Why social determinants of health matter during a pandemic

This blog post was originally posted in February 2020, but a lot has changed since then (namely, a pandemic happened). We thought it was important to revisit the subject, but in the context of a global health crisis. We’ve updated the original blog post accordingly. 

Late last year, our CEO, Mike Serbinis, was joined by renowned physician and Chief Wellness Officer at Cleveland Clinic, Dr. Michael Roizen, for a powerful discussion about employee health. Since then, organizations have been upended by a pandemic, throwing out rulebooks and pushing companies to the edge in terms of business continuity and healthcare spending. They’re now focused on the most basic of needs: keeping employees healthy and safe. 

It’s more important than ever for employers to understand their role in influencing better health outcomes for their employees. The issue that many may not realize is that health outcomes are greatly determined by non-medical factors. In fact, 80% of health has been attributed to social determinants of health. 

Understanding social determinants of health

As the term suggests, social determinants of health are factors linked to social aspects of a person’s life. This includes where they live, learn, work, and play. It’s linked to their quality of life and how it contributes to their health outcomes and risks.

According to the Kaiser Family Foundation, there are six key areas that have been linked to health outcomes:

• Economic stability, including things like employment status, household income, expenses, and financial support.
• Neighborhood & physical environment, such as housing status, transportation, safety, parks, walkability, etc. 
• Education, including literacy, language, early childhood education, vocational training, and higher education.
• Food, including access to health options and hunger levels.
• Community & social context, such as social integration, available support systems, community engagement, discrimination, and stress levels.
• Healthcare system, including health coverage, provider availability, and quality of care.

For example, a person’s zip code can at times matter more than their genetic code. In fact, one study found that the difference of nine subway stops in Chicago can mean a sixteen year difference in life expectancy. This effect is not exclusive to urban environments. In Mississippi, a life expectancy difference of seven years was found in less than an hour drive on Route 82.

Apply this same research to today’s global pandemic, and the impact is far-reaching. Where a person lives has shown to have a major impact on their risk for contracting COVID-19. What is less often talked about, though, is the impact of those cut-off from their support network of friends and family. The same can be said for those without alternative childcare options or with a spouse that has been laid off or furloughed. 

This is the reality for so many people who would otherwise have healthy social determinants under normal circumstances. 

The solution lies with employers

With approximately 150 million Americans gaining access to healthcare coverage through their employer, the need for employers to address the social determinants of health is critical. Keep in mind that employers have traditionally provided employees with benefits beyond a paycheck and health coverage—things like routine, social interaction and a secondary space from home—that are just as important for mental health. 

Employers have the ability to impact how employees are equipped to manage and access their healthcare, thus improving health outcomes across the nation.

The motivation for employers is financial too. After all the financial impact caused by social determinants of health is huge. The cost of over-treatment or low-value care in the U.S. is estimated to be as high as more than $100 billion per year and the failure of care delivery is over $165 billion per year.

Health risk assessments of yesterday aren’t enough

When assessing the impact social determinants of health on an employee population, traditional health risk assessments simply don’t cut it. Industry experts have long criticized health risk assessments as being out-of-date for placing too much emphasis on medical health factors, such as family history, versus an employee’s overall health and wellbeing. Industry experts have also claimed that the data captured by these traditional assessments lack practical insights that enable employers to effectively design a health and wellness program for their employee population.

For the most part, employers have agreed. Employers have often lamented about completion rates when it comes to traditional health risk assessments. Unless employers offer some type of incentive, the completion rate can be as low as 10%. However, offering an incentive for completion does not guarantee an employee will accurately complete the assessment. As a result, employers are left with an incomplete picture of their population’s health, how they’re accessing care, and what their real needs are to improve health.

The new way forward: modern, data-driven solutions

Employers are turning to modern solutions that go beyond what a traditional health risk assessment can offer. These modern solutions harness employee data to provide a personalized experience that in turn empower them to be better healthcare consumers. However, not all modern health risk assessments are created equally. In order to improve employee health outcomes, a modern health assessment approach should follow four best practices.

Best practices for a modern health assessment approach

Here are four key best practices to developing health assessments today:

• Grounded in research: A modern assessment should be designed around the Social Determinants of Health framework. Otherwise, it will not address the 80% of health outcomes that are determined by non-medical factors, like where an employee lives or their economic stability.
• Designed to be easy for anyone to understand: A modern health risk assessment should be built around the employee experience so that it’s easy to understand. This means avoiding any clinical language and instead using simple, human-centered language. It should aim to educate employees with the “why” so they feel empowered to take action and control their own health.
• Encourages completion: Rather than offering a generic incentive, a modern assessment should encourage completion in ways that are relevant to an individual. This means asking health-related questions that pertain to the individual taking the assessment.It should also be short and continuous. Rather than risk an employee losing patience with a long assessment and abandoning it, a modern approach is to shorten the initial assessment. Then, follow up with the employee with nudges to complete additional questions.
• Deliver meaningful value: As with an assessment, the value needs to be clear and meaningful. When it comes to a modern health assessment, it should offer immediate, actionable insights, recommendations, and support to an employee’s individual health needs and interests.

By leaning in on these modern practices employers can give employees what they really need – a personalized path to health that breaks down the non-medical barriers. Employees can understand their health and feel empowered to take actions. At the same time, employers improve their population’s health outcomes and lower their healthcare spend.

Read more about social determinants of health in our eBook Social Influence on Workforce Health.