The COVID-19 pandemic unmasked the impact of social determinants of health across the globe. Startling but not surprising, people who experience social and economic disadvantages are more likely to contract and die from the virus, as well as have financial difficulties. This is especially true for many racial and ethnic minority groups.
Amidst the pandemic, our attention turned to another public health crisis and underlying contributor to many social determinants: systemic racism. Racism is a public health issue, and it is critical that we continue to seek and work for health equity.
Large employers increasingly see a need to address social determinants—the conditions in which we are born, grow, live, work and age that influence our physical health and well-being. In response, Business Group on Health developed Social Determinants: Acting to Achieve Well-being for All, a resource for benefits and well-being leaders that describes what social determinants are, and how to strategically align them with business priorities and actionable solutions related to six social determinants—income, health care, transportation, food, childcare and housing. Future additions to this work will highlight strategies and solutions relevant to employers and their diverse workforces.
Looking at Social Needs Through a COVID-19 Lens
Health Care Access
For many people, including those with employer-sponsored health coverage, the COVID-19 pandemic has heightened barriers to needed health services. Furloughs and layoffs have increased the number of people without coverage, while simultaneously decreasing employees’ ability to afford health insurance on their own. Hourly employees who are still working may also lose eligibility for health insurance due to a reduction in hours. Beyond coverage, additional roadblocks to health care access include increased financial insecurity - and thus greater challenges paying for even the most necessary care; closures of rural hospitals; and a lack of mobile or broadband internet that’s required to engage in telehealth, a particular issue for low-income and rural communities. At a time when access to health care is more critical than ever, employers should ensure that affordability and the characteristics of the communities in which employees live do not stand in the way. In addition to the recommendations included in the Social Determinants Guide ideas for action include:
- Maintain health care coverage for furloughed employees;
- Reconsider the minimum number of hours required for part-time employees to be eligible for coverage;
- Outfit worksites that do not have health clinics with private areas that include computers or tablets for employees to access telehealth;
- Promote the use of navigators, who can help employees find nearby in-network care or free or reduced-cost community-based health services; and
- Offer home care solutions for chronic conditions, such as dialysis and infusions.
Childcare
In response to COVID-19, many childcare centers closed, and troublingly, some closures may be permanent. These unmet childcare needs will have a short- and long-term impact if not addressed. Childcare plays a critical role in the health and development of children through improved nutrition, increased access to health screenings and better mental health later in life, and it enables parents to work.1
As employers turn their attention to return to the workplace, they consider childcare needs of employees. Beyond the considerations included in the new Social Determinants Guide (e.g., offering childcare subsidies, tiered childcare benefits based on family income, on- and near-site childcare centers/creches and predictable work hours) some employers may decide to go a step further and address childcare issues in the communities where they operate. Ideas for action include:
- Start or participate in a coalition of business and community leaders to explore childcare challenges and solutions;
- Help local childcare centers develop return to work plans;
- Provide in-kind contributions to support the business side of local childcare centers (e.g., assistance with purchasing, payroll and billing, IT support, etc.),
- Advocate for the availability of quality and affordable childcare; and
- Explore additional supports and benefits for families with children with special needs, who will likely experience greater difficulty with access and affordability to critical care and treatment.
For related information, see our Employer Role in Support Working Parents During COVID-19 Pandemic.
Food Access and Insecurity
COVID-19 has drastically increased food insecurity, for those without and with jobs. The World Food Program estimates that 265 million people could face acute food insecurity by the end of 2020.2 This is almost double to what was originally projected for 2020, prior to the pandemic.2,3 Disruptions in normal food supply chains have made food access more difficult, and the loss of income due to mass layoffs and furloughs has made it hard for people to afford food.2 Some households are forced to make the difficult decision to pay their utilities and housing costs or purchase food. This is especially true for low-wage workers and their families, many who now have children at home that received free meals at school.
Each of these factors have caused a surge in requests for food at food pantries and banks around the world. For example, in Yolo County, California, the demand for free food has increased dramatically, with calls to food banks increasing a thousand-fold.4 In Italy, requests for food assistance have surged by 40%, with many being from workers who have always been able to put a meal on the table.5
Employers can play a critical role in ensuring employees and their families are food secure. In addition to the ideas for action captured in the Social Determinants Guide, other considerations include:
- Provide electronic meal vouchers for employees, so they can purchase food;
- Help employees navigate how to apply for government and community assistance programs that supplement food costs;
- Review and address pay disparities for market competitiveness;
- Deliver meals to employees and their families that may be in need;
- Donate cash and products to food pantries and banks; and
- Establish an employee relief fund.
As we chart the path forward, addressing social determinants will remain a priority in improving employee health and well-being, reducing health disparities and positioning large companies as employers of choice. To learn how you can make a meaningful change for your workforce and beyond, dive into Social Determinants: Acting to Achieve Well-being for All.
References
- 1 | Friedman-Kraus A, Bernstein S, Barnett WS. Early childhood education: Three pathways to better health. National Institute for Early Education Research. December 2018. Available at http://nieer.org/wp-content/uploads/2018/12/NIEER-Policy-Update_Health_2019.pdf. Accessed February 15, 2020.
- 2 | The World Bank. (2020). “Food security and COVID-19.” Retrieved May 18, 2020, from https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19.
- 3 | Anthem P. (2020). “Risk of hunger pandemic as COVID-19 set to almost double acute hunger by end of 2020.” Retrieved May 18, 2020, from https://insight.wfp.org/covid-19-will-almost-double-people-in-acute-hunger-by-end-of-2020-59df0c4a8072.
- 4 | Smith J. “How coronavirus created 21st century breadlines.” Retrieved May 27, 2020, from https://www.dailydemocrat.com/2020/05/23/windows-up-trunks-open-how-coronavirus-created-the-breadline-of-2020/.
- 5 | Horobin W, Migliaccio A, Neumann J, Rotondi F. Europe’s bread lines get new faces in warning of crisis to come. Retrieved May 22, 2020, from https://www.bloomberg.com/news/articles/2020-05-22/europe-s-bread-lines-get-new-faces-in-warning-of-crisis-to-come.
