How Employers Impact Individual and Community Health During Public Health Emergencies: Rationale for Public Health/Private Sector Partnerships

1. Impact of Employer's Products and Services During Emergencies

The products and services provided by employers can have a profound impact on individual and community health during a public health emergency. Healthcare-oriented employers, such as clinics, hospitals, pharmacies, and pharmaceutical manufacturers, provide critical services that have an obvious influence on health every day and during emergencies. The products and unprecedented services that health-related employers provided during the COVID-19 pandemic were essential for diagnosing and caring for sick persons and saving lives; mitigating the spread of the disease; rapidly developing vaccines, tests, and therapeutics; providing vaccinations and medications to millions of people; and sharing key surveillance data about cases and hospitalizations with public health.

However, other (nonhealthcare-related) employers who supply goods and services can also affect health during emergencies, especially critical infrastructure businesses that produce or deliver essential consumer goods, communications, transportation, and utilities, as well as restaurants, grocery stores, food delivery services, home improvement stores, and others. During the COVID-19 pandemic, although some businesses were temporarily closed, many employers provided wages to furloughed employees and donated products, services, and funds to help their communities. ⁶ A large proportion of restaurants pivoted from serving customers indoors to creating outdoor seating and expanding the availability of takeout and delivery-ready meals. Other businesses launched delivery services, pickup windows, and other means to continue to provide services and abide by public health recommendations. ⁷ The public health sector also relied on technology and data companies throughout the COVID-19 pandemic, sharing information on disease transmission mapping, allowing access to data visualization dashboards, and providing information exchanges to inform response decisionmaking. ⁸

Some employers also produced new products and services to serve the community. For example, some car manufacturers converted a few of their production lines to manufacturing ventilators, alcohol manufacturers produced and distributed hand sanitizers, and rideshare companies partnered with health departments and pharmacies to transport people to and from vaccination clinics.^6,9-11

2. Employers Are the Major Providers of Health Insurance Coverage in the United States

Many businesses want to maximize workforce productivity and understand that poor health of their employees can lead to increased absenteeism and lost productivity at work, which can affect the company's bottom line. Therefore, they routinely invest in providing healthcare services and benefits. ¹² More than half (54%) of Americans receive their health insurance coverage through their employer or as a beneficiary of another's employment. ¹³ This role has an important impact on health status and healthcare quality every day, as employers make decisions about access to care, which benefits are covered, and they provide oversight for preventive, curative, and palliative healthcare services. Employers' benefit purchasing decisions, especially those that embrace value-based purchasing, largely affect what services are delivered and the quality of the services rendered.^5,14-15

Timely access to medical care is critical during a pandemic. Public health officials can partner with employers to ensure the inclusion of key medical services and countermeasures needed for emergency responses in benefit packages for employees and their families, if they are not provided by the government. Employers can ensure that their employees have alternate access to care, such as telehealth services, which served as an efficient and effective way of providing care during the pandemic when social distancing policies were in effect and when medical offices were closed or had limited hours of operation. ¹⁶

Since 2020, some employers have responded to the uptick in the need for mental health services that emerged during the pandemic and have increased their availability for employees. In 2020, 41 million people, nearly 1 in 4 Americans, received mental health services through employer-provided coverage. ¹⁷ In 2022, 48% of large employers saw an increase in the number of employees seeking mental health services, ¹⁸ and in 2023, 30% of large businesses (1,000 to 4,999 employees) and 44% of very large firms (5,000+ employees) increased the number of mental healthcare providers in their health plan networks. ¹⁹

3. Worksite Services, Policies, and Procedures Can Impact Health During a Public Health Emergency

Although some employers have continued to support remote and/or hybrid work schedules, most employees spend some time at the worksite. Fostering a safe worksite is a well-established mandate for employers, especially during health emergencies. ²⁰ Employers offering an array of worksite wellness measures and policies can enhance health and reduce injuries. Workplace health promotion programs have improved workers' health, productivity, and quality of life and yielded a positive return on investment. ²¹

During a public health emergency, workplace policies that are aligned with public health recommendations can play a very important role to protect the health and safety of staff and reduce the transmission of infectious diseases in the community. ²² However, many businesses were slow to change their policies at the start of the COVID-19 pandemic. Employees polled in a study in late March 2020 reported that only about half (52%) of nonhealthcare businesses immediately issued protective policies and were prepared for the pandemic. ²³ Although some health departments issued specific COVID-19 protective policy guidance for employers in their jurisdictions, some employers were not aware of or did not incorporate public health recommendations into their workplace policies in the first months of the pandemic. ²⁴

