With corporate employees spending 60-70% of their time in offices, workplace health is not an option or a benefit but a necessity. Large firms are beginning to play a larger role as far as the well-being of their workforce is concerned, but the country is not investing on preventive care, panellists said at the fifth Mint Healthcare Conclave in Mumbai on 17 June. Not doing so will mean enormous costs in terms of illness and insurance claims, they warned.
N. Rajaram, country head and general manager-pharmaceuticals at Sanofi India Ltd; Rohit Kapoor, senior director and chief growth officer, Max Healthcare Ltd; Vishal Gondal, founder and chief executive officer (CEO) of fitness technology venture GOQii Inc.; Shrinivas Ranade, chief medical officer, Mahindra and Mahindra Ltd (M&M); Azfar Hussain, global head-human resources, Zensar Technologies Ltd, took part in the discussion, moderated by Mint’s deputy managing editor Ira Dugal.
On convincing people to fit in healthcare at work:
Gondal: Two of our biggest users of GOQii—Sanofi and M&M—are on this panel. The good news is that clearly people are taking lifestyle seriously. You see in newspapers how people are just dropping dead working in their offices, or how diabetes and the corresponding lifestyle diseases are on the rise. And, ultimately, people are spending more and more time in their offices and they are drinking too much tea, coffee and eating junk food. Many companies have pizza outlets within their campuses, which is not a good thing according to me. So the work is knowingly or unknowingly making you more prone to lifestyle issues. The problem in this space is not information—everybody knows you should not be drinking too much tea, coffee, eating junk food and you should exercise. It is a motivation problem. You need someone to measure and motivate. We are using the power of data and motivation to get people to make lifestyle changes. It is incredible to see in media and in boardrooms conversations around lifestyle and health becoming more important, because this has direct impact on productivity and employee morale. In India, we do not have enough infrastructure for healthcare, there are not enough doctors, not enough hospitals, so the only way India can cope up with this is to adopt a healthy lifestyle. Our corporate plan is new, but it is the fastest growing category because firms now understand this space.
Ranade: When we talk about corporate healthcare, the first and foremost thing is that this message should come from the top. Our group president (of auto and farm sector and executive director at M&M) Pawan Goenka has declared health and wellness of employees as one of his “delight targets”. We are working on three pillars—the first is health awareness, second is food and nutrition, third is health promotion activities. As far as health awareness is concerned, one must be passing health awareness messages repeatedly. We do it through bulletins, way to wellness emailers, lectures; we use various platforms to propagate healthcare. We try to focus on food and nutrition as two-thirds of a day’s food comes from the workplace. We have revamped our canteen menu. Across our 10 plants, we have healthcare counters under the guidance of nutritionists. All this is of no use if you don’t encourage employees to increase their physical activity. Sitting in one place for eight hours; smoking. We enrolled for GOQii to increase the physical activity of employees. We have now a health index and a medical software whereby we can measure a person’s health.
The drivers for organizations to invest in wellness:
Hussain: The larger part about the focus on healthcare is connected to engagement and productivity. We run a survey every year called the Great Places to Work, which has specific questions around wellness. As a result of this, we started a wellness programme, which tracks four kinds of wellness for employees—physical, emotional, financial and spiritual. The other part is if you invest in wellness and preventive care, it has an impact on the health of employees and, in turn, the number of hospital visits and, ultimately, a reduction in insurance premiums.
Whether employees are demanding healthcare at work:
Rajaram: Without doubt, that is the case. I think all responsible employers have to make it a part of the organization. There was a time when medical care and healthcare was a benefit. What has changed now increasingly is that responsible organizations are investing in the healthcare of their employees because they fundamentally believe that it is important for productivity and loss of absenteeism; but, more importantly, it is a very attractive employer proposition. People want to join organizations which take care of them; people want to continue to work in organizations which take care of them. Organizations such as ours have 100,000 employees all over the world. We must remember a lot of employees are also in manufacturing in the world, it’s not just an office or air-conditioned space for everybody. It is very critical for us to take a very active role and companies are beginning to take that role. There are two components to this—one is screening and identifying health risks in your organization and the second part is about changing behaviour. So, when you have large organizations like Sanofi, it is very critical for us to continuously screen and evaluate the risk profile of our employees and intervene on that. Simultaneously, you need to invest in behaviour change (towards healthcare).
Challenges to corporate adoption of wellness:
Kapoor: I think we have over-simplified corporate wellness, that if you have done your screening or tests, you are done. I think there are three components to wellness for any individual. It is physical fitness, mental fitness and spiritual fitness. And if I look at corporates today, probably what is totally understated and not attended to is the whole mental fitness part. If you think about how much stress people go through in the workplace atmosphere, and the rollover effect on other things, which is a lot. The good thing for us from the vantage point of observation is that we observe everything—right from a baby being born to a 100-year-old either being cured or not getting cured. We are able to see the full spectrum of what’s happening as a reflection of corporates, individuals or households. So, great corporate programmes will actually start for mental fitness first, which has a lead back into how leaders are trained. For example, if the leadership style is that you expect people to be in office at 9pm because you are there, then you are going to get a certain level of wellness even if you have all sorts of fitness programmes, etc. The second is, we have restricted the wellness discussion to a very elite category of the workforce today, which starts with single leadership and may be percolated down to middle management. In our context, we have 3,000 nurses who man our facilities and who actually provide the bulwark of our organization in terms of effectiveness. On an average, people across cadres are spending 60-70% of their time in the workplace or connected to the workplace. That’s a huge number. So, in a holistic programme, corporates which really get it right will start from mental fitness first and culture, and that has a huge throwback into physical fitness. I joke about this that if we actually walked as much as we speak in India, we will be a very fit country. We love our chola bhaturas, we love our aloo parathas, and patients ask for chola bhaturas after a cardiac surgery. We are a bizarre country. People only keep talking about it. You meet someone who says he went for a yoga class, who is nine out of ten times probably only exaggerating—last went to a yoga class three months back but has discussed this with 77 people saying “that instructor is great”. Unfortunately, the culture is top-down; I wish it was bottom-up. So, the more the senior leaders actually walk the talk, and have the confidence and ability to pick up the bag at 7pm and go home, or have the ability to post their vacation photographs on Facebook for employees to see, or post pictures of playing with their kids, I think it will have to start from there. We are a very tight society and wear the work on our sleeves saying “bahut busy hoon”; that is actually seen as a badge of honour. It’s a complicated topic.
