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Missing the DX

Posted By Molly McGuane, Wednesday, April 17, 2019

It’s estimated that every year 12 million people in the United States are affected by a misdiagnosed disease or condition. Incidences of cancer misdiagnosis can be particularly concerning, unfortunately altering the course of a person’s life. In the beginning stages of many cancers, symptoms can be vague and difficult to differentiate from more common illnesses. A misdiagnosis early on can be very detrimental and potentially lethal if the cancer continues to grow and spread. While the fault of a misdiagnosis of a disease doesn’t necessarily fall on a specific doctor or healthcare team, there are steps that doctors and patients can take to reduce the instance of a misdiagnosis.

Commonly Misdiagnosed Cancers


Woman with a tan applying sun blockAs an unfortunately common skin cancer, melanoma takes the lives of nearly 9,000 patients every year. Melanoma is caused by exposure to UV radiation that is generated from tanning beds and from exposure to the sun. Melanomas emerge on the skin as an irregular-looking mole or dark spot on your skin, but can be easily missed or misdiagnosed.

Health care providers and patients can be more vigilant about their skin by remembering the anagram ABCDE when looking at their moles and beauty spots. “A” stands for asymmetrical, “B” for irregular borders, “C” for abnormal color, “D” is for diameter, and “E” is for evolving in shape or size. These signs shouldn’t be ignored and moles or marks with these characteristics should be tested by a pathologist.

Primary care doctors and physician assistants should also recommend that patients see a dermatologist annually or biannually based on their risk. They should also encourage patients to perform “self check-ups” regularly to be alert of any new or changing skin lesions. Extra diligence could lead to a more accurate and early diagnosis, which is crucial in skin cancer and melanoma cases.

Colorectal Cancer

In many cases, cancer of the colon or the rectum often begins as a growths known as polyps, that grow in the walls of these areas over time. The best way to find colorectal cancer early is through screenings, but the problem of misdiagnosis comes when symptoms are misunderstood and screenings are done too late.

Symptoms of colorectal cancer can be uncertain, like unexplained weight loss, fatigue, and a change in bowel movements and symptoms like these can be misunderstood even by medical professionals, especially in younger patients. Most frequently, colon cancer can be misdiagnosed as irritable bowel syndrome (IBS), diverticulitis, and ulcerative colitis due to similar symptoms including rectal bleeding and abdominal pain.

If pain continues or new symptoms arise, a colonoscopy or CT scan might be necessary to check for any serious issues. It’s also important to keep in mind that colorectal can be genetically connected and 1 in 3 people who are diagnosed with colorectal cancer have a familial connection. Understanding a patient's family history is an important step in diagnosing disease and can provide additional insight into their symptoms. While it’s on the patient to know their family history, healthcare professionals can assist by impressing the importance of knowing that history upon their patients and making sure to ask when issues arise.

Lung Cancer

Man smokingThe most widespread cancer globally is lung cancer, and it can be caused by a number of environmental factors. The most obvious reason for developing lung cancer has historically been smoking and secondhand smoke, but cancers of the lung can also arise from elements in the air and invisible and odorless carcinogens we may not even realize that we are exposed to.

Symptoms of lung cancer, and related cancers of the lung like mesothelioma, often first appear as a persistent cough, pain in the chest, or shortness of breath. These symptoms could be easily misdiagnosed as asthma, COPD, or even a common cold. Lung cancer and mesothelioma are common occupational cancers, so knowing a patient’s occupational history can also lead to a better understanding of their condition. Those who have worked as firefighters, miners, and in the construction industry are more vulnerable to carcinogens like asbestos and silicates.

Breast Cancer

Understanding a patient's family medical history can also help in being vigilant about the beginning stages of breast cancer. Breast cancer affects 1 in 8 women in the United States and the risk of a patient developing breast cancer can nearly double if a mother, sister, or daughter has also been diagnosed.

The beginning stages of breast cancer develop as a lump in the breast tissue but can be missed entirely if screening isn’t done frequently enough. Breast cancer screens are done routinely at primary care and OB-GYN appointments, and self checkups can also be performed to check for any abnormal bumps.

If there are any abnormalities in a mammogram, a follow-up imaging screening, mammogram, or biopsy should be scheduled in a timely manner so that the potential cancer does not worsen. Those who are at a higher risk for developing breast cancer need to communicate that risk with their primary physicians and specialists as well as their family history for the most accurate and timely testing.

