How Workplace Programs & Policies Can Shape Employee Health - SDoH Series, Part 4

Following the Healthy People 2030 model, this article series focuses on 6 aspects of social determinants of health, including food insecurity, economic stability, neighborhood and the physical environment, education, community, social support, and healthcare access. Here we'll discuss the impact of one's workplace on health and well-being with examples of employer programing and support to address SDoH.

Where you work can impact your health

It's well established that where people live can have a sizable impact on their health and well-being. But the places where people work also play a key role in influencing their social determinants of health (SDoH), or the nonmedical factors that can affect health outcomes.

With more than half of people in the United States using employer-sponsored health insurance, benefit design decisions contribute to healthcare choices and outcomes. At the same time, the work environment itself can also influence one's SDoH. An increasing awareness of this complex interplay is encouraging more organizations to examine and address their role in shaping employee health outcomes.

Employers play an instrumental role in SDoH

At first glance, some businesses might question the corporate responsibility in promoting health, pointing to the responsibility of government or the healthcare delivery system. Employers, though, play a key role in addressing SDoH, points out a 2023 article in the Harvard Business Review.

“The short answer is that income, economic stability, workplace benefits, such as paid time off and medical benefits, and social conditions in the communities where companies operate are major drivers of health disparities, and employers can play a lead role in addressing many of them," the authors write.

“Employees don't leave SDoH at the door"

Turning attention to SDoH is a relevant and pressing priority. Each year, health-related problems, chronic disease, and unhealthy behaviors cost American companies billions in lost productivity, writes Dr. Ari Hoffman of Collective Health in an article looking at why SDoH should matter to employers. Health struggles manifest in the workplace in absenteeism, drops in performance, and productivity, as well as loss of overall satisfaction and well-being.

Consider the example of someone who has high blood pressure and might not have transportation to get to his assigned pharmacy—or the financial freedom to pay his share of the medication bill. As a result, he could end up hospitalized for high blood pressure, Hoffman explained. Similarly, a retail worker with diabetes, who lives somewhere with poor transportation, might struggle to access medication and appointments to manage the chronic condition.

“Employees don't leave SDoH at the door, they bring them to work every day," Hoffman writes.

How workplaces can shape health

The environments where people work can also affect health in both direct and indirect ways. Some people might experience unsafe working conditions or exposures to hazardous substances, while other jobs might not provide healthcare access, paid sick leave, and other benefits that can help people take care of their health needs.

On the other hand, workplaces can also be a positive force in shaping health. The Centers for Disease Control and Prevention offers several examples of how jobs can shape workers' health in positive ways in this 2023 blog post.

A good job will provide:

• A safe, healthy workplace
• Income and benefits, such as access to affordable healthcare and paid leave
• Work/life balance
• Employment security
• Voice in decision making
• Opportunities to gain skills
• Positive employment-related relationships

Collaborative aims to encourage healthier workers

As recognition of the workplace's critical role grows, industry and healthcare organizations are turning their attention to the specific steps employers can take to encourage healthier workers. The National Alliance of Healthcare Purchaser Coalitions conducted a yearlong learning collaborative with the CDC and the National Network of Public Health Institutes to better understand and pinpoint workplace recommendations. Creating positive changes not only create a healthier and more productive workforce but can also have influence on the broader community.

“Given the far-reaching impact to performance, morale and cost of care, this project found that employers were interested in their employees' SDoH," said Dr. Christa-Marie Singleton, the Chief Medical Officer of the Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention in a news release on the effort.

Report offers tips and strategies for workplace health

Their report offered key takeaways and examples of specific actions employers have taken, such as:

• Employers combined community data and employee zip codes to better understand the population health challenges and health inequities their employees face. They also used internal tools, such as survey data and employee resource groups, to confirm the prevalence of these barriers.
• Participants created a plan that prioritized actions that may have the biggest impact, such as addressing employee transportation challenges or creating financial stability programs.
• They looked to systems of accountability to monitor progress and outcomes over time using key data metrics.

