A Chief Health Concern

The lifestyle of a C-suite executive often carries health risks far tougher to manage than seen in the work force at large, potentially exposing the entire organization to risk. Finding the right solution, though, is not without its own challenges.

By Dennis Boone

Consider the CEO and the Bus Driver. Each spends a disproportionate number of hours every day doing something that health counselors discourage—sitting.

At the end of his shift, the Bus Driver will go home. The CEO, by contrast, might be just getting warmed up at 5 o’clock. If he works for a large corporation, that could mean meetings that run into the night, grueling business travel or black-tie fund-raisers that cut into a full night’s sleep needed before the next day’s early-morning breakfast meeting. If she’s a small-business owner, it might mean dashing off to manage after-school activities for the kids, tackling a Pike’s Peak of accrued paperwork whose deadline clock is ticking down, or trying to plug leaks in everything from operations to administration to marketing to accounts receivable.

So, unlike the Bus Driver—who can assume the position on the couch to catch up on back episodes of “The Walking Dead”—the C-level exec must confront an entirely different set of health risks. Many of those, health professionals say, are related to the additional stresses that go with the responsibilities of being a decision-maker.

So whether it’s because they’re too busy, work too many hours, develop poor eating habits or skip time at the gym to focus on business duties, many executives face significant health challenges grounded in the type of job they have, and coronary issues are a key concern.

“There are a few studies that show higher risk factors for heart disease” among executives, says Ravi Govila, a physician who serves as chief medical officer for Blue Cross Blue Shield of Kansas City. “The added responsibility often equates to increased work, which is associated with increased stress and anxiety, commonly associated with more time behind a desk or computer.”

Whether they’re in the office early or staying late, Govila said, executives are too often dedicating to their workloads the little time they have to attend to their own fitness and health issues. “Another component we shouldn’t overlook in winding down from a stressful day is alcohol,” he said, which can open the door to a new array of risks.

Richard Moe, a physician who runs the executive health program for Saint Luke’s Health System, said his operation conducts about 200 detailed, day-long health assessments for business leaders every year.

“I would say the executives who come to our program are very driven by responsibilities to their businesses and to the people who work for them,” Moe said, “and they tend to ignore their health, and tend to not be involved in physical activity or stress-relief activities. Quite a few I see don’t see anybody else—they don’t have a primary-care doctor, and have no interest in a primary-care doctor. Some are compulsive about work and health, but on average, they don’t take care of themselves.”

But many seek him out because they’ve hit a tipping point with their personal health.

“We are dealing with people who have caved in to the idea that they ought to have some kind of check-up,” Moe said. “I can’t speak for those we don’t see or know, but with the ones we do see, it’s not uncommon that they begrudgingly come and check—somebody says to them ‘You need to do this or that,’ whether it’s a spouse or a board, because they want to make sure that person’s health is good.”

Corporate wellness programs, though, rarely tend to focus on conditions that ail the C-suite; they are largely aimed at raising the health scores of a company’s broader work force, from owner to janitor. As a consequence, research on health issues specific to executive populations is scant. But one oft-cited study, conducted by a cardiologist at Tufts University in 2000, showed that senior executives indeed flirted with higher risk of heart disease than people in other organizational roles. A more recent study on behalf of Apollo Life found that:

  • Among CEOs, nearly 59 percent carried a high cardiac risk, nearly 36 per-cent were at risk of hypertension and nearly 13 percent for diabetes. More than 23 percent had high blood cholesterol and more than 10 percent had existing heart problems.
  • CEOs faced a slightly higher risk of heart attack than other executives, but a significantly higher risk of hypertension.
  • More than 82 percent were overweight, and nearly 70 percent were classified as physically unfit.

Those are big concerns for the executives themselves and their families, of course. But they also affect shareholders, partners and employees who depend on those key personnel to drive business growth, profitability and employment.

And the health of those at top leadership levels extends beyond the corporate boardroom:  What are the odds that two former presidents who served back to back—Bill Clinton and George W. Bush—would both undergo cardiac stent implants within a three-year period? Neither underwent the procedure while in office, (Clinton’s was in 2010, six years after his quadruple bypass; Bush’s was in 2013), but both had long-developing cardiac issues that were likely present when each was serving as America’s chief executive.

The potential impacts of heart failure in either case could have had profound—even global—implications. For American businesses, though, the implications are just as threatening: Every company, from Fortune 500-level to small business, has a tremendous risk exposure if the health of its senior managers isn’t part of the strategic planning process.

Executive risks, of course, aren’t limited to cardiac issues, or even matters of physical health, as we saw with Micron’s Steve Appleton, who died in 2012 while flying an experimental aircraft, or former Amazon CFO Joy Covey, who died after a bike accident in 2012.