How are we Closing the Gap?

Missing a cancer or other disease diagnosis can have regrettable consequences for patients and their families. Both healthcare professionals and those they treat can play a role in a misdiagnosis and they are an unfortunate reality of human error. However, the medical community is taking the time to learn from mistakes and invest in technology that analyzes stored data and can close the gap on inaccuracy. Being able to log patient data from around the world can help better understand symptom patterns and allow for more accurate testing, including mammograms and lung cancer screenings.

The use of artificial intelligence and telehealth in the medical field is helping connect the dots on cancer symptoms, but there is still a lot of ground to cover in perfecting these technologies in the real world. Today, AI should just be used to augment the human work of healthcare and there is still an active role doctors and other professionals can take to avoid a misdiagnosis.

Physician's assistant going over a patient's medical history.

Discussing personal, family, and occupational history and impressing the importance of gathering and communicating that information on your patients is vital to their well being. The more information you know about their health and history, the more accurately you can understand their symptoms. Recommending patients to keep up with an annual schedule of appointments and cancer screenings is another way primary care physicians can help their patients be preventative and avoid a missed or late diagnosis. Communicating closely with every healthcare provider working with the patient including nurses, radiologists and lab technicians is important for everyone’s understanding. Attention to detail and thorough communications will ensure that no important information is missed.

Molly McGuaneMolly McGuane is a communications specialist and health advocate for the Mesothelioma and Asbestos Awareness Center. She is passionate about informing others on cancer prevention and rare disease. Molly's areas of content expertise are cancer prevention, rare disease, occupational health, and asbestos exposure.

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5 Things I Learned During an Unanticipated Job Search

Posted By Suzanne Hunt, Wednesday, April 17, 2019
Updated: Tuesday, April 9, 2019

"Congratulations, you got the job!"

Everyone wants to hear those words, right? Well, in this case, I heard those words, except they were meant for my husband. In what I can only describe as a whirlwind, we were notified that my amazing husband obtained a promotion, and was being moved to a new location, in two weeks or less. I was proud, excited, and terrified all at once. Though this was a surprise to us both, my husband was going to remain with the same company, who would be there to support him throughout the process. I, on the other hand, had to turn in my resignation knowing the job search wouldn’t be an easy feat. Working in public health in the south is already difficult. Working in public health in higher education in the south is an even tougher job market. In the process of quickly moving, wrapping things up at my old job, and moving forward with an unanticipated job search, my plate was full! However, I managed to learn a few things along the way that have served as my roadmap during this process:

