Milken Institute Public Health Advisory Board Collective Insight: The Role of Employers as Key Public Health Stakeholders

The 3.5 billion people who make up the global workforce spend an average of 90,000 hours at work over their lifetime. As highlighted in an article from our Executive Insight series, “that places an incredible amount of power, responsibility, and opportunity for employers to adopt practices that promote whole-person health and contribute to society’s overall health and well-being.” Recognizing this unique opportunity, the Public Health Team at the Milken Institute has been working with employers since 2017 to accelerate solutions to the concurrent addiction and mental health crises, advocating for the holistic support of employee mental, financial, and physical health. This work has expanded to advocating for employers to adopt a whole-person health strategy (see Figure 2 in our Racial Equity and Mental Health in the Workplace report). The recently launched Employer Action Exchange provides a platform that includes expert guidance, briefings, and networking for diverse employers to take customized, tangible actions that anticipate the needs of a multi-generational workforce and surrounding communities to advance whole-person health priorities. Through the Exchange, our Executive Insight series, and project topics ranging from mental health to supporting next-gen employees, the future of employer-sponsored health-care, and employers accelerating modernized obesity care, the Public Health Team continues to engage employers and support them in leveraging their powerful role as agents of public health change.?

This summer, the Public Health Team surveyed our Advisory Board, consisting of thirteen top leaders in diverse areas of public health, on the role of employers in supporting and advancing public health in the US. Whole-person health involves looking at the multiple interconnected biological, behavioral, social, and environmental factors that drive health. Given the expansive scope of whole-person health, employers are currently defining whole-person health in a variety of ways. The 20+ interviews captured via our Executive Insights series reflect the various public health approaches they are taking for their employees and surrounding communities. Advisory Board members were asked to share five words that come to mind when thinking about how employers can support public health. The word cloud below shows every Advisory Board member mentioned prevention, respect, and caregiving in their response. Recognition of the roles people play outside of the workplace was a common theme, with parental leave, juggling life roles, childcare, and caregiver fatigue all discussed.

This emphasis on the policies that support caregiving builds on an Advisory Board conversation on the role of employers with the Director of National Drug Control Policy, Rahul Gupta, MD, during the December annual meeting. The call for thoughtful, supportive caregiver policy change was further echoed in the recent US Surgeon General's Advisory on the Mental Health & Well-Being of Parents. In addition to caregiver support and leave policies, during that conversation, Advisory Board members highlighted the power of public policy engagement, employer-sponsored health-care innovation, investments in technology, stigma reduction, naloxone access, food and nutrition security, and community engagement. Board members were then asked to rate these areas of opportunity for employers to impact public health on a scale of 1 to 5, with 1 being not very impactful and 5 being very impactful. On this 5-point scale, caregiver support and time-off/leave policies were rated the highest at 4.5 and 4.17 respectively. Additionally, community engagement and nutrition security efforts were both rated very impactful with an average score of 4. Lastly, public policy engagement and employer-sponsored health-care transformation were both rated as impactful.

Advisory Board members then further described potential areas of focus for employers to prioritize to improve whole-person health, with a particular emphasis on the intersection of employer impact and health equity. A diverse range of topics were mentioned, ranging from systems change approaches to integration of diversity equity and inclusion efforts throughout organizations. Emphasis was placed on creating a safe and respectful workplace while “changing the systems in which people live.” This included access to time off, time for movement, and the space to live an active life. Other priorities and areas of investment discussed included:

• Addressing the pressures of juggling life roles that contribute to stress and absenteeism, which may lead to mental health issues like burnout, depression, or substance misuse.
• Supporting healthier lifestyles, including policies and programs for tobacco cessation and nutrition. Of the nearly 44 million people experiencing food insecurity in the US, over half live in households with one or more adults employed full-time. Employers have an opportunity to address both food and nutrition security by providing food benefits that consider cultural and health needs.
• Mitigating the impact of an increasingly changing climate on employee physical and mental health. Given that environmental risks, including extreme weather events, often disproportionately impact communities that have historically experienced disinvestment, Advisory Board members emphasized the need to consider equity when implementing such measures.
• Driving change at the policy level, especially in the states and local communities where employers operate. Impactful community-supportive policies include those focused on holistic health access, education, spaces for play and activity, public safety, and sanitation.

The multilayered, complex nature of these opportunities highlights that there is no single solution to address whole-person health. Employers are uniquely positioned to embrace their role as champions of public health, crafting policies, systems, and environments that support whole-person health. Embracing a public health view means constantly monitoring the current environment to identify the greatest needs, balancing immediate support with upstream prevention. Employers can get started by identifying their strengths, cataloging existing employee health and engagement data, and understanding the actions already taking place across the organization. By analyzing this data, in combination with information on community context, employers can establish an interconnected whole-person health strategy with actionable goals. No single employer can address these issues on their own, but collaborating as an employer community evolves the whole-of-society approach committed to improving whole-person health for all.