March 26, 2024

Introduction

Recognized by many for its role in fostering a fair and healthy workforce, health equity is also acknowledged as a strategic business lever for maximizing potential. The World Health Organization (WHO) defines health equity as “the opportunity for all people to realize their full health and well-being potential regardless of demographic, social or geographical differences¹.” Business Group on Health’s 14th Annual Employer-Sponsored Health and Well-being Survey² reveals that 80% of employers are either maintaining a globally consistent approach or are in the process of formulating a strategy, with members highlighting health equity as a key element of a global benefits strategy to ensure all employees, regardless of their location, have access to the same high standard of care. This resource is designed to guide employers in weaving health equity into their global workforce strategy by offering actionable and sustainable recommendations.

The resource is built around the following key points:

• The ”why”: The imperative for building a business case for health equity;
• The ”what”: Leveraging data and strategic insights; and
• The ”where”: Navigating the complexities of global regulatory landscapes.
• The ”who”: Identifying the stakeholders
• The ”when”: The optimal timing for implementing health equity measures;

The comprehensive roadmap presented here aims to guide employers from the foundational stage of understanding and commitment to strategy development and evaluation, charting a clear course toward achieving health equity across the global workforce.

The Why: Building the Business Case for Global Health Equity

Among global employers, the reasons to achieve health equity are multifactorial:  It enhances employee well-being, boosts productivity and solidifies a global brand reputation by demonstrating a commitment to every employee's health and well-being, regardless of their location³. Companies like Microsoft have taken this understanding to heart, recognizing that a global workforce thrives when disparities in health care access are addressed.

The approach to health equity, however, varies significantly between the U.S. and other parts of the world. This is due to differing health care systems, regulatory environments and cultural norms. As echoed by employer interviews, addressing these variations requires a flexible strategy that adapts to local contexts while maintaining a core commitment to equity. For instance, many employers interviewed noted that while U.S.-based initiatives might focus on increasing access to insurance coverage and closing disparities in preventive care, programs in other countries might prioritize providing basic health care services, filling gaps in government-provided care or addressing specific local health restrictions.

The What: Data-Driven Health Equity Strategies

Use of data is the compass that guides the journey toward health equity. By utilizing robust data analytics, employers can pinpoint health disparities and target interventions where they are most needed. Automated claims data, for instance, can reveal high-claim drivers that necessitate policy updates. Similarly, global benchmarking through surveys provides a comparative lens to measure progress and identify best practices. Among employers, there is a growing interest in using benchmarking data in the form of surveys, employer-sharing calls and industry reports to inform their health equity strategies. In interviews, employers explained that they’re keen on metrics like employee health outcomes, utilization rates of health services and employee satisfaction with health benefits, which can provide valuable insights into the effectiveness of health equity initiatives and help identify areas for improvement.

The Where: Navigating Global Regulatory Obstacles

Navigating the complex maze of global regulatory environments is a critical – and challenging - aspect of advancing global health equity goals. This is primarily due to variance in health care regulations and legal requirements from one country to another. To address this issue, employers must blend awareness and agility: adopting a flexible approach across geographies and staying continuously informed about the regulatory landscapes of the countries in which they operate. To accomplish this goal, employers may need to establish dedicated teams or hire local experts and global consultants/brokers who understand the nuances of regional health care laws and can provide guidance on compliance.

To illustrate:

• In Germany, where strict data privacy laws like the General Data Protection Regulation (GDPR) govern health information, a company might partner with local health providers to ensure secure data handling while still gathering the necessary health data for equity initiatives.
• In India, with limited government-provided health care, an employer might focus on supplementing coverage with private health insurance, ensuring that employees have access to essential health services.
• In Singapore, a multinational company might deploy a flexible benefits platform, allowing employees in different regions to choose benefits that are relevant and compliant with their local health care system.

Adaptability not only ensures legal compliance but also reinforces the commitment to health equity by respecting and accommodating the diverse needs of a global workforce.

The Who: Stakeholders in the Health Equity Ecosystem

In pursuit of health equity, a diverse array of stakeholders, including internal teams, vendors and external partners, play crucial roles. Key strategies employers may evaluate to effectively engage with multiple stakeholders include the following:

• 1 | Assessing vendor capabilities and commitment: Health and well-being vendors can play a role in addressing health equity, yet their capabilities and commitment to health equity vary. It's essential to assess whether a vendor's vision aligns with your health equity goals. This is especially challenging outside the U.S., where holding vendors to the same level of accountability can be difficult. During the vetting process, companies should consider whether vendors can offer scalable solutions that adapt to different regulatory environments and cultural contexts.
• 2 | Building vs. partnering for health equity solutions: Deciding between building in-house solutions or partnering with external vendors depends on several factors, including the company's internal capabilities, the complexity of the health equity challenges and the specific needs of the workforce. An initial analysis or audit of internal resources and gaps can guide this decision. Where in-house expertise is lacking, partnering with vendors who can provide specialized skills or resources becomes necessary.
• 3 | Evaluating vendors: A tiered approach: As employers pointed out in interviews, a tiered approach to vendor evaluation helps in categorizing them based on their ability to meet current needs and their potential to adapt to future challenges. This process involves assessing vendors not just on their immediate offerings but also on their capacity for innovation and alignment with long-term health equity goals. An example of a three-tiered assessment can include:
• Capability to deliver immediate solutions: This tier includes vendors that can address current needs effectively and efficiently.
• Potential for scalability and adaptability: Vendors in this tier are evaluated based on their ability to scale solutions across different geographies and adapt to evolving regulatory and cultural landscapes.
• Innovation and long-term alignment: The top tier focuses on vendors that not only meet current needs but also demonstrate a commitment to innovation, offering forward-thinking solutions that align with the company's long-term vision for health equity.

By segmenting vendors into these tiers, employers can prioritize their engagement and investment, focusing first on partners who can meet immediate needs while also considering the potential for long-term collaboration.

• 4 | Establishing expertise in target areas for global expansion: As companies expand globally, they should develop expertise in the specific health equity challenges and opportunities in their target areas. This might involve building internal teams with regional knowledge or partnering with local entities who understand the nuances of the local health equity landscape.
• 5 | Engaging global and regional business leaders: Key internal stakeholders, including global and regional business leaders, play a critical role in the pursuit of health equity. Benefit teams should be prepared to keep these leaders informed on progress and barriers to success, as their support is critical along the way. This engagement demonstrates the importance of leadership buy-in for overcoming challenges and achieving health equity goals across diverse locations.

NewsCorp's Progressive Approach to Global Health Equity

NewsCorp has revamped its global health equity strategy to align with evolving environmental, social and governance (ESG) and diversity initiatives. Recognizing that equitable health care access is a multifaceted challenge, the company has introduced a comprehensive framework to address various aspects of health equity.




• Affordable and accessible health care: NewsCorp's approach considers the diverse health care needs of its global workforce by setting global minimum standards for health care benefits, including provisions for preexisting conditions and HIV benefits. The strategy includes affordability and multiple points of contact, ensuring that employees, irrespective of their location or economic status, have access to essential health services.
• Vendor role and capability: NewsCorp's initiatives, such as setting global minimum standards and ensuring inclusive health benefits, require collaboration with a range of vendors who can adapt to diverse global needs. The company's strategy implies a need for vendors that can offer scalable and inclusive solutions, from health care benefits that cover preexisting conditions to those addressing the needs of LGBTQ+ employees and other underrepresented groups. For instance, NewsCorp's expansion into regions like Canada, where existing vendors have branched out, demonstrates the importance of vendor flexibility and capability in supporting global health equity goals.
• Assessing vendor commitment to health equity: NewsCorp values vendors who contribute to the diversity of health care plans and provider networks. This aligns with assessing vendors based on their commitment to diversity, equity and inclusion (DEI) and ESG principles, such as those offering alternative health care plans with a diverse portfolio of providers or facilitating reimbursements for services not directly covered, such as the EU directive on eyewear. NewsCorp's ongoing assessment and evolution of its health equity initiatives include evaluating vendors for their alignment with these values, influencing decisions on partnerships.
• Data-Driven and localized strategies: While a data-driven approach remains ideal, NewsCorp faces challenges in uniformly applying this strategy across its global portfolio. In the U.S., the company utilizes detailed demographic and family construct data to tailor its health care offerings. This approach involves analyzing comprehensive datasets that provide insights into the various characteristics of their workforce, including age, gender, ethnicity, family size and specific health needs. By understanding these diverse demographics, the company can identify patterns, preferences and particular health challenges faced by different segments of its employees. The strategy also involves a focus on employee resource groups (ERGs), especially for employees with disabilities, fostering a proactive and inclusive workplace culture.
• Ongoing assessment and evolution: With support from varied stakeholders, the company continues to assess the effectiveness of its health equity initiatives and remains open to evolving its strategies while navigating regulatory challenges. This includes exploring alternative health care plans and examining the diversity of provider networks, with a keen eye on the future integration of DEI in vendor standards.

Through these initiatives, NewsCorp aims to not only provide equitable health care to its employees but also to set an industry standard for comprehensive and inclusive health care benefits.

