Could Internet Access Make Your Employees Healthier?

Reader, you’re about to read a post that is decidedly pro-internet. Like Nixon in China, we at KBGH feel we have particularly powerful priors to make this pro-internet argument. We’ve posted in the past on the potential ill health effects of social media, which, along with Amazon commerce, is maybe the leading driver of internet activity in 2021. And we freely acknowledge all the other bad things that come with internet use, like leaky personal data, mean anonymous messages, poor interoperability of electronic health records, and the general time-suck of streaming services. So we’re not coming from a magical internet land of digital butterflies and rainbows when we tell you that access to the internet is good.

With access to the internet, you can see pictures of your grandkids now, for almost free. You can push a few buttons, drive to the airport, and fly, float, or bus anywhere in the world. We gaze in wonder at the seemingly impossible tasks made possible by internet connectivity and its associated computing power, like the recent news of AlphaFold2 (part of Google/Alphabet’s DeepMind) outdoing legions of human biologists by solving the problem of protein folding and publicly releasing 350,000 protein structure predictions, more than double the number that have been determined in all of human history by traditional methods, and including nearly every protein expressed in the human body. We all have access to our doctors’ notes now, thanks to the internet.

So the internet is increasingly seen not as a luxury, but as a utility, like electricity or city water. Access to cheap electricity undoubtedly increases your risk of being electrocuted. But it also increases your likelihood of having heat in the winter. We take the bad with the good. And a new tool from the Agency for Healthcare Research and Quality shows that access to the internet, in spite of all its flaws, may be valuable to your health. The effect is so powerful that many believe that internet access–which 25 million Americans lack–should be considered a “social determinant of health,” just like income or education level.

The new tool looks at years 2014 to 2018 and shows that internet access, both in terms of broadband and internet-connected devices, is unequally distributed. In the darkest blue counties, between 22% and 62% (!) of homes have no computing devices:

Here is Kansas, with data from Sedgwick County:

The darkest blue counties align closely with counties with the highest poverty rates and highest levels of chronic disease. People on Medicaid and Medicare make up about two-thirds of those without home internet, and around a fifth of Americans under the poverty line lack internet. So a skeptic might say that the lack of internet access is just a proxy for poverty. But other studies show an independent effect, even after controlling for income and other determinants of health. It does not take a huge leap of the imagination to see how internet access may improve health outcomes, given our recent history of a global pandemic and forced entry into telemedicine. And with more social distancing likely on the horizon this fall (*gentle reminder: update your vaccines*), we are likely to get another heapin’ helpin’ of telemedicine as 2021 turns into 2022. But the benefit of internet access likely extends far beyond simple access to a physician. Less than 20% of health outcomes are directly attributable to the care of a physician and his care team, after all.

We don’t know the exact mechanism by which internet access may improve health outcomes. Caregivers may have more informal access to health information. It may give people access to their physician’s electronic health record portal. It may simply lead to more economic opportunities, like the gig economy. Regardless, we believe that it may be helpful to determine which of your employees lack home internet access. For those that do, it may be beneficial to their health to assist them in getting access. I can’t find any good studies of specific strategies, but off the top of my head, we could make sure access to broadband is widely available at the workplace so that they can take advantage of breaks in the day. We could instruct employees on local sources of free broadband like the public library. We could coach them on using publicly available apps like WiFi Maps or the Facebook mobile app to find wifi hotspots (and coach them on the potential data insecurity of public wifi while we’re at it; this is not an endorsement of WiFi Maps, and Lord knows it’s not an endorsement of Facebook). If any of your employees are taking continuing education courses, there is a chance the course vendor or institution offers free internet access for the duration of the course.

Has your company taken steps to increase broadband access? What potential interventions have we overlooked? We’d love to hear from you.

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.

How Employers Can Address Social Determinants of Health

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!