How Do Healthcare Workers Face Social Determinants of Health?

Many healthcare workers experience social determinants of health, with new data published in Health Affairs particularly outlining disparities in food insecurity between healthcare support staff and clinical staff.

Although food insecurity is lower among the total healthcare worker population than the rest of the United States, healthcare support staff are significantly more likely to experience food insecurity than doctors or nurses, the data emailed to PatientEngagementHIT showed.

Additionally, healthcare support staff working in residential or nursing home settings are extremely likely to experience food insecurity.

Food insecurity is a key social determinant of health that has gained significant attention in recent years. In addition to the intrinsic impacts food has on health, those experiencing food insecurity may have trouble managing their chronic illnesses because they cannot follow a specific diet. Individuals also may increase their risk for developing a chronic illness, like diabetes, without a regular source of nutritious foods.

“In many respects, the characteristics of low-wage health care workers resemble those of the populations at greatest risk for food insecurity,” the researchers said.

These workers tend to be low wage, have irregular or unpredictable hours, and are more likely to be women of color.

And using nationally representative data from between 2013 and 2018, the researchers said those characteristics manifested themselves in food insecurity rates among healthcare workers, too.

Overall, the food insecurity rate among healthcare workers was lower than among the general US population, shaking out to 6.6 percent and 10.5 percent, respectively. However, there were key disparities largely linked to income, the researchers observed.

The odds of food insecurity for healthcare support staff were 5.1 times that of clinical staff, while the odds for technologists and technicians was 2.5 times higher than clinical staff. These findings were more pronounced among residential or nursing home staff. Sixteen percent of all healthcare workers in these settings reported food insecurity, while 22.7 percent of healthcare support staff in residential and nursing home settings experienced the same.

Healthcare support workers in any setting were more likely to use SNAP benefits than their clinical staff counterparts, at 25.4 percent versus 2.3 percent, respectively. But the researchers pointed out that many healthcare support staffers may need SNAP benefits but not qualify; their wages may be too high to get the benefit, but not high enough to meet their families’ needs.

Many of these differences could likely be attributed to differences in income, the researchers noted. Healthcare support workers tend to have hourly wages that are ultimately lower than the salaries clinical staffers see. Additionally, hospital workers tend to see higher pay than those working in residential or nursing home settings.

Variable work hours also could impact food security, the researchers said.

Addressing food insecurity among healthcare workers will be essential considering the vastness of the healthcare workforce, the researchers said.

“It is vital that health care leaders and policy makers address food insecurity facing the US health care workforce,” the team explained. Representing more than twenty million people, the health care industry is the largest employer within the US and will only continue to grow.”

What’s more, ensuring the workforce is well supported will be key as the US predicts growing healthcare needs. As Baby Boomers age into retirement, they are expected to put a strain on the healthcare workforce.

And currently, the COVID-19 crisis has stretched all healthcare workers, from the practitioner staff all the way down to healthcare support staff. Retaining healthcare staff by giving them enough social support will be critical.

“In addition, if health care workers are not nourished, they may find it difficult to provide high-quality care to their patients,” the researchers added. “This is particularly the case for health care support workers because their job responsibilities are physically strenuous (for example, providing assistance with using the toilet, bathing, and walking) and psychologically demanding (for example, caring for residents with dementia).”

Foremost, addressing wage issues could help address some food insecurity among healthcare workers. The researchers suggested implementing a $15 minimum wage could be effective. Doing so could cut poverty among female healthcare workers by about 50 percent, they added.

But there are a number of policy changes that could also help workers facing food insecurity.

“Short of an increase in wages, health care employers can implement more equitable human resource policies such as benefit packages that maximize take-home pay, including creating a sliding scale for health insurance coverage so that low-wage workers pay less than higher wage earners,” the research team posited.

“Providing nontraditional benefits such as transportation assistance, child care, cafeteria meal stipends, and employee housing could also help alleviate financial burden among low-wage workers, particularly in high-cost locations.”

In the near term, healthcare organizations may also consider building out social services navigation as part of workers’ benefits or extending community health partnerships with food pantries to employees in need. These strategies should employ the insight of healthcare workers in need, particularly, as they have firsthand knowledge of their deepest social needs.

Additionally, future research could include qualitative interviews to determine the driving forces behind food insecurity among healthcare workers, also enabling policymakers to create tailored interventions.