The pandemic exposed the dark underbelly of health that has gone unnoticed – or ignored – for years. That is the social determinants of health (SDOH), the nonmedical factors that influence health outcomes. These are the circumstances in which employees and their families are born, grow, work, live and age, along with the wider set of forces and systems that shape their daily lives.
Examples of SDOH include:
- Safe housing, transportation and neighborhoods
- Economic policies and systems
- Access to nutritious foods and opportunities for physical activity
- Racism, discrimination and violence
- Language and literacy skills
- Education, job opportunities and income
- Climate change and polluted air and water
Social determinants of health (SDOH) have a major impact on someone’s ability to live a healthy and fulfilling life, accounting for 80 to 90 percent of the modifiable contributors that are linked to health and risk outcomes.
Accessing care and achieving one’s highest level of health is easier for some people than others and this has a direct impact on outcomes. In rural areas, for example, there is an 8% higher mortality rate from cancer. And black people are more likely to undergo major surgery at low-quality hospitals than their white counterparts, even when they live closer to a high-quality hospital.
There is also a large portion of workers, particularly in the hospitality and service industries, who are making just enough to get by. They may be experiencing housing insecurity or food insecurity. They may live in a so-called “food desert” where they lack access to lean meat, fresh fruits and vegetables and their primary options are processed foods.
This is especially concerning as the medical community increasingly embraces the “food as medicine” movement, which maintains that healthy choices – specifically, increased consumption of a variety of whole, minimally processed plant-based foods, and limited intake of highly processed foods rich in added sugar, oil and salt – may prevent, reduce symptoms of or even reverse a disease state.
When someone doesn’t have easy access to healthy options – and they may be low on money – the dollar menu at the nearby fast-food restaurant becomes a way of life. They don’t even have to get out of their car to procure an inexpensive meal comprised of artery-clogging, blood pressure-raising, obesity-inducing foods that are going to shorten their life and increase their need for medical services.
These challenges have been compounded by sky-high inflation, which reinforces social inequality. This is putting even more strain on healthcare affordability and patient care access, according to the Nationwide Retirement Institute. With inflation at a 40-year high, Americans have found themselves facing tough healthcare decisions, influenced by their ability to pay for medications, doctor visits and healthy food.
Rising costs for day-to-day necessities like transportation and housing have caused many people to cut back on medical care at the expense of their health. And while the price of medical care hasn’t risen as quickly as the price of just about everything else – 5% for medical care compared to 7.7% for all goods and services – the immediate impact on the cost of food and goods limits buying power, leading to shortfalls in nutrition, avoidance of care and delay in care.
A June 2022 survey by West Health and Gallup found that in the prior six months, high health care prices drove 38% of American adults - nearly 100 million people - to delay or skip treatment or cut back on driving, utilities and food or borrow money to pay medical bills. Delays in treatment result in patients being sicker when they do seek care, leading to costly health events such as hospitalizations and surgeries.
Inflation-fueled healthcare affordability problems are especially problematic for people of color, who say the rising cost of healthcare is limiting patient care access, according to polling from NPR, the Harvard T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation. In particular, people of color are reporting challenges affording medical care and prescription drugs, saying they cannot access necessary medical care for current illnesses.
Other factors, such as skyrocketing rental costs, lead to housing insecurity and reduce the amount of money people have available for other essential needs. The inability to pay utility bills can be quite detrimental, as extremes of weather may lead to heat stroke or hypothermia. The stress of dealing with such matters adds to the burden of mental health and concomitant deterioration of chronic disease, along with the inability to afford medication/rationing of medicines (e.g. insulin) and increased risk of uncontrolled chronic disease.
Employers are taking note of the challenges faced by their people who are impacted by the SDOH. According to the Business Group on Health 2022 Large Employers’ Health Care Strategy and Plan Design Survey, three-quarters of large employers are concerned about ways to improve health equity by way of their company’s health and wellbeing initiatives.
This recognition has helped usher in strategies like increasing access to healthy foods. Increasingly, employers are looking to implement virtual health care delivery alternatives for primary care, mental health and urgent care. This led to the success of the burgeoning telehealth industry, which improves access for people in rural and minority areas where providers are few and far between, as well as for those who face cultural or discriminatory barriers.
Employers are also boosting their wellbeing benefits, reducing or eliminating out-of-pocket costs for employees and offering free telehealth visits and food programs. Working with their health plan, many are striving to ensure medications are affordable, while others are adopting creative approaches to assist employees struggling with housing. Above all, employers are finding ways to engage employees in their health-care journey.
While many factors influence inflation’s impact on health behavior, it’s essential for employers to recognize its effect on their people and find ways to help them access the care they need. With Alight Total Guidance and our quality provider algorithms, we can guide underserved populations to high-quality, low-cost providers, provide medical decision support to improve health literacy, and better understand their care options so they can feel better prepared for their provider visits. We also address the social drivers based on the social determinants of health domains and guide employees to appropriate solutions.