  1. Your resume is a living, breathing document; maintain it as such
    You wouldn’t go months, or possibly years without feeding your pet right? Well, the same goes for your resume. Don’t go months or years without updating it! Even if you can’t spare the time to work on it consistently as you achieve at your current job, make a continuous effort to maintain a document with your ongoing accomplishments. This ensures you will have something to go by when you are able to update your resume. Secondly, it’s 2019- make sure your resume doesn’t look like a word document from 1995. Regardless of what type of job or field you work in, your resume is the first way to market yourself, so you don’t want to get off on the wrong foot by having an outdated resume (regarding both content and visual appeal). There are free design websites where you can ensure your resume represents your personality, and performance in the field. One of my favorite sites is Canva, it’s free and easy to use!
  2. Establish and maintain relationships at your jobs
    Yes, I said jobs. Regardless of whether it was an internship, a graduate assistantship, or your first ‘real’ job out of school, it’s imperative to establish relationships with people during each experience. Arguably more important is maintaining these relationships because you never know when they can provide an amazing reference, letter of recommendation, or insight into a future job you’re looking into. After all, I’m sure you’ve heard the saying, “it’s not what you know, but who you know”. Keep these people in your corner, because they can help advocate for your skillset, and current or past successes. Further, you never know when you might need them! In my case, my connections have been a continual help during the relocation process.
  3. Do your research
    I know this sounds so cliché, but what I mean is to do your research on the people in your industry. One of my favorite supervisors taught me this, and I am forever thankful. Even if you love your current job, you should still be making strides to learn about the leaders in your industry and how they got to where they are. I took the time to look at bios, talk to direct contacts, and even made the additional effort to talk to them myself. I have also been lucky to establish trusting relationships with a few of my supervisors-to where I felt comfortable truly asking about their personal experiences, and opinions. This insight has served to my benefit by helping me understand the intersectionalities between different aspects of the industry and the all-important hierarchy of working in higher education. Having this understanding has helped lead to several consulting opportunities, which I am thoroughly enjoying, while I continue my search for a full-time job.
  4. Utilize your expertise and passions—outside of work
    I know what you’re probably thinking here- what about work/life balance? I am still (and will always) advocate for balance, and doing things you enjoy outside of work! However, I volunteer my time outside of work with the National Wellness Institute (NWI) Emerging Wellness Professionals (EWP) Task Force because I have been a part of this organization since I was in undergrad. I am really passionate about what they do to support professionals in the wellness field like myself, and it has not only provided me with more contacts in the industry across the U.S., but it has also helped me learn more about the field that I wouldn’t have been able to learn in my previous jobs. Moreover, I have learned new skills, expanded my leadership capabilities, and now have connections with this organization that continues to support me, no matter where I go.
  5. Utilize weak ties to network!
    There is an aspect of luck that can play an important role in being successful, particularly when it comes to networking. In fact, according to Eric Barker, the author of Barking Up the Wrong Tree, he concludes that some of this has to do with taking small steps to network, meet new people, and properly invest your time in establishing and maintaining those relationships. This requires stepping out of the ‘box’ of solely networking on LinkedIn, or via that email that gets lost in someone’s ever-growing inbox. According to Barker, there’s a theory of weak ties, meaning the people who aren’t your closest friends, but one degree out, are the people who make the best connections. A lot of new possibilities or opportunities come from these weak ties because these are the people that are hearing about things (job openings, new ideas, conferences, leadership opportunities), that you may not be hearing about, and therefore present the possibility of something new and beneficial for your career. Weak ties have hands down been the most successful aspect thus far in my ongoing job search!

Though none of these concepts are necessarily new, it’s important to refresh your lens and scope, in the event that like me, you embark on the adventure of an unanticipated job search.

Sabrina WalasekSuzanne Hunt, MPH, CWP provides leadership in the development of holistic approaches to wellbeing for students, faculty, and staff at Wake Forest University in North Carolina.

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NWI Joins GW4W at Philadelphia Event

Posted By NWI, Monday, April 15, 2019
Updated: Monday, April 8, 2019

NWI Board President Linda Howard participated at Global Women 4 Wellbeing's (GW4W) event on March 28, 2019.

Mental Wellbeing and the Workplace — Minding The Gender Gap  

GW4W President & CEO Mim Senft with NWI Board President Linda Howard in Philadelphia on March 28, 2019

GW4W President & CEO Mim Senft with NWI Board President Linda Howard in Philadelphia

For true gender equity in the workplace, we need to recognize how our mental health and wellbeing is connected to our ability to lead and how those issues impact how we are seen as leaders. That includes how bad stress and other barriers unique to women disproportionately impact the overall mental health of the workplace and its impact on getting more women into leadership.

On March 28, like-minded leaders attended the event at Parkway Central Library in Philadelphia, PA as part of a world-wide movement to empower more healthy female leadership at all levels. Their goal was to gain a deeper understanding of workplace strategies that can help women lead well.

Discussion focused on:

  • Workforce and the mental wellbeing challenge.
  • What organizations can do to help their teams thrive.
  • How leadership can better address personal stressors for both women and men to help them be more resilient and better innovators.
  • And you’ll have a chance to add your voice to the conversation.
GW4W event attendees on March 28, 2019

GW4W event attendees in Philadelphia in March

Featured Speakers:

Linda E. Yoo, MFT is the Head of Global Mental Wellbeing & Workplace Effectiveness, Johnson and Johnson. Prior to that, she was responsible for all National Accounts EAP & WorkLife and behavioral health sales activities for Aetna occurring in the Northeast & Southeast regions of the country and served as the Director of Operations for United Health Group/United Behavioral Health.


Shaillee J. Chopra runs a successful healthcare consulting practice, Lumina Health Partners, and has held positions as global leader Digital Health and Advanced Analytics; Chief Data Officer, VP Customer Success, IT Director Interoperability; and National Lead Business Services Transformation.  As Chief Global Strategist with Empower Billion Women Inc., Shaillee assists with development and execution of global strategy allowing EBW to expand its contribution and impact within domestic and international markets by financially empowering women to launch, grow and scale their businesses and support UN Sustainable Development Goal of gender equality.  She has a special interest in addressing mental health for women in the workplace.

