Understanding the Social Determinants of Health and What is Beyond Your Employee’s Control

What does childcare have to do with healthcare? For one of my patients – a working mother – the two are directly connected due to social determinants of health.

My patient was stressed, unfocused, and felt overwhelmed at work. Rather than treating the stress, I wanted to understand the cause. I asked what the top three barriers were that would keep her from reducing her stress level. Top of the list? Childcare. She didn’t have stable childcare and it created a stressful situation for her both at home and at work. While this issue is certainly not medical, it affects her health and ultimately her productivity at work. By understanding this external health factor, I was able to connect her with a social service agency that could help her find local childcare services and financial assistance. This patient came to me for stress management, not for help with childcare, but when you start to get to the root cause of a health issue, it is almost always a social determinant of health.

The Social Determinants of Health

Health is personal, and it is easy to place the burden of responsibility for good health entirely on the employee. Let’s look at the bigger picture. What we now know as clinicians is that your employee’s poor health is not necessarily a result of poor choices. To complete an employees’ health picture we need to look beyond the doctor’s office. Reports show medical care determines only 20% of overall health – while social, economic, and environmental factors determine 50% of overall health.

The social determinants of health – location, income, literacy, education, transportation, and housing, to name a few – greatly impact the presence of chronic diseases and other clinical conditions.

As a medical professional, I have come to understand and accept the limitations of clinical data alone. By considering these external factors, medical professionals like myself can better understand your employee’s unique journey to health improvement and the very real barriers in their way.

Supporting Employee Health

In our work lives, we often create silos between the office and the home, but really they’re all tangled together. As a registered nurse and health coach at Marathon Health, I involve elements of social determinants of health inquiry into every health coaching opportunity.

To understand why your employees are unhealthy, we need to consider health risks that are influenced by social, economic, and environmental factors that are often beyond your employee’s control.

“The issue of social determinants of health has become part of every conversation around improving care quality while lowering costs. This concept recognizes that not every healthcare problem can be addressed with a prescription pad or a hospital procedure.” – Patient EngagementHIT

When we keep digging into why, we can get to something we can solve and begin fixing what is causing poor health. The questions look something like this:

Why isn’t the employee taking their medicine?

Is cost an issue? Do they have difficulty getting to the pharmacy? Is the employee unable to take breaks to take the medicine?

Why is the employee not eating nutritious food?

What is their food education level? Do they truly understand what is healthy and what is not? Is the nearest or most accessible store a convenience store without fresh foods, fruits, and vegetables?

Why is the employee sedentary?

Do they live in a neighborhood that is unsafe to walk at night when they return home from work? Do they work a second job? Do transportation barriers extend the length of their commute cutting into time to exercise? Do they know how to exercise?

When I ask questions and involve the employee in their care, together we can make progress. When we focus on the root cause and social determinants of health, we can achieve better outcomes and improve employee health. There’s much work to be done across our country’s health systems, but I’m thankful that onsite healthcare is positioned to evolve and embrace the social determinants of health. Onsite healthcare’s relationship-based approach, health coaching, and appreciative inquiry create a natural place for medical professionals like myself to identify and address life issues affecting health.

We’re not just trying to control the health issue, we’re trying to find out why it exists.

Written by Mary Meyer – a registered nurse and health coach at Marathon Health.