Driving Health Equity in the Workplace

Strategies, guiding principles, best practices and other resources organizations can use to build toward health equity. 

Equity improves the health of employees, their families and communities

Inequity, discrimination and bias have no place in the workplace. Yet, they remain, rooted in historical and present-day policies and systems that may favor one group.

These problems have been proven to take a heavy toll on the health and well-being of employees, organizations and their communities. That’s also why the American Heart Association’s CEO Roundtable a leadership collaborative of nearly 50 CEOs – is dedicated to helping employers further understand, identify and eliminate workplace practices that lead to inequities.

The CEO Roundtable’s new report, Driving Health Equity in the Workplace, includes guiding principles and actionable strategies that can help organizations wherever they are on their health equity journey. The report is part of the AHA’s goal of promoting health equity – which means everyone having a just opportunity to be healthy – in all aspects of society.

Driving Health Equity was developed by a writing group made up of business leaders and experts in health equity. It’s based on scientific evidence, market research, best practices and examples from leading organizations. The report and market research findings can be found here, and highlights of the report and market research findings can be found on these web pages.

Our aim is to help end historical structures and workplace cultures that advertently or inadvertently treat people inequitably based on race, ethnicity, gender, sexual orientation, age, ability, veteran status or other factors.

Working toward health equity is the right thing to do for all organizations. Research shows that promoting health equity can benefit employee health and productivity, and reduce health care costs. The health of the entire nation will improve if employers commit to actions that eliminate inequities – benefitting employees, their families and their communities.

We hope employers everywhere will join us in our efforts to build health equity.

Guiding Principles:  Driving Health Equity in the Workplace

Here’s a look at the principles that can guide organizations wherever they are in their health equity journey with commentary from the report’s authors.

As business leaders, we have a responsibility to our employees and to our communities to help advance workplace health. At WW, we have made it a priority to cultivate an inclusive and diverse wellness community and we will continue to be a champion for equitable health until we’ve eradicated broken systems and changed the health trajectory of the world. 


Mindy Grossman, WW CEO 

Internal Strategies for Achieving Health Equity

Whether an organization is well along on a journey toward health equity or just getting started, relying on comprehensive, evidence-based strategies is critical to inform policy and procedural changes, and evaluate impact.

Review and revise hiring, retention and recruitment practices to eliminate policies that may favor one group of people or disadvantage others.

What is it?

Deliberate, equitable hiring practices ensure a diverse and inclusive staff that reflects clients and communities. Inclusivity is best achieved through intentional sourcing via broad community outreach. Good-faith marketing efforts may introduce people to opportunities at organizations they had not considered.

How does it impact health?

Jobs with benefits mean opportunities to access health insurance, which is strongly associated with better health. Many organizations offer additional benefits designed to improve physical and mental health, education and incentive-based programs focused on health.

How does it reduce inequities?

A greater diversity of people who have a chance for well-paying jobs can help reduce economic inequities that impact health and well-being. It also provides an opportunity for people to feel valued.

How can employers act?

Hiring practices can become more equitable with these actions:

  • Evaluate your organization with this simple question: Is your hiring reflective of the community?
  • Establish goals for hiring a workforce representative of the community.
  • Reach out to local organizations to find potential employees from groups historically excluded based on race, ethnicity, gender, sexual orientation, age, ability, veteran status or other factors.
  • Provide training to hiring managers to mitigate bias in recruiting and select diverse talent.
  • Ensure oversight to ensure goals are met and necessary course corrections are made.
    • This will require implementing processes for collecting and monitoring data on diverse groups.
  • Benchmark against external hiring standards.
  • Leverage employee resource groups to improve the hiring process.
  • Prioritize transparency with employee perception surveys by providing actionable next steps.
  • Review job descriptions during hiring to ensure they emphasize the skills and competencies required by the position and not just formal education requirements.

Hear from Jaye
Include equity in evaluation of employees, managers and leadership.

What is it?

Employers should assess employee performance fairly based on their contributions, evaluating both results and how they were achieved. After standardized evaluations of all employees, leaders can begin to ensure evaluations are consistent and reward performance fairly and equitably. organizations should audit their approach to ensure certain populations aren’t unfairly evaluated.