Guest MC:
Lesley Jane Seymour has spent her life helping women change the world, having spent more than 30 years in the media industry and serving as Editor In Chief for publications such as Redbook Magazine, Marie Claire Magazine, and most recently, More Magazine and Currently, Lesley is the founder of CoveyClub, a membership supported online-offline experience that connects women around the world and helps them live their most authentic lives. 

Panel Discussion Facilitators:
Patricia Baxter, Ed.D has served as a leader in global organizations such as CITI, Sykes Enterprises, UNISYS, Deloitte & Touche Consulting, and Right Management. As an executive coach, Pat has worked with leaders in American Express, Dollar General, Comcast, Toyota, Quintiles Pharmaceuticals, and the Association of Black Foundation Executives (ABFE).

Karyn Detje has spent her career helping organizations and people perform at their best. Her experience ranges from start-ups to Fortune 500 companies, including Pepsi, Allied-Signal and Atlantic Richfield. Karyn has been the Chief Human Resources Officer at several global organizations including Quokka Sports, Publicis Group Media and Tory Burch.

GW4W panelists at Philadelphia event March 28, 2019

GW4W panelists in Philadelphia

Linda Howard, J.D., is chief executive officer of Alturnative, a health care compliance consultancy that helps build people-forward organizations and establish compliance and ethics standards for the health, fitness and wellness industries. She is president of the board of directors of the National Wellness Institute and a founding member of its multicultural competence committee. Howard has more than 30 years of combined experience in law, compliance and health care operations. 

Yuming Shen is the Director of Product Management at Archetype Solutions Group (ASG), a strategic consulting and venture firm. As one of the primary leads in ASG’s shared services division, she drives marketing and product development for both consulting partners and venture operations. Before helping to launch ASG in 2010, Yuming worked in alternative assets at BlackRock. 

Lynette Davis is a mental health advocate and peer support specialist trained by NAMI (National Alliance on Mental Illness) and in Mental Health First Aid. She is the author of "Success To Die For" and the Executive Director of Love Yourself Love Your Business, a mental health organization that creates intentional spaces for small business owners and entrepreneurs. 

Marjorie Lau spent over 20 years in the beauty industry, where she served in several leadership roles at the Estee Lauder Companies Inc. She has also worked in a branding and marketing capacity across several sectors, including consumer products at Clorox, and technology at Google and Apple. Marjorie is currently the Marketing and Communications Director at the Baker Retailing Center at the Wharton School...

GW4W works to empower healthy female leadership.

This accelerator event supported the mission of Global Women 4 Wellbeing (GW4W) and is organized in collaboration with Archetype Solutions Group.

GW4W is:

  • a cross-disciplinary membership association committed to empowering more healthy female leadership at all levels for a more sustainable world.
  • A diverse group of dedicated professionals, community leaders, researchers and entrepreneurs from around the world that collaborate to create positive change.
  • A connector organization that brings diverse VOICES together to address health, wellbeing and leadership equity.
  • A non-political organization. We strive to provide common ground to solve for pay equity, health equity and leadership equity for women from all backgrounds.

Have questions about Mental Wellbeing and the Workplace — Minding The Gender Gap? Contact GW4W

Interested in a GW4W membership? Members of NWI enjoy a 25% discount on an annual individual membership to Global Women 4 Wellbeing. Click here to Find out more.

Tags:  gender equality  gender gap  GW4W  Linda Howard 

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Gratitude for Caregivers

Posted By Linda Roszak Burton, Thursday, April 11, 2019

Gratitude Heals

John Henry Jowett quote says Gratitude is a vaccine, an antitoxin, and an antiseptic. A vaccine against the invasion of a disgruntled attitude. An antitoxin against the poison of fault-finding and grumbling. A soothing antiseptic in the spirit of thanksgiving.

Photo courtesy of Unsplash

When you read the phrase, gratitude for caregivers, what meaning do you apply? Is it a patient expressing gratitude to their caregiver for care and compassion shown to them during a recent health scare or recovery from an illness? Or, do you interpret it as an element of a positive and healthy work culture, where leaders and caregivers express gratitude to each other and their patients—genuinely, frequently, and value-based?

