As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This is a reprint of a blog post from KBGH:
What makes us healthy?
Modern medicine has something to do with it, and we should work to make sure everyone has access to good care. But visits to the doctor and the hospital probably only account for around 20% of health outcomes. Far more powerful predictors of health come from social and economic factors like family support and income, or from health behaviors like levels of diet, exercise, and smoking. So even countries with universal health coverage see differences in life expectancy between demographic groups, albeit smaller than those in the U.S. We call these predictors of health, the differences in conditions in the places where people live, learn, work and play, “social determinants of health.” They can be diced and divided a number of ways, but respected researcher Michael Marmot lists six categories: 1) conditions of birth and early childhood, like prenatal care and abuse; 2) education; 3) work; 4) the social circumstances of elders; 5) elements of community resilience, like transportation, housing, security, and a sense of community self-efficacy; and, 6) “fairness,” which he defines broadly as sufficient redistribution of wealth to ensure social and economic security and basic equity.
This can seem abstract, so to bring this idea home I encourage you to experiment with the CDC’s Life Expectancy Data Visualization Tool. You’ll see that the life expectancy in Wichita’s census tract 0027.00, centered on Seneca Street and Kellogg Avenue, is 67.1 years, far below the Kansas average life expectancy of 78.6 years. But go east to census tract 0073.02, centered on Rock Road and Douglas Avenue, and you’ll find a life expectancy of 83.8 years. Not coincidentally, the average income for census tract 0027.00 is $29,202, while the average income for census tract 0073.02 is almost three times higher, at $82,679. By my back-of-the-envelope calculations, traveling east from Seneca to Rock Road earns you an average of $8,488.41 additional annual income per mile and an additional 2.65 years of life expectancy per mile.
There are things we can do
That’s depressing. But what’s uplifting about thinking of health in terms of social determinants is that social determinants are modifiable. You can’t change your genetics or your family history of early heart disease. But you can, in theory, move to a safer neighborhood or get a higher-paying job or buy healthier food. And employers can help directly. Round two of what seems to be a revolving door of an infectious pandemic, as we’re experiencing now, may seem like a weird time to talk about this since many businesses are struggling even to keep their doors open and to hang on to essential employees. But I bring it up because COVID-19 has put a magnifying glass on the differences in medical outcomes between groups. Don Berwick has a powerful essay in last week’s Journal of the American Medical Association (paywall) in which he argues that due to political calcification, organizations–like your own company or employer–are possibly the best conduit for addressing social determinants of health, and they don’t have to be social workers to do it.
Help in some cases may be as simple as identifying employees that have been under-valued at your company and making sure they’re paid appropriately. People who make more money simply tend to live longer:
Taking care of employees also makes good business sense
This isn’t intended as a paean to socialism. It’s a strategy that may pay off for employers, too, and I don’t say that as a pointy-headed former academic. I’m simply repeating the case I’ve read in study after study. For example, in a well-known analysis in Harvard Business Review in the mid-aughts, researchers made the case that Costco, by paying its employees a higher wage with more generous benefits, not only had a superior, more stable workforce with less turnover than competitor Sam’s Club, but made almost twice as much money employee-for-employee: in the period of the study Costco made $21,805 in annual profit per hourly employee, compared with $11,615 at Sam’s Club.
Not everything is related to money. We know times are tight. If raises for certain employees aren’t in the cards, you could work within your own Human Relations department or with your employees’ physicians or payors to make sure your employees are screened for risk within social determinants, and it can be done via telemedicine. The University of California-San Francisco has compiled screening tools through its SIREN network. Your employees’ physicians may need some guidance with this. If so, tell them that they can document any positive findings and diagnosis codes from section Z55-Z65 in the ICD-10 catalog for billing and coding. If that seems too big a bite to take right now, organizations like 2-1-1 are ready to assist with local resources, even (or especially) during the current pandemic crisis.
If you decide to take on a project that aims for improvement in one of the social determinants, we are available to help with setting goals, managing progress, and measuring outcomes. Please get in touch with us as you move forward!