There's now a strong understanding that social factors can have a greater impact on health and well-being than clinical care.
This insight coupled with payment models that reward providers for keeping the populations they serve healthy has led some innovative health systems to address these social factors directly—investing in housing for homeless patients, opening food pantries or farmer's markets to address food insecurity, creating medical-legal partnerships to assist patients under threat of eviction and promoting healthy development in their neighborhoods.
These efforts are laudable and should be expanded where possible. At the same time, health systems need to look inward and consider similar efforts to improve the health of their own employees and contractors, especially those who are likely to be challenged by the same issues facing their most at-risk patients. The institutions are likely to benefit as well.
Despite the limitations of the healthcare system in assuring health, we know that affordable, high-quality health coverage is important. More than 13 million Americans, or 1 in 8 workers, are currently employed in the healthcare sector, yet fully one-quarter of them are not offered employer-based health coverage. Nearly 6 million work in hospitals, and about 10% of these workers do not receive medical benefits. Health systems should be the least likely to have a workforce in which many go without health coverage.
Earning a living wage is critical to health, yet many healthcare institutions lag in achieving this goal for all their employees. For example, in Colorado, many of the lower-paying healthcare jobs such as medical assistant, occupational and physical therapy assistants and phlebotomists, have an average entry-level annual salary of $24,661. This is below the living wage in Denver for a single adult of $26,936 and far below the $58,260 living wage for a family of four. This also likely occurs in entry-level jobs that aren't specific to healthcare, such as for housekeepers or food service workers and contract employees.
Persistent income gaps by race and gender further contribute to long-term health inequities and should not be tolerated. Healthcare leaders can set a national example by collecting and sharing more reliable data about pay inequities and working hard to erase them.
Industry leaders can also contribute to employees' health through education, another major determinant of health; that's particularly true for entry level workers who are not fluent in English or have not completed high school or earned a post-secondary degree.
Many healthcare institutions offer tuition reimbursements for advanced training. They also should support comparatively inexpensive GED courses, associate degrees, or other professional training such as EMT certification.
Stable affordable housing is an important determinant of health. Housing assistance in the form of loan programs and housing allowances are common incentives to recruit and retain high level executives or physicians. Given the evidence that housing stability boosts workplace retention and job performance, health systems should also offer home ownership assistance to employees at the lower end of the income scale.
Healthcare systems could further support their workers with on- or off-site early childhood education. Such programs would especially benefit women employees, who make up a majority of the healthcare workforce and often have primary child-care responsibility. In addition to reducing absenteeism, quality early childhood education programs are proven to boost educational achievement among young children, improving health outcomes and economic mobility for the next generation of workers.
Health systems obviously cannot address every social determinant of health and well-being, but they can do much more. Innovative systems deserve credit for working to change conditions for the populations and communities they serve. Those same organizations should look inside their institutions and recognize the opportunity to help their own employees and to report on their efforts to inspire other employers. What a step forward this would be in creating meaningful population health.