But the health status of C-suite executives came sharply into focus when Apple’s Steve Jobs underwent a liver transplant in 2009, four years before his death. The consequences of his failing health showed up when the company’s stock would rise and fall on reports of his flagging or improving condition. The same was true when lung cancer killed the CEO and chairman of Coca-Cola, Roberto Goizueta, in 1997.

Heart issues among senior corporate leaders present immediate challenges to companies because they can prove fatal without warning, as when Wendy’s International was caught without a designated successor after a heart attack killed CEO Gordon Teter in 1999. Other companies suddenly deprived of a CEO because of heart attack were Dallas Semiconductor Corp. in 2000 (Vin Prothro), McDonalds’s in 2004 (Jim Cantalupo), and the family-owned makers of Tabasco sauce (Paul McIlhenny) and Analog Devices (Jerald Fishman), both in 2013.

Those are not entirely isolated incidents; a 2012 white paper by Stanford University’s Graduate School of Business noted that, on average, seven CEOs of publicly traded companies die each year, and publicly traded companies make up a tiny fraction of U.S. businesses overall.

That same study noted that if companies fail to address succession plans before a chief executive’s death, they tend to suffer direct, negative effects on organizational performance, and the longer the succession period, the greater the risk to future operating results.

“When a CEO passes away, two distinct events occur,” the Stanford researchers said. “The first is the announ-cement of the death itself. The second is the announcement of the successor. The price of a company tends to go down following news of a CEO’s death if the CEO is seen as a strong leader or vital to the company, and it tends to go up if the CEO is seen as entrenched, a poor leader, or inhibiting a sale of the company.”

The study cited previous findings that showed of 161 CEO deaths from all causes over a 22-year period, half (81) came without notice, and nearly half of those (39), were the result of heart attacks.

The question is: What can companies, large and small, do to minimize the risk exposure?

Sensing an emerging niche market, area medical centers, including the University of Kansas Hospital and North Kansas City Hospital, have joined Saint Luke’s in developing executive fitness programs of their own. Like Saint Luke’s, though, a lack of statistically meaningful population data specific to the C-suite is hard to come by at this point.

“We have no specific data on executives,” says Deb Hall, manager of the occupational health division for North Kansas City Hospital. “What we’re finding as we talk to employers about wellness programs is that it’s a huge topic now. Most of the executives we see are being pulled into overall wellness programs set up by the company,” she said, pointing to large employers like Cerner and Hallmark as examples.

Like many other companies, she said, they are discovering the power of executive engagement with corporate wellness initiatives. “When their executives are part of the program, what we find is employers are saying that employees want that buy-in at the top, to know that they’re all included and that ‘we’re a team, were in this together.’”

That sense of shared pain is important, she said.

“It’s all part of a need to look at the health and well-being of all employees; all companies are looking at improving overall costs, lowering premiums, and the goal is keeping people healthy,” Hall said. “That starts at the top. One company we worked with recently had a weight-loss program with the executives buying in at the beginning, but once they dropped out, the whole thing fizzled. It really is true: With the executives buying in, it’s almost like parent with a child and showing them with your example.”

One other factor that can lead to success, Govila noted, is the inherent drive among many executives to succeed at whatever they do.

“One of the challenges for designing any program is the need to take strategic approaches to address larger populations,” he said. “Anecdotally, executives tend to be somewhat competitive in nature, so introducing programs that have a competitive component
can improve outcomes, and the Fittest
Execs & Fittest Companies Challenge”—launched by Ingram’s in 2009—is that type of program.”

Moe also believes that work site programs only work if the top of management is engaged.

“If not, if they check it off their list as something they needed to do it, those don’t go as well,” he says. “Upper management is what makes or breaks it, just from the buy-in.”

Other failure factors, he said, stem from one-size-fits-all approaches. “Those have trouble being universally successful because they are not tailored to one person at a time,” Moe said. “It’s like a diet book that makes sense, but it’s not written to you, it’s written to a group” and the different motivations each person brings to their own fitness goals can render those programs ineffective.”

Beyond that, companies can promote the fitness of executives and rank-and-file alike, Hall said, by taking a harder look at ways to incorporate fitness into work routines and settings. Even little things, collectively, can make a difference in the aggregate.

“The thing we’re seeing with more companies do with people at a desk is changing the structure of that desk,” she said. “If you stand, it’s better, and we’re seeing more offices where employers have computers at various levels to accommodate use while standing. We haven’t seen the treadmills, yet,” she says, “but we have read about them, at larger companies’ going to where executives are standing on treadmills and walking part of the day.”

Beyond the potential savings that can come from lower premiums on employer-sponsored health-insurance plans, health professionals note that companies could realize a huge return on any dollar invested in ensuring C-level wellness.

“I think the amounts that many corporations expend on some of their C-level executives,” Govila said, “is an investment that would be minimal compared to what they stand to lose with a CEO going down because of a health–related condition.”