If employers truly want toimprove their employees' well-being, they need to giveall the factors contributing to their overall healthproper attention. (Image: Shutterstock)

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Low employee participation rates in preventive health careprograms, such as fitness programs, employee assistance programs, smokingcessation programs and preventive cancer screenings, results in significant coststo employers. This leads to higher absence rates and reducedemployee performance because of decreased well-being.

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Many employees don't participate in these programs even thoughthey are in their best interest. So what's stopping them and howcan employers design benefit programs to change this trend and improve their employees'overall well-being?

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In a recent research review I completed with Emily Stiehl,Clinical Assistant Professor in Health Policy and Administration atUniversity of Illinois at Chicago, we concluded that social determinants of health, centering onsocioeconomic status, are significant factors in employeeengagement rates in health-related benefits.

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Employers—and their employees—will benefit from benefitsprograms and tactics tailored to address social determinants ofhealth that may affect their employees.

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Related: How do social factors affecthealth?

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According to some public health researchers, social determinantsof health account for as much as 40 percent of an individual'shealth status. Despite social determinants being discussed inpublic health conversations for many years, their role in theworkplace has not been broadly recognized, and therefore, are oftennot considered when employers design benefits programs.

Defining employee health

Many factors—or determinants—contribute to an individual'shealth, including biology and genetics, lifestyle behaviors, socialand physical (external) environments, and availability of andaccess to health services. While lifestyle behaviors are important,a recent estimate indicates they only contribute to approximately30 percent of an individual's health status; social circumstancescontribute 40 percent, environment contributes 10 percent, andmedical care 20 percent.

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If employers truly want to improve their employees' well-being,they need to give all these factors proper attention.

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Related: 4 factors driving consumers' shifting perception ofhealth

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Let's take a closer look at social determinants of health. TheWorld Health Organization defines them as ''the complex,integrated, and overlapping social structures and economic systemsthat are responsible for most health inequities.'' Based onpublished analyses, three primary social determinants of health areincome, education and occupation, all of which are interrelated ina decidedly complex manner.

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Income is directly linked to the individual's materialresources, which can affect a range of factors that contribute tohealth outcomes, including aspects of the physical/homeenvironment, dietary habits, lifestyle behaviors, financialwell-being and mental health. Education can have an importantimpact on financial and medical literacy, as well as employmentoptions. And because employment is an important factor for shapingsocial position, contributing to income, and providing access tohealthcare, it is a foundational contributor to social determinantsof health, especially since many adults spend a large portion oftheir time at work.

Employer benefit strategy: The missing pieces

Yet despite this, in the United States, efforts to addressworkforce health and rising healthcare costs have historically beendirected toward the economics of healthcare services delivery, withless attention paid to the value of social services expenditures,much less workplaces as determinants of health. In the past decade,however, the recognition that higher healthcare expenditures havenot yielded better health outcomes has shifted the focus toward anincreased interest in employees' social environments and the impactthese have on their health, and how they can improvewell-being.

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By considering social determinants of health when designingbenefits programs, companies can more comprehensively andeffectively address a diverse population's health needs—andultimately, the value of their workforces' human capital, includingknowledge, skills, abilities, motivation and creativity. Indeed,there is growing recognition in research and in practice thatinvesting in well-being programs can benefit employers in terms ofbusiness, and employees in terms of overall life satisfaction.

Social determinants for low-wage workers

Recent economic analyses have highlighted increasing wealthdisparities among U.S. adults, including those in the workforce.During the past two decades, annual salary increases for low-wageworkers have been the lowest of all wage groups. At the same time,the proportion of low-wage workers in the workforce isincreasing.

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According to 2016 census data, 28.8 percent of adult civilianworkers with employer-sponsored health insurance earn less than$30,000 per year, with an additional 13.8 percent earning between$30,001 and $40,000 per year. Employee wage level is associatedwith health status, with low-wage workers generally experiencingpoorer health outcomes.

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Compounding the issues for low-wage workers, the overallpercentage of firms offering health insurance coverage has declinedduring the past 10 years, particularly among smaller employers andthose with many lower-wage workers. The confluence of structuralchanges, including continued healthcare cost growth in excess ofinflation, wage stagnation among lower-wage earners and increasingemployer adoption of higher deductible health plans have createdsignificant financial pressures for low-income earners.

