Addressing Social and Community Context to Improve Health Outcomes

For our health and well-being, where we live geographically is just as important as our social and community context — that is, the social circles in which we interact and the relationships we form with family, friends and beyond. This context is one of several social determinants that affect our health risks and outcomes, and it’s one that employers can influence for the better.

Social and community context encompasses the following four topics:

  1. Civic participation. This involves individual activities that benefit society (such as voting) as well as group activities that benefit either the group members (like recreational soccer teams) or society (as with volunteer organizations). Civic participation is associated with better psychological and emotional well-being.
  2. Community cohesion. High levels of solidarity within a community and social support can improve health outcomes, while social isolation is usually detrimental to health and increases mortality.
  3. Discrimination. The routinely unfair treatment of one person or group of people based on their race, sex, disability, age, ethnicity, nationality, sexual orientation or gender identity actually has a physiological effect on individuals — including irregular heartbeat, anxiety and heartburn — that can lead to long-term negative health outcomes.
  4. Incarceration. When compared to the general population, men and women with a history of incarceration are, on average, in worse mental and physical health and are more likely to have high blood pressure, asthma, cancer, arthritis and infectious diseases such as tuberculosis, hepatitis C and HIV.

Each of these topics is vitally important to overall health.

Community Beliefs and Health Care

Deeply rooted beliefs and traditions within communities can also affect how people understand health concepts and manage their own health. Different cultural heritages may link wellness closely to faith systems and societal expectations.

Religion and spiritual beliefs in particular often influence people’s willingness to seek out health care and accept certain treatments. For example, Muslim dietary restrictions can affect whether patients use certain medications, especially drugs that contain gelatin or alcohol. Jehovah’s Witnesses refuse blood transfusions. Even nonverbal communication can vary by culture and affect health care interactions. For instance, in some cultures, it’s considered rude to hold eye contact with an elder or authority figure, including health professionals. It’s very difficult to move the needle on social determinants of health without understanding these beliefs and customs.

Commonly Affected Populations

Older adults, people with disabilities, LGBTQ individuals, and people of color are more likely to experience discrimination. Racial and ethnic minorities, as well as people with lower levels of education, are more likely to be incarcerated. Older people in long-term care facilities or who have debilitating conditions may be lonely and lack social cohesion. All of these factors can worsen health risks and outcomes.

What’s Already Being Done

Various initiatives are underway to address the factors that complicate patients’ health. For example, the Agency for Healthcare Research and Quality has published several educational tools to help providers render culturally competent care.

The Center for Community Investment recently launched Accelerating Investments for Healthy Communities, an initiative designed to help health systems and hospitals amass resources to increase affordable housing. The group aims to eventually boost social cohesion within the communities they serve.

Payers are also getting involved. Blue Cross Blue Shield of Rhode Island, for example, identifies providers who offer safe, inclusive care for the LGBTQ community. Blue Cross Blue Shield of Illinois requires cultural competency training for providers and other health care personnel as part of Medicaid’s contractual requirements.

How Employers Can Help

Employers have the ability to address social and community context in a variety of ways. You might:

  • Organize social gatherings outside of work to promote stronger relationships and build social cohesion.
  • Permit employees to take paid time off to vote in elections or volunteer at local organizations to boost civic engagement.
  • Provide diversity training and establish anti-discrimination policies to protect vulnerable populations.
  • Refer employees to providers who render culturally competent care.

Employers play an important role in addressing factors at the root of employees’ health. The nature of today’s 40-hour work week — if not 50-hour or more — means that many people spend more time with their coworkers than they do with loved ones. By addressing this important social determinant of health, employers can support better health outcomes and reduce overall costs.

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