A person’s health is determined by more than their visits to the doctor. Yet millions of Americans’ well-being is defined by factors that are outside of their control.
According to the National Academy of Medicine, medical care only accounts for 10% to 20% of people’s health outcomes, while social determinants of health, such as access to stable housing, transportation and healthy foods, account for 80% to 90%.
To help employers understand what really impacts their employees’ health, the Centers for Disease Control and Prevention and the National Alliance of Healthcare Purchaser Coalitions pushed employers to gather data culled from workplaces and community records to identify the social needs, risks and determinants of health that impact their employees.
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“Oftentimes, healthcare is thought of as the individual doctor-patient relationship spent in a physician’s office,” says Dr. Christa-Marie Singleton, chief medical officer for the Office of the Associate Director for Policy and Strategy at the CDC. “But employers need to recognize what happens with the rest of that 24-hour day.”
Tammy Fennessy tackled some of these external issues on the behalf of her own workforce. As the director of benefits for American Eagle Outfitters and the chair for the Pittsburgh Business Group on Health, Fennessy looked at American Eagle’s demographic and personal data, as well as community data, and discovered that essential workers in their distribution centers in Hazleton, Pennsylvania were opting out of their health insurance offering — likely because they couldn’t afford it — while those in Ottawa, Kansas had high rates of emergency room visits.
Fennessy and her team discovered that people in these communities were being impacted by social needs and risks outside of their work hours. Social needs address immediate needs that impact a person’s well-being in the moment: for example, if a doctor tells a patient they need to eat more, that patient needs food. However, meeting that need could be influenced by social risks, which are defined as adverse social conditions associated with poor health, like lack of access to fresh or affordable foods.
When these problems impact an entire community or demographic, these social determinants of health point to the broader conditions of the places in which people live and work. This speaks to the economic stability, safety and access to vital services of a community — and spotlights where employers have an opportunity to effect change.
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“Employers have now realized if they take a look at the social determinants that are impacting their particular workforce, it narrows the playing field of what needs to be addressed,” says Margaret Rehayem, vice president of National Alliance. “But it requires them to actually take a look at their data and in some very different ways.”
For American Eagle, these communities were located in food and healthcare deserts, where access to both was difficult to find. To address these pain points, Fennessy and her team established healthcare centers in both distribution centers. Now, regardless of whether employees are enrolled in medical insurance, they have access to most non-acute services, such as physical therapy, at zero cost. If an employee needs short-term treatment for a serious illness or trauma, which would be defined as acute care, they have no more than $15 copay, explains Fennessy.
“The folks at our distribution centers have been critical to the survival of our business and have given us the ability to thrive as a company throughout the pandemic,” says Fennessy. “I don’t think any business can be successful if they don’t care for their employees and their community. And I believe wholeheartedly that our employees are our community.”
The healthcare center in Hazleton also hired a Spanish-speaking nurse, hoping to better reach a working population that is nearly 80% Dominican. This is especially critical, as race plays a prominent role in access to and quality of care, and not only from a linguistic standpoint. The CDC even declared racism a serious public health threat in April of 2021, stating that one’s race can limit their access to housing, education, wealth, employment and healthcare.
“Race impacts where a person lives, where they work, where they worship and gather as a community,” says Dr. Singleton. “And in turn, these social determinants of health have lifelong effects on the mental and physical health of individuals in communities of color.”
Beyond expanding
“I met with the transit folks in Luzerne county, and then they got me in contact with the folks who run the transit in Hazleton, before getting me in contact with the person who actually manages the routes,” Fennessy says. “From there, they actually made it very easy, but navigating that infrastructure was definitely challenging.”
Despite the red tape, the project connected Fennessy with the communities her employees live and work in — something that Rehayem hopes more employers will do as they seek to better the conditions that impact their own workers’ well-being.
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“This is a beautiful opportunity for employers and communities to partner as one and actively address the issues people face,” she says. “If they're just looking at ROI, they're missing the point, and the human aspect of ‘why’ got lost somewhere.”
For Dr. Singleton, this is also a chance for employers to truly know their employees as human beings who endure struggles outside of work, and with enough effort, ease the burden on their workers’ shoulders.
“Employers may not think they have employees that are dealing with homelessness, but almost every employer has an employee somewhere living in their car and then coming to work,” says Dr. Singleton. “Employers must shift from a one-size-fits-all approach to benefits that are aligned geographically, economically and linguistically with their workforce.”
National Alliance and the CDC want to bring this project to more employers, and further examine how partnerships between employers and communities can be a game-changer for the millions who face inequity every day.
As for Fennessy, she plans to continue working with communities in Ottawa and Hazleton to cultivate healthier environments, whether that takes the shape of a community garden, better walking paths for recreation and exercise, or an idea her team has yet to have considered.
“This year, we will figure out what is going to make the biggest difference in our workers’ lives,” says Fennessy. “Employees only come to work for a certain number of hours a week, but we have to remember that they go home to their community to eat, play, raise families and live productive and meaningful lives.”