The good news is that it can, and based on research, needs to be interpreted both ways! We would assert that gratitude isn’t limited to any particular individual, profession, setting, or industry. Current research demonstrates that when gratitude is practiced, expressed, and received, the benefits are undeniable, significant, and multifaceted.

The POWER of gratitude:

  • Promotes healing, strengthens our immune system, lowers blood pressure, reduces symptoms of illness, and increases pain thresholds;
  • Motivates philanthropic giving. Being grateful has been found to make us more charitable and giving of our time, treasure, and talents;
  • Creates resilience by fostering greater mental, emotional, and physical health and well-being, for both the caregiver and patient;
  • Improves employee engagement by recognizing the value and contributions of coworkers;
  • Generates more positive social behaviors, buffering against negativity-bias, bolstering civility, respect, and broadening our attention to positive emotions.

To read more about these benefits go to Discovering the Health and Wellness Benefits of Gratitude

man suffering from burnout

A Remedy for Burnout

A Google search on the subject of burnout yields 114,000,000 results and counting! Job burnout as defined by the Mayo Clinic is a special type of work-related stress - a state of physical or emotional exhaustion (EE), a sense of reduced personal accomplishment (PA), and a loss of personal identity or depersonalization (DP). This widely accepted definition and the prevalence of burnout in healthcare has given us staggering and sometimes shocking statistics about the negative impact on individuals, teams, and organizations. Even more astounding are studies linking burnout to physician suicides, a higher rate of emotional exhaustion in as much as one-third of all US nurses, and the association between burnout and poor patient safety and quality outcomes, including mortality.

In a 2018 article in STAT, comes an even more disturbing reference to burnout…moral injury! First used to describe soldiers’ responses to their actions in war is now linked to “physicians being unable to provide high-quality care and healing in the context of healthcare.”

The Journal of Nursing Management, recently published a scoping review using the terms gratitude and health professionals. This scoping review consisted of synthesizing and thematically analyzing existing evidence regarding gratitude in healthcare relationships with the specific focus on patients and families expressing gratitude to their health professional. Health professionals were defined as physicians, nurses, patient care teams, and other healthcare providers. This broad review of existing knowledge included empirical and non-empirical literature and was not focused on evaluating the quality of research studies.

beautiful stylized black and white sunburst mosaic with the word imagine in the middle of it

Photo courtesy of Unsplash

In this particular study, expressions of gratitude from patients and family members to their health professional indicated a positive impact on caregiver well-being, stress reduction, and a possible reduction in symptoms and consequences of burnout. In addition, this review suggests gratitude from patients and families could contribute to “motivation and retention among health professionals, and when nurtured, is associated with a healthy work environment.”

An article on physician burnout in the Family Practice Management Journal identified practicing gratitude and offering resilience training as potential burnout interventions. Additionally, a mental technique of reframing negative events was recognized as helpful when dealing with burnout. Articles published in the NeuroLeadership Journal suggests reframing or re-contextualizing the way we think about a situation as an approach to minimize a negative emotional impact. Reframing is also defined as a “cognitive reappraisal” of ideas and emotions with more positive alternatives.

Quote from Rick Hanson, PhD, Buddha's Brain that says what flows through your mind sculpts your brain.

Photo courtesy of Unsplash

Similar to the scoping review in the Journal of Nursing Management, a research article in Frontiers in Psychology looked at the positive effect of patient gratitude and support on nurses’ burnout. Of the findings, when support and gratitude was expressed by patients to nurses, improvements were seen in one or more of the dimensions of burnout: emotional exhaustion (EE); personal accomplishment (PA); and depersonalization (DP).

Another important study highlighting the positive impact of gratitude on organizational wellness is from the International Journal of Workplace Health Management. This study showed that gratitude was found to be a consistent predictor of these outcomes among nurses:

  • Less exhaustion and less cynicism;
  • More proactive behaviors;
  • Higher rating of the health and safety climate;
  • Higher job satisfaction;
  • Fewer absences due to illness.

Additionally, The Greater Good Science Center published an article recognizing several healthcare organizations that have turned to this innovative remedy of gratitude to reduce burnout. Healthcare organizations such as Sutter Health, Kaiser Permanente, and Scripps Health have instituted programming to cultivate gratitude as part of their healthy work cultures.

