“Big” Health Promotion

By Tanya Dillard

Reflecting on three Health Promotion Industry conferences (HERO Forum, NBGH Workforce Strategy, and AJHP’s Art and Science), I am more encouraged than ever about the future of Health Promotion in the United States. The most encouraging concept transcending all three conferences was the notion of “Big E” vs. “Little E.” “Big E” refers to the complete engagement in and at work as evidenced by enthusiasm, contribution, collaboration, productivity and engagement in worksite resources. In contrast, “Little E” is limited to participation in a wellness program like a biometric screening or earning program points. For many years, our industry was about the business of “little e,” developing programs that sought to reduce health risks and, in many cases, we thought these programs would produce the “Big E” engagement that is correlated with lower health risks, higher productivity, lower rates of absenteeism, and more positive cultures. Indeed, we industry veterans can all point to a success story of someone who participated in the wellness program, dropped weight and got a new lease on life. But we also know that, while inspirational, these stories are sometimes seen as the exception rather than the rule.

Observing this, the industry has been asking, “Why?” Why, when offered the “latest, high tech, gamified, mobile-enabled, incentive-based, personalized” program intended to help people become healthier, happier and more empowered do we not more willingly adopt them and in droves? Well, it turns out it’s complicated and spans multiple domains. Thankfully, these conference organizers have increasingly welcomed other disciplines in to offer their insights on impacting the health of the U.S. worker. Indeed, sessions dedicated to tackling cultures of fear and anxiety, organizational development, the role of finances in well-being, the politics of food, companionate love in the workplace, and the role of purpose  had just as much bandwidth as sessions dedicated to the practical success of “little e” programs. It is this confluence that I am most excited about but with a measure of trepidation.

I, for one, am thrilled with the inclusion of allied fields of work into workplace health promotion initiatives, and in fact, contend it’s long overdue. However, this should not negate the good science of what we know reduces health risks. Indeed, my hope is that the industry doesn’t abandon good health science solely in favor of workplace cultural endeavors. Don’t we want an engaged, happy workforce with various tools to expand and reinforce that? Indeed, employers should be able to confidently craft a solution that supports healthy culture with integrated systems that also offer the best in evidence-based health improvement. In my eyes, the most encouraging way forward is “big E” AND “little e”.


Tanya Dillard, Director of Health Promotion and Education, is a mother, fitness instructor, and fantasy football dominator. When not at her desk, she is likely skiing in the mountains of Colorado.

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