If you work in the healthcare world, “social determinants of health” (SDoH) is something you’re starting to hear everywhere. While it has long been a focus in public health, the healthcare industry and employers have been slower to make it one of their foci. Since half of Americans receive healthcare through their employer, this is a problem.
It has been easier for plan sponsors to focus on employees as individual actors, rather than thinking broadly about how employees are functioning overall with regard to the SDoH in their communities: economic stability, education, health and healthcare, neighborhood and built environment, and social and larger community context. In fact, most wellness programming and associated tools (i.e. fitness watches, reimbursements for gym use, and financial wellness seminars) are completely focused on changing an individual’s behavior notwithstanding the external forces beyond the company walls. But it hasn’t been working. The sick are sicker and healthcare prices continue to rise in part because we are not individual actors and health and wellbeing are much bigger than what happens within the company walls. If employers want to continue being the conduit to healthcare for most Americans, they need to understand how programming works both on the individual and how it fits into the local fabric of the community.
Large employers are expected to spend an average of $3.6 million on wellness programming for employees in 2019. This includes everything from gym membership subsidies, to in-house seminars, to Fitbits. Nevertheless, the CDC says that 6 in 10 adults have a chronic disease and 4 in 10 have two or more chronic diseases. This is not limited to the unemployed or underemployed. Our research of consumers with health insurance shows that at least half are overweight or obese, a condition linked with many chronic diseases.
Clearly the investment in wellness isn’t solving the problem on its own. In our conversations with healthcare consumers, we know that wellness programming doesn’t work for everyone. This is because most wellness programming is implemented on a company-wide scale, without taking into account the nuances of the members and communities that it serves. While some of the challenges cross cultures and people, that doesn’t mean that there is a blanket solution. Gym memberships and financial wellness classes alone will not change behavior if the employees are worried about where their next meal will come from, if they are in physical danger, or if they simply don’t understand the point of changing behavior. Wellness programming is currently focused on the individual or the company, not the broader context in which those individuals live – their community. There is opportunity for employers and their health partners to look beyond their walls, into the communities to which their employees belong.
Employers first need to cultivate a trust and consciousness with employees and the communities so that they understand their unique challenges and resources. Only then can wellness programming leverage this knowledge to actually change behavior. To do so, companies can partner with community leaders who can educate them about the particular challenges of the community and who can educate and encourage community members to make changes for the better. Thinking locally requires a decentralization of health and wellness thinking, but it will be far more powerful and effective than a one-size-fits-all healthcare approach.
What are the root causes of poor health and health decision-making and what can be done?
Engagement of healthcare consumers requires us to scrap that one-size-fits-all approach of health initiatives today. It requires trust-building and engagement at the local level. Professor Raghuram Rajan, of The University of Chicago, calls the community “The Third Pillar,” and calls on us to practice “inspired localism,” where we engage with and energize communities to inspire real and lasting change. In this context, when community is engaged and energized, it will develop solutions to its healthcare problems.
Employers are often the biggest stakeholders in a community. They are dependent on the vitality and stability of the community in the same way that a community depends on them. Employers can take a good look at themselves and how well they are engaging with employees and their communities to empower them to take control of their healthcare and health expenses. To do so, they need an understanding of SDoH at each of their plants, offices, and other locations. Simply deploying libraries of information or wellness programming without understanding the root-level issues that might interfere with getting health and wellness mindshare is ineffective. For some companies, it might require a radical change of focus to recognize the value of potentially decentralizing some aspects of their benefits. Nevertheless, thinking this way will ensure that everyone will be better off.
 National Business Group on Health/Fidelity, https://www.businessgrouphealth.org/news/nbgh-news/press-releases/press-release-details/?ID=355
 CDC, https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm.
 Greenwald & Associates/EBRI, Consumer Engagement in Healthcare, Annual Survey. 2018 edition.
 Greenwald & Associates/EBRI, Consumer Engagement in Healthcare, Annual Survey. 2018 Edition.