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Health Equity, Social Determinants of Health, and Your Wellness Program

We already know attaining wellness is easier for some people than others. Some attribute it to motivation, others to body shape or genetics.

But what if it’s because of their neighborhood—or the society they live in?

You’ve likely heard the terms “health equity” and “social determinants of health.” As it turns out, paying careful attention to these two things can be key to increasing employee engagement and improving the health and well-being of employees.

We spoke with Vanessa Guzman, CEO of SmartRise Health, to get a better understanding of why health equity and social determinants of health have become so important and how your company can leverage them to improve health outcomes.

We’ll start with a few definitions.

What Do “Health Equity” and “Social Determinants of Health” Mean?

  • The CDC defines health equity as the state when “every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”
  • Social determinants of health (SDOH) refer to the factors that either help or hinder a person’s ability to become healthy. These include their family and living situation, community and culture, socio-economic status, race, gender, etc.

Their impact on health and wellness is significant.

Why Health Equity and SDOH Are Important

"Health equity and social determinants of health are about caring for the whole person while addressing specific clinical profiles and needs."
Vanessa Guzman
Chief Executive Officer, SmartRise Health

In the health care world, initiatives to implement health equity and social determinants of health have become a top priority.

Ever since health organizations started collecting demographic data about patients and comparing it to the benefits they use and their overall health, they’ve discovered there’s more to consider than just disease and treatment.

While it may seem obvious that a person’s environment can affect their health, it actually goes much deeper than that. It turns out our life expectancy depends heavily on where we live, our race, our socio-economic status, and even our language. Health care experts are realizing that 80% of what influences a person’s health comes from factors outside of the doctor’s office.

Health Equity and SDOH Can Impact Outcomes

It’s not enough to simply offer health and wellness services to someone. There are numerous factors that need to be considered … that have been long overlooked.

Consider this realistic example. Two women, Sandra and Susan, are diagnosed with diabetes on the same day:

Sandra Susan
Lives in a dual income house in a wealthy, predominantly white suburb with no children. Is a single mother of two who lives in an urban apartment
Has access to a full team of specialists, including a nutritionist who creates an easy-to-follow diet, complete with menus and shopping lists packed full of healthy foods. Only has access to a primary care provider who tells her she needs to eat “healthier” and gives her a list of suggested foods—many of which she’s never tried before and has no idea how to cook.
She has a number of large (some organic) grocers in her neighborhood and a reliable vehicle. She lives in a food desert, with only a small corner store nearby. The nearest “real” grocer is a crowded, 40-minute bus route away.
Her partner is willing and able to change their diet to match hers. One of Susan’s children has a nut allergy, making several of the foods on her list off-limits.

Is there health equity here? Absolutely not.

You can already predict how well each of these women will be able to adopt healthier eating habits and manage their diabetes. Sandra has a lot of support and good odds of doing well. Susan isn’t destined to fail … but she has a lot more barriers in the way of her success.

We could level the playing field to some degree by making sure Susan gets to meet with a nutritionist. But to be more equitable, the nutritionist has to understand Susan’s needs, priorities, and barriers to success. Which recipes on the list can she realistically add to her diet that her kids will eat? What foods on the list are available at her local store and within her budget?

These are just a few of the needs based on social determinants of health that can help the nutritionist personalize a menu for Susan, greatly improving her outcomes.

“This level of cultural competence is critical in health care,” says Vanessa.

How Health Equity and SDOH Benefit Companies

Social determinants of health don’t just apply to the medical community. They can inform the programs and benefits within your corporate wellness program and help further your DEI initiatives.

SDOH Help Identify Gaps in Care

There are probably employees in your company who can’t use the benefits and wellness programs you offer because of factors you haven’t considered.

Fortunately, your health plan can help you shine some light on the matter. Health plans collect a wealth of information about their members—socioeconomic status, demographics, ethnicity, etc. That data gives them an aggregated view of any population, their utilization, and their barriers to health care.

Companies can partner with their health plans or even take advantage of their health plans’ white labeled wellness programs to access that data—and determine where those gaps exist for their employees.

(And don’t forget about the information your wellness platform collects. It can help you see patterns and other factors that may be keeping employees from taking full advantage of your program.)

