Thursday, Sep 22, 2022

Employer Strategies for Equitable Healthcare

Tanya LittleChief Commercial Officer, Vitality

HLTH Foundation

Prior to the COVID-19 pandemic, more than 57% of women participated in the US workforce. While both men and women suffered a 3% drop in labor force participation at the height of the pandemic, men have returned to the workforce at higher rates than women, with an estimated 1 million women still missing from pre-COVID workforce levels.


Moreover, for those women that remain in the workforce, the struggle is real. McKinsey research shows that working mothers (75%) are more likely than fathers (69%) to have mental health concerns. This is confirmed by Vitality’s member mental health assessment data which shows a 5% increase in women reporting moderate to high mental health risk scores throughout the course of the pandemic, compared to a 3% increase for men. Equally, we saw a 28% overall drop in physical activity in our members during COVID lockdowns, with women struggling to keep up their activity levels when compared to men, recording 32% fewer fitness points on average.


In addition to the impact on physical and mental health, the pandemic highlighted additional systemic challenges that make it harder for women to thrive both in the workplace and at home. These include hidden disparities in employer health and wellness benefit offerings, lack of access to childcare and/or high costs—made more burdensome by the gender pay gap—and the always-on nature of remote work. As we’ve seen time and again, this is an even greater issue for women of color.


Because women are integral to the workforce, employers have a unique opportunity to help optimize their health and productivity. This can also have a broader impact on families and society given the role women typically play as caregivers and household decision makers, and the fact that physical, mental, and financial health are inextricably linked. To shift the wellbeing of women in a meaningful way, employers need to consider their potentially significant role as societal influencers in equity for women and re-examine not only the benefits they are offering, but also other factors related to the environment in which these benefits are offered. 


Meeting employees where they are


Well-being initiatives often appeal to the fit and healthy, leaving behind those who most need help, notably individuals facing health challenges and environmental barriers to engagement. To achieve real impact, well-being initiatives must go beyond boosting motivation, and attempt to understand the dimensions of opportunity and capability for diverse sets of employees.


E. & J. Gallo Winery is an example of an employer that has made strides to engage, connect and support their diverse workforce of 7,000 blue- and white-collar employees. One of the largest wineries in the US, the organization ensured that its workers had access to healthcare at their on-site clinic, which served as a central hub of health information to on-site workers and remote workers alike. Gallo has also been working hard to engage its diverse workforce, who work long hours and represent different cultures. 


One strategy Gallo implemented was inviting employees to serve as advocates that deliver messages across the organization to build trust and create inclusive engagement. A top down approach isn’t always effective. People trust the folks they work side by side with and Gallo’s employee advocates serve as important conduits to health and wellness information and encouragement.


When clothing retailer American Eagle Outfitters closely examined the demographic, personal and community data for its employees, the company discovered that essential workers in its distribution centers in Hazleton, Pennsylvania opted out of health insurance, while the Ottawa, Kansas facility had high rates of emergency room visits. American Eagle noted that these communities were also located in food and healthcare deserts. 


In response, the company added healthcare centers in both locations to give employees affordable access to care, and hired a Spanish speaking nurse in Hazelton, since 80% of the employees there were Dominican.  


When the company discovered a lack of access to public transportation between the Hazelton facility and the community where the majority of employees lived, executives worked with public transit authorities to create a convenient and affordable bus route.


When employers address the broader socio-economic issues impacting their employees, it not only benefits the communities where they live and work but ensures a healthier and more productive workforce.


The power of messaging and framing


Employers can address socio-economic issues and offer the most robust benefits packages in market, but if benefits aren’t communicated properly, they will remain underutilized and unappreciated. When it comes to benefits, the rule is: over-communicate what benefits exist, and why they are important. However, this is not sufficient as a sole strategy, especially for people facing significant barriers to achieving their health goals and those who historically have been underserved in healthcare. 


To understand how to maximize the likelihood that employees will take an interest in their health, Vitality recently collaborated with behavioral scientist Hal Herschfield, Professor of Marketing, Behavioral Decision Making, and Psychology at UCLA. We found that what, how, and who are all important factors in influencing employees’ health behaviors:


  • Keep messages simple 
  • Use a trusted source for communications
  • Clearly outline a limited number of next steps rather than providing a laundry list of possible actions, for short-term and long-term impact
  • Tailor communications wherever possible
  • Repeat messaging several times
  • Provide nudges, reminders, and incentives to help overcome inertia 


E. & J. Gallo Winery Senior Benefits Manager Carmella Smyth notes the importance of a tailored approach, “A one-size-fits-all communication strategy does not work for such a diverse workforce. We have employees who work rotating 12-hour shifts, seven rotating days, day and night. Physically it’s hard for them. Psychologically it’s hard for them. From a communications standpoint, we start with simple sound bites to bring our employees information in the easiest way possible through emails, flyers, posters, and jumbotrons throughout all our plants.”


The role of men in women’s health


Finally, even the best-intentioned employers may find their benefits policies don’t support health equity, either in design or implementation. For example, research has shown the numerous benefits of paternity leave to both mothers and fathers when fathers are given time off after expanding their families, and yet most companies still don’t offer equal time off for both the birthing parent as well as the non-birthing parent. Consider also parity in support for men and women with regard to fertility treatment and childcare. 


Rising inflation and the threat of a recession are making it worse. An employer survey from the Society for Human Resource Management found that the share of employers offering paid maternity leave beyond what is required by law dropped to 35% this year, down from 53% in 2020. Paring down parental leave benefits is a short-term solution that only further entrenches health inequities and hurts employees, families and ultimately employers in the long-term.


Given that 85% of Fortune 500 companies are run by men, men play an essential role in influencing the workplace policies that impact women’s health. Organizational leaders decide what benefits are offered, and have the influence to adopt policies such as paid parental leave and flexible work schedules which have been shown to help keep women in the workforce. Leaders also play a large role in influencing organizational culture. When they model culture that is inclusive and supportive, it can shift culture or alternatively it could negate even the most equitable of policies. 


Equitable and inclusive healthcare


Achieving healthy behavior change at an enterprise level is hard. Ensuring that it is equitable and inclusive is even harder. Gallo and American Eagle show us we can improve health equity when employers are committed to the journey and serious about identifying the needs of their diverse employees and using all the levers at their disposal. Imagine the impact to the US workforce if this was the norm rather than the exception.


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