Employers need to address how inequality affects health

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The COVID-19 pandemic has highlighted vast economic and health inequality among workers. Employers can — and must — address these issues with their workforce management strategy, a panel of employer group leaders said.

In a digital town hall, the National Alliance of Healthcare Purchaser Coalitions gathered representatives of employer groups from around the nation to discuss the impact of coronavirus on employee health, as well as how economic disparities prevent many in the workforce from accessing a healthy lifestyle.

“It’s never been more apparent that the health of my community has a direct impact on my health and the employees we work with,” said Cristie Travis, CEO of the Memphis Business Group on Health. “I don’t think we should let this moment pass; we need to discuss how social determinants impact the health of employees.”

Economic stability, access to healthcare and living environment all play a role in preventing employees from achieving optimal health, according to the Centers for Disease Control and Prevention’s Healthy People 2020 study. But employers have major influence on closing the socioeconomic gap through resources and benefits, experts said.

“As an employer, it’s incumbent on us to think about what we can offer these people in terms of providing access to healthcare and food security,” said Shelley Duncan, executive director of the Kansas Business Group on Health. “That should go for the employees we have, and the ones we’ve had to furlough.”

Christa-Marie Singleton, senior medical advisor for the CDC, pointed out that “many of the lowest paid workers are the ones we’re considering essential to do their work.” But these employees are also the most likely to suffer from lack of health insurance and food insecurity. Just two-thirds of lower-wage “essential workers” have access to health insurance and almost 32% of low-income workers are “food insecure,” leaving this population even more vulnerable during the COVID-19 crisis.

Food insecurity provides a direct link to health issues down the line. Among households receiving food from Feed America, a national network of food pantries, 58% have a family member with high blood pressure, and 33% have someone with diabetes.

“If you live in an area without access to supermarkets, or there’s only a neighborhood store that doesn’t sell fresh produce — or if they do, it’s outrageously priced — that’s going to limit your access to a healthy diet,” said Neil Goldfarb, president and CEO of the Greater Philadelphia Coalition on Health.

It’s crucial employers seriously consider increasing wages as one way to combat these disparities, the panelists said.

“Just adding $2 can make a difference at the bottom of the pay scale,” said Somava Saha, founder of Wellbeing in the Nation. “It might mean those at the top of the payscale will have less, but it makes a much bigger difference for those at the bottom.”

Additionally, employers should provide financial wellness benefits, like personal finance education and early wage access, to help employees struggling with poverty and food insecurity, Travis said.

“We know employers are beginning to help employees improve their credit scores, buy their first house and pay for college — these were things employers were not traditionally engaged in,” Travis said. “Now, I think we’re definitely starting to see employers not thinking about benefit plans in a traditional way [to offset economic disparities] and financial wellness is a great example of that.”

While economic stress, lack of healthcare and food insecurity have affected a large portion of the population due to coronavirus, minorities are disproportionately affected, Goldfarb said. Referencing a report by Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, 72% of coronavirus-related deaths in Chicago are African American, even though they make up 32% of the city’s population. Similar rates occurred in Wisconsin; within Milwaukee County, 72% of COVID-19 deaths were African American, even though they only make up 28% of the county’s population.

“I [also] saw results from my hometown in Philadelphia, and they’re showing similar rates,” Goldfarb said. “Hopefully we can talk about what employers and coalitions can do to not only shine bright light on the problem, but start to solve it.”

Jessica Brooks, CEO and executive director of the Pittsburgh Business Group on Health, said employers have a responsibility to address implicit bias against diverse employees in the healthcare system — and not just because it’s the ethical thing to do.

“Employers are paying for biased care,” she said. “They’re paying the same amount to cover each employee, but some employees are receiving worse care because of implicit bias and racism.”

Brooks said employers can address biased care by partnering with advocacy groups, and adopting health coverage that utilizes value-based payment to ensure employees are getting the best care.

“Employers have to get comfortable with being uncomfortable, and realize these issues are their issues,” Brooks said.

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