“Health screening has often felt something like Marmite; with some people loving it, and others thinking it’s a waste of time.”
So says Nick Davison, health and wellbeing strategist and managing director at myadv1ce, who formerly held senior positions at John Lewis and Aviva.
However, the ‘Marmite’ debate has upped a level lately, as Davison says, due to the fact technology is improving at such a pace that the ability to screen for different, life-threatening diseases, and for genetic predispositions, is increasing dramatically.
UK worst cancer outcomes in Europe
Yet, despite this technological advancement, it recently also hit the headlines that the UK has the worst cancer outcomes in Europe due to the fact the disease doesn’t get picked up as early; other countries do more and earlier screening.
Both these trends might suggest employers could play a really positive role in keeping the nation healthier and more productive, by taking on some of the burden of screening.
But, before we get into the meat of that debate, let’s rewind slightly and acknowledge that the area of health screening is vast, and not all of it is controversial. In some instances, it’s hard to argue that employer involvement wouldn’t be beneficial and lead to better health outcomes all round.
Cholesterol levels, heart disease, blood pressure and diabetes
For example, knowing our cholesterol levels. This test result could be an early indicator of one of the biggest killers – heart disease – which can be managed through diet, lifestyle and exercise. Other more straightforward tests include blood pressure, vitamins & nutrients, thyroid and even diabetes, which Davison led a health screening campaign for when at John Lewis (see here).
“Testing for heart disease, breast cancer in women and diabetes is where I’ve seen screening work brilliantly,” he says. “Early indications of problems allow people to make positive changes to their lifestyles, to manage their individual risks and often lead to better clinical outcomes. These Diseases impact lots of people but can be easily tested for and can make a real difference to the quality of their life.”
Employees loved health kiosks
During his career Davison also oversaw the use of health kiosks, which were positioned in highly populated work sites. Employees could access a free health MOT, including a weight check and blood pressure. He says:
“Everytime we periodically introduced health kiosks our employees absolutely loved it. It became a local topic of discussion amongst teams andsignificantly raised levels of awareness amongst elements of the working population not known for looking after themselves. By starting the conversation locally in this way you are more likely to influence people to make some positive changes, provided that the awareness is backed up with strong communication and localised proactive support. The way that health screening is delivered is so important.”
So, too, is the existing company culture and the level of trust an employee has in the employer. If trust is lacking, then screening could be perceived, as Davison says, as “some kind of Machiavellian subplot where the company is actually intending to weed people out, or make them redundant”.
In order for engagement to be high, employees have to believe employers have their best interests at heart. If you have an issue on this front, you are better to direct your attention there first before even considering introducing any kind of health screening programme.
Now, to the Marmite issue of more controversial screening….
Now, to the Marmite. Where health screening becomes really divisive is concerning some serious conditions, like cancer, and genetic testing, which measures an individual’s likelihood to develop certain serious illnesses.
For instance, there is currently concern around the health screening taking place for prostate cancer with one headline in the British Medical Journal saying: “Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit”.
Qured does offer screening for cancers, including prostate, but it doesn’t offer genetic screening.
“The potential for value and help, and the potential for harm varies a lot in health screening,” says Elizabeth Swanton, Chief Operating Officer, employee health screening firm Qured (for our recent webinar featuring Qured about cancer in the workplace see here).
Controversy around testing for prostate cancer
She concedes that testing for prostate cancer in isolation, at a single point of time, rather than over a longer period, could do more harm than good. This is because the test can trigger false positives due to other factors such as if the individual has had a urinary infection or recently had anal sex, for example. Also, some argue that the test causes unnecessary stress because many people are able to live with the disease as are asymptomatic and it doesn’t bother them.
Swanton argues that the most important thing to consider if thinking about a health screening programme is contextualisation. In Qured’s case, an individual who is being tested for prostate cancer is given the information about the pros and cons of the test before they decide whether to take it, so they’re aware of the risks and benefits, and then is monitored over time and overseen by a doctor, with the opportunity to discuss any concerns as they arise.
The importance of context
“Our philosophy is that every test we provide must be contextualised and the results need to be provided by a specialist who can talk them through, that’s an essential part of the process and it’s not happening everywhere,” says Swanton.
