As employers adjust benefit offerings to address the needs of all employees, health equity and social determinants of health have become an increasingly important priority.
When people think about their health, they often consider factors like blood pressure, diet and level of physical activity — not their home zip code or the reliability of their car.
So, it may come as a shock to most that studies show medical care determines only 20% of overall health, while a combination of social, economic and environmental factors play a far bigger role, accounting for 50% of overall health.
Employers strive to offer uniform benefits to their employees, but it’s not an equitable comparison if one worker lives in a food desert, or another bypasses health services to pay for childcare.
These social determinants of health (SDoH) — income, community, transportation, literacy, housing, among others — significantly impact whether an employee can obtain equitable access to healthcare.
“Vulnerable populations often have a higher mortality rate, higher risk for disease complications, and these otherwise underlying health conditions that have been influenced by the environment and socioeconomic status of individuals,” says Rebecca Berlin, a health coach at Marathon Health.
Increasingly, the concepts of health equity and SDoH have become more prevalent in health plans as employers adapt benefit offerings to address the needs of all employee groups.By strategically targeting the inequities in how health policies and disease management impact workers, employers can create a more just system while improving employee health.
What is Health Equity and Social Determinants of Health?
Before we dive into strategies to tackle health inequities in the workplace, let’s define what we mean by health equity and SDoH.
According to the Centers for Disease Control and Prevention (CDC), “Health equity is achieved when 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.”
The CDC defines social determinants of health as “conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes.”
How can Employers Identify Barriers to Healthcare Equity?
Employers have long relied on employee surveys and assessments to uncover population risks like high blood pressure, diabetes and unhealthy lifestyle habits. Nowadays, they increasingly incorporate socially informed screening questions to identify needs and inequities, so they can connect employees with local health departments, community health resources and social services.
“Employer surveys might ask, ‘What services do you need more convenient or affordable access to? Food, medication, housing? Is there an immediate threat to your housing, transportation or personal safety (abuse at home/work)? Are you behind on your mortgage?’ These are the kinds of things we can draw from questions regarding someone’s home life, socioeconomic status, and personal safety,” Berlin says.
The American Academy of Family Physicians (AAFP) developed a screening tool that includes validated questionnaires to assess five core health-related social needs, which include housing, food, transportation, utilities and personal safety, as well as the additional needs of
employment, education, childcare, and financial strain.
Employers can also spotlight health inequities and unaddressed social needs by analyzing their electronic medical records (EMR) and claims data. For instance, employers may examine where clusters of employees live to determine if they can conveniently access a grocery store or pharmacy. Additionally, a high number of referrals to mental or behavioral health services may indicate the need for a dedicated therapist.
How can Employers Ensure Health Equity for Employees?
As a benefits leader, it’s important to note how employers play a bigger role in promoting employee health beyond offering robust benefits and services. In fact, a recent study found workers trust their employers to be a top source for obtaining accurate health information, second only to national health authorities.
Bottom line: Employers need to take the lead in offering equitable health benefits. Consider the following tips to address health equity and the SDoH:
Regularly evaluate health benefits and services: Employers should regularly take inventory of their health offerings and analyze employee surveys and assessments to ensure available services cover the population’s evolving social needs.
Many organizations saw an increased need for behavioral and mental health services caused by the pandemic. To address the need, they took measures like adding a behavioral specialist to their worksite health center, offering virtual access to behavioral support and covering all related expenses for mental health treatment.
Communicate health benefits and remove barriers: In addition to clearly communicating available services, employers need to ensure all employees, from the CEO to assembly line workers, enjoy equal access to care and services.
As the Human Resources Director for Chatham County, Georgia, Carolyn Smalls says the County brings health screenings, health coaches and other needed services directly to the job site to accommodate workers who would not otherwise take the time to seek these services at the County’s Marathon Employee Health Center. Additionally, the County allows employees to access the health center during work hours and without using PTO.
“Going directly to where people are was a big factor in letting employees see that it’s okay to engage a provider around your health,” Smalls says.
Expand benefits to address social and environmental needs: Besides regularly evaluating current benefits and services, employers also need to act on their employees’ most critical social needs.
Frank Alexander, Manager of Health & Welfare Benefits for ConocoPhillips, says the company implemented several policies to accommodate employees in remote areas who lack access to high-quality health services. He says they now offer virtual access to expert second opinions from medical professionals, and reimburse travel and lodging expenses for plan participants and one adult companion if they need to travel to a center of excellence.
“It doesn’t matter where an employee lives in the country,” Alexander says. “If they are faced with a significant healthcare challenge, they have access to the best medical care and the best experts anywhere in the country. For many of these programs, there’s no expense to our participants.”
Overcome healthcare stigmas: Various social stigmas prevent employees from seeking needed care, which exacerbates existing problems and increases the risk of preventable diseases.
In fact, one study found nearly 40% of employees reported bypassing needed mental health services out of fear of shame and embarrassment.
Berlin says employers can overcome stigmas by being inclusive and sensitive to employees’ societal needs, asking employees to share their positive experiences from engaging with health care and promoting a top-down strategy where senior executives not only access the same health services but actively promote them to all employees.
This article is the first in a four-part series on how employers can deliver an equitable healthcare experience for all employees. Throughout the series, we’ll explore how health risk assessments and employee surveys can uncover health barriers, examine how to destigmatize healthcare in the workplace — especially mental healthcare — and discuss strategies to make employee healthcare more equitable and accessible for all.