Wellness started as a big idea about thriving before office programs made it small

Key takeaways

• In 1959, Halbert Dunn, the federal official in charge of counting births and deaths, gave 29 talks on “high-level wellness” that became a 1961 book.
• John Travis opened a wellness center in Mill Valley, California, in 1975, and Bill Hettler created his six-dimension wellness model in 1976.
• A 2019 study put workplace wellness coverage at more than 50 million U.S. workers, and in 2025, 83% of larger firms that offer health benefits had at least one program.
• Two large randomized trials, at BJ’s Wholesale Club and the University of Illinois, found no significant effect on medical spending, clinical measures or job performance.
• Before you join any wellness program, ask whether it changes your surroundings or only asks you to change, and who sees your data.

In 1959, a government statistician began a series of 29 talks at a Unitarian church in Arlington, Virginia¹. The talks were also aired on the radio¹. His subject was not death rates or census tables. It was something he called “high-level wellness”¹.

The speaker, Halbert Dunn, had run the nation’s office of vital statistics, the system that counts births and deaths, since 1935¹. Now he wanted people to think about the other end of the scale: not just avoiding illness, but living at full capacity.

His idea took off. In 2019, a team of economists wrote that workplace wellness programs covered more than 50 million U.S. workers¹⁰. An industry research group valued the global wellness economy at $6.8 trillion in 2024¹⁵.

But when researchers finally put workplace programs to rigorous tests, the results were humbling. If you value prevention and self-care, the story of how a big idea shrank is worth knowing. It shows which parts of “wellness” deserve your time and money.

A man who counted deaths set out to describe thriving

Dunn trained as both a doctor and a scientist. He earned a medical degree in 1922 and a Ph.D. in 1923 at the University of Minnesota, then taught biometry, the statistics of living things, at Johns Hopkins¹. In 1935 he became chief of the National Office of Vital Statistics, the forerunner of today’s National Center for Health Statistics¹.

He tried out his wellness ideas on professional audiences in 1957 and 1958¹. The church talks followed, and in 1961 he collected them in a book titled High-Level Wellness¹.

His definition was dense. High-level wellness, he wrote, is “an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable”¹. In plain words: wellness means growing toward your best, not just staying out of the hospital.

The idea had a cousin. The World Health Organization’s constitution, signed in 1946 and in force by 1948, already described health as “complete physical, mental and social well-being,” not merely the absence of disease². Dunn added motion. In his framing, wellness was less a finish line than a direction you could keep moving in.

He also had blind spots. Philipp Hauß, writing in a German history journal in 2014, notes that Dunn’s book lacks precise terms and blends medicine, politics, psychology and mysticism¹. Dunn even floated testing leaders in politics and business for wellness as a guard against another Hitler¹.

The idea was inspiring, and it was also vague. That vagueness would matter later.

A California clinic and a Wisconsin campus gave wellness a home

The book found its most important reader by chance. John Travis, a doctor who had worked for the U.S. Public Health Service, had developed one of the first computerized health risk assessments, a questionnaire that estimates your odds of future illness¹.

While he was a visiting scholar in preventive medicine at Johns Hopkins, he reportedly found Dunn’s book on a bargain table¹. At first, Hauß reports, Travis thought the word “wellness” would never catch on¹.

He changed his mind. In 1975, Travis and psychologist Bonnie Burdett opened the Wellness Resource Center in Mill Valley, north of San Francisco, which Hauß calls the world’s first wellness center¹. Clients paid $1,500 for an eight-month outpatient program, and the center took about 80 people a year¹. Courses covered nutrition, self-responsibility and fitness, but the main focus was stress control, with tools such as biofeedback, meditation, massage and saunas¹.

The idea spread to the Midwest. Bill Hettler, a staff physician at the University of Wisconsin–Stevens Point, drew on the work of Travis and author Donald Ardell⁴. In 1976, Hettler developed the Six Dimensions of Wellness model³. The next year, Fred Leafgren and colleagues launched the first National Wellness Conference, and the National Wellness Institute grew out of it, with Hettler as a co-founder³.

