Drug Education and Intervention in the Workplace

Even in an at-will employment environment, individuals are still guarded from discrimination (including wrongful termination) by virtue of belonging to a protected class. Before implementing a Company Health Promotion Program, corporations need to be aware of the relevant legal restrictions and the potential affects these measures can have on benefi ts and employee behavior programs.

Title VII of the Civil Rights Act of 1964 – Prohibits employment discrimination based on race, color, religion, sex or national origin.

This means that standards and offerings need to be applied equally (or possibly proportionally) to all protected classes. In other words, if a company is offering access to gyms, it should be sure that men and women have equal access to facilities. Companies should also consider whether individuals who may live in areas heavily populated by one race, religion or ethnicity also have access to facilities and programs. The easiest way to address this concern is to provide onsite Company Wellness Programs whenever possible. This not only ensures equal access, but according to Northwestern Memorial’s Krivy, also stimulates participation.

Organizations must also be aware that particular health problems may disproportionately affect protected classes. Health Risk Assessments and any incentives/rewards put in place may really should be customized to account for non-lifestyle related differences.

The Equal Pay Act of 1963 (EPA) – Protects men and women who perform substantially equal work in the same establishment from sex-based wage discrimination. Benefits, incentives and programs need to be applied equally to men and women. A employer cannot set a weight goal for men and not for women, although a employer can set health parameters by work function. The Age Discrimination in Employment Act of 1967 (ADEA) – Protects individuals who are 40 years of age or older from discrimination based on age.

Policies not only need to be available to individuals of all ages, but program objectives, restrictions and incentives need to be designed with age appropriateness. While older employees (or retirees and dependents) may inherently pose a higher health risk, their behaviors ought to be judged in terms of demographically appropriate measures.

Title I and Title V of the Americans with Disabilities Act of 1990 (ADA) – Prohibits employment discrimination against qualified individuals with disabilities in the private sector, and in state and local governments. Similar to other workplace offerings, any Workplace Health Promotion Programs, such as a fitness center or health clinic, would have to make reasonable accommodations for staff members with disabilities.

One area of ambiguity is whether obese employees qualify as disabled. The issue is complicated because weight is caused by several factors (genetics, environment, behavior), some of which may be out of the employee’s control. Generally, for employees to qualify for disability based on weight, the condition must signifi cantly impair their physical or mental ability to perform their job. This determination would need to be made by a qualifi ed physician. Although this label may affect the types of incentives and rewards and program requirements offered, it likely would not affect the central implementation of behavioral-focused initiatives.

Civil Rights Act of 1991 – Provides monetary damages in cases of intentional employment discrimination.

This legislation allows individuals to sue employers for improper treatment. Compensation can be in the form of actual damages such as lost or expected wages, compensatory damages for a postion that causes public embarrassment, or even punitive damages meant to send a message to a employer for egregious or habitual violations.

While these laws govern all corporation activities, there are even more stringent restrictions with regard to Medical Care topics. Most policies, communications and data collection regarding employee health are governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under HIPAA businesses can’t deny eligibility for benefits or charge a higher premium on the basis of:

• Health status
• Health condition (including both physical and mental illnesses)
• Claims experience
• Receipt of medical care
• Health history
• Genetic information
• Evidence of insurability (covers activities such as riding a motorcycle, skiing, snowmobiling and other similar pursuits)
• Disability

Still, because wellness programs may not include health care treatment or be insurance related, and may instead be confined to behavioral initiatives, HIPAA’s nondiscrimination provisions do not totally apply. To address this, in 2001 the U.S. Department of Labor, the Internal Revenue Service and the U.S. Department of Health and Human Services jointly issued a proposed regulation to help clarify the lawful provisions of a “bona fi de Wellness Program” in the context of HIPAA’s existing language (See Box p. 14). Although the regulation is not yet final, companies that comply with the measure will be viewed by the government as making a good-faith effort to avert discrimination in wellness programs.

Complete Company Wellness Programs are still relatively new to corporate America and the legal implications of implementation and enforcement are not totally known. By their very nature, these programs potentially expose businesses to discrimination lawsuits, disengaged employees and detrimental public relations. Nonetheless, businesses that make a good-faith effort to comply with current Health Care-related laws, discover ways to engage employees, and communicate strategically, will be able to minimize these risks while finding plenty of room to develop a creative and effective Company Wellness Program.