When teachers and other school staff in West Virginia walked off the job in 2018, news coverage of the historic strike focused on bread-and-butter issues like their rising health-care premiums and low wages. There were horror stories of teachers working extra jobs and struggling to pay for emergency medical costs. But there were other galvanizing factors that, though less discussed, were no less galling—indignities that have become increasingly familiar to workers across the country.

As Brandon Wolford, a teacher from Mingo County, West Virginia, told a packed room at the LaborNotes conference in Chicago last year, he and his coworkers were moved to action when they were required to either pay a fee or participate in a workplace wellness program called “Healthy Tomorrows,” which penalized members for not scoring “acceptable” on a series of biometric measures. “The next thing you know we get a paper in the mail,” he said. “It says you have to go to the doctor by such and such a date. Your blood glucose levels must be at certain amounts, your waist size must be at certain amounts, and if it is not, you don’t meet all these stipulations, then you get a $500 penalty on your out-of-pocket deductible.”

But, Wolford said, it was a subsequent wellness program that really “awoke the sleeping giant.” In 2018, the West Virginia Public Employee Insurance Agency (PEIA), the board that determines health insurance plans for all West Virginia public employees, announced that, in addition to hiking premiums, it was enrolling everyone in a program from Humana, a for-profit insurance company, called Go365. This initiative required workers to participate in screenings and earn wellness points through a variety of activities to avoid incurring fees. Employees could receive points for wearing a Fitbit and tracking their steps or keeping their body mass index (BMI) below a designated threshold. According to Wolford, it also “included private questions such as: How much sexual activity do you perform in a week? Is it vigorous?” Anyone who refused to participate was charged an additional $25 per month—up to a $300 yearly burden for workers who were often making less than $47,000 annually, the fifth-lowest salary rate for teachers in the country.

Go365 was discontinued in the aftermath of the strike. But the scourge of worker wellness programs elsewhere continues unabated, for private- and public-sector workers alike.

A 2018 survey by the Kaiser Foundation found that 82 percent of large companies (those with more than 200 employees) and 53 percent of small companies have an option for some kind of wellness program. Some, like Go365, are obviously punitive, levying up to thousands of dollars in fines on workers who refuse to participate in wellness campaigns or fail to meet certain biometric measures of health. Others have more nebulous “incentives”—a gift card, say, or a discount on gym membership. The line between punishment and incentive, however, is thin. If a worker gets a gym reimbursement for working out six times a month, doesn’t that translate to a material punishment for those with physical disabilities, those who are overworked, and those who simply would prefer not to?