How does it impact health?

Equitable evaluation leads to equitable compensation, which can benefit mental health and impart the feeling of being valued. Conversely, inequitable evaluations and their outcomes lead to stress and can be viewed as harmful microaggressions. Microaggressions – everyday and often-subtle verbal, nonverbal and environmental slights, snubs or insults – can be intentional or unintentional.

How does it reduce inequities?

Auditing evaluation practices may give organizations the opportunity to challenge and change practices that are unfair to some groups. For example, if women are typically evaluated lower than their male counterparts, leaders would need data-based explanations, and adjustments to ensure equity.

How can employers act?

Ensuring equitable evaluations requires intentionality, commitment, hard work and relentless analysis. An across-the-board comparison of pay, raises and promotions can make equity issues very clear. Regularly scheduled comparisons are recommended, based on gender, race, ethnicity, sexual orientation, age, ability, veteran status and other areas where inequities may exist. Another approach is to create a “talent task force” that assesses equitable representation in leadership. If not already doing so, employers can also consider using a detailed rubric to assess employee and manager performance. Employers can also consider providing opportunities for mentorship and sponsorship.

Hear from Jaye
Offer comprehensive, understandable, and affordable health care coverage for all employees.

What is it?

Most people get health coverage through employers. However, not all employer-sponsored health insurance is the same, and some employees must contend with issues such as underinsurance, unaffordability, and confusing terminology, processes and payment structures. Equity in employer-sponsored health insurance is foundational to equity in health, employment and society overall.

How does it impact health?

Health insurance is closely linked to health outcomes. Uninsured adults are much more likely to have no usual source of care, are more likely to skip or postpone care, and generally are less likely to receive preventive care and other services. For example, only about a quarter of uninsured people have their high blood pressure under control (24.2%) vs. nearly half of those with private insurance (48.2%) or Medicare (53.4%).

How does it reduce inequities?

People expect health insurance to pay reasonable costs of maintaining and restoring physical and mental health. Employer-sponsored health plans have the power and responsibility to deliver on that promise for all participants, which means continually questioning and affirming equitable coverage across the diversity of the population. Some rules for coverage or reimbursement belie a deeper inherent disparity. Whether due to cost, access, or other barriers, Hispanic/Latino (29.7%) and Black (14.7%) people are significantly more likely to be uninsured than white people (10.5%) in the United States.

How can employers act?

Employers can closely examine coverage levels, ensuring equal access and thinking past traditional definitions of affordability.

  • Ensure adequate provider networks that ensure equitable access (beyond the limited definition of adequate typically set by states and employers).
  • Ensure access to providers representative of the employee population.
  • Ensure adequate coverage for mental health services by all providers. 
  • Endeavor to make all aspects of the health care coverage reasonably affordable to all employees. For example, by adjusting monthly premiums, deductibles, out-of-pocket maximums and copayments on a sliding scale based on employee income
  • Ensure parity between coverage for physical and mental health.
  • Emphasize value-based services that balance clinical benefit with cost.
  • Ensure determinations of medical necessity are made equitably for all employees.
  • Regularly evaluate employer-sponsored health coverage to ensure it is meeting the needs of employees in regard to affordability and coverage of services. 
  • Through collective action, employers can partner to leverage their market power to influence changes in health insurance providers, such as greater transparency, better value, and improved data collection and management.   

Hear from Felipe
Ensure leadership is composed of people from diverse backgrounds and representative of your workforce and community.

What is it?

According to the Stanford Corporate Governance Research Initiative, 84% of Fortune 100 CEOs in 2020 were white, and 93% were men. These rates are similar in other senior leadership positions. Ensuring leadership is equitably composed of people from diverse backgrounds and representative of the workforce and community is critical to meeting an organization’s equity goals.

How does it impact health?

Ensuring senior leadership (and middle management) is diverse and representative of employees and the community demonstrates that employers value the capacity, perspectives and unique identities of employees from groups that have been historically excluded. This in turn can promote good emotional, mental and physical health, reduce chronic stress, and ensure specific health needs of employees from diverse backgrounds are understood and supported.  

How does it reduce inequities?