Hettler’s model has six parts: emotional, physical, intellectual, occupational, spiritual and social⁵. It describes wellness as functioning at your best in your current surroundings, and as a conscious, self-directed process⁵. It is a framework for reflection, not a medical test.

One detail shows where wellness went next. The National Wellness Institute and the Wellness Council of America now operate together as the Wellness Alliance⁶. The Alliance is an affiliate of the International Foundation of Employee Benefit Plans⁶. An idea first aired in a church hall now lives largely at work.

What “wellness” adds to “health”

The two words overlap, but they point in different directions. Here is our own side-by-side, drawn from the founders’ writing and the six-dimension model.

Question	“Health” in everyday medicine	“Wellness” as its founders used it
Starting point	Is something wrong?	How far can you grow?1
Who leads	A clinician diagnoses and treats	You set the direction5
Time frame	A visit, an illness, a recovery	A lifelong process5
Scope	Mostly the body, checked by tests	Six areas, including work, meaning and community5
How it’s measured	Lab values, scans, diagnoses	Mostly how you feel and function
Biggest strength	Clear proof when a treatment works	Puts prevention and purpose first
Biggest risk	Can ignore life outside the clinic	Can turn into a shopping list or a moral duty7

The last row matters most. Both ideas can fail you. Medicine can miss the life around the disease. Wellness can drift into buying things or blaming yourself.

Employers bought the idea by the billions

Over time, wellness found its biggest customer: the employer. Companies hoped healthier workers would cost less to insure and miss fewer days.

The law helped. The Affordable Care Act let employers offer wellness rewards worth up to 30% of health insurance costs⁹. In 2019, NPR described workplace wellness as an $8 billion industry in the United States⁹.

The programs are now common. In KFF’s 2025 survey of employers that offer health benefits, 56% of firms with 10 to 199 workers and 83% of larger firms offered at least one wellness program, such as help to quit smoking, lose weight or change habits¹⁴.

Many also screen. Among larger firms, 53% offer a health risk assessment and 43% offer biometric screening, meaning checks such as blood pressure and cholesterol¹⁴. Of the larger firms that screen, 62% use rewards or penalties to push workers to take part¹⁴.

Earlier studies had often reported big savings¹⁰. Most of them compared people who signed up with people who didn’t. That turned out to be a serious flaw.

Two large trials put workplace wellness to a fair test

A randomized trial assigns people to groups by chance, like a coin flip. The groups start out alike, so any later difference is likely caused by the program.

The Illinois study. Economists Damon Jones, David Molitor and Julian Reif randomly chose which of nearly 5,000 University of Illinois employees would be offered a program called iThrive¹⁰. It included screenings, an online health questionnaire, wellness activities, paid time off and cash rewards of up to $650 over two years¹⁰. In the first year, 56% of those offered the program completed the screening and questionnaire¹⁰.

After more than two years, screening rates were higher. But the program had no significant effect on medical spending, other health habits, productivity or self-rated health¹⁰. The results ruled out 84% of earlier estimates of savings on medical costs and missed work¹⁰.

A follow-up in JAMA Internal Medicine found no significant effect on clinical measures, diagnoses or medical use at 24 months¹¹. One bright spot: more people offered the program said they had a primary care doctor, 92.2% versus 86.1%¹¹.

The BJ’s trial. Zirui Song of Harvard Medical School and Katherine Baicker of the University of Chicago studied 160 BJ’s Wholesale Club locations with nearly 33,000 workers⁸⁹. Twenty sites were picked at random to offer eight wellness modules taught by registered dietitians⁸.