Woman relaxing by a window with eyes closed while sunlight washes over her

Photo courtesy of Unsplash

Finally, perhaps the best way to wrap-up these insights and findings comes from research done by the National Research Corporation/NRC Health and Accordant Philanthropy. When asked what influenced their feelings of gratitude during a healthcare experience, thirty percent of participants said gratitude was spurred by the compassion, empathy, or kindness of caregivers. Similarly, when asked what would most likely make them feel grateful to caregivers, forty-one percent of the study participants indicated feeling genuinely cared about as a person.

Findings from these studies and others highlight the “perfect timing” for greater focus and attention to the important role gratitude plays in our healthcare settings.


What one action can you take, personally, to tap into your own gratitude circuitry and that of your coworkers?

What learning opportunities can your organization or department initiate to promote gratitude as a cultural imperative?

Photos courtesy of Unsplash
Linda Roszak BurtonLinda Roszak Burton provides brain-based coaching and training programs to help healthcare organizations, their leaders and teams emerge stronger, more knowledgeable, and engaged for greater success and satisfaction. As a leadership coach, Linda utilizes the latest research and evidence-based practices from positive psychology, gratitude, and neuroscience to help her clients be at their best in todays stressful and overwhelming work environments. In addition, she supports various research initiatives and is currently conducting research on gratitude interventions for creating greater health and well-being for health care employees.

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Measuring Worksite Wellness Programs by Multicultural Competencies Standards

Posted By Linda Howard, Friday, April 5, 2019

Does Your Worksite Wellness Program Measure Up?  

If your worksite wellness program were to be measured against multicultural competency standards, would it meet, exceed, or fall short of those standards? As you will see, ensuring that your program considers the attributes and demographics that make up culture is mandated by a number of federal laws, renders a greater return on your investment, and serves the public good.

When I speak of multicultural competency as it relates to worksite wellness, I am looking at the competency of those who design and implement the program as well as the program’s overall effectiveness in serving people of different cultures. Multicultural competency requires the individuals designing or implementing the program to:

  1. Be aware of their own cultural worldviews
  2. Possess knowledge of different cultural practices and worldviews
  3. Examine their own attitudes toward cultural differences
  4. Explore the attitudes of those they serve toward cultural differences
  5. Have the interpersonal skills necessary to communicate and effectively interact with people across cultures

Diverse group of employees in a meetingMany people confuse "diversity" with "multicultural competency." They mistakenly use the terms interchangeably. While diversity is a good starting point, diversity does not equal multicultural competency. Nor do you achieve diversity by varying your team considering race alone. Cultural competency encompasses more than race. Culture includes such things as religion, gender, socioeconomic status, geographic location, language, sexual orientation, and education. Having a diverse group of people at the table is an excellent way to learn about other cultures; it is a way to begin to meet the second requirement on the list above (to possess knowledge of different cultural practices and worldviews).

Multicultural competency is a skill that must be learned. The answer as to whether your team has multicultural competency skills will largely turn on the answer to the following question: has your team had multicultural competency training? If the answer is no, then your team is probably lacking some element of multicultural competency.

To determine if your program measures up, I say the proof is in the pudding. It’s not just about your intentions; it’s also about results. Evaluate your program to see its effectiveness across cultural lines and whether it is in compliance with laws designed to eliminate discrimination and promote inclusion in wellness programs.

Why Should Worksite Wellness Programs Focus on Multicultural Competency?

Why should you care if your program measures up by Multicultural Competency standards? Simply put, because the law says you must and because you should!

Why Should Your Worksite Wellness Programs Focus on Multicultural Competency? Because They Should

You should be concerned about the effectiveness of your wellness program across cultures for the good of it – the social good, as a good business practice, and because programs that lack multicultural competency simply "ain’t good."

Social Good
The CDC predicts that worksite wellness programs will become part of a national public health strategy to address an increase in chronic diseases that could cost the U.S. healthcare system an estimated $4.2 trillion annually by 2023. Chronic diseases linked to health disparities are connected to, among other things, variances in cultural health norms, healthcare literacy, and provider delivery systems, as well as the provider’s culture and multicultural competency. Worksite wellness programs can only achieve a notable impact on national public health by reducing chronic diseases if those programs effectively reach groups that are most impacted by chronic disease. Multicultural competency is a core ingredient in reaching those suffering with chronic diseases.

