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Well-being and Workforce Strategy

Inclusive Experience

Inclusion in work, benefits and health care experience is critical to helping all employees reach their highest health and well-being potential.

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October 31, 2023

Employer Guide to Health Equity
Employers play a major role in setting the stage for health equity around the world.
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Inclusion in work, benefits and health care experience is critical to helping all employees reach their highest health and well-being potential. Marginalized communities exist all over the world and face unconscious bias, exclusion, microaggressions and other stressors at work and when engaging in health care which have significant impacts on their physical and mental health. The good news is that many leading companies are doubling down on diversity, equity, inclusion & belonging (DEIB) efforts and aligning health and well-being strategies with these efforts to advance health equity.

KEY EMPLOYER STRATEGIES

  • 1 | Prioritize DEIB principles and practices throughout the organization.
  • 2 | Understand DEIB priorities and challenges across different countries and cultures and proactively work to translate and advance the company’s commitments within local contexts.
  • 3 | Ensure employees have access to and can easily find culturally relevant care.

Below are ideas for action related to each key strategy. Implementing a holistic approach - and when possible, a global approach - will promote equity and consistency throughout the organization.


1 | Prioritize DEIB principles and practices throughout the organization.

  • DEIB assessment: Review organizational policies and practices, particularly those specific to health and well-being, to identify and mitigate disparities. When reviewing benefits through a DEIB lens, health and well-being leaders may reflect on questions like: Do marginalized communities have comprehensive coverage that meets their unique health care needs? Do disparities in engagement in care, adherence to treatments and prevalence of health conditions and/or outcomes exist among different employee populations? Does equity exist in access to and engagement with leave? Is there equity and global consistency in benefits across geographical locations?
  • Employee feedback: Offer regular opportunities for employee feedback on DEIB at work and with their health care and benefits experience through surveys and focus groups.
  • Pilot testing DEIB investment: Utilize pilot programs to test DEIB and health equity initiatives to ensure that investments are made in ones that work best for those with the greatest needs and are culturally responsive to their experience.
  • Inclusive internal initiatives and activities: Ensure that initiatives and activities for employees reflect and accommodate the unique needs of different employees, from representation in communications through the activities and offerings themselves. For example, if the company has a steps challenge, ensure that appropriate accommodations are made upfront for employees who use wheelchairs so that they can participate.
  • Inclusive communications: Establish and apply inclusive language/cultural sensitivity guidance for internal and external communications and share it with vendor partners as appropriate. Ensure that resources, particularly those for employees, are available in national and local languages and dialects.
  • Employee self-identification: Provide a means for employees to self-identify their gender, sexual orientation, disability status, military distinction and other demographics.
  • Social connectedness: Foster kindness and social connectedness to build solidarity and bridge differences among colleagues.
  • Leader accountability: Set leaders up for success by helping them understand unique experiences and needs marginalized employee populations may experience and how to refer them to appropriate benefits and solutions.
  • DEIB lens to new locations: Integrate DEIB factors into decision-making related to workspaces, new office locations and employee relocations. For example, when establishing a new work location, a company may assess the location’s support for LGBTQ+ and women’s rights to ensure alignment with company values and employee psychological safety. Similarly, consider DEIB when relocating employees. Employers can create a safe, inclusive experience where employees feel comfortable sharing how they and their members identify. They company can then ensure that these employees’ health and well-being needs are appropriately met if/when they relocate to a new region or country.

Employers in Action

Stellantis’s D&I Awareness Trainings: Stellantis developed a strong D&I awareness project within Manufacturing Plants in South America. Approximately 200 employees participated in 20 listening group sessions conducted by National Service for Industrial Learning (SENAI). Diverse topics were addressed, such as gender, ethnicity, generation, citizenship, disability and LGBTQ+. Based on these insights, training, mentoring and awareness initiatives have been launched and will continue through 2023. In total, about 1,620 employees will be involved in these actions.12

Hubspot’s DEIB Framework for New Locations: Hubspot developed a key considerations framework for new operations in candidate countries. The factors include questions like the following: Does the country have legislation related to sexual harassment, equal compensation and parental leave? Based on the assessment, the company decided to open its new LATAM operations in Colombia, because it scored highest on support for LGBTQ+ and women’s rights.13

Cardinal Health’s Option to Self-Identify: Cardinal Health launched a new Workday capability where employees can self-identify their gender preferences. This capability has significantly improved the company’s ability to capture important gender and identification data. That information is shared with benefits carriers who use gender data to send targeted communications. Employees who select “male” or “female,” receive information about those respective health care benefits. When employees select “non-declared” or “non-binary,” benefits information they receive is not gendered.


2 | Understand DEIB priorities and challenges across countries and cultures, and proactively work to advance company commitments within local contexts.

