Not all health outcomes are issues of personal choice and genetics. Social determinants — the conditions into which we’re born, live, work, and play — have a huge effect on our health. This is especially true in our workplace, where stress and group habits can significantly undermine health at an individual, family and community level.
In fact, a 2015 study on work stressors and health outcomes for Behavioral Science & Policy found that job insecurity increases the odds of reporting poor health by about 50 percent, with high job demands raising the odds of having a physician-diagnosed illness by 35 percent Researchers also found that long work hours increase mortality by almost 20 percent. None of these numbers bode well for the overall health of a workplace population, which can lead to revenue loss through employee turnover, sick-time coverage, and claims.
Clearly, there’s a serious need to address and treat social determinants, not just through workplace culture but healthcare as well. But how do we take action on these issues when the current, reactive healthcare system itself can be a major obstacle?
Over 40 percent of Americans put off doctor visits due to concerns about cost. The average appointment only lasts around 15 minutes. That means the majority of patients are seeing their providers very rarely — and only briefly when they do. If patients aren’t seeing their providers regularly and are only going to urgent care or an emergency room when the situation seems serious enough to warrant the price of a visit, then “sick care” becomes the standard. Social determinants of health aren’t even on the radar.
The good news is that we have the means to solve the problem. Not only is primary care the perfect tool to address people’s whole health — the symptoms they present and the underlying causes that comprise so much of who they are — but a useful way to further understand, predict, and prevent the negative effects of social determinants in the workplace.
Primary care as the frontline in combating social determinants at work
Providers in the current, reactive sick care system are hard-pressed to get to know their patients or understand the social factors that are impacting their health. These short visits take a toll on provider-patient relationships, so providers can’t serve as they were trained to do and patients are more likely to leave with a prescription instead of the help they really need to change critical behaviors and situations.
When modeled correctly, removing time, cost and accessibility barriers via employer-funded care centers, primary care can become what it was always meant to be, and the perfect strategy to address social determinants in the workplace and beyond. Especially when the emphasis is on empathetic listening as a means to build stronger and more involved provider-patient relationships – where the primary care provider is the patient’s first and most important stop for healthcare, providers are able to delve more deeply into symptoms, concerns, and any contributing workplace social factors.
Add to that, a centralized primary care model lets employees receive the majority of their healthcare in one place with a single team that they know and trust. This results in less “sick care as healthcare” and more proactive, engaged employees who are more likely to visit their provider and manage their own health rather than waiting for the next expensive trip to the urgent care clinic or emergency room. And with knowledgeable professionals trained in empathetic listening to help guide behavioral change, patients are better equipped to make choices that minimize the effects of negative social determinants, both at work and outside of it.
Finally, the most effective primary care model includes embedded health coaches trained in behavior change methods, the facilitation of workplace health councils to take on suggestions for further improvement of services and delivery, and care coordination for specialist treatment when necessary.Primary care fights negative social determinants exactly where they occur
Working in an office exposes employees to historically unhealthy social determinants like unhampered access to sugar-laden sodas and snack foods from vending machines, secondhand smoke during breaks, sedentary habits, and psychosocial stressors that can include long work hours and high-performance demands.
Despite spending nearly 17.8 percent of GDP on healthcare, patient outcomes in the US are often much worse than in other highly developed high-income countries. This staggering figure reflects a huge gap in addressing non-clinical factors like social determinants of health.
An effective working model of primary care is a perfect tool for leveraging both healthcare and behavior change in a population, like an office or shared workspace, to improve health at scale right where it matters most.
Since social determinants affect particular groups of people in a community, it only makes sense that addressing them takes a community effort. By using empathetic listening to connect more fully with patients about their workplace environments and stressors, and implementing primary care to counteract social determinants of health in the workplace, better habits spread and health improves via 1:1 and community effects: provider to patient, peer to peer, employers to employees, and employees to their families.
In this type of system, even small changes can have a lasting impact. The City of Kirkland, for example, saw over 80 percent employee engagement and a 23 percent increase in primary care after incorporating a healthcare model that included an onsite primary care center. One of the smallest changes they made (initiated by one of their own employees) was to remove candy dishes from public areas. Coupled with behavior change health coaching, advocated and supported by a primary care team, several employees lost a significant amount of weight (50 lbs in one case) and became much healthier. Primary care improves workplace population health and social determinants into the future
With access to informatics based on previous years’ healthcare claims (including disease burden and predictive analysis), providers have the visibility and context necessary to anticipate health risks and engage employees proactively.
Primary care also allows for better targeting of negative social factors through claims data analysis, which is more effective than siloed “wellness” programs that provide mixed results and no evidence of reduced healthcare costs. Notable trends or patterns in claims data can help employers fine-tune workplace health initiatives, including onsite education or additional services to complement primary care — like health coaching and behavior change — to support patients even further in combating the effects of social determinants to their own health. When offered the exact kind of help they need, combined with empathetic listening and professional guidance to help them succeed, patients are more likely to take action on their own health journey and meet their goals. Progress and outcomes data can then be collected and more easily tracked, for further proof of primary care’s life-changing (and life-saving) effect on populations.
As the compiled data increases and the needs of the population become more predictable, the primary care team is able to further improve the healthcare experience by increasing efficiency in the system. Staff is able to create better appointment templates, stock the most frequently prescribed medications, adjust resources to meet population needs, and provide better risk identification and insight into the impact of social factors on community health.
The results are compelling. Employers utilizing a successful primary care model have saved up to 25 percent on overall healthcare costs in the first year alone. Moving away from the sick care toward primary care is not only a more efficient way to address social determinants of health in the workplace but a more budget-friendly one as well.
Picture: Benjavisa, Getty Images