Diverse leadership allows the voice of employees from historically excluded groups to be heard and respected. Leadership that represents the employee population and community ensures staff perspectives and needs are considered and met in organizational decision-making on issues such as benefits design, organizational policies and equity training.  

How can employers act?

There is no shortage of strategies to help organizations hire, maintain and equitably elevate more diverse leadership teams. These often start with building the pipeline of diverse candidates prepared to step in when openings finally come. Other strategies include removing bias from talent-acquisition processes and performance evaluations, and considering benefits that support the needs of underrepresented employees.

Hear from Angela
Support employee financial well-being through education, employee benefits and other strategies.

What is it?

Historical practices have limited the ability of some people to accrue wealth because of their race, ethnicity, gender, sexual orientation, age, ability, veteran status and other factors. A survey by the Federal Reserve found that white families have 8 times the wealth of Black families, and 5 times the wealth of Hispanic/Latino families. 

How does it affect health?

Financial well-being is the single strongest predictor of lower levels of daily worry and stress for people with jobs. Chronic stress, from any source, is a well-established risk factor for poor mental and physical health. Poor financial well-being also affects an employee’s ability to pay for health insurance costs. 

How does it reduce inequities?

It is challenging for historically marginalized groups to overcome income and wage gaps –notably among racial and ethnic groups that have been disproportionately harmed financially by the COVID-19 pandemic and historical practices. By providing supporting programs and benefits, employers can ensure equitable opportunity for employees to manage their finances, save money, build wealth and ensure financial stability.  

How can employers act?

Programs and solutions that focus on long-term financial well-being goals help prepare for future financial health. But they don’t support employees dealing with acute financial stress. Until this short-term acute financial stress is addressed, employees cannot and will not engage in programs aimed at long-term financial health. Practices to consider include: 

  • Assessment:
    • Assess disparities that may exist in how programs are used to inform how to better market financial well-being programs. 
    • Survey employees to understand the state of financial well-being of the workforce.
  • Emergency support/relief:
    • Temporary benefits (childcare grants and time-off options) 
    • Emergency funding programs
  • Education:
    • Financial coaching programs (one-on-one support)
    • Financial wellness platforms that offer personalized education, financial fitness scores/profiles, tips and tools to build knowledge and increase awareness.
    • Educational content that covers a variety of topics. 
  • Employer benefits:
    • Retirement plans with an opt-out design, and scaled employer matching based on income.
    • Employee stock purchase plans can be a large driver of wealth building. 
    • Education funds (529 plans and children’s savings programs) promote participation to plan ahead and ease future financial burdens.
    • Payroll deducted low-interest employee loans.
  • Communication and engagement strategies:
    • Communicating financial security not as a journey. 
    • Use social networks to encourage and support employees along their financial well-being journey.
    • Inclusive messaging and imaging that is positive and hopeful.

Adopt anti-racism principles and implement anti-racism policies.

What is it?

Anti-racism refers to the “conscious decision to make frequent, consistent, intentional, equitable choices daily.” Leaders must adopt anti-racism principles to actualize an organization’s mission, embody its values and attain equity. That means wide-ranging change, including community engagement, employee benefits, talent recruitment and hiring at all levels, and appointment of its board of directors.  

How does it impact health?

Structural racism adversely affects health and well-being. Well-being encompasses physical health, mental health, social relationships and the ability to meet basic needs. Anti-racist principles that foster the equitable distribution of resources, access and opportunity support employee health and well-being.

How does it reduce health inequities?

An organization’s history and present-day practices, procedures, and policies may disadvantage certain groups, directly or indirectly. Anti-racist principles can support employee well-being and promote health equity across the organization.

How can employers act?

Anti-racism policies have typically focused on benefits such as affordable and comprehensive medical plans, culturally sensitive mental health care, and paid leave. However, other policies and practices can improve health and well-being. Examples include:

  • Proactively conducting workplace climate surveys to understand employee experiences and address concerns.
  • Paying a living wage.
  • Supporting employee resource groups.
  • Establishing mentorship, sponsorship, and leadership development programs.
  • Providing tuition assistance.
  • Investing in local community development in historically marginalized neighborhoods.

Hear from Austin
Promote employee health literacy and employee benefits literacy.

What is it?

