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Calls to address workforce health inequities have been met with expanded well-being programming, without an assessment of programming relevance or evaluation of equity-related outcomes. The goal of this commentary is to summarize current practices and gaps in evaluation of well-being programs, provide evidence supporting the need for broader participation in well-being offerings, and make recommendations to incorporate health equity measures into planning and evaluation efforts conducted by both employers and vendors. Data sharing, expanded measurement, more rigorous evaluation methods, and alignment of goals are some of the recommendations to better address health inequities and differential participation among employees.

Purpose: To understand differences in health risk assessment (HRA) and biometric screening participation rates among benefits-enrolled employees in association with wage category. Design: Cross-sectional analysis of employee eligibility file and health benefits (wellness and claims) data. Setting: Data from self-insured employers participating in the RightOpt private exchange (Conduent HR Services) during 2014. Participants: Active employees from 4 companies continuously enrolled in health insurance for which wage data were available. Measures: Measures included HRA and biometric screening participation rates and wage status, with employee age, sex, employer, job tenure, household income, geographic location, and health benefits deductible as a percentage of total wages serving as covariates. Analysis: Employees were separated into 5 groups based on wage status. Logistic regression analysis incorporated other measures as covariates to adjust for differences between groups, with HRA and biometric screening participation rates determined as binary outcomes. Results: Participation rates for HRA and biometric screening were 90% and 87%, respectively, in the highest wage category, decreasing to 67% and 60%, respectively, among the lowest wage category. Conclusion: Employee wage status is associated with significant differences in HRA and biometric participation rates. Generalizing the results generated by modest participation in these offerings to entire populations may risk misinterpretation of results based on variable participation rates across wage categories.

Equitable health benefit design is central to addressing the health inequities of individuals with commercial health insurance in the United States. To do so, employers and other plan sponsors must take action to identify and address unmet health and well-being priorities among racialized groups and low-income workers. These historically underrepresented subpopulations will also benefit from more equitable approaches to healthcare benefits design that recognize and meaningfully address access and affordability concerns. Targeted appropriately, these actions have the potential to foster greater employee engagement and productivity, leading to enhanced business performance.

Purpose: This study examines the association between nonparticipation in wellness activities and employee turnover risk. Design: Retrospective, cross-sectional analysis. Setting: Large university in the Midwestern United States. Participants: Employees with continuous employment during 2016 and complete human resources and wellness program data (n = 34 405). Methods: Demographic, health risk assessment (HRA), and wellness program participation data were collected in 2016 and paired with administratively recorded turnover status from 2017. For the multivariate analyses, logistic regression models were used. Results: There were statistically significant associations between various socioeconomic and demographic characteristics (gender, age, race, wage, union and faculty status, and health score) with turnover status. Also, all 3 participation levels (participated in the HRA only, participated in the HRA and wellness programming, and participated in wellness programming only) had lower odds of experiencing turnover compared to nonparticipants (participated in the HRA only [adjusted odds ratio, AOR: 0.89; confidence interval, CI: 0.80-0.99], participated in wellness program(s) only [AOR: 0.77; CI: 0.62-0.95] and participated in both the HRA and program(s) [AOR: 0.82; CI: 0.74-0.91], respectively). Conclusion: Employee participation in wellness program activities appears to represent a measure of engagement with work. Nonparticipation in these programs is associated with increased risk of employment turnover in the subsequent year.

Our collective experience with COVID-19 and Black Lives Matter has heightened awareness of deeply embedded racial and socioeconomic disparities in American businesses. This time, perhaps, sustained change is within reach. As organizations advance diversity, equity and inclusion (DEI) initiatives, an often overlooked focus of is the health status of employees and their families, where equitable access to high-value health benefits offerings should be available to all. This commentary provides guidance for employers to expand their DEI initiatives to include employee and family health and well-being as a central outcome measure. Employers should ensure that DEI efforts incorporate equitable benefits design, and objectively assess benefit design impact on healthcare utilization and cost. Additionally, employers must appreciate the workplace as a significant determinant of health—for lower income workers, in particular—with review of policies and practices to mitigate any discriminatory negative health or well-being impact. Further, race and ethnicity data should be incorporated in health benefits data analysis to understand more clearly the differential outcomes of health management offerings on these different sub-populations. Finally, social needs data should be incorporated into strategic benefits planning to better understand gaps and opportunities to foster greater benefits equity. The provided recommendations can support employer goals of achieving greater equity and value in workforce health, measurably contributing to business success.

