Preserving Health and Productivity in Times of Chaos

COVID-19 Shined a Light on Business Continuity and Recovery Plans

The COVID-19 pandemic has triggered a massive shock to the global economy—causing more than a million deaths, turning economies upside down and straining the finances of countless individuals and businesses. ¹ Yet the damage caused to businesses over a few months may only hint at the long-term challenges posed by the ongoing—and rising—risks of climate change and natural disasters. If the pandemic has any silver lining, it is that business continuity and recovery plans are now recognized as essential tools for uncertain times. The lessons learned from reengaging scattered, traumatized workers to restart operations after unprecedented disruptions have given employers a chance to refine their preparations for surviving futures disasters. As custodians of workers’ resilience and readiness for work, health benefits professionals and their skillsets are valuable business assets in those efforts.

Climate Change Poses an Ongoing Economic Threat

According to the National Oceanic and Atmospheric Administration, in 1980 a drought in the central and eastern states, flooding in the south and a Category-3 hurricane in Texas each caused at least a billion dollars of damage to buildings, vehicles, offshore energy platforms, public infrastructure, agriculture assets, and business operations. Total losses amounted to $38B (in today’s dollars). ²

The number of disasters—and their economic toll—grew steadily for the next 3 decades but seemed to intensify in frequency and damage during this most recent decade. In fact, the total weather and climate related economic losses from 2010 through 2019 ($802B) exceed the total for the previous 20 years ($780B from 1990 through 2009, a figure that includes $169B from Hurricane Katrina alone).

Business Operations Are Adapting to the Threat of Climate Change

Despite any lingering political debates about the causes of climate change, many businesses and other major organizations are preparing contingencies to protect their infrastructure and supply chains from disasters, climate-related litigation and expensive new regulations. ^3,4 By one analysis, 215 of the 500 largest global corporations estimate that climate change will result in about half a trillion dollars in losses in the short and medium term (2 to 5 years), and up to a trillion dollars in the longer term. ⁵ At the same time, many large companies see even bigger revenue opportunities from adapting to changing consumer preferences for climate-friendly products and services.

The Health Risks of Climate Change Are Clear

Though businesses have taken the operational realities of climate change seriously, it is not clear whether they are preparing for the impacts on workers’ health. The U.S. Global Change Research Program (USGCRP)—tasked by the U.S. government with coordinating research into the causes and impacts of climate change—advises that extreme heat, worsening air quality, reduced food and water quality, the spread of infectious agents, and population displacement will likely increase the frequency or severity of several types of health conditions. ^6,7 These include respiratory conditions, cardiovascular conditions, heat-related illnesses, food-, water-, and vector-borne diseases, and mental health and stress conditions.

The empirical evidence for these predicted health risks is mounting. Studies have linked respiratory and cardiovascular risks to air pollution ⁸ and wildfires; ^9,10 the spread of Lyme disease, West Nile virus and Zika to changing temperature and precipitation patterns in North America that favor conditions for disease-carrying species of ticks and mosquitoes; ^11,12 and mental health difficulties to higher temperatures and exposure to traumatic natural and environmental disasters. ^10,13

Impacts on Health and Productivity May be Less Obvious to Businesses

Severe weather events that temporarily shut down business operations or put first responders and outdoor workers at risk of work-related injuries and illnesses have clear productivity implications. Yet climate change’s more pervasive toll on health and productivity may come from further complicating the management of non-occupational illnesses that already impose heavy burdens. For example, depression and stress are among the most expensive modifiable health risk factors in terms of commercially-insured health care spending, accounting for about 4% of total costs by one estimate. ¹⁴

Depression, anxiety and allergies impose some of the highest productivity burdens on employers in terms of sick day absences and presenteeism (i.e., impaired performance on the job due to symptoms of illness). ¹⁵ The Integrated Benefits Institute’s (IBI) analysis of claims filed against U.S. employers’ short-term disability (STD) insurance policies from 2011-2015 found that one in 7 were for climate-impacted conditions—most notably, mental health conditions such as mood disorders (including depression), anxiety disorders, adjustment reactions and acute stress reactions. ¹⁶ As a group, this makes climate-impacted conditions the third largest category of STD diagnoses, after pregnancies and musculoskeletal diseases.

Additionally, STD incidence rates for climate-impacted diagnoses differed geographically. ¹⁶ This implies differential risks for employers and employees with exposures to different types of severe weather events. Disability leaves for some types of conditions also seemed to rise and fall at extreme temperatures. ¹⁷ For example, extreme low temperatures, such as those the Midwest United States experienced in 2019’s polar vortex, increased the risk of claims for mental health conditions such as depression and acute stress reaction. Higher temperatures increased the risk of claims for cerebrovascular disease and decreased the risk of claims for respiratory infections.

