Social determinants of health aren’t just for patients. Health systems looking to promote health equity within their communities can start internally, by looking at their own workforce.
Healthcare facilities are often the largest employers in their regions, and can employ 8%–15% of a state's workforce, according to a Kaiser Family Foundation analysis of 2021 Bureau of Labor Statistics data. That means healthcare executives hold the key to many social determinants of health within their hospitals’ doors, such as workplace environment, financial compensation, and access to other benefits.
“So much of what keeps us healthy or unfortunately makes us ill happens outside of the walls of a clinic, even a virtual one—where people live, where they work, where they play, where they pray,” Saranya Loehrer, chief health equity officer at Teladoc, told Healthcare Brew.
Workplace hazards
Healthcare jobs, especially low-wage positions, are physically demanding, prone to injury, and highly stressful, according to Mignon Duffy, sociology professor at the University of Massachusetts, Lowell. These factors and others, such as excessive workloads, lack of leadership support, and harassment in the workplace, can lead to mental-health challenges such as burnout, according to a 2022 Surgeon General’s Advisory report.
“Burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions,” the report says.
Healthcare executives can instead improve the workplace environment to prevent burnout by, for example, redesigning workflow to reduce administrative burdens and ensuring workers have access to mental health and substance use care, the report suggests.
Health systems with burnout reduction initiatives spent $11,592 per nurse per year on burnout-related turnover costs, compared to $16,736 for hospitals without such programs, per a 2021 study from the University of Virginia School of Nursing.
Low wages, lower health outcomes
Health outcomes are worse for low-wage healthcare workers such as nursing assistants, janitorial staff, and phlebotomists, according to a 2020 report from the Brookings Institution, a public policy think tank.
The median wage for healthcare support, direct care, and service workers was $13.48 in 2019, which is “well short of a living wage,” the report notes. Socioeconomic factors like poverty and low educational attainment are some of the main drivers of poor health outcomes that negatively influence health equity, a 2022 Office of Health Policy report found.
“People who are living on poverty wages are not healthy humans,” Duffy said.
Some health systems are raising wages.
Employees at North Carolina-based Novant Health saw a $2 increase to their hourly minimum wage starting March 3; it’s now $17 (the state’s minimum wage is $7.25). The system invested more than $100 million on this initiative and other staff salary increases.
“Novant Health’s commitment to upward and economic mobility starts with looking internally and ensuring our team members have the ability to thrive,” Carmen Canales, SVP and chief people and belonging officer at Novant Health, said in a statement. “When we invest in our team members, we invest in their families and our communities.”
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Wages are not the only part of the compensation package that can boost health equity.
The Covid-19 pandemic highlighted how low-wage healthcare workers have less access to paid sick leave, according to the Brookings report. Those without paid sick leave are less likely to seek medical care, leading to delayed and costlier treatments, per the National Partnership for Women and Families, a nonprofit aimed at improving women’s health and economic justice.
Health systems can “provide equity of benefits across different staff levels—access to paid sick days, access to paid leave, access to health insurance, all those things that we know support worker health,” said Duffy.
DE&I and health
Many of the improvements health systems can make to improve the health equity of their workforce falls under the realm of DE&I, according to Loehrer.
The CDC recognizes discrimination and racism as obstacles to health equity. Low-wage healthcare workers are more likely to be women and/or people of color, according to the Brookings report. Black women are overrepresented among low-wage and hazardous healthcare jobs, according to a 2022 study published in Health Affairs. Policies such as increasing wages and career advancement within the workplace can also address racial inequity within the healthcare workforce, the study suggests.
It may also improve health equity for their patients.
In Massachusetts, for example, “clear and accessible career ladders for direct care workers will help increase the diversity of the Commonwealth’s health care workforce, and help it better resemble the patients it serves,” according to a report released in March from the state’s Health Policy Commission.
“There is no question to me that health equity is one of the top issues on the minds of healthcare leaders,” Loehrer said. “They’re thinking about, how do we recruit and retain a robust and diverse healthcare workforce within our own organizations?...How do we make sure that the work we do equitably serves our patients and our communities?”
By investing in their own employees, health systems are supporting their local workforce and addressing issues of health equity both inside their doors and beyond, according to the Healthcare Anchor Network, a collaboration of 70+ hospitals dedicated to addressing racial and economic inequities in the communities they serve.