Abstract
Social Determinants of Health have long been a central focus in the field of public health. Addressing such factors as income, education, neighborhood safety, environmental conditions, employment, and social support networks has tremendous potential to impact health behavior and health outcomes. 1 More specifically, evidence suggests that heath behavior accounts for approximately 30% of health outcomes, while social determinants can account for as much as 40%. 2 Considering that the workplace can be a force for positive population health impacts, the field of employee wellness has renewed interest in this area. 3 Large employers, in particular, are well-positioned to make an impact in regard to SDOH given their role as anchor institutions in the community.
The University of Michigan recognizes this and as such, MHealthy, the University of Michigan’s (U-M’s) Health and Wellbeing program has initiated an effort to understand and address SDOH within U-M’s faculty and staff population. To better understand SDOH within this population, MHealthy began an extensive review of evidence within the wellness field generally and within U-M’s population specifically. For example, an important data point (shown in Table 1) that has informed MHealthy’s SDOH efforts is related to employee health-care utilization at U-M. Lower-wage earning employees have, on average, the same health care spend as higher-wage earning employees. However, those in the lower-wage earning group utilize far fewer preventive services and mental health/substance use services, while utilizing far more emergency department and inpatient services. 4
Health-Care Use for U-M Full-Time Employees by Income Group, 2017 Claims From Premier Care, Blue PPO, Blue CMM, and HAP.
Abbreviations: U-M, University of Michigan; PPO, Preferred Provider Organization; CMM, Comprehensive Major Medical; HAP, Health Alliance Plan.
This evidence suggests that the lower-wage earning populations may be living much more “in the moment,” with a focus on meeting basic needs, with less focus on longer-term needs and prevention. Similarly, when U-M sought to review evidence that identifies particular job families with higher proportions of individuals with high priority chronic conditions and self-reported risk factors, there was a clear overlap with vulnerable employees, particularly those in lower-wage earning groups (see Figure 1). These and other data led to a growing recognition that expanding health promotion efforts should be sensitive to the needs of the most economically vulnerable employee populations.
Overlapping vulnerabilities in higher risk employee populations.
Given this evidence, the majority of MHealthy’s efforts to address SDOH within U-M’s faculty and staff population have been the facilitation of meeting basic needs, 5 particularly around food insecurity and economic instability. One such example is to utilize a phased approach within units at higher risk for food insecurity. The first phase (2-3 months) consists of relationship building within the target unit. This phase involves produce and farmers market token giveaways as well as the promotion of local food pantries. Phase 2 (3-6 months) involves enhancing trust and providing more substantial support such as stocking food-sharing cupboards, disseminating recipes made from healthy pantry staples, and offering brief cooking demos. Phase three (6-12 months) includes more focused interventions such as 1:1 meal planning and food budgeting sessions for staff, wherein an assessment of eligibility for and referral to state and local food assistance programs can be conducted. Cooking classes for resource-limited individuals utilizing the Cooking Matters curriculum will also be offered. 6 In the last phase, maintenance, continued promotion of local resources, occasional seminars on meal planning/food budgeting, and 1:1 meal planning/food budget counseling as requested are included.
Another approach to MHealthy’s efforts to address social needs in the workplace includes population-based organizational supports and messaging, as well as more direct assistance. At an organizational level, U-M provides internal EAPs who offer short-term counseling for faculty and staff and their families on a variety of concerns. These EAPs also administer U-M’s Emergency Hardship Fund, which offers individuals experiencing a short-term, unexpected financial emergency one-time grants of up to $1000. In an attempt to remove financial barriers to health promotion activities at the organizational level, MHealthy is offering scholarships to eligible individuals for group exercise classes. Additionally, MHealthy has been shifting the messaging focus of various monthly health observances. For example, March is nutrition month. In past years, promotions have focused on encouraging consumption of fruits and vegetables. This year, based on feedback from a staff advisory group called VOICES of the Staff, the key messages included several collected resources on how to find food on campus, particularly for those in remote areas or working a non-standard shift.
In addition to 1:1 budget counseling in lower-wage earning units, more direct assistance in the SDOH effort is the launch of the MHealthy Resource Coach pilot program. Based on encouraging results from similar efforts nationwide 6 , the Resource Coach is a newly created position to be embedded in the MHealthy department to serve faculty and staff experiencing financial or other crises who require assistance in navigation. This could include housing or food insecurity; public assistance program applications; soft or hard skills training; and budget counseling. The Resource Coach will also be able to access a small pool of funds to help individuals experiencing a crisis. Adding this team member enables an employer to serve as a resource and an important element of the social safety net, providing navigational and occasional direct financial assistance while promoting retention and enhancing engagement at the workplace.
MHealthy staff understands that a culture of health that realizes the importance of SDOH in their work is necessary for the success of these activities. Thus, MHealthy has focused on building a healthy culture that fosters staff development in this area. Some of the specific staff development activities that MHealthy engages in are regular dialogues on diversity, equity, and inclusion topics; the screening and discussion of the PBS Documentary “Unnatural Causes;” 7 and the promotion of departmental and organizational values of respect, inclusion, and compassion that incorporate SDOH concepts. This includes a new recognition program for staff that honors and celebrates behaviors in the workplace that align with these values.
In the future, MHealthy will maintain a sense of humble curiosity and eagerness to identify possible avenues for an employer to impact SDOH through well-being programs. This will require a robust evaluation of each of the above efforts, coupled with identifying opportunities to bring them to scale. Aligning with U-M’s organizational vision to enhance diversity, equity, and inclusion across the U-M community will also remain core to MHealthy’s efforts in this space.