SDOH Improve Equity and Inclusion

Health equity and social determinants of health initiatives can go a long way in forwarding your company’s commitment to DEI. Why? Because they truly see each employee, helping you hyper-personalize, and create actual inclusion.

In fact, they will help you uncover the gaps in training, education, wellness, and health care that you may not otherwise have recognized.

This can have incredible snowball effects. By uncovering those gaps, businesses can improve the career development pathway for all their employees. The cascade effect of career development on social determinants of health probably can’t be overstated.

Aside from the life-changing effects salary increases can bring, when an employee feels their management finally sees them and invests in them, it creates a sense of belonging. Suddenly, they have a stake in the game and can empower themselves and the people around them to want more. The impact extends far beyond the employee.

“We're playing catch up with certain groups of employees, so we need to bring them up to speed,” Vanessa says. “Even having career paths defined by their employer to make sure those individuals are successfully integrated into the workforce equally can have an impact.”

How to Incorporate Health Equity and SDOH Into Wellness Programs

Once you’re ready to put these initiatives in action, make sure you have everything in place to help you succeed.

Start With What You Do Best

It’s natural to want to completely overhaul your wellness program and implement these initiatives everywhere, but that’s not realistic.

When Vanessa is asked by her clients where to begin, she always points to their core competencies. “You need to start with the path of least resistance,” she says. “Whatever can be easily implemented is where you focus first.”

That might mean making sure all employees have access to a laptop or desktop that allows for telehealth visits. It could also mean implementing a multi-lingual chatbot, if the tech is in-house and easy to access. Prioritizing community partnerships through strategic investments in local organizations and research can also empower vulnerable communities that are often overlooked when creating wellness programs.

The idea here is to get an easy win for two reasons—budget and buy-in, which leads to Vanessa’s next suggestion.

Make Sure Leadership Is Committed

Implementing health equity in your organization isn’t a one-shot endeavor. You need a long-term commitment of budget, resources, time allocation, and senior leadership to guarantee your initiative will evolve with your company and your mix of employees.

Work with your Wellness Champion Network to gain support, create excitement, and leverage their C-suite relationships.

“This is an ongoing behavior change over time that requires an understanding of these concepts and how they apply to your core competencies,” Vanessa highlights. “It sounds cliche to say this starts at the top, but it does. Without that, it will be a nice program to have that checks a box and has little impact.”

Gather Data That Identify Known Disparities

To get their buy-in, you need to prove to leadership there is disparity, and you need to clearly define the gaps so they can be addressed. That means data and lots of it.

The good news? There’s a resource for that.

Health plans have to collect data about race, ethnicity, language, and sexual orientation and gender identity and expression (SOGIE) for their quality report cards. Cross-reference that with claims data and you’ll have a comprehensive picture. You can use it to identify, down to the block, the most predominant needs, gaps in care, and the potential social determinants of health for any population of your employees.

Find Out Your Employees’ Needs and Priorities

Next, you need to start getting personal and dive deep to understand what employees really need.

This is where health assessments really prove their worth. If your health equity initiative is going to be effective, it has to allow for personalization. Create a series of assessments within your wellness portal that can help you measure everything from health literacy to social demographic gaps.

Both the National Rural Health Resource Center and the American Academy of Family Physicians have assessments and screening tools to identify and measure social determinants of health.

“You need to know who is dropping and who you are leaving behind, so you can customize programs to account for those gaps,” Vanessa points out.

Implement Programs and Benefits

This is where the rubber hits the road, as it were.

Every service within your wellness program can inform and benefit from health equity and social determinants of health initiatives.

  • Health coaches can add SDOH assessments and tools to their repertoire to measure and monitor how well initiatives are closing gaps to care. They can also help employees strategize how to work around the social determinants of health to help them access the care they need.
  • Mental health services can be expanded to accommodate employees’ needs—from telehealth to texting, self-directed training and other digital solutions.
  • Wellness challenges can include modifications for employees who don’t have access to resources. For example, a physical wellness challenge can include instructions with equipment and just using body weight.

From closing care gaps, to improving engagement, to reinforcing your commitment to DEI initiatives, health equity and social determinants of health initiatives should be a part of every wellness program.

If your company would like to discuss how to implement these initiatives, one of our consultants is ready to talk to you. At WellRight, we’re here to help.

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