Smart Business Decision
According to the March 2011 Thomson Reuters Workforce Wellness Index, unhealthy behaviors of employees in the U.S. cost employers an average of $670 per employee annually. The Society for Human Resource Management (SHRM) states that there is evidence indicating that healthier lifestyles among employees are a plus for employers, because "[e]mployees who pursue healthful behaviors have fewer illnesses and injuries than other workers, and they recover from illnesses and injuries faster.”1  Wellness programs that encourage healthy behavior can therefore reduce sick days and workplace injuries.

Racial and ethnic health disparities add another layer to the correlation of employee health and business productivity. Many employers are generally unaware of racial and ethnic health disparities as a business issue.2   It is important to recognize that many chronic diseases related to health disparities, such as hypertension, diabetes, cancer, cardiovascular disease, and obesity, greatly effect productivity and absenteeism. It follows that reducing or better managing of chronic diseases improves productivity and absenteeism. Since ethnic minorities and the poor have higher incidences of chronic diseases, reaching these populations (which is achieved with culturally competent programs and coaches) is critical to improving productivity numbers and reducing absentee numbers.

Lastly, studies have shown that effective wellness programs reduce the cost of insurance. Therefore, not only is there social good in positively impacting people’s wellbeing and reducing the stress on the U.S. healthcare system, there is a good business case for effective wellness programs that speak to a cross section of the population. A multiculturally competent wellness program will only serve to increase productivity while further reducing insurance cost and other expenses related to absenteeism. The business case is simply that it will improve the bottom line.

Standardized Programs Don’t Work
Racial and ethnic minorities comprise approximately 1/3 of the U.S. population and are projected to equal 54% by 2050.3  Plus, as described above the workforce today is diverse in ways that go beyond race and ethnicity (religion, age, sexual orientation, creed, geographic, etc.). Differences affect health norms, access to care, environmental health factors, desired providers, and wellness journey preference. A program that fails to factor in culture will fail to meet the preferences and needs of large segments of the workforce, likely resulting in less program participation or less than optimum results.

Why Should Your Worksite Wellness Programs Focus on Multicultural Competency? Because They Must

Worksite wellness programs must comply with numerous federal laws requiring that employers recognize disparities as well as genetics and physical and mental limitations when designing programs to avoid discriminatory behavior and impact.

Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act promotes and funds prevention and wellness in the interest of public health. The Affordable Care Act explicitly sets out to reduce health disparities and improve the health of racially and ethnically diverse populations.

The Act was passed by Congress and then signed into law by President Obama on March 23, 2010. It is comprised of the Affordable Health Care for America Act, the Patient Protection Act, and the healthcare-related sections of the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It also amends several other federal laws, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Employee Retirement Income Security Act (ERISA) of 1974, and the Health and Public Services Act. Additionally, it reauthorizes The Indian Health Care Improvement Act (ICHIA).

The Act prohibits discrimination in wellness programs that are group health plans. It is very prescriptive as to standards and requirements that must be met to avoid discrimination in these wellness programs.

The Age Discrimination in Employment Act of 1967 (ADEA)
The Age Discrimination in Employment Act of 1967 protects people who are 40 or older from discrimination because of their ages with respect to any term, condition, or privilege of employment, including hiring, firing, promotion, layoff, compensation, benefits, job assignments, and training.

An example of a practice that could cause issues with ADEA is if the wellness program has a mandatory program that requires employees to meet a certain health standard which does not consider the age of the employee.

Americans with Disabilities Act (ADA) and The Rehabilitation Act of 1973
Title I of the ADA is a federal civil rights law that prohibits an employer from discriminating against an individual with a disability in connection with, among other things, employee compensation and benefits. Title I of the ADA also generally restricts employers from obtaining medical information from applicants and employees. Additionally, Title I of the ADA prohibits employers from denying employees access to wellness programs on the basis of disability and requires employers to provide reasonable accommodations (adjustments or modifications) that allow employees with disabilities to participate in wellness programs and also to keep any medical information gathered as part of the wellness program confidential.

Note: The ADA does not, however, prohibit employers from inquiring about employees' health or doing medical examinations as part of a voluntary employee health program as defined by the ADA. For guidance on designing a wellness program that is ADA compliant, read “Are You Up-to-Date on ADA and Wellness Programs Compliance? - EEOC's Final Rule on Employer Wellness Programs and the Americans with Disabilities Act.”