After 18 months, workers at those sites were more likely to say they exercised regularly (69.8% compared with 61.9%) and actively managed their weight (69.2% compared with 54.7%)⁸. But there were no significant differences in 10 clinical measures, including blood pressure, cholesterol and body mass index⁸. Health spending, absenteeism, job tenure and job performance didn’t budge either⁸. The average worker finished just 1.3 modules⁸.

Defenders of wellness programs raised fair points. A JAMA editorial said broad programs like this one may lack the intensity, duration and focus on higher-risk workers needed to make a difference⁹. Eighteen months is also short. Still, two independent trials with different designs reached the same answer.

Where workplace wellness shows more promise

The trials don’t mean every program fails. They tested broad programs aimed at everyone. Targeted help for people who are already sick may be different.

A RAND Corporation study of seven years of PepsiCo’s program, with more than 67,000 eligible workers, looked at disease management¹². That means helping people manage chronic conditions they already have. It saved $136 per member per month, and participants had 29% fewer hospital admissions¹².

The lifestyle part of the same program did not save more than it cost¹². This was an observational study, not a randomized one, so the savings need confirming.

A 2024 study from the University of Oxford points the same way for mental well-being. William Fleming analyzed survey answers from 46,336 workers at 233 British organizations¹³. Workers who joined mindfulness sessions, resilience training, stress classes or wellbeing apps were no better off than coworkers who didn’t¹³.

It was a survey comparison, not a trial, so it can’t prove these offerings fail. Fleming concluded that employers likely need to change schedules, management and job design, not just the worker¹³.

Critics say wellness hands you the whole bill

Long before these trials, some scholars worried about the idea itself. In 1980, the scholar Robert Crawford gave that worry a name: “healthism”⁷. He meant treating personal health as the main road to a good life, pursued mostly through lifestyle change⁷.

Crawford saw real value in the holistic and self-care movements of his day. They challenged mainstream medicine and gave people meaning⁷. But he warned that healthism puts both the problem and the fix inside the individual⁷.

That can turn illness into personal failure. It can also make shared problems, like unsafe jobs or polluted neighborhoods, look like private ones⁷. He urged people to pair personal effort with collective action⁷.

The consumer side has grown since. The Global Wellness Institute’s $6.8 trillion estimate spans 11 sectors, and wellness real estate and mental wellness grew fastest from 2019 to 2024¹⁵. Our article on the history of natural health movements looks at that figure more closely.

None of this argues against caring for yourself. Self-responsibility, prevention and a whole-person view are values many natural-health readers have held for decades, and self-responsibility was on Travis’s course list from the start¹. The point is that personal effort works best on solid ground: time to sleep, safe places to walk, food you can afford and work that doesn’t grind you down.

What the evidence shows

Claim	Rating	What the research found
Broad workplace programs lower medical costs within about two years	Evidence says no	Two randomized trials found no significant savings810
They improve blood pressure, cholesterol or weight in the short run	Evidence says no	No significant change in clinical measures at 18 or 24 months811
They nudge some habits people report themselves	Promising but early	More self-reported exercise and weight management in one trial, no change in other habits in the other810
Disease management for people with chronic illness saves money	Promising but early	Savings and fewer hospital stays in one large observational study12
Individual mental-wellbeing offerings at work lift well-being	Not enough evidence	A large survey found participants no better off; trials are needed13
The six-dimension model is a tested way to measure wellness	Not enough evidence	A useful map for reflection, built as a framework rather than tested as a measure35

How to choose a wellness program worth your time

Use this scorecard for an employer program, a gym challenge or a community class. Give yourself one point for each yes.

