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March 10, 2022

Social determinants of health and how they influence employee populations

In For Employers, For Consultants

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This guest post is written by Collective Health. AccessHope is a part of Collective Health’s Premier Partner Program™.

Health-related problems are responsible for hundreds of billions in lost productivity for companies across the U.S. In 2019 alone, poor health cost employers as much as $575 billion and 1.5 billion days of lost productivity. As data emerges on the impact of COVID-19 in the workplace, it could be even higher now.

With 6 in 10 Americans diagnosed with a chronic disease and millions of new cancer cases emerging every year, safeguarding the health of employees is more critical than ever. Add to that the intense labor market pressures and fierce competition for talent, and the need for informed and accessible benefits plans becomes a linchpin for companies looking to grow.

However, the healthcare landscape in the U.S. is notoriously difficult to navigate, and spending more money does not necessarily guarantee better outcomes. For benefits leaders and brokers, evaluating the non-medical factors that influence employee health presents an opportunity to build a more inclusive workplace that empowers all employees to take control of their health.

Medical care and genetics only provide part of the picture when it comes to a person's health status. Economic, social, environmental, and behavioral factors account for the rest, which could account for as much as 55% of health outcomes. These non-medical aspects are known as the Social Determinants of Health (SDoH), and they contain key insights for benefits leaders and brokers looking for novel strategies to enhance and tailor their plan offerings.

What are the social determinants of health?

For centuries, human health was believed to rely primarily on biochemical parameters. While this type of thinking still dominates Western medicine (i.e., using medical interventions to target disease, but not the environmental factors that contribute to it), the world is moving towards a more balanced approach, which recognizes the role of economic and societal factors on a person’s health status.

Health is a holistic concept: physical and mental ill health cannot be dissociated. For example, experiencing chronic stress can dysregulate the immune system and stimulate inflammation, triggering depressive symptoms or worsening depression which, in turn, is associated with higher cancer-specific mortality and poorer cancer survival.

There are more obvious challenges associated with socioeconomic status too. Imagine this: a retail worker with no personal vehicle is diagnosed with cancer. The compounding effect of low income, lack of transportation, and the inability to set their own schedule puts the entire care journey at risk. This person may miss appointments, struggle to afford medication, and delay care until the problem becomes too entrenched to ignore, at which point, their employment and their financial situation are in jeopardy.

Cancer patients are particularly vulnerable due to the high costs of modern cancer care. One study showed that 42% of cancer patients depleted their entire life savings in the first two years after diagnosis. In recent research by AccessHope that noted cost savings associated with their care model, it also highlighted the role of smoking in lung cancer emergence with 83% of the cases found in past and present smokers (57% and 26% respectively). How does this tie into SDoH, you might wonder? Well, according to the Centers for Disease Control, smoking is more prevalent in low economic status groups, those with lower levels of education, and those living near or below the poverty line.

For companies, these barriers to health should not be underestimated. It is only by understanding the unique situations faced by employee populations that brokers and benefits leaders can design plans that empower members with the tools and resources they need to stay healthy. It starts with the five primary social determinants of health:

  • Healthcare quality and access: barriers to good health include health insurance coverage, level of health literacy, and the availability and quality of healthcare services at a person’s disposal.
  • Education access and quality: the quality, level, and duration of education, including early childhood development, influence the health status of adults.
  • Social and community context: broader considerations such as discrimination, incarceration rates, community cohesion, civic participation, and employee relationships can take a toll on health.
  • Economic stability: the availability of financial resources to individuals influences factors such as poverty, food security, and housing stability.
  • Neighborhood and built environment: housing quality, transport links, access to nutritious foods, pollution, and crime can affect health.
Not every segment of the population is affected equally by SDoH. Depending on the industry, the geography of the employee population, their background, and the nature of their employment, the social determinants may have a protective effect–like tech workers, who tend to be highly educated and better compensated. Conversely, they may increase the risk, particularly for say, companies operating in dense urban areas, those with a high percentage of low-wage workers, or those with a high percentage of workers working in hazardous conditions.

