Introduction

In the aftermath of major transformations in the economic and political systems, which relate to notions of globalization and post-industrialization, increasingly, scholarly and popular attention has moved to ‘flexible,’ ‘innovation-driven,’ ‘explorative’ and ‘entrepreneurial’ organizations. Such organizations are straining traditional management practices and systems of control. Rather than strict technical and bureaucratic regulations, these organizations are said to require a new management paradigm that empowers individuals and encourages responsibility and initiative. On the basis of such observations, the popular management literature has

filled a large quantity of books and journal articles with a multitude of models and ideas that all convey the promise of helping organizations replace traditional modes of control that are based on a technical and formally hierarchical regulation of the work processes with new, subtler forms of managerial influence and authority that seek to win employees’ commitment, dedication, enthusiasm and involvement. Scholarly contributions to this discourse have pointed out that these new types of control operate through shared cultural values and norms (e.g. Halal, 1994; Heckscher, 1994; Hogget, 1991; Volberda, 1998). The notion of ‘corporate culture’ is treated both as an important managerial philosophy and as a technology for instilling devotion to work and to the organization’s mission. Properly managed corporate culture is seen to build a sense of direction into highly informal, ‘post-bureaucratic procedures’ (Kunda, 1992; Savage, 1996). Hence, the main task of corporate managers in contemporary organizations is no longer the direct control of employees, but the institutionalization of shared basic values on the basis of which empowered and self-governed work become possible (e.g. Drucker, 1988; Heckscher and Donnellon, 1994; Kanter, 1990; Mintzberg, 1998). The existing critique of this discourse has primarily addressed issues of

organizational power and individual autonomy and identity. It is commonly argued that the new cultural controls operate not merely ‘on the surface’ of employees, forcing or motivating them to behave in ways which are aligned with corporate visions and goals; they also ‘seep’ into the very identities of individuals, constituting them as particular types of subjects

who manage themselves in accordance with corporate values (e.g. Alvesson and Willmott, 2002; Casey, 1999; Covaleski et al., 1998; Deetz, 1998; DuGay, 2000). Hence, the new cultural controls are regarded as mechanisms of power that make individuals’ freedom of choice not an element to be restricted, but a key resource in the workings of power (Maravelias, 2003). Whereas managerially endorsed cultural programs can be understood as explicit expressions of the ideological function of corporate culture, ‘human resource management’ (HRM) is regarded as the specific representation of certain technologies whose main task it is to substantiate the corporate culture (Casey, 1999; Townley, 1994). In essence, HRM techniques make up ‘appropriate individuals’ who can be trusted with considerable autonomy because they subscribe to the culture of the organization (Alvesson and Willmott, 2002; Covaleski et al., 1998; Townley, 1994). According to this view, HRM techniques such as assessment centers, performance appraisals, attitude surveys, mentoring, etc. discipline employees by accumulating knowledge about them, which can then be used to advise and persuade them to work on themselves in order to even further align them to corporate norms and values. In that HRM techniques are based on knowledge about employees, they exercise a kind of power in organizations that are at once more intimate and intense, and at the same time more invisible and unobtrusive; HRM appears less as an exercise of power and more as a form of care for employees (see Barratt, 2002: 2003; Townley, 1994). It is in this familiar context that the recent phenomenon of worksite

health promotion (WHP) can be explored and conceptualized. Certainly, as stressed by Conrad and Walsh (1992), within the field of organization studies there has been a long interest in the reciprocal relationship between work and health. The majority of studies bear a direct relation to the gradual growth, from the 1920s and onwards, of industrial health programs in large corporations, which institutionalized a corporate medical presence in the workplace and established occupational medicine as a recognized speciality. However, just like these programs, the studies of work and health have addressed problems directly associated with work. A distinction has typically been made between health on and off the job, and a line has been drawn between work and private life. Hence, relatively little interest has been given to how contemporary WHP programs in fact challenge the traditional distinction between work and private life. Furthermore, most studies of work and health have tended to take for granted that health programs are primarily aligned with employees’ interests and that they are instigated by various reform movements and workers’ struggles to expose and reduce hazards related to their work. This has resulted in little attention being given to the other side of the work-health nexus: How employers factor health considerations into workforce management and productivity control. Typical WHP programs such as lifestyle examinations and coaching, accident prevention, risk behavior assessment, help to self-help, etc. indicate that measures which are taken for employees’ health are becoming

