Last week, Department of Commerce Sec. Sharon Decker spoke to business leaders gathered at the North Carolina Hospital Association about the importance of workplace wellness and helping North Carolina’s workers get more healthy. Then she sat down with North Carolina Health News editor Rose Hoban to answer some questions.
North Carolina Health News: Thinking about the political milieu right now, and here we are with businesses talking about health care and health care costs, so the most obvious question to me is: If paying for health care for businesses is such a big cost, why not support something like the Affordable Care Act and Medicaid expansion in order to shift some of the burden of paying for health care away from business?
Commerce Sec. Sharon Decker: I think all of those issues are on the table. I think this is why the governor has formed this committee [a five-member Medicaid Advisory Committee named in the beginning of November] to look at all this again. What pleases me about the event today is that the focus is on the front end of the problem. I think we also have to deal with the back end of it, and we don’t have all the answers yet; I’d be the first to say that.
I think the work here is really important, and it’s got to become more of the norm rather than the exception. I think that’s where my primary interest is from a Commerce standpoint, is that the trend in worker health has been negative for a very long time, so how do we turn that corner? And it fundamentally is a cultural shift that has to take place.
The trend towards poor health, all the measures relative to the health of our country and our state, are not improving, generally, and the cost of care is going up because of that; that’s the driver of it. So, yes, we’ve got to deal with the issue on the back side: How do we provide health care in a way that’s affordable and accessible? But ultimately, and I’d say that’s now, we’ve got to deal with what’s driving those negative outcomes and the increasing costs.
It is a cultural thing. When they asked us, ‘Tell us the greatest challenge to doing this,’ everyone said the same thing: It’s the front end, acceptance; that there’s a different normal that could be established. There’s a movement in the culture that prevents healthy activity, that prevents a focus on healthy food. So to really change this for us will require a momentum that we are nowhere near. We’re under the avalanche, the snow is falling on us, and we’re trying to get the snow to stick back on the side of the hill!
NCHN: I’m sure you’re familiar with the workplace coverage surveys done annually, and the Southeast has the lowest level of employer health insurance provision. These business leaders talk about pushing their employees toward wellness, how it’s going to be good for their bottom line in the long run. But a lot of businesses have not seen it that way, and they don’t even provide health insurance for their workers.
Decker: I grew up in Gastonia, a textile community, and in that community activity and family engagement was part of the way that we lived. I remember that Groves Mill had a gym, and all of the kids activity centered around that gym. There were a lot of community-related sports, family-related events; so there was encouragement with engagement in physical activity and involvement in the community. And, somewhere, where was it that that disconnected? Was it with the closure of those specific mills and plants where communities had grown up around the manufacturing? And then there began to be more commuting; there began to be higher unemployment. What was it that drove the difference in behavior? I don’t know, but I think it would be interesting to think about that.
So I shared those five tenets of economic health [with the group]. Those tenets really come out of the community-redevelopment movement of the ’40s and ’50s. Think about it. That’s when those types of employment opportunities began to develop in the South. I think we’re in that phase again, where you have to look at this as more community-based and more holistic. I think we’re seeing a cycle again that is an important cycle. And how do you sustain that when things don’t go so well, when the economy turns again? How do you maintain those behaviors?
I think the biggest challenge in this is that we’re talking about a cultural change, where we value health, we value healthy behaviors.
Now, I’m encouraged. I have four children between the ages of 17 and 28, and they’re all about this. It is a lifestyle for them. It is a way of life. One of them works for the YMCA in Asheville. My youngest daughter is going to enter this field as well. But it’s a lifestyle for them; they’re all active in sports. So I’m encouraged. But I think the biggest challenge is re-engaging.
If we can grasp this in the workplace, we can make that cultural shift, because that’s where most of us spend the majority of our time.
Then again, I think about the number of workers now who are home-based. How do you take this model and link them and the community around wellness? YMCAs do that, community centers do that, fitness programs do that…. But is there some way that we can facilitate that? The thought occurred to me, and I will follow up on this.
NCHN: If you look at state-by-state health statistics, there seems to be a relationship between states with right-to-work laws and poor health outcomes.
Decker: That’s interesting.
NCHN: What is a business’ incentive to keep workers healthy and to keep an unhealthy worker when you can just fire him or her at will?
Decker: You have to help the businesses rebuild and reframe.