Higher health literacy is the degree to which a person can obtain, process, understand and communicate health information needed to make appropriate health decisions. Health literacy has been linked to behaviors, outcomes and health care costs. Employees who lack benefits literacy may be less likely to use available benefits, as well as pay for health expenses they don’t need to pay or pay too much. 

How does it impact health?

Research shows health literacy is associated with a variety of health-promoting behaviors such as being more physically active and eating healthier foods. People with adequate health literacy are also less likely to delay or forgo health care or report difficulty finding a health care provider, and they are more likely to have a usual source of care. 

How does it reduce inequities?

Health literacy is directly connected to health equity. Unfortunately, the health care system is so complex that workers and their families often do not understand their coverage and costs. For a number of systemic and historical reasons, Black, Hispanic and Spanish-speaking people appear to have lower health care literacy than white people, which may further exacerbate health and health care inequities. 

How can employers act?

The first step in addressing health and benefits illiteracy is understanding the extent of the issue and not assuming employees understand the basic terms and concepts of health and health care. Navigating health care and employee benefits can be complex, confusing and intimidating. Providing a health literacy program can increase employee understanding and appreciation for the benefits provided and options available. Considerations for employers addressing health care literacy include: 

  • Understand your employees and recognize that navigating health care and employee benefits can be complex and confusing. 
  • Empower employees to engage and take charge of their health and health care.
  • Provide educational programs, resources and tools.
  • Familiarize employees with their financial responsibilities and the meanings of such terms as out-of-pocket max, deductibles, prescription co-pays, etc.
  • Communicate about benefits year-round, not only during open enrollment periods.
  • Provide access to benefit experts who can answer general questions as well as questions that might be uncomfortable to ask the employer’s HR representative. 
  • Employ a broad array of communication technologies for education and support, recognizing that not everyone is comfortable or familiar with all of them.  

Hear from Caren
Offer paid family and medical leave.

What is it?

Everyone should have time away from work, to rest and re-energize, spend time with friends and loved ones, tend to health needs, volunteer for causes and any number of other activities that improve well-being. The ability to take the time needed away from work affects engagement, performance and speed of recovery from health issues.

How does it impact health?

Robust leave policies that provide employees adequate time off to meet their needs for rest and managing personal priorities can create a healthier and happier workforce, and advance health equity within an organization. Studies have shown access to paid family leave can have positive impacts on health such as reductions in low-birth weight and early-term babies and infant mortality; reductions in parental stress levels,; and improvements in the longer-term emotional health of children. 

How does it reduce inequities?

The ability to take paid time off can improve financial stability – which can have a more favorable effect on people of color and people with disabilities. It also can improve the likelihood of women returning to the workforce, and support employees serving as caregivers for immediate and extended family members.  

How can employers act?

Employers should consider implementing the following strategies to promote health equity in their organizations:

  • Provide adequate paid time off for vacation, holidays, sickness and well-being.
  • Provide access to robust paid family leave, driving better longer-term health outcomes and shifts in the parental expectations (e.g., more equal split of parental duties).
  • Provide job-protected, paid caregiver leave to provide employees the flexibility to care for a sick loved-one without jeopardizing financial stability.

Hear from Adrien
Ensure pay equity and provide a living wage.

What is it?

Pay equity is fair compensation for similar work. While pay inequities often center on current earnings, pay gaps widen over time and impact future earning potential, including merit raises and retirement contributions. Pay inequities have been well-documented for women compared with men. A living wage refers to sufficient income for basic living expenses and takes into account the local cost of living.

How does it impact health?

The links between income and health are well-documented; people with fewer resources face higher risk for disease, poor mental health and shorter life expectancy. Pay inequities and the absence of a living wage affect financial stability. That may have indirect health impacts, such as being unable to afford medical insurance or foregoing health care to avoid out-of-pocket expenses.

How does it reduce inequities?

Equitable pay can help reduce disparities in employees’ ability to afford necessary items such as housing, food and health insurance, and makes it easier to take care of their families. While often thought of in regard to gender, pay inequity also significantly impacts people of color.  

How can employers act?