The Rehabilitation Act of 1973 makes it illegal to discriminate against a qualified person with a disability in federal agencies, in programs that receive federal financial assistance, or in any federal employment, including the employment practices of federal contractors. It also requires that employers covered by the Act make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability unless doing so would impose an undue hardship on the operation of the employer's business.

An example of how a program could violate the ADA or the Rehabilitation Act is when an employer has a program that rewards employees for taking so many steps a day or walking a certain number of miles a week. An employee with a disability that limits his or her ability to walk could not participate and therefore cannot earn an award in the program (the additional compensation). To remain in good standing, the program would need to provide alternative methods for the disabled employees to earn the additional compensation.

Title VII of the Civil Rights Act of 1964 (Title VII)
Title VII makes it illegal to discriminate against someone on the basis of race, color, religion, national origin, or sex. It generally applies to employers with 15 or more employees, including federal, state, and local governments. It considers disparate impacts. Disparate impact is when your practices or program adversely affect one group of people with a protected characteristic more than another although rules are neutral. Certain races are at risk of drastically higher rates of high blood pressure, high cholesterol, and diabetes. Tethering premium savings to what the program has defined as a "healthy level" of these measurements could be seen as discriminatory under Title VII.

The Act also requires that employers reasonably accommodate applicants' and employees' sincerely held religious practices, unless doing so would impose an undue hardship on the operation of the employer's business. A violation on religious grounds could arise if an employer requires employees to submit to a health screening to qualify for savings on their premiums and an employee refuses to submit to the screening based on religious beliefs.

The Genetic Information Nondiscrimination Act of 2008 (GINA)
GINA is a federal law that forbids discrimination on the basis of genetic information in health insurance and any aspect of employment. It has two parts, Title I and Title II. Title I prohibits discrimination based on genetic information by health insurers and group health plans. Title II prohibits discrimination based on genetic information in employment. Genetic information includes information about an individual's genetic tests and the genetic tests of an individual's family members, as well as information about any disease, disorder, or condition of an individual's family members (i.e. an individual's family medical history). For guidance on designing a wellness program that is GINA compliant, read “Are You Up-to-Date on GINA and Wellness Programs Compliance? - EEOC's Final Rule on Employer Wellness Programs and GINA.”

Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) was first enacted to address the problem of the uninsured. HIPAA includes provisions that limit exclusions for preexisting conditions under group health plans. It prohibits group health plans and health insurance issuers from discriminating against enrollees and beneficiaries with respect to eligibility, benefits, and premiums based on a health factor, with some limited exceptions.

A wellness program that is a part of an employer-based health plan could face problems under HIPAA if the wellness program is not "reasonably designed" to promote health or prevent disease, or if the full reward is not available to all similarly situated individuals.

State Laws
Be sure to look at your state laws as well the federal laws mentioned about. For example, some state laws prohibit an employer from penalizing an employee from engaging in lawful conduct outside of work4 including smoking5, drinking, and eating fast food. Restrictions related to smoking may not comply with those state regulations.



2  Employer Survey on Racial and Ethnic Disparities: Final Results. The National Business Group on Health. July 30, 20083

3  US Census Bureau. (August 14, 2008). “An older and more diverse nation by midcentury.” Retrieved May 13, 2014, from

4  Examples of states that protect employees from being fired for legal off-duty activity include California, Colorado, New York, North Carolina, and North Dakota.

5  There are a host of states that specifically protect tobacco use, including Connecticut, the District of Columbia, Illinois, Indiana, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, and Wyoming.


Linda Howard, JD, CHC (7-2013)Linda Howard, JD, CHC (7-2013) is the CEO of Alturnative, a healthcare compliance consultancy that helps build people-forward organizations and establish compliance, ethics, and quality standards for the health, fitness, and wellness industries. She is a multi-faceted compliance and ethics consultant with over 30 years of combined experience in law, compliance, and healthcare operations and a passion for wellness, and a believer in social responsibility. Her prior professional titles include Chief Compliance Intellect Officer; Associate Vice President, Business Ethics; Privacy Officer; Associate (Attorney); and Senior In-House Counsel.

Tags:  diversity  inclusion  multicultural competency  worksite wellness 

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