It would be interesting also to factor into that how many companies have employee-assistance programs where you would see more of that behavior; where if you’ve got an issue, this is the course of action to help them get to a better place.
One of my bigger concerns around this health issue is the whole issue of alcoholism and drug abuse – and that’s a huge issue in North Carolina – but as a factor of employment; as a factor of individual health and community health. And we certainly don’t have the answers in addressing those issues. But all of that is kind of wrapped up in here together.
NCHN: But coming back to the whole idea that in the Southeast only about half of businesses provide health insurance for their workers.
Decker: I think the dialogue that we are not having yet but one that I’m trying to tee up as I move around is that the nature of work is changing. I worked from home for six years; I consciously chose to do it because I wanted flexibility, I wanted time with my children that I didn’t have when I was in corporate life. I am watching my children make career choices, and they are loving having these alternatives – contractual work, freelance work – all of these kinds of things.
So what are the implications when the conscious choice around the nature of work is not full-time employment? Companies are doing more of this because of costs, but there is this trend in terms of preference. So how does that impact this whole issue? And how will that ultimately change the outcomes? Does it help possibly change outcomes because these kids are more active and part of the reason they choose this alternative work life is so that they can be? That’s what’s driving our kids; they are not going to be tied to somebody else for 60 hours a week, because they want the engagement of physical life, and a healthy life. So I think that’s kind of interesting to watch – the changing nature of work and how that will impact health outcomes moving forward.
NCHN: You’re talking to all these business leaders today, and the top of your list is health, having healthy workers. What do you feel like your mandate, your message as the representative of state government, is to these folks?
Decker: North Carolina has got to be a competitive state. So we are trying to attract new jobs to the state, and that’s jobs that we can recruit here and that’s jobs that we can help grow with business that already is here. So I think that the key message is that we need to be in a competitive position. And that means having healthy employees and workforce prepared to go to work and able to go to work and stay at work. So that’s one of my factors that I talk about for us to stay competitive.
I think that’s the key message today – this whole idea of the workplace initiative around health is a viable and important one. You know, I think sometimes we think about this as being, ‘Well, isn’t that nice what those people are doing?’ But I think as you heard, it’s not only a nice thing to do, but it’s also the right thing to do if you want to manage the cost of operations in your business, if you want better performance from your employees and you want better outcomes for your business.
NCHN: In terms of policy, is the governor thinking about policy proposals that may hope to nudge businesses in this direction, or is this mostly you folks providing a carrot?
Decker: I think it’s a carrot; it’s an encouragement. But can there be policy? There can be. It’s not something that I have talked to the governor about specifically; but I think that’s kind of part of my thinking, is let’s begin to talk about this as an important element of our competitiveness as a state from a business standpoint, which is really a new thing for Commerce to be really talking about that publicly and aggressively. So that’s where it starts.
NCHN: These are large employers, but more than half of people work for small businesses …
Decker: … under 50 people. Yes. I think it doesn’t really matter the size; like the CPA firm who was here has 55 employees. It’s harder the bigger you get, I think.
So I think where we can really gain some traction is by really talking with small businesses about this. This is one way to manage your costs, by encouraging your employees. And what you might do in terms of Y membership or gym membership might be a better investment for you than a lot you are probably doing. Rather than having the Christmas party or a holiday party, why don’t you take that money for a holiday party and buy gym memberships for next year? Say, ‘This is a gift we give to you for a healthy New Year.’
There are little things like that in a small business that can really have an impact. For instance, having some flexibility around arrival times if folks go to the gym early in the morning, or take a walk, or take a break at lunch…. There are a lot of things small businesses can do. And in fact, I think they can gain a lot more traction faster than the big companies can.
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Nice job, NC Health News, as always, but Sec. Decker danced around the question about expanding Medicaid, which would include low-wage employees who earn up to 133% of the poverty income limit and have no insurance, which must be exponentially much higher than the 50 % of uninsured employees in NC cited in the article. Maybe the “Ew Factor” might appeal to Sec. Decker & our state legislators: the majority of NC workers who are earning 133% or less of the PIL are working directly with the public in food-related, hospitality or retail jobs. They drag themselves to work with flu, cold or even Hepatitus symptoms because they know they will get fired for not showing up for work without a doctor’s notice, which they can’t get unless they go to the ER. To all you folks in Raleigh, I hope your “Subway Artist ” sneezed on your sandwich today!