Ensuring pay equity and providing a living wage are critical ways employers can advance equity and support employee well-being. Ways employers can act include:

  • Ensure the organization adopts formal, written policies that commit to ensuring pay equity and providing a living wage.
  • Proactively initiate systematic and regular pay equity audits to ensure sources of inequity are identified early and promptly corrected.
  • Evaluate and adjust wages regularly to ensure all employees are paid a living wage. 
  • Support increased living wage and pay equity policies through your organization’s external advocacy efforts.  
  • Ensure special skills and capacities, such as multi-lingual proficiency, are fairly compensated.

Promote use of employee assistance programs.

What is it?

Employee assistance programs, or EAPs, have long been a source of crisis intervention. The traditional model mainly relies on a call center that’s always open. For the past few decades, many EAPs have expanded services (nutrition, wellness, financial and legal assistance). EAPs offer confidentiality and usually are available to all employees, immediate family and all who live in their household. 

How does it impact health?

An effective EAP can help address the unique and often traumatic experiences endured by members of different race, ethnicity, gender, sexual orientation, age, ability, veteran status or other groups. As mental health comes more to the forefront as a driver of overall health, the demand for EAPs will likely increase. 

How does it reduce inequities?

EAPs are a particularly strong vehicle to help achieve health equity. Their easy accessibility, broad mandate to help, and strategic desire to position and differentiate themselves outside of crisis response make them ideal for helping employees manage and respond to inequities.

How can employers act?

There are several ways for employers to start leveraging their EAP for the more equitable delivery of wellness and health care:

  • Simplify access to services. 
  • Segment your employee population and target messaging. 
  • Create a life-coaching intake protocol..
  • Connect with employees where they are. 
  • Make sure your EAP delivers promised services well. 
  • Continuous improvement.
  • Assess the diversity of the EAP’s providers. 

Ensure employees have a voice in organizational decision-making.

What is it?

Employee participation in decision-making is a key contributor to organizational performance and employee satisfaction. Active and meaningful employee engagement helps organizations achieve their mission, execute on strategies and generate business results.

How does it impact health?

Effective and meaningful engagement can increase employee participation in workplace wellness activities. It also helps employees create and maintain healthy behaviors at home and at work, and improves overall health and wellness. Engagement also increases the ability to address normal workplace stressors.

How does it reduce inequities?

Workers who are engaged and who perceive a sense of partnership make proud advocates, promoters and defenders of the organization. Elevating the employee voice ensures the opportunity to contribute to deliberation and decision-making and demonstrates partnership, trust, and respect. Including the employee perspective in decision-making embraces the full participation and perspectives of historically excluded individuals and promotes health equity

How can employers act?

To ensure effective and meaningful employee engagement and input into decision-making include:

  • Foster a culture of inclusion, engagement and employee participation. 
  • Make active listening a priority. 
  • Follow up and provide feedback on actions taken based on input received. 
  • Adopt and ensure a principle of transparency.
  • Develop mechanisms that encourage and enable employee input and involvement in decision-making as a way of taking innovative approaches to promote organizational excellence. 
  • Recognize and reward inclusion and participation.  
  • Involve employee resource groups in relevant organizational decision-making processes. 
  • Contract with an external entity that has the infrastructure to process employee feedback (confidentially) and provide real-time responses to employee concerns and suggestions.

Offer diversity, equity, and inclusion training among employees.

What is it?

Diversity, equity and inclusion training can include a wide range of activities. At its core it seeks to help employees better understand the value of lifting up the voices and perspectives of people with diverse experiences, as well as instill organizational values such as respect, equity and belonging.

How does it impact health?

Effective training can improve employee health by creating a great place to work for all and by reducing chronic stress caused by racism, discrimination, biases and microaggressions. It is well established that chronic stress has a significant, negative impact on people’s mental and physical health.  

How does it reduce inequities?

Building staff and management skills through training, learning resources and ongoing dialogue builds cultural competency. This helps to create psychologically safe work environments, fosters belonging and helps employees learn how to apply an equity-focused lens to policies and norms to confront inequity, discrimination and biases.

How can employers act?

