Why executive health screening needs a check-up

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Interesting to hear what Fit for Work offers Andrew. You make some valid points especially the importance of detection of the ( potentially reversible or treatable) early stages of chronic disease. ...


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Executive health screens are a common benefit, but does the evidence behind such a perk stack up?

The ritual of the annual executive health screen is well-entrenched. Estimates suggest that private health assessments cost UK industry more than £65 million annually. Is this money well spent, or should the perk carry its own health warning?

At first glance an annual health check is a sensible, progressive and responsible service for organisations to provide. It ensures employee wellbeing, provides opportunity for early diagnosis of undetected illness, and peace of mind to executives with plenty of other things to worry about. So what’s not to like?

Testing, testing…

Medical scepticism about the efficacy of health checks has long existed. The Academy of Medical Royal Colleges and the British Medical Association have independently voiced concerns that some tests performed demonstrate little or no evidence of patient benefit. Private executive medical examinations incorporate tests that may not be recommended in an otherwise well population and may be ineffective at picking up real disease.

More is certainly not better – the more screening tests on offer the greater the cumulative likelihood of a false result requiring needless investigation. So far from being a benefit, in a substantial minority of cases they actually lead to harm.

False positive

Over-investigation is not the only problem. The insidious effect of false reassurance also comes into play. Already busy executives may be tempted to devolve responsibility for their health, assuming that they can defer reporting new symptoms in favour of awaiting the next annual health check, or being over-reliant on the seemingly favourable set of results from the last. Sadly, despite the gold-plated service, the plush comfort of the clinics, and the apparently scientific reports produced, executives are not receiving a service with an evidence base to commend it.

Bad for your wealth

Annual checks are not cost-effective. Consumer publication Which? concluded that private health screening represents poor value for money, and a recent paper in the New England Journal of Medicine judged that executive medicals fail on three counts; efficacy, cost and equity. There is no direct evidence of any correlation between investment in health checks and the health or performance of the employee or executive.

It is therefore surprising that HRDs have been slow to challenge in this area. Perhaps the corporate health check is “part of the package” for many executives, and its withdrawal would send the wrong message. But to carry on investing significant sums in an intervention that lacks evidence because you can’t imagine an alternative option is a lazy solution.

Time for a different medicine?

Company health interventions should ideally meet two criteria; improvement of colleague health and increasing in-role performance. Wellness is less about the absence of sickness, and more about the ability to perform with an agile body and mind. Organisations need to find ways to enhance employees' ability to manage their ongoing health and performance.

These include:

  • Redirecting investment towards the provision of relevant and effective advice that drives real health and performance benefit. This could be direct-to-business delivery of practical tools to maximise daily health awareness and improvement. Such interventions equip executives to take informed responsibility for their ongoing health and performance.
  • Addressing organisational culture and heath concurrently to enable executives to maximise individual health, energy and performance. More enlightened management teams are actively managing work patterns and support mechanisms.
  • Targeted one-to-one or small group programmes that create specific goals, track changes, and provide ongoing support and feedback.

Companies prepared to make investments in employee health and wellbeing deserve applause. They have the potential to both improve productivity in the workplace and create healthier and happier individuals. Sadly the annual corporate medical isn’t making a meaningful contribution, so it’s time to change the prescription.

Sarah Hattam is a GP from West Yorkshire who has an interest in the application of health to improve performance in the workplace

Comments

I agree that more is not necessarily better. The Fit for Work Team offer an employee health checks service in workplaces. We know offering health checks in the workplace increases uptake compared with the national NHS Health Check Programme. Our approach follows the NHS Health Check model of delivery and related competencies and best practices. Whilst POC testing doesn't provide the most accurate set of results it does allow a good enough indication of their cardio vascular health. More importantly it has the potential to pick up the early stages of chronic ill health. Appropriate and onward lifestyle advice or referral to GPs can then be given to encourage lifestyle behaviour change and prevent conditions from worsening. Ultimately in this scenario the cost of offering a health check is really cost effective for both businesses and the NHS. Compare the cost of not offering a health checks against the likelihood of increased sickness absence, recruitment costs, loss of productivity to the business and hospital care/treatment and NHS resource drain should you not.


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Interesting to hear what Fit for Work offers Andrew. You make some valid points especially the importance of detection of the ( potentially reversible or treatable) early stages of chronic disease. The NHS health check programme was implemented without a single RCT to support its efficacy compared with other interventions. In fact Scotland have quietly shelved theirs. What is needed in the workplace is a more holistic approach which takes a broader view of "health" and allows best practice to be applied at the individual level but which also addresses the causes of poor organisational health and culture thereby improving performance across the board.


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Indeed. Identifying and prioritising how and where employers can provide opportunities for people to access health improvement interventions is our day job. Our holistic approach makes a real difference to our clients in the East Midlands. You make a excellent point in relation to poor organisational culture. Toxic work environments breed poor employee health , morale and productivity. We need to keep influencing and persuading those key decision makers that prevention simply makes good commercial sense, plus its just the right thing to do.


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Screening is certainly not the answer. Behaviour change to create long lasting health improvement is where we should be. Where testing does provide benefit is part of an overall package of health measurement. What I mean by this is that to effect behaviour change we need to be able to start with measurement, then add objectives, education and support followed by measurement again. After all no one would try and lose weight without a scale. Similarly how do you improve your health if you don't know where you stand today? At www.getlivesmart.com we use a combination of pathology, nutrition, exercise, lifestyle and cognitive assessments to help people to measure their health, then support them to make gradual changes before they re measure in the future. We try to stay far away from tests that give false positives and keep the cost down to as little as possible. Overall we are trying to help our customers see the link between lifestyle choice and future health as we think it drives motivation and action. I'd to think that Which might have some positive things to say about our service when compared with some of the old guard.


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