Workplace wellness programs, as defined by PHSA, are programs established by employers with the goal of health promotion or disease prevention. Many of these programs target “lifestyle diseases” that are brought on by unhealthy daily activities or environments, such as smoking, drinking, poor diet, and lack of exercise. These programs aim to curb these diseases as well as enhance preventative measures for other chronic or genetic diseases by incentivizing participation in health-related activities, like the following:
While these programs enjoy bipartisan support politically as well as general support amongst employers and employees alike, there is limited evidence demonstrating that they lower costs or that they improve health outcomes for employees. Studies about the efficacy of wellness programs are often criticized for weak methodology and only considering short-term impacts, and many are funded by the workplace wellness industry itself, presenting a potential conflict of interest. No general conclusions about their efficacy have been drawn by the scientific community at this time.
One of the more controversial aspects of workplace wellness programs is the collection of genetic information, which is essentially the results of an individual’s or family member’s genetic tests or evidence of a genetic disease or disorder of a family member. These tests, as defined by GINA, cover a vast number of techniques that analyze human DNA, RNA, chromosomes, proteins, or metabolites, to detect an individual’s genetic makeup (genotypes, mutations, or chromosomal changes). They are often used in health care to assess genetic risk factors and potentially mitigate the harms associated with genetic diseases, sometimes before they even emerge.
In the context of wellness programs, genetic tests can help ensure that employees have the necessary working knowledge to increase preventive care or avoid certain behaviors associated with higher risk to certain diseases. For example, a person whose genetic history shows a hereditary risk for skin cancer might take efforts to avoid exposure to the sun or be more inclined to apply sunscreen. This could both reduce healthcare costs as well as increase employee health by staving off costly and deleterious disease.
A long-term future benefit of genetic information lies in the potential of precision medicine. This emerging approach to medicine seeks to incorporate information about an individual’s genes, lifestyle, and environment to create ‘personalized’ medical interventions, as opposed to the general approaches that are thought of as ‘one-size-fits-all.’ Genetic information also might allow researchers to predict how effective an intervention would be based on a patient’s specific genetic variants. Extensive health data collection and sharing will be critical for the development of precision medicine, as researchers need to be able to compare data (genetic and otherwise) from a lot of people, both sick and healthy, to identify the important factors contributing to both disease and health (see the All of Us Research Program).
While genetic tests and their potential medical benefits have expanded greatly in recent years, so has their potential for misuse. Broadening employer access to employee genetic information increases the opportunity (and perhaps likelihood) for discrimination, whether implicit or explicit. Furthermore, privacy fears could cause employees to balk at undergoing genetic tests, which could negatively impact individual health as well as the development of precision medicine. Meanwhile, there remains little commentary on how exactly allowing employers to access this information makes wellness program implementation easier or more effective.