A more effective approach to employer-based health care
What should employers do to help our colleagues maintain a strong purpose in life or work while they’re stressed by social insecurities?
Here’s a two-part question for you: Looking back over the past year, have you found that you’ve eaten all the food you had and you don’t have the money to buy more? Did that happen never, rarely, sometimes, often or always?
In collaboration with ProMedica, a multistate health system, and Kumanu, a well-being consultancy, The Harris Poll recently asked a nationally representative sample of 856 full-time-working American adults this question. Taking a conservative approach, we counted only those who reported having been in this situation often or always as experiencing “food insecurity.” As citizens of the richest country in the world, we were disturbed by the poll’s results.
Related: Should housing, food and transportation be covered health costs?
One in four respondents — people with full-time jobs — was often or always food insecure in 2020. One in four also had been insecure about housing. At a time of all-time highs on the stock market, the warp-speed production of coronavirus vaccines and record sales of $2,495 in-home exercise bikes, we found that more than a third of working Americans often or always experienced food, housing or financial insecurity.
We call these insecurities “social determinants of health,” factors that are more distinguishable by your Zip Code than your genetic code. Their toll on physical and mental health is well established. In our survey, we found that those reporting social insecurities were over 150% more likely to screen positive for depression. Similarly, text messages to the federal disaster distress hotline spiked by more than 900% last April, when more than 20 million people suddenly lost their jobs as COVID-19 struck.
We also found that these social insecurities disproportionately hit hourly workers. People in lower-paying support positions were 60% more likely to say their financial situation worsened over the past year than salaried employees in upper management. Also, by a factor of 2 to 1, full-timers fared better financially across the economy than part-timers, who work disproportionately in retail and hospitality and also generally receive fewer benefits.
Another toll from these social insecurities, not discussed as much, is a loss of life purpose. As the pandemic threatened the financial well-being of millions of Americans, it also endangered their existential well-being. Two-thirds of working Americans say they lack a strong sense of purpose in life and work today.
Purpose in life may be thought of as a “personal determinant of health” and is strongly associated with positive physical and mental health. Research has shown that people with self-transcending purpose in their lives produce more antibodies and mount stronger antiviral responses, which would come in handy right now. UCLA researcher Steve Cole and his team found that purpose in life also shields individuals from toxic biological effects of social isolation, another common effect of the pandemic.
Our poll found, as you’d suspect, that those reporting a strong sense of shared purpose from work were far more engaged in their work. We also found that having a strong sense of shared purpose from work enabled people to cope with financial stress brought on by the pandemic. Imagine an athlete who, despite injuries, is committed to being there for their team and continues to play well.
So what should we, as employers, do to help our colleagues maintain a strong purpose in life or work while they’re stressed by social insecurities? The answer, like our survey question, is two-part. We must work to reduce the impact of these external determinants of health. That could mean providing workplace benefits and community outreach to sustain the health of employees and our other stakeholders. At the same time, we need to pay attention to those personal determinants, by assessing and then addressing the individual mental and emotional well-being of our coworkers.
A few leading businesses already take on both sets of determinants together. Many of us, though, might think we’re done if we provide, say, flexible schedules or company-matched savings plans. Or, on the other hand, offer employee assistance programs that include mental health treatment. Alone, each is beneficial, of course, and can foster a more productive and engaged workforce. But woven together, they are more than doubly effective.
A novel epidemiological study conducted by researchers at Morehouse and Emory Universities shows the overlapping and compounding effects of social and personal determinants on health. They examined Black Americans living in areas of high risk or low risk for cardiovascular disease risk. Reporting their findings in 2019, they wrote that three social determinants were predictive of low risk: a pleasant neighborhood, access to healthy foods and low violence. Independent of these social determinants, one personal determinant emerged: purpose in life.
In our partnership, our three organizations are researching tandem approaches to counteract or even prevent harmful social and personal determinants of health. Our work is at the early stage; it will probably take a few years to measure how powerful more holistic programs are. By then, the Covid-19 pandemic should be only a painful memory. History teaches us, though, that other calamities will follow, and individuals still will need ways to maintain a purpose in life when their world comes apart, just like today.
Vic Strecher is CEO of Kumanu, a well-being technology company, and professor of health behavior at the University of Michigan. Randy Oostra is CEO of ProMedica, a nonprofit health system serving communities in 28 states. Will Johnson is CEO of The Harris Poll, one of the world’s leading public opinion research firms.
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