How Employers Can Mitigate Health Disparities Among Black Americans

The US population is over 330 million people. 60% of US adults have one chronic disease, and 40% have two or more chronic diseases, running the US annual health care cost of $3.8 trillion. The most common chronic diseases that lead to these high health care costs, death, and disability, are heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes, and chronic kidney disease[1].

In the workplace, IBI research shows chronic conditions such as heart disease and cancer can be costly in a financial and productivity sense. Overall, for heart disease, disability claims amount to $1.9B and over 13M lost workdays; for cancer, these costs are even higher at $2.0 billion and 15 billion lost workdays.

Black Americans make up 13.4%[2] (41.4million) of the US population but account for the highest population of poverty rates at 19.5%[3]. As of 2019, Black people made up 13% of the entire US workforce. The employment-population ratio for Black people was 58.3%[4], meaning that a little more than half of the entire Black population in the US was present in the workforce. Black women have higher participation in the workforce than any other group of women, while Black men have the lowest workforce participation rate compared to any other group of men.[5] Unemployment rates were some of the highest for the Black population at 6.5% compared to 3.5% for the white population.

Black Americans represent a significantly underserved segment of the population despite significant need.  Black people experience higher death rates from chronic conditions, more symptoms of mental and emotional distress and have been disproportionately affected by the COVID-19 pandemic. This coupled with poor access to health care and health insurance make the situation even more grave.

Chronic Health Conditions for Black Americans[6]

• Asthma – three times more likely to die from asthma related conditions than white people.
• Cancer – have the highest mortality rate for all cancers compared to any other ethnic group.
• Chronic Liver disease – Black men and women are respectively 60% and 30% more likely to have and die from chronic liver disease than white men and women.
• Diabetes – 60% more likely to be diagnosed with diabetes and twice as likely to die from the disease
• Heart Disease – 40% more likely to have hypertension and 30% more likely to die from heart disease
• Obesity – Black women have the highest rates of obesity among any other population in the US

COVID19 disparities for Black Americans

Health and social inequities put Black people at increased risk of being hospitalized and dying from the COVID-19 virus. Data[7] shows that Black people had 13.8% positive COVID-19 tests, compared to 7% for white people. Black people have accounted for 34% of COVID-19 related deaths, despite being only 13.4% of the entire US population. Income and livelihoods have also been affected for Black people more than white people, with 43% of Black people reporting jobs loss or pay cuts, compared to 38% of white people.

Mental health disparities for Black Americans

Recent data show that suicide was the second leading cause of death for young Black people in 2019, and more Black female teenagers attempted suicide than their white counterparts.[8] In 2020, only 37.1% of Black adults received mental health services compared to 51.8% of white adults[9]. Many Black people avoid seeking mental health care services because of stigma, and access to culturally competent care is lacking. Black people experience bias and discrimination in the health care system, which can often time lead to inaccurate and more aggressive diagnoses such as schizophrenia, compared to white people who are more likely diagnosed with mood disorders. [10]

Insurance Coverage

Healthcare in the US is a complex system among healthcare providers, insurance companies, the government, and patients. There is a mix of public and private coverage that makes access and costs of healthcare challenging to many Americans. Even though the Affordable Care Act increased the rates of health insurance for the Black population in the past decade, they remained under-insured (13.2% without insurance) when compared to white people (9.7% without insurance)[11]. Progress made under the ACA was stalled after 2017[12], and with the onset of the pandemic affecting African Americans at higher levels, their coverage has been ever further disrupted.

What can employers do?

Research has shown that racial health disparities significantly impact employee retention, productivity, and engagement, as well as employers’ long-term costs. Health equity is important to employees, and Black employees are 30% more likely to switch employers based on health care benefits. Research also shows that Black employees were more likely to miss 6 or more days of work because of health, compared to white employees. Projected data indicated without this productivity loss, the economy could boom by $20 billion.[13]

Employers should have acute awareness of these disparities and implement programs to address health care issues for their Black employees not only to reduce costs and increase productivity, but to create a more equal society. Employers can help bridge this divide in a few key ways:

• By implementing health and wellness program initiatives with professionals that are culturally competent and relatable for Black employees. Research has shown that Black people communicate more openly and are more likely to trust Black healthcare providers.
•  
• Use data and health disparity reports to develop initiatives that are appropriately targeted for screenings, education, and treatment guidelines
  
  
• Be consistent and track changes to know what needs improvement and what is working for Black employees Communicate with Black employees to understand their health and wellness needs, and let their voices be heard when making decisions regarding their health

Employers and organizations have started implementing initiatives to tackle these disparities. One example is the Black Community Innovation Coalition spearheaded by large employers like Target, Walmart, and Best Buy. Employers are partnering with Grand Rounds and Doctors on Demand to provide virtual health care to their Black employees. The program is doing outreach for maternity care for Black women, as they experience three times higher death rates in pregnancy than white women. Grand Rounds and Doctors on Demand are proud to have a diverse team of doctors, with nearly 50% of their physicians identifying as Black.

Another is the Black Barbershop Health Outreach Program, providing health care services such as blood pressure and diabetes screening at the barbershop, with a mission to decrease health disparities among the Black population. This initiative is focused on ensuring that Black men receive culturally competent and affordable health care, health screens and health education for high-risk conditions. They have also recently implemented a telehealth option, for patients to meet with the healthcare providers virtually.

[1] ^{https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm}

[2] ^{https://www.census.gov/quickfacts/fact/table/US/RHI225219}

[3] ^{https://www.census.gov/library/publications/2021/demo/p60-273.html}

[4] ^{https://www.bls.gov/opub/reports/race-and-ethnicity/2018/}

[5] ^{https://www.bls.gov/spotlight/2020/african-american-history-month/home.htm}

[6] ^{https://www.minorityhealth.hhs.gov/}

[7] ^{https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html}

[8] ^{https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24}

[9] ^{https://www.nimh.nih.gov/health/statistics/mental-illness}

[10] ^{https://www.mhanational.org/issues/black-and-african-american-communities-and-mental-health}

[11] ^{https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202102-508.pdf}

[12] ^{https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/}

[13] ^{https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/income-alone-may-be-insufficient-how-employers-can-help-advance-health-equity-in-the-workplace}