2 Introduction

parts of a new, more encompassing form of managerial control of employees. As expressed by Conrad and Walsh (ibid.), the advancement of modern WHP programs may be a sign of a new corporate health ethic that seeks to manage the ‘whole employee’ and especially what the employees may become, the risks they face and the abilities they have to shoulder for developing their selves into a real corporate value. From the 1990s onward, corporate management has come to take an

active role in promoting the health of employees (e.g. MacIntosh et al., 2007; Zoller, 2003). For instance, in the special issue “Managerial Dimensions of Organizational Health: The Healthy Leader at Work” of the Journal of Management Studies, Quick et al. (2007) stressed that “for organizations to maintain their vitality, their productivity, and their competitive edge requires executives and leaders who are healthy, strong, and capable.” Management gurus like Stewart Friedman argue that “people that feel better in all domains of their lives … perform better” (2008a: 112). Such ambitions resound well with the basic tenets of health promotion that is defined as “the process of enabling people to increase control over, and to improve, their health” (WHO, 2010). The definition indicates that health promotion is rooted in a critique of traditional occupational medicine’s restricted focus on individuals’ bio-psychological problems and, in that connection, its treatment of individuals as passive objects. It is commonly argued that long-term health and well-being presupposes, on the one hand, that individuals actively take part in managing their health and, on the other hand, that a holistic focus on family relations, working life, andin particular-lifestyles is used when examining and promoting individuals’ health (Downie et al., 1996; Hanson, 2007). Hence, whether or not an individual can be defined as ‘healthy’ is from this perspective not merely a question of bodily and psychological issues; it is also a question of his or her motivation to work on maintaining and improving desired social abilities and competencies. This view of health-as comprising individuals’ lifestyles and their com-

mitment to become ‘better’—is interesting from the perspective of contemporary work organizations as it stresses an integration of work and private life. In organizations that pursue WHP programs, the ambitions of improving employees’ health and well-being are not limited to the circumstances underlying and circumscribing the work their employees do; they also concern employees’ activities away from work (see Zoller, 2003). WHP programs typically underline the importance of maintaining a balance between the professional and the private lives of employees (MacDonald, 1998). Ultimately, this is not about protecting employees’ health and well-being from the intrusion of work into the sphere of private life. Rather, it is to organize work and private life into a productive balance. According to the discourse on WHP, the professional and the private spheres of life are not assumed to be at odds with each other. On the contrary, ‘healthy individuals’ are typically seen as being able to work harder and longer,

Introduction 3

especially if their work is stimulating-and stimulating work is by itself regarded as positive for individuals’ health (Ziglio et al., 1999; Gillies, 1998). More specifically, four principles appear to be central to such synergies:

First, employees’ situation at work should be approached holistically (Davies and Macdonald, 1998). Management should consider how its decisions affect employees’ lives and whether or not employees’ lifestyles make them up to the challenges that management lets them face. Second, management should further the development of an honest and ‘family-like’ atmosphere where interaction and cooperation between colleagues is genuine as opposed to formal (Hanson, 2007; Wilkinson, 1999). Third, individuals should be empowered with enough autonomy to handle their tasks flexibly and with self-control (Docherty et al., 2002; Kira 2000). Finally, management must respect and secure employees’ need of maintaining a balance between professional life and private life (O’Donnell, 2002). Largely consistent with the dominant management paradigm of corporate cultures, active and self-regulating employees, work should be infused with personal values and genuine motivation and commitment; colleagues should be friends; and cooperation should be informal rather than formal. Together, this makes work a very direct and integrated part of life in general. Through a qualitative case study of the health-promoting activities as

exercised by corporate health experts at the internationally leading manufacturer of heavy trucks, buses and coaches Scania (www.scania.com), this book explores how WHP operates as a specific form of management of employees, expanding the principles of control of corporate culture programs and traditional human resource management techniques. In the Appendix, a detailed account of the research process is proposed. In short, over the course of one year we interviewed 118 persons (including representatives from other companies than Scania); conducted a number of sessions of participant observations; and collected documents and other archival material that were of relevance to the study. The efficiency of Scania’s WHP comes from its potential to establish forms of management and control, which do not appear as or are not presented as management. More specifically, its WHP opens up a subtle and unobtrusive form of exercising power, first, because it comes forth as a form of expert-based care for the employees, and, second, because it does not operate through authoritative directives and instructions, but through the informed and free choices of the employees themselves. In this sense it addresses employees’ potential to manage all aspects of their lives in a committed, energetic and enthusiastic way. The basic observation of our study is that WHP programs are based on an internalization of self-discipline and self-control; WHP instils in employees the proper motivation and the proper knowledge for people to control themselves along the lines of a ‘healthy life’ and a ‘good career.’ In this respect, WHP programs involve much more than reducing health costs and furthering the subjective well-being of single employees; they are