Employers look to SDoH in benefit design

Focus is also turning to the design of health insurance plans, and how adjustments can influence health outcomes. Last year, the Northeast Business Group on Health, a nonprofit that represents employers that sponsor health benefit plans, released a “Social Determinants of Health" guide for employers who are increasingly looking to better understand their role in reducing health inequities.

While physicians, clinics, hospitals, and health systems have largely been at the forefront of SDoH efforts, employers have routine, frequent contact with their employees, offering a window into the distinct SDoH factors influencing their health and well-being. That heightened focus comes at the heels of the devastating COVID-19 pandemic and the far-reaching inequities it lay bare.

Gather information, analyze, and evaluate SDoH

The guide highlights key steps employers can take to address SDoH, such as:

• Start with data: Ask employees about their health needs and risks in anonymous SDoH surveys that are mindful of privacy. You can also talk to your health plans about data they collect.
• Use a health equity lens: Assess your benefit designs with an eye toward health equity. For example, consider whether you offer the same health plans and benefits to all employees regardless of salary. Similarly, some companies offer 401K matching programs that offer the most generous contribution when the employee contributes the most.
• Consider missing benefits: The guide encourages employers to evaluate what programs they may not offer that could help employees with health-related social needs, such as caregiving benefits for children and older adults, transportation subsidies, and programs that support healthy nutrition.
• Evaluate how benefits are structured: Look at other programs such as caregiving benefits, sick leave, tuition reimbursement, and gym membership and see who is using them.
• Support financial and health literacy: Counseling and training can aid employees as they navigate the complexity of their health benefits and the best financial choices for themselves and their families. Informational lunch meetings, webinars and tip sheets in multiple languages can help communicate your offerings.

Healthcare plan design can influence health equity

The types of health plans employers offer can influence how employees use healthcare. Plans with higher levels of cost sharing, such as ones that offer high deductibles, can change how people use healthcare and the outcomes of those choices.

A 2022 literature review found that higher employee cost sharing consistently impacted whether people started and continued medications. The greater the cost sharing, the worse the medication adherence, according to findings published in The Journal of Managed Care and Specialty Pharmacy.

Harnessing data to improve employee wellness programs

While some employer-sponsored wellness programs have led to positive results, other analyses have called into question whether they make a difference. To achieve more effective wellness programming, it's important to understand the underlying conditions that are impacting employees' health conditions, explains Margaret Rehayem of the National Alliance of Healthcare Purchaser Coalitions in a HealthPayer Intelligence article.

Better understanding the SDoH that influence employees' health and well-being can lead to more customized approaches, she noted. Gathering data on employees' SDoH and combining that with community demographic data can be helpful in better understanding specific challenges. This data can be used to design health interventions and programs that best reflect needs. Once these plans are created, it's important to measure outcomes and gather insights that can be used to further refine the approach, she noted.

Workplace plays key role in improving health literacy

Another increasing area of attention in the workplace is employee health literacy. Employers have a better opportunity to influence workers' health literacy than the CDC or even someone's family doctor, points out this Forbes article.

Broadly speaking, health literacy refers to the set of skills individuals need to obtain, understand, and use information to make decisions impacting health. Health literacy skills not only affect an individual's decision making, but also have broader effects on population health, such as environmental health advocacy.

“Individuals with these most advanced skills can obtain and use information to exert greater control over life events and situations that have an impact on health," explain the authors of a piece looking at health literacy as a SDoH, published in the Annual Review of Public Health.

Clear, accessible information facilitates healthy choices

Organizations play a role in employees' ability to find, understand, and use health information, points out a recent blog post from the Office of Disease Prevention and Health Promotion. Health information that is unnecessarily complex or full of jargon can post a barrier to people's ability to assess information and resources.

“On the other hand, organizations that follow health literacy principles—making information easy to understand and act on and ensuring systems are easy to navigate—equip people to make healthy lifestyle choices and seek healthcare when they need it," writes Dr. Paul Reed.

RTI Health Advance can guide you to create a better workplace

As employers navigate their increasing role in addressing SDoH, RTI Health Advance can help you design, analyze, and implement steps and strategies to reduce health inequities in the workplace and beyond. Our team of health experts can leverage SDoH data and create effective policies and interventions to improve population health.