Practices to consider include:

  • Ensure diversity, equity, accessibility and inclusion training is supported by the necessary policies, programs, practices, structures and resources to promote employee learning.
  • Implement training that fosters inclusion and social justice, and how to disrupt bias and dismantle institutional racism to build new habits and sustainable practices.
  • Deliver allyship training to empower employees and leaders to advocate for themselves and others.
  • Embed leadership training for managers that builds healthy relationships and trust, increases engagement and productivity, and helps leaders model inclusion.
  • Offer skill development and training opportunities for employee resource group leaders.
  • Providing mentoring and sponsorship programs.
  • Regularly reinforce training to ensure continued understanding.
  • Be careful in the framing to help employees understand the true value of diversity, equity and inclusion, rather than view it as remedial action.

Hear from Jean
Review contracts to maximize hiring of historically underrepresented businesses and ensure supplier commitment to equity and equitable practices.

What is it?

The overall makeup of vendors and contractors can be easily overlooked. But reviewing an organization’s vendor agreements and purchasing contracts, and the processes related to them, can quickly support more equitable economic development. It also can give supply chain access to businesses owned by historically underrepresented groups.

How does it impact health?

Increased investment in historically underrepresented businesses can allow them to offer more affordable and higher-quality health care coverage and benefits to their employees. It is well established that health insurance coverage is associated with improved health outcomes, increased use of health services and an increase in health-promoting behaviors.

How does it reduce inequities?

Investment provides revenue opportunities for businesses owned by people from historically underrepresented groups. That, in turn, can provide benefits back to their communities, where employees also live. Holding business partners to equity standards can magnify the downstream impact and implementation of diversity, equity and inclusion efforts such as offering a living wage and having equitable hiring practices.

How can employers act?

After reviewing supplier contracts, employers should set clear and increasing goals for the share of contracts they award to organizations that are women-owned or owned by people from historically underrepresented communities, including those that are often less visible, such as businesses owned by members of the LGBTQ community. Ideally, those would be locally based. All vendors, suppliers and partners should be assessed to ensure alignment through the lens of diversity, equity and inclusion.  

Advocate for culturally and linguistically effective training for all employees, providers and vendors.

What is it?

Educational programs commonly aim to promote cultural competence as a means of decreasing health disparities and improving the overall quality of care. These programs generally educate people on cultural differences based on race, ethnicity, gender, sexual orientation, age, ability, veteran status or other factors.

How does it impact health?

Negative health care encounters can have lasting impacts on patients. One study found 22% of Black patients surveyed avoided seeking health care due to anticipated discrimination. A similar study found 23% of Native Americans reported discrimination from health care professionals, and 15% avoided seeking health care. Language has a major impact on people’s health, well-being and quality of life.

How does it reduce inequities?

Research has shown significant health care disparities between underrepresented groups and majority populations, which may have implications for patient safety and outcomes. Though the evidence base is not robust, some studies have shown interventions to improve cultural competency can improve health care access and outcomes.

How can employers act?

Implementing culturally and linguistically effective training for all employees, providers and vendors can help ensure all people have equitable access to health care and are comfortable in seeking assistance when needed. Practices to consider include:

  • Education about cultural effectiveness and humility, including assessment of one’s own values and biases.
  • Organizational policies and guidelines for how to optimize communications.
  • Creation of resources in different languages that address and promote acceptance of various cultural beliefs.
  • Use of interpreters, as needed.

Review organizational communications for cultural appropriateness, diverse representation and accessibility.

What is it?

The U.S. population is increasingly racially and ethnically diverse. As the U.S. and the world continue to diversify in terms of how people identify, there is a unique opportunity for communications that are representative of and respectful to employees, families, friends, colleagues and neighbors.

How does it impact health?

Inclusive communications that consider cultural appropriateness, diverse representation and accessibility can have direct and indirect impacts on people’s health. Inappropriate language and lack of representation can adversely affect employee mental health. Building communications that engage a diverse workforce can lead to increased knowledge and understanding of health and other benefits.

How does it reduce inequities?

Clear and inclusive communications can help to build trust and advance health equity. Many groups that have been historically excluded don’t see themselves or others like them in media and other communications, and they may subsequently be less likely to access resources and benefits. 

How can employers act?