4 Introduction

primarily about controlling productivity by shaping values and attitudes of employees toward lifestyles which are aligned with corporate cultures that reward activity, motivation, self-discipline and responsibility. The book is outlined in the following way: In chapter 2 we discuss lit-

erature on organizational control. In particular we outline the major transformations in organizational control regimes that have taken place during the twentieth century and address how these organizational control regimes are seen by organizational scholars to relate to employees’ health and wellbeing. The chapter suggests how organizational control has generally been taken to be at odds with employees’ health and well-being. However, the review also stresses that with the advent of contemporary ‘concertive’ forms of control in organizations, organizational control, and employees’ health and well-being are increasingly seen as mutually supportive. The concertive control regime breaks with previous control regimes’ sharp distinction between the professional and private self that is seen to underlie its potential of at once generating a more encompassing control of employees’ behavior and of furthering employees’ health and well-being. These points are important for the ideas we put forth in chapter 3, where

we explore literature on health promotion and particularly workplace health promotion. The chapter suggests how contemporary health promotion programs and activities have developed from a critique of the restricted focus of traditional medicine on individual illness and disease, and its lack of attention to the whole life situation of the individual. Furthermore, it stresses how the tendency of health promotion programs and activities to establish non-hierarchical relations between the health expert and the individual around broad lifestyle issues opens up a link to contemporary concertive control regimes. In this sense health promotion and concertive control alike are based on the idea that individuals become healthier and more efficient if they become self-managing and, in that connection, if they are given opportunities to bring together the professional and private spheres of their lives. It is, we suggest, here that health promotion conveys a potential of becoming a significant part of the concertive control regimes of contemporary organizations. For whereas the concertive control regime requires individuals that are able to autonomously govern their work and private lives into a fruitful and healthy balance, health promotion is specifically focused on making up this self-managing and active individual. In order to substantiate the theoretical ideas as outlined in chapters 1-3,

we then go on to explore the interrelations between the worksite health promotion activities of Scania and its production and management system. In chapter 4 we account for the principles of a new production and management system that was established by Scania in the early to mid 1990s. Whereas the old production and management system operated according to traditional ‘technical’ and ‘bureaucratic’ control principles, leading to problems related to employee health and well-being; the new production and management system has emphasized employees’ commitment, activity and

Introduction 5

autonomy in structuring their own work, and has, according to Scania, resulted in a substantially reduced absence due to sickness and poor health among the employees. The ideal employee in the new production and management system is not the traditional, obedient factory worker who willingly does what he or she is told; but an active, social and reflective individual who is able to manage his or her own work and continuously seeks to improve his or her abilities. In chapter 5 we turn toward the Health and Work Environment unit at Scania and account for how it began to develop and grow at about the same time as Scania sought to establish its new production and management system. By emphasizing that employees should remain healthy in the sense of being committed, active and motivated both on and off the job, Scania’s health organization can be seen as a close ally to the new system’s ambition to create a new attitude and mindset among the employees which centers on their ability to manage themselves. We account for this organization’s main policies and its overall organizational structure and functioning, particularly emphasizing the interplay between the health professionals (such as company doctors, ergonomic experts and behavioral experts) and the management team in pursuing health-promoting activities for all of Scania’s employees. In chapter 6 we address how the health organization through its programs and activities both adapts to the demands and requirements of the new production regime, and how it actively tries to shape the basic principles of that regime. Specific attention is given to how the health professionals negotiate with managers in the production line and how they try to contribute to supporting employees to make them able to cope with the new requirements of ‘constant improvements’ that is at the core of the production system. In chapter 7 we turn toward the specific programs and services (e.g. health counselling and screening, and physical exercise programs) that the health organization and its different professionals provide, and we seek to show the social and individual effects that they attempt to bring about among the employees and Scania’s organization. In chapter 8 we conclude the study by outlining how the health promo-

tion activities and programs that we have studied at Scania operate as a specific form of managing Scania’s employees. In all, our study of Scania suggests that concerns for the health of employees and corporate economics do not lead in two different directions, but may in fact be joined so that measures taken for the health of the employees become directly linked to the measures taken for the economic well-being of the corporation; not only or even primarily in the sense of reducing costs for absence due to sickness, but rather in the sense of creating more committed, able and motivated employees who are willing to work hard in order to execute the principles of modern management. Our study furthermore suggests that the link between employees’ health and corporate economic concerns are provided through a new form of managing employees, which is defined by a caring and therapeutic ethos. We conclude that although this new management regime has

6 Introduction

considerable potential to make way for at once more efficient forms of work, it also conveys risks of making ill-health and incapacities to perform one’s work a result of employees’ moral inadequacies. In chapter 9, finally, we discuss the broader social and political implica-

tions of the health-oriented management regime that we have studied. This discussion centers on the notion of ‘employability,’ i.e. individuals’ capability of gaining and maintaining employment, thus stressing their ability to be self-sufficient actors that draw on an appropriate set of skills, experiences and attitudes. A reason as to why some groups of the working population are excluded from the regular labor market is because of the fact that they are considered ‘unhealthy,’ ‘disabled,’ or in some other way ‘unfit for work.’ Hence, not only is this group of individuals seen as lacking in certain skills and abilities, their shortcomings also concern their health. Rather than turning this trend around, the increased significance of the health promotion discourse in contemporary working life may fuel this development by changing norms of ‘employability.’ The discourse’s inclination to treat individuals’ lifestyles and personal characteristics as key features of their health, well-being and employability, implies that ‘unhealthy lifestyles,’ ‘passivity’ and a general inability to manage oneself, may become signs not only of illness or disability, but also of un-employability.