In a world where “wellness” has become a cultural signal of the American elite (think yoga and spa treatments), employers have not been afraid to market wellness programs as a one-way ticket to greater health, wealth, and happiness. Watching this kind of rhetoric on display in the wellness movement, it’s hard not to think that wellness programs actually strengthen biases against what they’re intended to combat: disability, economic stagnancy, and mental illness. In this post, I articulate precisely this worry.
Wellness programs are viewed as relatively innocuous. A common employee benefit, wellness programs encompass a wide range of activities that seek to improve the health of employees and reduce total insurance costs for employers. This can include nutrition classes, weight loss programs, or chronic illness interventions. Programs may target employees who are identified as outside a healthy range to take additional wellness steps, like meeting with a health coach. Employers become the stewards and ultimate beneficiaries of each employee’s healthier lifestyle. Though some scholars have concerns about this kind of intimate involvement in employees’ private lives, most favor wellness programs as a bipartisan health solution in a landscape where political agreement on healthcare is seldom found. Notably, President Obama invested in wellness as part of reforms under the Affordable Care Act (or Obamacare).
I have many concerns about the wellness movement – the lack of privacy, the evidence of ineffectiveness, and the penalties for nonparticipation are among them. But I also worry that the wellness movement is complicit in furthering the stigmatization of people with disabilities. Wellness programs assume that the primary barrier to health and productivity is an individual’s lack of motivation. They view health as controllable, provided we make slight wellness adjustments and take personal responsibility for our unhealthy choices. It’s noteworthy that this is the attitude the wellness movement has embraced – one that relaxes our anxieties about chronic illness by telling us that anyone, if sufficiently disciplined, can achieve health and prosperity. This push to avoid chronic illness is often accomplished to the marginalization of the chronically ill. Because the wellness approach acknowledges almost none of the social and environmental determinants of health, it reinforces stereotypes that disabled people are lazy, culpable, and a burden on society. At the same time, it implies an interchangeability between health and success. In short, the wellness movement uncritically endorses the aesthetic of the able-bodied, reflecting broader beliefs we have about those left on the outside.
So, what is the upshot of wellness for people with disabilities? Ultimately, I think wellness gives credibility to the idea that the individual, and not society, is responsible for dealing with the effects of poor health. A wellness program does little in the way of assuaging the various social and economic barriers to health and longevity. In fact, a recent study suggests that the apparent health benefits of wellness programs are actually attributable to self-selection. But, the programs do create the illusion of personal control over health, and they cast blame on those who can’t comply. It would not be a great leap, therefore, for wellness advocates to think that society should not have to ameliorate the differences in social opportunity that arise from poor health, since such differences are perceived as self-imposed.
If we accept this conclusion, then many people with disabilities become bound by the sympathy of the other. The more we regard health as a part of individual responsibility, the more society can legitimately ask whether the benefit of medical intervention is worth the cost. People with disabilities become beholden to the private alms and the good will of others for needed services. And, the available choices for people with disabilities are limited to what would be congruent with the charitable attitudes of others. As a result, the wellness movement ultimately causes dignitary harm.
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