As health care costs continue to spiral upward while outcomes improve only incrementally, research suggests a promising focus for intervention: curbing the many ways that companies inflict damage on workers’ health. But that’s not where the effort is going. Recently, I sat in a meeting where insurance executives reprised a common theme: The problem is that people choose to eat too much, smoke too much, drink too much, and exercise far too little. The solution, these experts said, is for companies to promote better choices (by, say, changing cafeteria menus or adding gyms and showers) and offer incentives (apparently the answer to everything these days) to make healthier personal decisions.

While working to influence individuals’ health-related decisions is helpful, an enormous body of epidemiological research shows that management’s decisions contribute to mortality and morbidity at least as much as, if not more than, the employees’ own actions. For example:


Layoffs have been shown to increase the risk of dying from cardiovascular disease by 44% over a four-year period. Other studies demonstrate that layoffs produce numerous unhealthful behaviors and increase the incidence of suicide.

Long work hours.

Members of the U.S. labor force put in more time on the job than the workers of almost any other industrialized country, and those long hours lead to accidents, hypertension, and a host of problems related to lack of sleep.

Failing to provide health insurance.

Only 60% of employers now offer health insurance. Meanwhile, mortality and morbidity are on the rise, in part because the uninsured are much less likely to undergo preventive screenings, such as mammograms and cholesterol checks.

Lack of control over one’s job.

A worker who faces high job demands but has little discretion over when and how to meet those demands is likely to suffer from stress and its correlates, including increased cardiovascular disease.

Economic insecurity.

Workers who feel financially vulnerable are prone to stress and its associated mental and physical health costs.

The research consistently shows that individual choices are negatively influenced by all these things. Longer hours at desks, for example, often translate into a more sedentary lifestyle and greater consumption of high-sugar, fatty foods. And on-site gyms don’t do much good if people think they’ve got neither the time nor the company’s support to use them.

At the moment, corporate decisions promoting poor health result in costs that are certainly real to individuals and society but are largely hidden from companies’ view. After all, a company is not responsible for a laid-off worker who has a heart attack, and no corporate payroll supports a person who is too ill to work to begin with. If a company does not currently pay for those costs, then where’s the motivation to invest in the fixes?

In some instances, companies do see the direct economic consequences of their choices. Unemployment insurance rates, for example, are customarily based on an employer’s history of creating job loss. Environmental regulations largely prevent companies from externalizing the costs of fouling the air and water. Prices and markets, too, can help businesses make good decisions, though only if they reflect the full costs—and consequences—of those decisions.

If we are to create healthier workplaces, companies need to pay attention to this growing body of evidence and open their eyes to the costs of decisions that cause ill health.

The costs of corporate decisions promoting poor health remain largely hidden from companies’ view.

A version of this article appeared in the November 2011 issue of Harvard Business Review.