Gondal: A lot of companies look at this as an expense or don’t have the budget. Till the time it is considered as a cost and not an investment, it will always be a challenge. There are going to be some massive disruptions coming in. Imagine if a company is healthier, their insurance bill goes down. Or there are other financial incentives given to organizations, which are healthy. That itself can become a game-changer. That is the ultimate solution.
Hussain: The key understanding in the company I work at is that anything that you do on preventive side is really an investment because it will pay many-fold in terms of not just reduction in insurance premiums but in creating a healthier, engaged and productive workforce. The benefits are manifold.
Rajaram: I support that. For example, after the sudden increases in cases of flu, last year we observed there have been over 200 organizations which actually have begun to organize vaccinations. Organizations are able to see the economic value out of it.
Kapoor: If I look at hard facts, companies are probably still more open to spending on preventive but individuals just don’t spend on preventive in India. We are a country where if health insurance goes unused for an entire year, they feel bad about it. We are a karma-nation, so the push is not there. Even in vaccination camps, you have to keep chasing people to show up. Corporates are a reflection of society at the end of the day. There is so much information on health out there that it is confusing; so, one of the things corporates can do is to filter all this noise and provide expert help.
Gondal: Specifically, if you look at habits, a huge problem is sleep. People are not getting enough sleep; 60% of our corporate users have sleep-related issues. In fact, we have international BPOs (business process outsourcing units) where there is a chronic problem of employees who work night shifts and we are running specialized programmes for them because they are awake in the night and then are also awake in the day. That’s a huge problem, especially with all the young people working in the nights. The second problem which is very big is alcohol. We have hundreds and thousands of users on the corporate side where alcohol de-addiction is a problem. We don’t talk about it but there are people who work in high-stress jobs and are smoking. We recently published a study where we were able to help somebody quit smoking after 29 years of trying every time to quit. And the simple insight was this person was not having vitamin C. When you are trying to go off smoking, you need to consume more vitamin C because that helps. The things which are creating a problem are sleep, alcohol and smoking.
Kapoor: Data shows sleep deprivation is linked to mobile phone. Attention deficit disorder is acute. I have worked in seven different countries; I have not seen people do this anywhere as much as we do in India. Trials are emerging now on the after-effects of this on a variety of health issues.
Ranade: Mental health is the biggest challenge, but in India we have a taboo around it. One will freely disclose they have been diagnosed with TB or diabetes, but I doubt one will freely disclose they have depression or anxiety. We are closed when it comes to mental health even at the individual or family level. Same thing is reflecting at the corporate level. As a corporate, we want to help people improve their mental well-being, because that’s the key to everything. The challenge is people coming forward and attending the counsellor’s session that we organize in the workplace, because of the social stigma.
Kapoor: There’s a stigma attached to it, but I think the source of it, which is corporate-related—the toxic behaviour on the work floor or corporate office—is something we observe very quickly. Some corporates are very quick at stamping it out without any compromise. At the leadership off-site, which our company had last month, we came out and said we will have a “no shouting” policy. It is very simple and one might wonder why we are even talking about it, but we have 10,000 people and everywhere we go, we hear a raised voice—one of us will go and pat the person and say “calm down”. Simple changes like that lead to a huge amount of employee satisfaction and lead to lower stress and slightly happier employees.
Hussain: In terms of what is appropriate behaviour, for example, I used to work with Hewlett Packard (HP), and HP had behaviours that were encouraged and behaviours that were unacceptable. Raising your voice and using foul language was completely unacceptable. In a lot of corporates, there is an awareness and sensitivity to the fact that there is appropriateness of leadership and managerial behaviour. If somebody doesn’t behave that way, irrespective of whether they are a top performer or not, they will either be counselled to begin with or shown the door thereafter. A lot of the organizations are going back to engagement surveys, which act as a feedback mechanism for the managers and that data of the manager is included as part of his appraisal.
But how much of this is a company’s problem and how much of it is an individual’s choice—where do you draw the line?
Ranade: What we are lacking is facilitators. The facilitators are the doctors, the nutritionists, the healthcare providers and maybe an HR manager. The whole corporate world works on goals, or KRAs (key result areas) as we call them. It should be in the KRAs of HR heads or department managers to encourage employees’ well-being.
Rajaram: One of the things which we have to recognize is we have 60% deaths in India happening on account of chronic diseases—it’s out of diabetes, it’s out of cardiovascular-related problems and that is not going to be any different in our own organization.
So, we have an enormous responsibility to manage this epidemic. You have a situation of working for 8-10 hours, a younger population, you have chronic diseases on the increase, and you have a sedentary lifestyle. It’s in this context that we must, as employers, take extra effort, to do both management of what is the disease as well as parallelly activate the behaviour part. That to me is an enormous responsibility.
It is not just a Mumbai or Delhi metro situation; we are talking about thousands of workers in different kinds of working conditions. Responsibility of corporates extends beyond head offices.
That is much more of a challenge. Even in public healthcare spending, which is poor, there is hardly any spending that is happening on preventive care.