How Assuming Autonomy May Undermine Wellness Programs
In recent years, corporate wellness programs have become a routine aspect of the employer provided health insurance system. While they vary tremendously in their requirements and incentives, what these programs share is the common goal of modifying employee behavior to improve health and, as a result, to lower costs. Recently, however, the effectiveness of wellness programs has been called into question. This Article offers one possible reason for these shortfalls by revealing an assumption underlying corporate wellness programs: encouraging people to make healthier decisions requires that they have access to meaningful choices. Put simply, wellness programs assume personal autonomy. Yet the growing literature on the social determinants of health has revealed that, due to socioeconomic factors and other structural barriers, the ability to make healthy decisions is not equally available to all Americans. We are not equally autonomous. Recognizing this reality can empower employers and health insurers to offer corporate wellness programs that do not assume autonomy but rather facilitate it. The Article concludes with examples of autonomy enhancing policies for promoting health.