Social Determinants of Health: An Employer’s Role

woman with laptop phone and yoga mat
Scott Foster Photo

3 minutes

Does your wellness program reduce your healthcare benefits costs?

When it comes to customer satisfaction, quality assurance and market competitiveness, leaders rely on the data. They reference case studies, surveys and research and compare multiple options before committing and implementing.

Yet when it comes to wellness programs, many organizations have either built internally or purchased bandwagon programs designed around trending topics in workplace wellness rather than evidence-based practice in preventative medicine. And because so few employers are measuring the ROI of their wellness programs, the jury is still out; one large, randomized controlled study found no benefits at all after the first year of implementation of a wellness program while another identified tremendous ROI in an 88,000-employee software company.

Where are Organizations Going Wrong?

One area of weakness in the trendy wellness program is its lack of acknowledgment of social determinants of health, or SDOH. 

What are social determinants of health?

The Centers for Disease Control describes social determinants of health as, “conditions in the places where people live, learn, work, and play.” These factors, which might include unsafe neighborhoods, unsafe relationships, poverty, stress or substandard education, have the power to dramatically impact health risks and patient outcomes—and employee outcomes. 

Healthy People 2020, a U.S. Government initiative aiming to identify and reduce the most significant preventable threats to American health, breaks social determinants of health into five key areas including education, economic stability, neighborhood and built environment, social and community context, and health and health care. Some of the issues that fall in these categories include access to healthy foods, quality of housing, health literacy, employment and access to primary care.

The incredible impact that the SDOH play in overall health and outcomes is widely researched and well-known, yet thousands of employers are providing free apples on Wednesdays and an Employee Assistance Program and calling it good. 

This might lead you to ask, "But where do we draw the line? When are employees responsible for themselves?" The answer is, "That depends on how much you care about your employees and how much you care about your bottom line."

So, What's the Impact?

According to the American Journal of Preventive Medicine, as many as 90% of the “modifiable contributors to healthy outcomes” are not medical, but social. That means that the medical focus of most wellness programs today may leave them missing the mark in 90% of cases, failing to prevent almost all preventable ailments among staff.

Think about that: The wellness program you invested in, continue to invest in and dedicate staff hours to, might be failing to prevent almost all preventable diseases that will afflict your staff. This is where it gets personal for employers.

Failing to prevent disease, your wellness program is then passively contributing to the increase in insurance premiums. Today, annual premiums average $7,188 for a single plan and $20,576 for a family plan. Even more shocking is the fact that while premiums have increased by 71% over the last 10 years, deductibles have increased concurrently. More employees have deductibles now than ever before, and the average has risen from $826 to $1,655 over the last decade. That means we're paying more and getting less, almost entirely because we're failing to prevent entirely preventable high claims.

How Do We Fix It?

There’s good news and bad news.

The bad news: The conditions that lead to poor health outcomes will hardly be eliminated. It is highly unlikely that any employer can eliminate SDOH among its workforce.

The good news? Small changes can quite literally prevent life-threatening disease among your staff, decrease your expenses, and allow you to reinvest in your most valuable resources: your people.

What you can do

Do your research. What are the most pressing conditions in your community and your workforce? Design a wellness program based on evidence, not trends—or partner with an expert who can do it for you. The most effective wellness programs are often developed by healthcare systems and healthcare-industry experts.

Socialize the idea in your organization. Build buy-in among staff and leaders and gain valuable insight from those who will be directly impacted by the initiative.

Sharpen your leadership skills. Calling employees to greatness, supporting mental and emotional health among staff, and adopting a no-tolerance policy when it comes to toxic negativity at work are free and yield a high return on investment.

Be open about the initial investment. Consider what you've invested in wellness programs with flimsy foundations in comparison to a wellness program that can reduce your annual healthcare spend, absenteeism and turnover, and increase productivity, employee engagement and ROI.

Scott Foster is president of Wellco, based in Michigan. Scott is a frequently invited expert and speaker regarding leadership, engagement, and high-value health and wellness. Wellco provides award-winning solutions to measurably improve health engagement and outcomes.

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