Employers should critically review and improve the representativeness and cultural effectiveness of their communications, and consider implementing the following strategies:

  • Work to build trust among employees from historically excluded groups, being mindful of the message, messenger and perceived intent.
  • Use an inclusive lens when developing communications. Make sure visuals represent your entire workforce and community.
  • Avoid pictures and videos that reinforce stereotypes based on race, ethnicity, gender, sexual orientation, age, ability, veteran status or other factors.
  • Design simple and concise communications.
  • Review communications, websites and other benefits-related documents for proper pronoun use. Where possible, avoid referring to he/she and use more gender-neutral pronouns such as they.
  • Demand the same from the vendor partners. They should be heavily invested in improving engagement.
  • Where possible, engage employee resource groups to help develop strategy, content and oversight.

External Strategies for Achieving Health Equity

Businesses have a unique role and opportunity to support a rational public dialogue on inequities and elevate the important discussion of societal investments to address structural barriers to optimal health. The following section identifies five external areas in which employers can focus their advocacy efforts in the name of equity.

Advocate for comprehensive, understandable and affordable health insurance coverage for all.

What is it?

The Affordable Care Act, also known as the ACA, defined comprehensive and understandable health insurance coverage as providing 10 essential health benefits: ambulatory, emergency, hospital-based, pregnancy, mental health, rehabilitative, preventive care, pediatric care, prescription drugs and laboratory services. The ACA includes provisions to make health care insurance more affordable.

How does it impact health?

Health insurance increases access to health care and makes it more affordable. Evidence has shown that gaining health insurance can substantially reduce medical debt and improve physical and mental health.

How does it reduce inequities?

After implementation of the ACA, lack of insurance and inequities decreased, as did inequities. But inequities persist. There was a large decrease in the proportion of non-elderly Americans without health insurance, from 18.2% in 2010 to 11.1% in 2020. The proportions of Hispanic, Black and white Americans without health insurance were disparate in 2010: 32%, 20%, and 14%, respectively. All fell but remained disparate: 12% and 7% for Black and white Americans, respectively, in 2019. Similarly, rates of uninsurance in the LGBTQ community decreased from 34% in 2013 to 16% in 2020. In 2015, 10.4% of adults with disabilities were uninsured. 

How can employers act?

In states that have not expanded Medicaid, employers can advocate for doing so. In all states, employers can advocate for premium subsidies to make health insurance affordable for middle-income people. Employers can also advocate for the permanent availability of the enhanced premium tax credits (PTCs) passed as part of the American Rescue plan. 

Advocate for affordable housing.

What is it?

Affordable housing is generally defined as costing 30% or less of a family’s income. Families spending more than this are “cost-burdened” and constituted 37.1 million American households in 2019 (30.2% of households nationwide). Renters are more likely than homeowners to be cost-burdened.

How does it affect health?

Lack of affordable housing results in housing instability and forced tradeoffs that limit other health-promoting expenditures. People who face housing instability are more likely to experience poor health. At the extreme, those who experience chronic homelessness are more likely to be sick and to die.

How does it reduce inequities?

White households are more likely to have affordable housing than families of color. Among renters in 2019, 41.9% of white households were cost-burdened, as were 51.9% of Latino households and 53.7% of Black households. Similarly, the home-ownership rate in 2019 for white, Asian, Latino and Black households was 73.3%, 57.3%, 46.3%, and 42.8%, respectively.

How can employers act?

Employers can advocate for the development of low-income housing, as well as low-income tax credits for housing. They can also contribute to community-development organizations that focus on housing. 

Employers can advocate for tenant-based housing voucher programs and Permanent Supportive Housing with Housing First to promote health equity for people who are experiencing homelessness and have a disabling condition.

Additional strategies employers can advocate for include affordable and environmentally friendly housing renovations in historically marginalized communities as part of renewed investment strategies, as well as support for more multi-income housing plans in community redevelopment.

Advocate for high-quality, accessible, and affordable early care and education for children.

What is it?

There are two main arrangements for early care and education, or ECE, in which pre-kindergarten children (ages 3 and 4 years old) are cared for and taught by people other than their parents or other primary caregivers with whom they live. One is center-based and includes child-care centers and preschools. The other is based in either the child’s home or a caregiver’s home. Center-based care tends to be of higher quality but is more expensive and harder to find. On the other hand, home-based childcare is often more likely to serve families of color, low-income families, families with non-traditional jobs and immigrant families. 

