Social Determinants of Health

Social determinants of health are the conditions in which people are born, grow, work, live, age and the wider set of forces and systems shaping the conditions of daily life. Work and employment have been shown to be one of the determinants that can have a positive impact on physical health, mental health and mortality. Not working is a reliable predictor of depression, decreased physical well-being and increased mortality rates. The bottom line is that working and being actively engaged in employment while of working age has a positive impact on both the physical and mental well-being of a person.

When an employee is injured on the job – the potential injury can be temporary or permanent. Returning to work in some capacity has been demonstrated to have a positive impact on the physical and mental approach to the employee’s engagement in the recovery process. How this process is managed – considering the social determinants that might impact the recovery process is critical to ensuring that the process is fair, equitable, and advocates for the employee. Understanding these social determinants – and incorporating them into your strategy – will increase the potential for positive outcomes for both employee and employer.

• Health Literacy – for many employees, they do not have a personal physician, or they may not have been to a physician in many years. Navigating the medical treatment process may be overwhelming. They may not have access to a social network that can support them or help to explain or educate them on the process. In addition, they may not have access to, or the ability to process, the options or solutions presented to them.
  • How you can be an advocate for them in this process
• Income Stressors – for lower wage workers, they may not have a financial safety net to make up the difference in their possible reduced or missing wages because of their injury or time away from work. This could create additional stressors that could exacerbate the injury, or cause them to make other decisions, such as obtaining an attorney, which could complicate the claim process.
  • How can you help to mitigate these issues or guide the employee to resources that might be able to help
• Financial Literacy – for many employees, the prospect of obtaining a large settlement can be overwhelming.  They may not have the financial resources or literacy to help them understand their options.  They may not be able to understand the long-term consequences of some of these decisions.
  • How can you provide resources to employees to help them make the best decisions
• Access to Resources – there may be other resources that can assist employees in both the short and long term.  For employees who may have permanent or life changing injuries, what are the protocols that are available to assist them?  These simple things can change the dynamic of a claim and the outcomes.
• Family Dynamics – for situations where there is a single parent, or where the injured employee is the sole breadwinner – having this person not working can increase tensions and stressors in other areas of their lives. It is important to understand these issues, address them and provide support
• Comorbidity and Health Related Issues – for employees with certain co-morbidity conditions, these factors will directly impact the treatment and recovery options. Identifying them and addressing them can have a major impact on the overall treatment.

Things to Consider –

• Can you have an impact on one or more of the Social Determinants of Health? Sometimes just being aware of these issues is the most important thing. It can help to provide context or understanding of the condition and how it may impact the progression of a claim.
• Can you have an impact on the overall health and well-being of the injured worker? Because many people do not have an existing and ongoing connection with a physician in the traditional sense, this injury may be their first encounter with the healthcare system in several years. Helping to guide a person through the process and make suggestions for things that might improve how they handle the situation may have a significant impact.
• Can you increase or decrease any of the health inequalities that may hamper or hinder return to work? Case managers can often provide guidance and direction on resources that might be available to injured workers to help them make their way through the healthcare system.
• How can you increase or improve the opportunities for return to work to allow for better engagement – even if these opportunities are outside of your organization? Alternative return to work programs are an excellent option to help keep a person engaged.

Key Points–

• Alternative RTW Programs as a method to get people re-engage quicker
• Using tools like structured settlements to help people manage money (financial literacy)
• Deploying Case Management strategically to help manage co-morbidities, health literacy issues, and overall health issues
• Deploying telemedicine models to help ease stress and time issues for appointments – which could include transportation and childcare issues