Once the pandemic was fully underway, about two-thirds of employers ²⁵ changed or created protective workplace policies and processes by providing nonpunitive sick leave, extended family leave, and flexible leave to care for others; modifying the workplace to create more physical distancing; canceling nonessential travel and meetings; promoting remote work arrangements; providing masks and hand hygiene supplies; encouraging or mandating vaccination; testing workers before workplace entry; and enhancing building ventilation. Although rigorous studies have not been conducted to measure the effects of individual policies and procedures, a meta-analysis found that employers that implemented multiple protective policies and strategies generally fared better than those that adopted only 1 strategy or did not adopt any pandemic protective policies. ²⁴

Hourly frontline workers were hit especially hard during the pandemic, as many of them could not perform their jobs remotely and most had few benefits such as paid sick leave. ²⁶ These workers typically work in close proximity to others and have other challenging working conditions that increase their risk of exposure. ²⁷ Early in the pandemic during spring 2020, workers at some meat and poultry processing facilities experienced frequent workplace outbreaks and disproportionately large numbers of COVID-19 cases. With few or no mitigation measures enacted initially, some workers who were ill were incentivized to work, had prolonged close contact with others while on production lines, and may not have received education about taking protective measures. ²⁸ In contrast, when some meatpacking plants implemented strategies like universal masking, installed physical barriers between workers, encouraged sick workers to stay home, enhanced facility ventilation, and educated their workforce on the use of masks, they experienced fewer cases. ²⁹

Employers also encouraged vaccination, and some offered worksite vaccinations as the supply of COVID-19 vaccine increased. A number of companies allowed paid time off for shift workers to get vaccinated at clinics with extended hours, offered incentives for vaccination, and some required employees to be fully vaccinated before entering the workplace.^30-33 For example, 1 small employer coordinated with their local health department and a contracted vaccination company to arrange an onsite vaccination clinic. ³⁴ The arrangement in this and other locations (usually managed through state and local health departments or the Federal Retail Pharmacy Program) eliminated time away from work and increased convenience and employee morale by bringing the vaccine to their workers. Businesses that offered onsite vaccinations increased community vaccine uptake and protected against infections at work. ³⁵

4. Employers Can Affect Health During an Emergency by Providing Services and Information to Employees' Families

Some employers routinely offer health insurance benefits to families of employees, as well as access to gyms and fitness centers, health screenings, and other health promotion services. ³⁶ With a plethora of misinformation and disinformation circulating during the pandemic, many employers served as an ongoing source of credible information for employees and their families. Information about the pandemic and protective practices was shared with workers to bring home to their families. Some employers provided additional support to workers' families during the pandemic, including paid leave for the employee to care for a sick family member, flexible work schedules especially when schools area closed, and no-cost participation for families with onsite vaccination clinics and contracted mental health services. ⁶ In future health emergencies, employers can efficiently extend the reach of public health by providing timely information and encouraging employees' families to get vaccinated and take other steps to protect themselves.

5. Employers Can Have a Profound Effect on the Health of the Community During a Public Health Emergency

Employers have an important impact on the health of their communities during emergencies and can reach people who may not regularly access the healthcare system or public health agencies. As community stakeholders, companies serve as economic engines for communities, which can affect the social determinants of health, particularly during emergencies. In addition to protecting the health of their workforce, employers can serve as active community partners during an emergency by taking measures to reduce community disease transmission, keep critical services functioning, ³⁷ and serve as response partners by offering services, logistics, personnel, and space. ³

In order to enact workplace policies that align with community public health recommendations, employers need to know where and how to access timely information and guidance from public health. This information can be discussed before emergencies, and linkages to key contacts and information sources during an emergency can be identified as part of preparedness activities. Including public health issues and infectious diseases as credible risks in corporate resilience planning; connecting to local, county, regional, and federal health agencies and boards for exercises and partnerships; and establishing policies before the next emergency are all tangible integration approaches that businesses can take now.^38,39 Employers also have important roles in community recovery after an emergency or disaster by contributing directly or indirectly to restoration efforts. ⁴⁰ An employer that actively contributes to its community during and after a pandemic or other emergency can improve health outcomes and create a positive impact on its brand and reputation.