Minorities and Wellness

In 2002 Prudential Financial’s employee wellness program had a participation rate that many employers would envy, but when executives examined who was signing up, they discovered that African-Americans were greatly underrepresented.

They developed a new communications strategy to get more African-American workers on board, but another problem emerged. As they looked more closely at the company’s health care data, they found that African-American employees had much higher rates of diabetes and hypertension than those from other racial and ethnic groups, according to Dr. K. Andrew Crighton, chief medical officer at Prudential Financial.

In order to address those disparities, the company created a data warehouse to collect and analyze employee health information by race, ethnicity, gender, age and job levels and to track chronic conditions like diabetes, cardiac disease and asthma. Armed with that information, Prudential launched the Healthy Diabetic program in 2011 to address the disproportionate incidences of the disease among various employee groups.

Prudential is part of a small but growing number of employers that are addressing inequities in the health status of their workforces. Racial and ethnic disparities in health care — whether in access, insurance coverage or quality of care — is typically thought of as a public health concern, but awareness among employers is growing, according to LuAnn Heinen, a vice president at the National Business Group on Health.

“As the U.S. workforce becomes increasingly diverse and company operations globalize, health disparities in the workplace are also becoming more common,” she said in an email. “By addressing health care disparities and health equity, employers are improving the value, quality and effectiveness of the services their employees receive through health care benefits and productivity programs.”

According to the U.S. Centers for Disease Control and Prevention, African-Americans are 60 percent more likely to develop diabetes and 30 percent more likely to die of heart disease than non-Hispanic white people. While insurance coverage and access to care affect health outcomes, disparities exist even among those with insurance. For example, when it comes to cardiac care, insured African-Americans are significantly less likely than white people with health insurance to undergo angiography, which identifies blockages in the heart’s arteries, according to an NBGH report on health care disparities. As a result, African-Americans are less likely to undergo heart bypass surgery and other potentially life-saving procedures.

“Employers are coming to see that this is really critical,” said Ron Goetzel, vice president at Truven Health Analytics, which helped Prudential develop its data warehouse. “Even companies that offer very good health benefits, even those in the Fortune 500, when you begin to analyze the data and look at different racial and ethnic groups, you will see differences in prevalence.

“It doesn’t start when you enter the workforce, it starts way before that. Your childhood, your education, the environment you grew up in, all of those factors come with you into the workplace. To the extent that employers can address those factors, it’s going to benefit the employee and the organization.”

In 2015, Goetzel co-authored a study of racial and ethnic health disparities at 46 large companies and found that even among employees with good health benefits, higher incomes and a safe work environment, disparities existed. The study points out that some differences may be attributed to social, environmental and economic differences that were not measured in the analysis.

At Prudential, on-site nurses provide personalized coaching to help diabetic employees manage their blood glucose levels. First-year results showed declines for all groups with 61 percent of diagnosed employees joining the program. The company also provides cultural competency training for all health and wellness professionals.

Unlike many employers, Prudential eschews outcomes-based wellness incentives like financial rewards for employees who complete weight-loss or fitness challenges because such practices could unfairly discriminate against those with conditions associated with race and ethnicity, according to Crighton, who also co-authored the 2015 study, which was published in the Journal of Occupational and Environmental Medicine.

Employers who are concerned about health care disparities in their workforce must look beyond the physical and take into account factors such as an employee’s social and cultural environment when designing a wellness program, he said.

“It’s about focusing on those nonmedical barriers to health and really sitting down and meeting the person where they are to find the best approach for them,” he said. “It’s not the old medical model of, ‘Here’s what you need to do.’ Even among minority groups there are differences. Not everyone is the same.”