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Social determinants of health and employers

Over the past decade, the focus on improving employee health has morphed from a single spotlight on physical wellness to an overarching view of well-being, including mental, physical, and social health.1 Even with that shift, however, the focus has remained on individual employees’ health risks and behaviors, rather than on the role employers can play in employee health.

As healthcare technology advances, research indicates that an individual’s health is comprised of more than just his or her actions and genetics. Social determinants of health (including the economic, political, and environmental conditions in which people are born, age, live, and work), have a significant impact on an individual’s development and future health.2 Public health organizations and healthcare providers have been leveraging this concept to foster better health in communities, but there’s a key player in healthcare that needs to shift its focus: employers.

On average, full-time employees spend more than one-third of each day, five days a week, at their workplace.3 With employees spending a large amount of time in one location, leaving work out of considerations of population health “creates a blind spot” in looking at the full scope of social determinants of health.4 Many aspects of a career, including the social environment, income, prestige, and stress, all play a factor in one’s health.4

What are social determinants of health?

Social determinants of health (SDOH) are conditions in the environment in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes.1 According to the US Department of Health and Human Services, SDOH can be grouped into 5 categories5:

  • Economic stability
  • Education access and quality
  • Healthcare access and quality
  • Neighborhood and physical environment
  • Social and community context

The effects of social determinants of health: at a glance

SDOH contribute to health inequities accross the nation. Sometimes these disparities occur in unexpected ways. Below is an example of a SDOH in each category and how they impact an individual's well-being and quality of life. 

  • Economic stability: 8% of Americans fail to obtain medical care due to cost barriers6
  • Education access and quality: By age 25, adults without a high school diploma are expected to die 9 years earlier than those with a diploma7
  • Neighborhood and physical environment: Transportation and distance to healthy food options impact the health of low-income and rural communities8
  • Social and community context: The stress of social isolation can lead to premature cognitive decline, chronic disease, and premature death7
  • Healthcare access and quality: The rate of physicians per 100,000 people ranges from 54.0 to 115.9 per state, meaning that the state someone lives in can have a significant impact on to the availability of care7

What can employers do to address social determinants of health?

When looking at how employment impacts SDOH, appropriate pay and working conditions are two key factors that immediately come to mind. However, by focusing on creating a culture of health, employers can address workplace-related social determinants of health, as well as impact those outside of the workplace.

Examples of how employers can improve social determinants of health include8,9,10:

  • Ensuring all workers are paid a living wage for their geographic location to address economic stability
  • Improving access to healthcare by offering yearly preventive screenings and connection to in-network primary care
  • Focusing on clinically-based services and virtual care solutions that help reduce healthcare spending for both employees and employers alike
  • Partnering with vendors who can help connect the right employees into the right care—it’s not everyone having access to every service, it’s about getting those who need the service most to engage
  • Creating policies that allow employees to take time away from work for health-related issues without fear of losing their job
  • Subsidizing healthy food options in the cafeteria and addressing food security through a workplace food bank
  • Selecting health plan providers that focus on the well-being of the community where employees live
  • Educating people managers on social determinants of health and how they can affect workplace performance

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1. Health IT Analytics. What are the social determinants of health? https://healthitanalytics.com/features/what-are-the-social-determinants-of-population-health. August 18, 2017. Accessed Oct. 25, 2019.

2. World Health Organization. Social determinants of health. https://www.who.int/social_determinants/en/. 2019. Accessed Dec. 16, 2019.

3. US Department of Labor - Bureau of Labor Statistics. News release: employee benefits in the United States March 2019. September 19, 2019. Accessed January 7, 2020. https://www.bls.gov/news.release/pdf/ebs2.pdf.

4. Centers for Disease Control and Prevention. Workplace health promotion. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/workplace-health.htm. March 12, 2019. Accessed Dec. 16, 2019.

5. US Department of Health and Human Services. Social determinants of health. Accessed August 16, 2021. https://health.gov/healthypeople/objectives-and-data/social-determinants-health 

6. Ahonen EQ, Fujishiro K, Cunningham T, Flynn, M. Work as an inclusive part of population health inequities research and prevention. Am J Public Health. 2018;108(3):306-311. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304214. Accessed Dec. 16, 2019.

7. Centers for Disease Control and Prevention. Access to health care. https://www.cdc.gov/nchs/fastats/access-to-health-care.htm. 2017. Accessed Oct. 25, 2019.

8. Centers for Disease Control and Prevention. Social determinants of health recommended queries. https://www.cdc.gov/nchhstp/atlas/slides/sdh-slideset.html. 2017. Accessed Oct. 25, 2019.

9. Office of Disease Prevention and Health Promotion. Access to foods that support healthy eating patterns. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-foods-that. 2019. Accessed Oct. 25, 2019.

10. Health Enhancement Research Organization. Social determinants of health – an employer priority. https://hero-health.org/wp-content/uploads/2019/09/HERO_HWHC_SDOH_Report_FINAL_090419.pdf. 2019. Accessed Dec. 16, 2019.

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