government, non-governmental organizations, and the healthcare industry simply do not have sufficient capabilities or resources to develop and execute innovative solutions on their own. That’s where forward thinking businesses are stepping in to implement health initiatives independently or through partnerships. Continue reading

The Marketing of Prevention

The US will devote 17.5% of GDP to health care this year, around $3 trillion. Yet only 3 percent of that will be spent on prevention, including both primary prevention (preventing illness in the first place) and secondary prevention (preventing sick people getting sicker or having a relapse). Medicine saves lives, doctors are heroes and the best earn Nobel prizes. Prevention, by contrast, is mundane, measurement of effectiveness is difficult, rewards and recognition pale by comparison.


In a recent NEJM paper, Tom Farley, Philadelphia Health Commissioner, bemoaned the underfunding of proven prevention programs while sick people certain to die nevertheless continue to receive expensive treatments. Why does a utilitarian greatest good for the greatest number perspective not prevail? Farley cites two reasons: when a life is at stake, it’s unethical to withhold treatment, regardless of cost effectiveness; second, medical treatments are funded by payers and providers whereas prevention programs are typically funded from public health budgets subject to annual budget cuts by short-sighted politicians.


There is another important reason. Diet, exercise and other lifestyle decisions are viewed by many as matters of personal choice, even though society may later have to pick up the health care costs associated with these decisions.  Prevention involves taking personal responsibility for one’s health. The worried well do so, wearing Fitbits or following diets, the chronically ill often do not.


Why do people not respond to good advice regarding diet and exercise? Continue reading