Benefits Professionals Can Preserve Health and Productivity in Chaotic Times

Whether it is intense, destructive disasters such as hurricanes and tornadoes, or less dramatic episodes of sustained weather extremes, climate change will continue to challenge employers’ efforts to promote a healthy and productive workforce. A potential bright spot for employers is that many of the recommendations that helped businesses maintain critical functions during the COVID-19 pandemic and begin to restart operations afterward were developed with natural disasters in mind.

While entities such as the U.S. Federal Emergency Management Agency (FEMA) focus most of their planning guidance on physical capital such as infrastructure and supply chain, ¹⁸ it is just as important, as the pandemic has shown, to incorporate employee benefits, leave policies, health promotion and absence management assets into business continuity and recovery plans to safeguard vital human capital.

A “how-to” guide is beyond the scope of this article—but also largely unnecessary, given that businesses can leverage health benefits professionals’ skillsets and practices in their disaster preparations. The remainder of this article focus on some core benefits functions that can strengthen business continuity and recovery plans. These include understanding workers’ health care needs; sustaining care management and keeping contact with employees with during crises; and supporting employees as they resume work after absences.

Understanding the at-Risk Population

Knowing how many employees have serious, but manageable, chronic conditions such as diabetes, hypertension, lipid disorders, depression or asthma can help employers develop strategies to promote care continuity during crises. Benefit utilization reports from healthcare plan sponsors, insurers and third-party administrators (TPAs) typically include diagnosis information as well as treatment modalities and sites of care. Health risk assessment surveys (often administered by insurers and TPAs to ensure employees’ privacy) may also include summary information, as well as insights into personal situations such as reliance on public transportation that may further complicate care management during crises.

Ensuring Care Management Continuity during Crises

In addition to identifying and communicating with employees who have critical needs, effective care management depends on coordinating services across primary, specialty, clinical pharmacy, and community service providers as well as supporting patients’ self-management. ¹⁹ The COVID-19 pandemic demonstrated how—in the absence of in-person care options—visits for all types of preventive and specialty treatments drop off dramatically and are only partially replaced by telehealth. ²⁰ Employees should be offered assistance in developing contingency plans for circumstances that prevent access to provider teams and supportive care, such as when healthcare facilities are incapacitated or during prolonged evacuations. In their simplest form, contingency plan templates could start with a set of questions employees could pose to themselves, such as:

“Do I have contact information for all members of my care management team?”

Answers to these questions should be available in plan sponsors’ summary plan documents—perhaps with the inclusion of a clear and simple Emergency Access Supplement (both online and printable or wallet-sized in the event that weather emergencies cause electrical or internet outages). Employees should also be encouraged to review their contingency plans with their primary care provider or other care coordinator.

Leveraging Absence Management Resources During Crises

While managing absences might seem of secondary (or even lower) importance during crises that temporarily shut down business operations, leave specialists can serve as a central point of contact for evacuated or sheltering employees. Under emergency conditions, skills and tools in place for verifying and tracking medical and family leaves can be adapted to account for employees’ whereabouts; disseminate consistent and accurate information about emergency resources and return to duty timelines; and avoid delays in accessing medical and leave benefits.

Supporting Employees After Return to Work

Care management and absence management professionals can help employers maintain workforce readiness during crises and speed the return to normal business operations when conditions improve. Nonetheless, many employees who experience intense or prolonged crises may need additional support to address unmanaged chronic conditions or lingering mental health and stress disorders (particularly major depression, substance abuse, post-traumatic stress disorder and anxiety). ¹³ Employers will want to ensure that their health benefits emphasize screening guidelines for conditions such as hypertension, diabetes, depression, and substance abuse, ²¹ and that their provider network is adequate to anticipate sharp increases in need. Current approaches to employee outreach and care navigation tools—including Employee Assistance Programs (EAP) that incorporate emotional and work-life, counseling, legal and financial guidance—should be evaluated and adapted to accommodate unmet needs. Employers should also prepare to adjust incentive structures to reflect the availability of different care options.

Final Thought

The COVID-19 pandemic halted operations for many businesses and left many others scrambling to function under unprecedented circumstances. Yet the crisis underscored the business value of supporting healthy, engaged and resilient employees. Future business continuity and recovery plans that address health risks from climate change and natural disasters will give employees a better chance of maintaining their health and readiness for work under the most challenging conditions. Leveraging health benefits professionals as key disaster plan assets will also strengthen these efforts.