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Tony Levene: Does wellbeing mean an end to individualism?

Easter egg, cakes, free fruit - and workplace wellbeing

Wellness – or should it be wellbeing? – is an unalloyed good. It’s just like motherhood and apple pie although too much of the latter is not great for wellness (or wellbeing – I’ll just use the terms interchangeably).

But if you agree it’s for the general good – and, if you run a medical facility dependent on those who suffer lifestyle conditions, you are allowed to disagree – then how does the insurance world deliver it?

Around half the NHS budget (and a substantial slice of private medical payments) goes to people suffering avoidable diseases. Leaving aside those of retirement age and above, the unhealthy workforce costs the economy around £100bn a year – that’s HS2 and Heathrow expansion every twelve months. If that’s what you want. Getting on for 10% of the NHS bill goes on diabetes, now running rampant in younger people.

Abraham Lincoln once said – apparently – that the best way to predict your future is to create it. So how do we make this wellness we (mostly) concur with?

Some insurance companies believe they are making an effort. But perhaps they should concentrate less on the individual (that’s admittedly the nature of cover) and look wider.

According to Dr Paul Litchfield, chair of the What Works Centre for Wellbeing, there’s lots of activity in wellness but little evidence of it working. Gym membership, exhortations to exercise, and eat fruit campaigns mostly help the better off – who are already likely to be healthier.

The least well-off can’t afford insurance or much else so all the incentives in the world pass them by.

New figures show not only the poor living up to twenty years less than the rich. They also indicate the gap is widening again – it’s now nearly four times as large as Sweden.

Litchfield was addressing a Wellbeing Symposium, held earlier this month in London, with help from C3, Collaborating for Health.

His basic theme was “we can’t go on like this – something has to give” – we can’t expect children to eat healthily if couch-cuddling parents are stuffing themselves with popcorn and cheap chips.

Insurance companies may have been winners from the technological changes of past decades but other than the well-off, (probably already customers for private health) most people in the UK are losers. It’s not the absolute standard of living that governs wellbeing, rather quality of life.

“Income is important but quality of work, stable relationships and health are more vital drivers of wellbeing.”

For the workforce, where the best chances of expanding protection cover lies, that means job security, a suitable physical and cultural environment, health, and – sorry about the jargon – eudaimonic wellbeing (which is the need to feel meaning in our lives).

Are private medical insurance providers telling that enough to workplace clients? Are those policyholders insisting on providing this – and negotiating premiums accordingly?

I am guilty of an error here. I have spoken of “workplace” but increasingly, that does not exist. Work is no longer automatically a location; take a look at those earning their keep from home or the local coffee shop. Yet, insurers so often confuse work with place – and we are still in the mindset where we not only work for one employer at a time; many in insurance still expect that employer to be constant throughout from 16 to 66.

“More of us are in work than ever before,” says Litchfield, “but is it good work? Probably not. We can talk about mental health issues but good work is the key to wellbeing.”

Why should employers – and by extension, protection insurers – care? There is some evidence, cited on Litchfield’s website, that wellbeing increases productivity and creates a better environment for customers.

Insurers could take a position in leading this – after all, a big reduction in state health spending is good for all taxpayers. And early stage support, via the state or privately, has a big return on investment.

But where’s the incentive to do something at the first sign rather than when that person is signed off sick? Not much sign of this in the medical world.

Providers could also – thanks to their large shareholdings and muscle – start to look beyond the individual at wider issuers.

Shirley Cramer, chief executive of the Royal Society for Public Health (RSPH), has looked at Easter Eggs – mostly full of sugar – now in shops from January onwards. Insurers own huge percentages of supermarkets. They could try doing something. Suggest healthy snacks. It would help the insurance bottom life while not harming the stores.

The industry should also use its undoubted clout with government. They should force the ruling group to think long term (that’s maybe akin to asking for the moon!) because we need to think of prevention differently. Where’s the shame in our health and other inequalities?

It may be hard for insurance, but individual choice will have to go. We no longer have the option to drive without seatbelts, or smoke indoors, or drink the gin that led to Hogarth’s Gin Lane cartoon.

Or drive polluting cars in some areas, or burn smokey coal, or have £100 limits on betting shop machines, or beat children at school.

The RSPH has looked at health on the high street. Unsurprisingly, the least healthy are in the poorest areas. They have bookmakers, pound shops, payday loan outlets leading to bad health and anxiety. The poorest are twice as likely to be obese and far more prone to mental health issues.

Much of the bad high street is down to weak planning laws and lax licensing. Is there an insurer taking this on? We need a law change to replace “freedom” (that’s being free to stuff yourself with stuff from a chicken shop – something no insurance boss would be seen dead doing) with a planning system where health is the default position. Scotland and Wales are ahead of England, which has done nothing, here.

Finally, what should be the attitude to cake at work? I am a freelance journalist now, but I used to work for a firm that provided healthy fruit on some days but also frequent deliveries of Krispy Kreme donuts. Eating one is like pouring Tate & Lyle down your throat. And wrecking your teeth at the same time.

We live in an obesogenic world (more jargon) but somehow, we have to balance the work cake culture, which can undermine health, but might also be good because it shows appreciation, cheers people up and brings them together. The Krispy Kremes did all this. And wreck health. But the staff were mostly on zero hours so someone else picked up the health cost bill.

Is “cake” a question group PMI providers ask? If not, should they? There’s a talk and a whole website devoted to this – try

We’ll see.