1. Does it change your surroundings, not just you? Walking breaks, better cafeteria food or flexible hours count. Fleming’s findings suggest this is where gains are likelier¹³.
2. Does it target a real need you have? Help with a diagnosed condition has a better track record than generic tips¹².
3. Does it include repeated contact with a person? A dietitian, coach or group that meets regularly beats a one-time module. Workers in the BJ’s trial averaged 1.3 modules⁸.
4. Can you say no without paying much? Ask whether skipping a screening raises your premium. Many larger firms tie screenings to rewards or penalties¹⁴.
5. Do you know who sees your results? Ask in writing whether a vendor holds your data and what your employer receives. Our guide to health app privacy explains why the usual medical privacy rules may not apply.
6. Does it judge itself fairly? A program that boasts about participants’ savings, without comparing them with similar people, may be counting the healthy-joiner effect¹⁰.
7. Does it fit your values and budget? Free and enjoyable beats costly and dreaded.

Five or more yeses: worth trying. Three or four: take what’s useful, such as a free screening. Two or fewer: a walking group or a friend who meets you at the gym may serve you better.

Questions readers ask

The bottom line

Wellness began as a generous idea: health is more than the absence of disease, and everyone can keep growing. Over six decades, much of it got packaged into screenings, apps and small rewards. When researchers tested those packages fairly, they found little change.

Keep the original idea, and be choosy about the packages. Programs that change your surroundings, help with a real condition or give you steady human support are worth a look. The rest may mostly be measuring who was already well.

Related reading

• From a $20 herbal patent to a $6.8 trillion wellness economy
• People come to wellness groups for answers and stay for belonging
• Behavior science tested its own tricks at scale, and rewards and repetition held up
• Walking clubs work, and you need fewer steps than you were told
• What protects your data when HIPAA doesn’t cover most health apps

Sources

1. Hauß P. “Die Geburt der »Wellness« aus dem Geiste der Statistik: Halbert L. Dunns Suche nach dem Gleichgewichtskontinuum.” Zeithistorische Forschungen / Studies in Contemporary History, vol. 11, 2014, pp. 478–484. doks.zeitgeschichte-digital.de
2. Grad FP. “The Preamble of the Constitution of the World Health Organization.” Bulletin of the World Health Organization, vol. 80, no. 12, 2002. scielosp.org
3. National Wellness Institute. “About NWI.” Accessed October 2026. members.nationalwellness.org
4. University of Wisconsin–Stevens Point, School of Health Sciences and Wellness. “About.” Accessed October 2026. uwsp.edu
5. Wellness Alliance. “Six Dimensions of Wellness” and “Wellness Defined.” Accessed October 2026. wellnessalliance.org
6. Wellness Alliance. “About Us.” Accessed October 2026. wellnessalliance.org
7. Crawford R. “Healthism and the medicalization of everyday life.” International Journal of Health Services, 1980; read in Portuguese translation, Reciis, vol. 13, no. 1, 2019. pubmed.ncbi.nlm.nih.gov
8. Song Z, Baicker K. “Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial.” JAMA, vol. 321, no. 15, 2019, pp. 1491–1501. pubmed.ncbi.nlm.nih.gov
9. NPR. “How Well Do Workplace Wellness Programs Work?” April 16, 2019 (via VPM). vpm.org
10. Jones D, Molitor D, Reif J. “What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study.” Quarterly Journal of Economics, vol. 134, no. 4, 2019, pp. 1747–1791 (accepted manuscript). par.nsf.gov
11. National Bureau of Economic Research. “Illinois Workplace Wellness – Results” (including Reif J, et al., JAMA Internal Medicine, 2020). nber.org
12. RAND Corporation. “Workplace Wellness Programs Can Cut Chronic Illness Costs; Savings for Lifestyle Improvements Are Smaller.” News release on a Health Affairs study, January 6, 2014. rand.org
13. Wellbeing Research Centre, University of Oxford. “More ambition needed to improve workplace wellbeing” (on Fleming WJ, Industrial Relations Journal, 2024). January 2024. wellbeing.hmc.ox.ac.uk
14. KFF. “2025 Employer Health Benefits Survey.” October 22, 2025. kff.org
15. Global Wellness Institute. “Wellness Economy Statistics & Facts” (Global Wellness Economy Monitor 2025; industry estimates). 2025. globalwellnessinstitute.org