  • Local understanding: Engage local leadership and employees in listening sessions to understand unique legislation, cultural norms and history that may influence health equity and DEIB approaches.
  • Adaptable strategies: Ensure that corporate strategies and goals related to DEIB and benefits can be adapted by local leaders. While DEIB strategies often launch from corporate headquarters, directly applying the DEIB approach used at headquarters to other locations within a country and globally may not be appropriate due to local legislation and cultural norms.
  • Local engagement: Ensure that employee resource groups (ERGs), well-being champions and any councils/committees that influence benefits strategies include local chapters and/or team members across different geographies and business lines as appropriate.

Examples of Cultural Characteristics, Norms and Challenges Influencing DEIB by Country

The list below is intended to provide HR and benefits leaders with a few examples of the types of local issues they need to understand when developing and adapting benefits, initiatives and communications to advance health equity.

China

  • Regional diversity: China is a vast country with many regional and cultural differences in traditions, cuisine and even language. For example, there are 56 officially recognized ethnicities within China, many with their own languages.14
  • Gender: According to the World Economic Forum’s 2022 Gender Gap Report, China ranked second to last place at 145 out of 146 countries for gender equity in health and survival.15
  • LGBTQ+: Chinese LGBTQ+ citizens are not legally protected against discrimination. Additionally, same-sex marriage and adoption are not allowed. Recently, there has been an increase in government censorship, surveillance and anti-LBGTQ+ activity, such as the 2023 forced closure of a pioneering Beijing LGBT Center.16, 17

India

  • Class: Even though caste discrimination is illegal in India, birth origin and parental background still impacts education and employment opportunities. Moreover, studies show low representation of marginalized castes in leadership roles.18
  • Gender: According to the 2022 World Economic Forum, India ranked 135 out of 146 countries for gender equity overall and last at 146 for equity in health and survival.15
  • Language and cultural diversity: The 1.4 billion Indian population speaks more than 450 languages, and great cultural diversity exists among different regions.19

Mexico

  • Colorism: Mexico’s recent racial reckoning involves discrimination based on skin color. Those with lighter skin tones achieve greater education (11 years vs. 5 years) and wealth (dark-skinned people earn 52% less than their white counterparts).20
  • Wealth disparities: According to the 2022 World Inequality Report, Mexico has one of the highest wealth gaps in the world. Moreover, differences in income and culture exist between the industrialized north and less developed south.21
  • Rural vs. urban disparities: Disparities in health care utilization and access to coverage in Mexico disproportionately persist for Mexicans living in rural areas compared to those living in highly populated areas.22
  • LGBTQ+: A clear majority (69%) of Mexicans believe homosexuality should be accepted.23 Recently, Mexico has made significant progress in LGBTQ+ rights; in 2022, same-sex marriage became legal in all states and HRC’s Equidad MX 2023 Report indicates unprecedented growth in corporate commitment to LGBTQ+ equality.24, 25

United Kingdom

  • Ethnic and racial disparities: While Black, Asian and minority ethnic (BAME) groups have made significant progress, health and economic disparities still exist. In one study that evaluated employment, earnings, education, health and well-being outcomes, Chinese and Indian people often fared better than White people, while Bangladeshis, Pakistanis and Black people demonstrated worse outcomes with higher incidence of obesity and diabetes, along with lower life satisfaction. Moreover, when comparing people with very similar individual and job characteristics, BAME employees earned 10% less than White employees.26
  • Gender: The United Kingdom fell from 9th place in 2020 out of 33 Organisation for Economic Co-operation and Development countries to 14th place in 2021 for gender equity in the workplace due to a widening gender pay gap and decreasing female labor force participation. A lack of affordable childcare and low uptake of parental leave and child-rearing responsibilities by fathers threatens to increase this disparity.27
  • Age discrimination: While the overall population is aging, ageism is far-reaching. One in three people within the UK report experiencing age-based prejudice or discrimination.28

United States

  • DEIB: While DEIB efforts have been a priority of companies headquartered in the U.S., DEIB in general is a polarizing and politicized topic within the country. Most recently, the Supreme Court’s decision to overturn affirmative action for educational institutions may hinder efforts to diversify the medical profession.29
  • Race: Many BIPOC (Black, Indigenous, and people of color) individuals face bias throughout much of their lives and specifically in their health care experience, which can lead to lower quality of care and poor health outcomes. For example, Black patients are prescribed less pain medication, receive fewer cardiovascular referrals, experience less patient-centered communications and rate care quality worse than White patients.30 To learn more about racism as a social determinant and ways employers can mitigate it, refer to the Racism section of Business Group on Health’s Social Determinants of Health Guide.
  • LGBTQ+: Seventy-two percent of Americans say homosexuality should be accepted.23 U.S. cities have strong support for LGBTQ+ rights and ranked high among the global 2022 Open for Business ratings of 145 global cities. However, state legislators are introducing more legislation that potentially exposes LGBTQ+ individuals, especially transgender people, to discrimination.31
  • Women’s health: In the wake of the 2022 Supreme Court decision in Dobbs v Jackson, employer health plan sponsors face unprecedented uncertainty, including potential civil and criminal legal risks, over reproductive health care coverage and related programs.32, 33

3 | Ensure that employees have access to and can easily find culturally relevant care.