Purpose To understand barriers around accessing or using workplace health promotion (WHP) programs among workers in different wage categories. Approach We conducted qualitative analysis of responses to three open-ended questions about WHP program participation, collected as part of an existing WHP program evaluation. Setting: A large mid-western university. Participants Of the 20,000 employees emailed an online survey, 3,212 responded (16.1%). The sample was mostly female (75%), white (79%), and comprised of staff members (84%). The average age was 44 years and 67% had annual incomes <$75,001. Method We used NVivo-12 Plus and two coders to apply Grounded Theory on the open-ended questions and identify emergent themes. Results Although most respondents were happy with the program, differences across wage categories emerged around time, financial incentives, commute, workload, and organizational policies/support. Employees at all wage levels were enthusiastic about creating a culture of health but needed different cultural supports to do so. For instance, higher-wage workers needed to overcome self-made time constraints, while lower-wage workers needed supervisor support to overcome coverage constraints that prevented participation. Conclusion The unique participation challenges experienced by employees in different wage categories provide justification for WHP programs that can better accommodate the participation barriers of all employees. While some programs may simply require more flexible offerings, supervisors may need to be trained to support and foster healthy environments.

Purpose: This study examines the association between sources of stress and perceptions of organizational and supervisor support for health and well-being. Design: Retrospective, cross-sectional analysis. Setting: Large university in the mid-western United States. Sample: This study focused on university employees with complete data for all variables (organizational support/N = 19,536; supervisor support/N = 20,287). Measures: 2019 socioeconomic and demographic characteristics, count of chronic conditions, sources of stress and perceptions of organizational and supervisor support. Analysis: For the multivariate analyzes, linear regression models were analyzed separately by wage bands (low ≤$46,100; middle >$46,100-$62,800; high >$62,800). Results: For all employees, workplace stressors, including problematic relationships at work and heavy job responsibilities, were negatively associated with perceptions of supervisor and organizational support. In comparison, the most salient home-based stressors were negatively associated with perceptions of supervisor support for the lowest-wage band (the death of a loved one, b = −0.13) and middle-wage band (personal illness or injury, b = −0.09), while the one for the highest-wage band (illness or injury of a loved one, b = 0.07) was positively associated with perceptions of supervisor support. Conclusion: Stressful job responsibilities and work relationships are associated with lower perceptions of supervisor and organizational support for health and well-being across all wage bands. Favorable perceived support for personal stressors only among high wage earning employees may suggest a need for improved equity of perceived support for these stressors among lower wage workers.

Purpose To assess improvements in eating behaviors and health measures among adults participating in a whole food plant predominant diet, Full Plate Living (FPL) program. Design Retrospective, post hoc analysis of self-reported 16-week pre-post participant data obtained over a 3 year program period (2017-19). Setting Wellness offering for employees in Southwest U.S. Subjects Of 6,820 enrollees, 4,477 completed the program, further segmented by generational cohorts. Intervention FPL program materials and weekly online video lessons. Measures Baseline and follow-up measures included eating behaviors, self-perceived health status and energy, body weight, and confidence in healthy eating and weight loss. Analysis Paired t-tests were used to examine changes in eating behaviors and health measures. Mixed-effects models were used to examine whether changes among generational cohorts differed. Results Significant pre-post improvements were demonstrated for all measures, including servings of fruits (1.54 to 2.34), vegetables (2.05 to 2.87), beans (.63 to .99), and weight loss (3.5) ( P < .001). Self-perceived health and energy values, and confidence in making healthy food choices and losing weight improved ( P < .001). Improvements were observed across generational cohorts ( P < .001). Conclusion The FPL healthy eating approach has a beneficial impact on health measures across generational cohorts, and may be an effective addition to lifestyle medicine and corporate wellness offerings. Longer-term program evaluation is warranted.