The When: The Future of Health Equity Strategies - Start Now and Adapt as You Go

As employers look toward the future, the landscape of health equity strategies is anticipated to evolve rapidly. One of the emerging trends is the utilization of technology to enhance the accessibility and effectiveness of health benefits. This includes digital health solutions, telemedicine outside the U.S. and health apps, which are particularly important for reaching global employees and addressing diverse health needs. These advancements offer a glimpse into the future but also serve as a call to action for employers to start integrating these innovations into their health equity strategies now.

Another key area of focus is the integration of social determinants of health (SDOH) into benefits design. Companies are increasingly recognizing that factors such as economic stability, education, social and community context and physical environment significantly impact employees' health. While the full adoption of these strategies on a global scale may seem daunting and not immediately feasible, starting with small, manageable steps can lay the foundation for more comprehensive integration in the future. Keeping an eye on future developments while actively engaging in current initiatives enable employers to be proactive rather than reactive, ensuring that their health equity strategies remain relevant and effective in the ever-changing global health landscape.

Eight Must-Do Tactics to Achieve Health Equity

A health equity strategy requires a structured approach that considers various factors such as cultural nuances, legal constraints and market-specific health challenges. The list of considerations for developing global priorities includes understanding local health landscapes, employee demographics and the interplay between global trends and regional specifics. The framework below synthesizes key information and constructs a comprehensive framework for developing and implementing a health equity strategy.

• 1 | Assess the current landscape: Begin by conducting a thorough assessment of the current health equity landscape within your organization. This includes understanding the health needs of your workforce, identifying existing disparities and recognizing the unique challenges and opportunities in the regions in which you operate. Utilize data analytics, employee surveys and health outcome metrics to form a baseline understanding. For many employers, this process may need to unfold over time depending on access to information about various geographies.
• 2 | Define clear objectives: Set specific, measurable, achievable, relevant and time-bound (SMART) objectives for your health equity strategy to achieve a minimum core of standards. These objectives should align with your broader organizational goals and address the key areas identified in your assessment. Objectives might include improving access to health care, addressing social determinants of health or enhancing the cultural competence of health services.
• 3 | Develop a tailored strategy: Based on your objectives, develop a strategy that is tailored to the needs of your global workforce. This strategy should consider cultural nuances, legal constraints and specific health challenges in different regions. It might involve a mix of global policies and local adaptations, ensuring both consistency and relevance.
• 4 | Engage stakeholders: Involve a range of stakeholders, including internal teams, vendors and possibly local health experts, in the development and implementation of your strategy. Alignment and buy-in from these groups are essential for a successful and sustainable health equity initiative.
• 5 | Implement with flexibility: Roll out your health equity strategy with a willingness to adapt and learn. Be prepared to adjust as you receive feedback, learn from the data and as health needs evolve. This agile approach allows for continuous improvement and responsiveness to changing circumstances.
• 6 | Monitor and evaluate: Establish a system for ongoing monitoring and evaluation of your health equity strategy. This should include regular reviews of health outcomes, employee feedback and benchmarking against industry standards. Use these insights to refine and enhance your strategy over time.
• 7 | Communicate progress: Keep all stakeholders informed about the progress and impact of your health equity initiatives. Transparent communication reinforces the commitment to health equity and encourages a culture of health and well-being within the organization.
• 8 | Plan for the future: Finally, look ahead to emerging trends and innovations in health equity. Stay informed about new technologies, evolving best practices and global health developments that could impact your strategy. Continuously exploring and integrating these advancements will keep your approach at the forefront of health equity.

By following these steps, employers can create a dynamic and effective health equity strategy that not only addresses immediate health needs but also paves the way for a healthier, more equitable future for their global workforce.

Appendix

The findings described in this guide are the result of qualitative interviews conducted in the second half of 2023. Senior-level HR/Benefits and well-being leaders from 12 large employers were interviewed. These leaders have in-depth knowledge of their companies' health equity strategies. Selection criteria included ensuring a diverse representation across industries and having a global presence. Interviews focused on exploring the nuances of health equity approaches within different organizational contexts.

Acknowledgements

Business Group on Health extends sincere thanks to all the participants who contributed to this research. Your expertise and diverse perspectives have been invaluable in enriching this study. The breadth of knowledge shared by professionals across various industries has significantly contributed to creating a comprehensive and practical guide for employers seeking to navigate and implement health equity strategies.

Citations

Before referring to or using this report in any way, you must receive permission from Business Group on Health. Please contact [email protected].

Suggested citation for this survey report:

Business Group on Health. Health Equity in Global Workforce Strategy. March 2024. Available at: https://www.businessgrouphealth.org/resources/health-equity-in-global-workforce-strategy

More Topics

Articles & Guides Culture and Strategy Physical Health Health Equity