How does it impact health?

ECE affects children’s health through access to health services and exposure to infectious diseases, or indirectly via education or by increasing parental employment and earnings. It can increase access to health screenings, health care, improved nutrition and other health promotion. But children entering ECE are also more likely to suffer respiratory infections and other infectious diseases in the short run. Long-term health effects of ECE include reduced blood pressure and smoking, as well as improved self-reported health.

How does it reduce inequities?

There are inequities in access to higher-quality center-based ECE, attended by 57% of children in households at or above poverty but only half of children below the federal poverty level.

Economic evidence indicates that there is a positive return on investment in early childhood education. The benefits from parents’ future earnings gains alone exceed program costs. If targeted to low-income or racial and ethnic minority communities, ECE programs are likely to reduce educational achievement gaps, improve the health of these student populations, and promote health equity 

How can employers act?

Employers can advocate for increases in federal, state and local financial support for ECE to increase access and quality. 

Specifically, employers can advocate for center-based early childhood education programs (ECE) to improve educational outcomes that are associated with long-term health as well as social- and health-related outcomes 

Advocate for culturally and linguistically appropriate services in the health system.

What is it?

Culturally and linguistically appropriate services, known also as CLAS, are respectful of and responsive to each person’s culture and communication needs. In 2013, the federal Office of Minority Health published 15 CLAS standards for health care organizations. The principal standard is to: “Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.” The other 14 standards are in three thematic areas: governance, leadership and workforce; communication and language assistance; and engagement, continuous improvement and accountability. 

How does it impact health?

Improving the availability of CAS can improve quality of care. Measures have been developed to evaluate adherence to CLAS standards in ambulatory, behavioral health, hospital and public health settings.

How does it reduce inequities?

Because people of color and under-resourced populations can struggle because of language, literacy and other barriers, adherence to the CLAS standards can reduce disparities and increase health equity.

How can employers act?

In purchasing health care for their employees, employers can use the established measures to hold contracted health care organizations accountable for adherence to the CLAS standards.

Advocate for increased support of public health infrastructure.

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What is it?

Throughout the COVID-19 pandemic, the need for and value of a comprehensive and well-funded public health infrastructure has been clear. The human, social and economic impact of an underfunded system that inadequately delivers public health services has been devastating. The public health system must be adequately resourced to be better prepared and respond better to the next pandemic.

How does it impact health?

Public health initiatives over the years have prevented innumerable cases of communicable and non-communicable diseases and saved countless lives. Public health also can improve health outcomes. During the 20th century, life expectancy at birth among U.S. residents increased by 62%, from 47.3 years in 1900 to 76.8 in 2000. Unprecedented improvements in population health status were observed at every stage of life. The almost 30-year increase in life expectancy is largely attributable to public health. For every 10% increase in local spending on public health, infant deaths and deaths from preventable causes such as heart disease, diabetes and cancer decrease on average between 1.1% and 6.9%.

How does it reduce inequities?

Public health plays a role in limiting the spread of communicable diseases and the burden of non-communicable diseases. Due to disproportionate exposure to health risks and inequitable access to health and health care services in communities of color, under-resourced communities and others, the extent to which these risk factors are addressed through science-based public health measures is the extent to which inequities can be mitigated. By supporting the public health system to adequately address communicable disease risk in the workplace, public transportation, and homes – with vaccines and non-pharmacological measures – and the non-communicable disease risk by assuring access to quality care to manage obesity, hypertension, and diabetes, inequities in exposure to health risk factors can be reduced and health outcomes can be improved.

How can employers act?

Employers can advocate for increased federal funding for the CDC, which provides funding and other support for state and local public health agencies. Employers also can advocate for increased state and local funding to adequately staff and resource health data systems and surveillance, preparedness, prevention and control of communicable and non-communicable diseases.

Employers can join public-private partnerships that leverage their internal data collection through biometric screenings, on-site health clinics, scorecards and other tools to support public health efforts through the provision of aggregate data to national public health surveillance systems.

Through their on-site clinics, call centers, and workforce, employers can also bolster public health response during emergencies by contributing their resources to support treatment and response efforts.

Resources and policies

Questions or suggestions can be directed to healthequity@heart.org