“If you don’t give someone the right pre-test counselling and education, and context around their results, they are not necessarily going to take the right action or know how to react at all. I understand the valid worry that testing will create this army of the ‘worried well’, going to their GPs waving test results and burdening the NHS further.”
As for genetic testing, Qured doesn’t offer that because the company doesn’t feel it has investigated the potential risks thoroughly enough yet. It also, like many in the industry, has concerns around the ethical considerations and regulation of the tests currently.
“The risk of testing someone’s vitamin D and magnesium is very different to doing a genetic test and requires different support, education and awareness. If you’re telling someone they have a higher potential risk of some sort of serious disease in future, that could be quite significant for them.” she says.
You can’t predict how individuals will react
Davison agrees, adding there is no way that an employer can predict how an individual will react to news, or that knowledge is always power:
“As an employer you need to be able to back up any screening with the appropriate support for the individual based on their results. Consequently the further out you push the screening remit the further you will need to match the support and the specialist nature of it. In a world of constrained budgets and tough trading environments that makes it less likely employers will stretch their screening proposition too far in the near term”.
That said, the “genie is out of the bottle now” on genetics with the industry valued at $7.5Bn in 2022 and an annual growth rate of more than 20% forecast over the next 7 years. This is being driven by higher cancer incidence and genetic disorders, with the growth coming in clinical and research based settings but it is likely we will see an increase in direct consumer engagement and it will be an area employers increasingly will need to consider.
There are better ways to make an impact currently
However, at this point in time Davison believes there are still ways to make a genuinely positive impact on your employee wellbeing, namely by focusing on the pillars of good health and wellbeing, which we know, across the board, help prevent disease: exercise, nutrition, looking after mental health, weight management, financial management etc.
Clare Fernandes, Chief Medical Officer at the BBC thinks that health screening tests are not the most effective way of improving the health of the workforce, and screening needs to be carefully thought through to avoid being another wellbeing washing initiative.
“There are so many other ways that employers can significantly reduce health risks and improve working conditions without going down that route,” she says. “Health promotion, for example. Considering the mental health risks of business activities, through psychological risk assessments and reducing the risks at the source; health promotion within the workplace through healthy eating options, for example; there are many simple, non-clinical options that can make a meaningful impact.”
Lifestyle before genetics
Fernandes’ preference would always be to focus on general lifestyle factors first rather than any testing, as improving these would reduce the occurrence of so called ‘lifestyle diseases’ such as heart disease, strokes and diabetes that greatly impact upon the health of the nation and therefore the workplace and burden on society.
Clinically she would only prioritise testing if there was a family history of a certain disease that would increase the risk, in which case screening would make sense. And for any testing, ranging from cholesterol to genetic tests, she would advise it only be done in the context of follow-up with a qualified medical professional. For genetic testing, she’d also recommend counselling prior to the test to ensure the employee understands the potential implications of the potential results of the test.
“Of course, an early diagnosis for certain diseases would be life changing for some employees but I do not currently believe health testing falls under an employer’s duty of care,” she says.
Another aspect – apart from the lack of regulation around genetic testing in particular – that concerns her is medical data storage and the issue of confidentiality and who, within and organisation has access to that information and for what purpose. “Because of GDPR, you’d need a whole new clinical governance structure,” she says.
Added complications with genetic testing
There’s the added as-yet unknown complications, too, around the implications of being identified as predisposed to serious diseases in terms of things like insurance. “Lots of issues need to be ironed out, not least ensuring the tests are accurate in the first place,” she says.
The potential benefit of genetic testing is that it flags up potential future heath dangers allowing individuals to change their behaviour in order to minimise their risk. However, behaviour change – even for simple lifestyle changes – is incredibly difficult to instigate in employees. It’s why articles like this on behavioural science always garner high views.
As Davison puts it:
“We know that stress and or burnout affects our mental health and can makes us well. We know that if you’re four stone overweight, you’re going to have a higher risk of heart attack or stroke or diabetes. We know that the exercise we do, and what we eat and drink affects our health. We don’t need a genetic test to tell us that. We already have plenty to be getting on with in terms of encouraging positive behaviour change in employees, before we even consider that level of testing.”
