BIG BROTHER WANTS YOU HEALTHY

By Christine Gorman

Like most Americans, Audrey Brantley, 42, of Birmingham, Alabama, thinks it would be a good idea to get more exercise, eat less fat and lose a few pounds. Until now those decisions have been hers to make. But Brantley, who works for the city as a library assistant, is enrolled in a new kind of health-and-wellness program that has the right, under certain circumstances, to tell her what kind of shape she should try to get into--or take away her insurance coverage. The program, which is run by the University of Alabama Birmingham School of Nursing, has kept the city's health-care costs below average for the past five years. Still, Brantley has mixed feelings. "At first, I thought it was a nuisance. I thought they were trying to control us," she says. "But now it seems like a good thing. I know of cases where folks found out they had high blood pressure or were borderline diabetics and didn't know it."

The downside of employee-wellness programs like this one has always been that most people who enroll are already fit. A company's unhealthiest, and therefore costliest, employees continue to smoke, drink and eat their way to an early grave. According to a 1993 study, half of the 2 million deaths that occur each year in the U.S. can be linked to unhealthy life-styles. The three biggest culprits--tobacco, lack of exercise and a high-fat diet--together account for at least $200 billion of the nation's $1 trillion in health-care costs.

A growing number of employers and managed-care companies are trying to reach these recalcitrant workers. Most, like the city of Birmingham, begin with a mandatory screening that allows them to identify who is at greatest risk of developing health problems. Many use positive incentives--the proverbial carrot--to promote healthy habits. Anthem Blue Cross-Blue Shield of Cincinnati, Ohio, for example, offers its plan participants $240 a year in extra benefits, like additional vacation days, if they get good scores on five out of seven categories of health-related behavior.

A few, usually self-insured firms, prefer to use the stick. Employees at E.A. Miller, a meat-packing unit of ConAgra in Hyrum, Utah, are charged extra for medical coverage if they smoke. They must also wear seat belts and, if they are pregnant, attend childbirth classes, or they could lose their insurance. It seems to work. Since the plan's inception in 1990, no employee has been killed in a car accident, and the number of premature births has dropped from three in a two-year period to just two in the past five years. "We want to teach employees to be responsible for their behavior," says Eric Falk, Miller's director of human resources. Of course, he adds, the line has to be drawn somewhere. "Obviously, if we start denying benefits for every ankle sprained playing softball, we've gone too far."

Some experts fear the programs have already gone too far. "It goes against the spirit of health promotion, which is a voluntary change in behavior," says Ted Wegleitner of HealthSystem Minnesota, a large health-care provider. If the incentives are too attractive or the punishments too harsh, some people will end up hiding their unhealthy behavior. Turner Broadcasting System in Atlanta has a policy by which the company can fire employees hired after 1986 who are caught smoking--whether at work or at home. So far, no one has been fired under the policy. But some people, says an employee, still manage to sneak a smoke.

--By Christine Gorman. Reported by Greg Fulton/Atlanta and Marc Hequet/St. Paul

With reporting by GREG FULTON/ATLANTA AND MARC HEQUET/ST. PAUL