  • Provider directory: Push health plans and vendors to have a diverse care delivery network and provide a means for providers to share their demographics, as well as a platform for employees to search for providers that match their identity (e.g., by race, gender, sexual orientation, language, etc.). According to the 2024 Large Employer Health Care Strategy Survey, 61% of large employers require health plan and navigation partners to maintain health care and mental health provider directories, making it easier for employees to find providers who match their culture and identity, and another 23% are considering doing so for 2025/2026.9
  • Culturally conscious clinical care training: Use contracting as a vehicle to require that providers are trained to deliver and implement culturally conscious and responsive care that starts with an evidence-based approach, takes into account one’s identity and adjusts treatment appropriately based on patients’ goals. Collaborate with health plan(s) to implement requirements for provider training on culturally conscious care, ensuring healthcare professionals are well equipped to address the diverse needs of their patient population.

Large Employers in the U.S. are Leading the Way in Implementing Inclusive Benefits

82% cover early diagnosis tools and care for neurodiversity

77% provide gender-affirming care

75% have fertility benefits for all types of families

57% have expanded provider network to include more diversity

32% cover doulas

For more large employer benchmarks, review the 2024 Large Employer Health Care Strategy Survey Report.

Employers in Action

Nielsen’s Approach to Improving Care for LGBTQ+ Populations: Nielsen expanded its benefits to ensure that LGBTQ+ employees were empowered to engage in health care. Employees have access to vetted in-network providers across 20+ specialties who are affirming, clinically competent and match employee preferences related to gender, race/ethnicity and sexual orientation. The company also expanded benefits to support transgender employees and covers thyroid reduction, mammoplasty, rhinoplasty, facial feminization and voice modification.


The Unique Needs of Employee Populations

Large employers have diverse employee populations with varying health care needs. Below are a few examples of the unique needs select populations face that must be addressed by employers, industry partners and providers to achieve health equity. All populations shown below need leaders to push for accountability for a health care experience that is free of bias and discrimination.

LGBTQ+ Community

  • Gender-affirming care
  • Family forming benefits from fertility services to adoption
  • Domestic partner coverage
  • Screenings for intimate partner or sexual violence
  • HIV/AIDS care coverage
  • Culturally responsive mental health care

BIPOC/BAME

  • Culturally responsive physical and mental health care
  • Access to BIPOC providers with shared lived experiences
  • Comprehensive, tailored maternal health benefits
  • Equal representation in health research

People with Disabilities

  • Accessibility and disability inclusion, beyond legally required accommodations, throughout the work and health care experience
  • Care coordination benefits and/or health care navigators to help employees and families find accessible providers, therapists and aides, including those who can offer virtual or at home care
  • Coverage for ongoing treatments improving functional abilities and assistive devices, as well as early screenings and diagnostic tools for neurodiversity

Rural Populations

  • Access to specialist care, skilled providers and care outside the emergency room
  • Tactics to address transportation barriers
  • Increased provider diversity

Women

  • Comprehensive reproductive care
  • Paid parental, family and medical leave
  • Equal representation in health research
  • Gender-based care that is responsive to different diagnosis and treatment needs

Don’t overlook intersectionality:

Intersectionality refers to the fact that people have more than one identity. For example, an employee may have a disability and be Latino. They will likely share health challenges and experiences of others with disabilities and other Latino employees, as well as have unique needs and experiences specific to being Latino with a disability. Employers can benefit from looking at employee data from multiple perspectives, facilitating opportunities for connection among employee populations (such as bringing together a LGBTQ+ ERG and Women’s ERG to focus together on the unique experience of lesbian women) and providing opportunities to learn about and discuss intersectionality throughout the organization and in conversations with health and wellbeing partners.


Business Group Resources on Marginalized Populations

To learn more about the unique challenges marginalized communities face and leading practices to supporting their health and well-being needs, explore these resources:

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TABLE OF CONTENTS

  1. Prioritize DEIB principles and practices throughout the organization
  2. Understand DEIB priorities and challenges across countries and cultures
  3. Ensure that employees have access to and can easily find culturally relevant care
  4. Business Group Resources on Marginalized Populations