Understanding these factors empowers benefits leaders to deliver meaningful programs by meeting employees where they are on their health journey, anchored in their lived experience as individuals.

How employers can make a difference

Employees can’t leave these challenges at home, and their consequences ripple through to the bottom lines of organizations, impacting everything from lower productivity and absenteeism to employee satisfaction and wellbeing. Forward-thinking leaders are integrating social determinants of health into their benefits planning strategies using these seven tools and perspectives.

1. Understand how SDoH affect your employee population

Get started with this free tool by the Robert Wood Johnson Foundation, which allows you to see how any U.S. zip code ranks on metrics such as health outcomes, quality of life, health behaviors (i.e., smoking, physical activity, obesity), and socioeconomic factors influencing health, to name a few.

2. Collect in-depth data from your employees

Dig deeper into the societal and economic factors that influence your workforce with PRAPARE, the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences. This standardized social risk evaluation tool was developed for use in clinical settings to evaluate the SDoH of patients, but can help brokers and benefits leaders looking to get a more comprehensive picture of the challenges facing their employee populations.

3. Build a targeted and holistic health benefits program

Once you’ve done your research, and collected and analyzed the data, consider how your benefits plan fits in. Start by looking at point solutions that can target population-specific issues. With the rise of digital health, there is now a wealth of remote, virtual, and self-service solutions to tackle a range of problems from behavioral health to remote cancer support.

4. Develop programs that mitigate unhealthy behaviors

Human behaviors, such as tobacco usage, physical inactivity, alcohol consumption, and drug use may be responsible for as much as 40% of premature deaths in the U.S. Identifying high-risk behaviors in your employee population is the first step to curating services and developing campaigns to raise awareness and empower employees to make changes that can transform their lives. For example, companies seeking to address obesity can make changes in the workplace to encourage positive behaviors by providing healthy food options, access to physical activity facilities, and health education classes. Conversely, industries where workers are at above-average risk of serious injury (and thus opioid dependency), like logging or construction, may benefit more from digital health services and wearable technologies that provide non-addictive pain management.

5. Identify community resources that support your employees

Your benefits plan cannot meet every need of your employee population, so it’s important to look towards the broader community to see which support services are available to help with the social determinants of health that are outside of the organization’s purview, such as financial or housing assistance and food pantries. Resources such as allow you and employees to search for community resources available to them in their locality.

6. Work with benefits platforms and TPAs that offer care navigation services

In 2020, 1 in 4 Americans avoided seeking treatment because they didn’t know what their plan covered. Healthcare avoidance is a serious problem that can be mitigated with reliable care navigation services provided by transdisciplinary teams of nurses, pharmacists, social workers, dietitians, and more. By leveraging the power of machine learning with inputs from various sources, including medical claims, combined with real-time human support, nowadays you can offer your members a personalized experience that takes into account SDoH. This approach, adopted by Collective Health, is especially valuable for high-risk members with complex care needs.

7. Ensure confidentiality to prevent fear of stigma

A person’s health is a private matter for many good reasons, including the stigma associated with various diseases, not to mention socioeconomic circumstances. Employees may not want to share sensitive information about their health status, financial difficulties, or living conditions with employers, which is why ensuring that members feel safe and their information is protected is paramount in a successful benefits strategy. You can give your employee population peace of mind by using a HIPAA-protected, PHI-secure network that allows people to access support confidently and privately.

About Collective Health

Collective Health simplifies employee healthcare with an integrated technology solution that makes healthcare work for everyone. With nearly a quarter of a million members and over 50 clients—including Driscoll’s, Pinterest, Red Bull, Restoration Hardware (RH), and more—Collective Health is reinventing the healthcare experience for forward-thinking organizations and their people across the U.S. The company has developed a range of population health management solutions, and partnered with innovative companies across care delivery and diagnostics to meet the most pressing healthcare challenges for employers today.