Health inequity is not a concept that everyone is familiar with, but it is an issue that employers need to address.
To understand the inequity part, let's first look at what health equity is. The CDC defines the term as the state in which “every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
When groups of people do not have the same access to healthcare, disease statistics differ.
In an article co-authored by Ellen Kelsay, President & CEO of Business Group on Health, the following statistics demonstrate health inequity.
- Black persons are 30% more likely than non-Hispanic whites to die from heart disease.
- Native Americans and Alaska Natives have an infant mortality rate that is 60% higher than the rate for their white counterparts.
- Hispanic women are 40% more likely to have cervical cancer and 30% more likely to die from cervical cancer than non-Hispanic white women.
- Adults with disabilities are four times as likely as adults without disabilities to report having fair or poor health.
Having data to uncover the issues and then create ways to address them is difficult as there aren’t always ways to understand the full picture of an employee’s health. While data from health plan claims can help, it’s not always broken out into specific groups. For example, some groups have higher rates of different chronic diseases and so solutions should be addressed differently. “As an employer, you don’t always know what is happening in the family that can affect an employee’s health or well-being, “says Kelsay.
One way to get to that information is by having a work culture that is inclusive. For example, many companies have Employee Resources Groups, which are often a source of information about what issues particular groups are facing. “You can leverage these groups to find what people are concerned about and then funnel that information back to your HR or benefits teams and ask how we as a company are addressing them,” explains Kelsay.
Changing View of Workforce
A new way of looking at health is to view it in terms of business operations. Kelsay notes a recent example of Delta Airlines which decided to correlate employee health with productivity. They saw the basic operations were falling short – flights were not going out on time, bags were getting lost, and customer satisfaction scores were plummeting. So, they looked at the correlations between those hubs and health problems. They looked at particular places and invested in the health of the employees to see if this would improve business operations. Within two years the company saw operations turn around and improve. Kelsay says that employees felt more cared for, were happier and did a better job while on the job.
That type of employee investment is something that is increasingly more important to employees. They look to employers to provide strong healthcare in terms of benefits and programs. This is especially true in a tight labor market. “These are becoming almost table stakes for a lot of people when they're thinking about where they want to work. They're asking these types of questions, and this area might be the determining factor in both attraction and also in terms of retention. These benefits might be what keeps them at your company or pushes them to leave.”
Ways to Address Health Inequity
As companies review what programs they have and what they need and how it affects different populations, Kelsay offers advice from an article she co-authored, Employers Can Do More to Advance Health Equity, in the Harvard Business Review.
The authors pointed out four opportunities for employers (excerpted from the article):
Optimize benefits and health plan offering
Some plan designs may inadvertently exacerbate health disparities. One example is co-payments for emergency room visits. Because people from groups that have been marginalized face barriers to accessing primary care (such as a dearth of nearby providers), they may rely on the emergency room for routine medical care. So, cost-sharing efforts may inadvertently worsen health outcomes for employees most at risk of serious complications.
With careful plan design, employers can improve health outcomes. In a randomized clinical trial whose results were published in the New England Journal of Medicine and Health Affairs, patients from racial and ethnic minoritized groups whose employers covered all the costs of their preventive medications after they had suffered heart attacks had 35% fewer major complications than patients with co-payments, and 70% lower total health care costs.
Address social determinants of health
Social determinants of health refer to the conditions in which people are born, grow, live, work, and age that impacts their health. Differences in exposure to the social determinants of health are often at the root of health inequities. These include educational and employment opportunities, access to safe environments, affordable housing, nutritious food, access to care, and social relationships and networks—factors that influence health and occur largely upstream of the traditional healthcare delivery system.
Decades of scientific research reveal that 80% of health outcomes are determined by income level, educational attainment, health behaviors, and environment (transportation systems, workplaces, schools, air quality, and access to clean water and healthful food). The 2021 McKinsey survey found that 65% of the full-time employees of large U.S. employers had experienced at least one unmet basic need.
Expand primary care and mental health access through virtual care and community partnerships
Eighty-seven million Americans reside in communities that lack sufficient numbers of primary care physicians and mental health providers. In addition, many more are impeded from accessing care by barriers such as daytime work, lack of transportation, inadequate childcare, and physical disabilities. Because of these and other factors, nearly one in four Americans does not have a primary care physician, and many mental health conditions go undiagnosed and untreated.
Most large employers today offer free or subsidized virtual health services that have the potential to overcome these barriers. However, those services often do not provide comprehensive primary care and adequate mental health services. So, it’s important for employers to evaluate the virtual services offered by their health plan networks and invest in solutions that offer care that is culturally informed, contextually appropriate, and socially concordant (delivered by clinicians who share a social identity with the employee).
Make benefits and health care easy to navigate
The 2021 McKinsey study found that employees of color were 1.4 to 1.5 times more likely than white employees to find the resources and tools explaining benefits unhelpful, regardless of income level.
Employers can leverage a range of tactics to make benefits easier to navigate, such as using inclusive language and imagery, employing a diverse and representative HR team, and training managers to identify employees with unmet needs and refer them to specific benefits programs. Employers may also choose to invest in a solution that gives employees a single point of contact for all their health and benefits needs.
Economic Cost of Inequity
As part of the research for the article, the authors found that inequities in the U.S. health system cost approximately $320 billion annually and, if left unaddressed, could cost $1 trillion or more a year by 2040.
In addition to the action steps outlined above, the authors suggested a way to start on this path.
- Collect data to understand the problems
- Identify an initial population to focus on
- Engage a broad group of stakeholders to design solutions
- Measure progress to drive accountability and build momentum
Kelsay acknowledges that this is a lot of work for employers. “But don’t let perfect be the enemy of the good. Even if you don’t have a full view of your data, just start with what you have. Take one step forward, even if it’s a small one, as every step forward is in the right direction.”