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As a result, these individuals may be challenged to allocatescarce financial resources between basic necessities (food andhousing) and medical care. Low-wage earners may also be less likelyto enroll in employer-sponsored health benefits because ofcompeting financial priorities. And recent analyses of treatmentcompliance have provided clear evidence that lower-income earnersare more likely to forgo or delay necessary care than theirhigher-earning counterparts.

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And yet, despite efforts by some employers to make healthbenefits more equitable for lower-wage workers throughemployer-provided wage-based insurance subsidies, most companieshave been largely unaware of the influence of socioeconomic statuson health benefits utilization and health outcomes. Indeed, morethan 95 percent of employers continue to embrace consistentbenefits design and cost options for employees and family members,regardless of wage group.

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Provision of wage-based health insurance subsidies and othermeasures designed specifically for low-wage workers must be givenpriority if employers are to improve the well-being of theiremployee base.

Looking at overall well-being

Interest in well-being as a more holistic view of individualhealth status has prompted some employers to expand their scope ofbenefits offerings to include financial literacy, resilience andcareer advancement programs. These initiatives provide someevidence of employer awareness of the implications of socialdeterminants of health for workforce well-being.

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But the current employer well-being framework of health, wealthand career still falls short in addressing employee socialdeterminants of health concerns.

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For instance, programs designed to encourage financial literacymay not improve financial well-being if the employees receiving thetraining do not also earn enough to improve their financialsituation or have opportunities for career advancement. Low-incomeearners may also be exposed to income risks due to just-in-timework scheduling, uncertain job security and emotional stress due tothe demands of their work, and may also not have access to paidsick leave. As a result, employers may want to broaden their viewof well-being to encompass other considerations.

Incorporating social determinants into employer strategies

So, what steps can employers take to reframe their benefitsofferings with social determinants of health in mind? With respectto the workplace as a unique determinant of health, review oforganizational policies and practices, determinants of workplaceculture, compensation framework, and employee perceptions caninform strategies to promote a more worker-friendly and supportiveworkplace environment.

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Such an evidence-based approach would help to address uniqueemployee needs, rather than provide a ''one-size-fits-all''benefits offering, with the seemingly naïve hope that mostemployees will engage. By so doing, employers will appreciate moremeaningful and lasting healthcare cost containment, as publichealth researchers have shown that comparatively small expendituresto address social determinants of health priorities can lead tosignificant reductions in overall healthcare costs. Given thehealth disparities that exist among income groups, specificallytargeting low-wage workers' health could yield even greaterresults.

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As an illustrative example, some employers have recognized thathealthcare costs can eat up as much as 20 percent or more of alow-wage worker's income. These employers have provided financialsubsidies in the form of premium or other subsidies for theseindividuals to make healthcare more affordable.

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Where is the best place for employers to start? At anoperational level, employers interested in expanding the impact ofwell-being initiatives can survey employees regarding perceptionsof work in relation to social determinants of health. This processcan help identify workplace practices, policies or culture that area detriment to employee well-being. Too often, as benefitsprofessionals, we tend to design benefits for people likeourselves, and risk losing sight of what may be important toothers.

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With these insights, employers can then work to addressidentified workplace social determinants of health concerns inaddition to implementing employee behavior change programs. Forinstance, organizations wanting to implement healthy eatingcampaigns could similarly assess the availability and affordabilityof healthy food options at work. These efforts can extend tocommunities where employees live. There, employers can supporthealthy environment initiatives that target community-based socialdeterminants of health priorities. In this way, attention to socialdeterminants of health effectively extends to incorporate corporatesocial responsibility considerations.

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As more research creates a growing knowledge base of insightinto the association of social determinants of health with keyhuman resources indicators, refinements in measures of these socialdeterminants can then be implemented. I believe that workforcesocial determinants of health measures can also be evaluated inrelation to business performance, including work quality, safety,efficiency and customer satisfaction.

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Insights from these data can ultimately be used to informthoughtful review of employer policies and practices that can bothimprove employee well-being and pay dividends to the employer thatbenefits from a healthier workforce.


Read more: 


Bruce Sherman is medical director,population health management at Conduent.

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