How Geography and Health Affect Outcomes and Access to Care

It may seem like a weak association, but your ZIP code is actually a pretty good predictor of your health status. In other words, geography and health go hand-in-hand: Where you live and work dictates the air you breathe, the food you eat, the viruses to which you’re exposed and, to some degree, the health care services you’re able to access.

Various initiatives — led by providers, payers and public health organizations alike — can help address geography as a social determinant of health. However, employers also play an important role, offering benefits and other services to offset geographic barriers to health care. When employers account for geography, they not only improve employee retention and satisfaction but also reduce overall health care costs.

The Link Between Geography and Health

Where you live can affect your health, for better or for worse. If you live in an urban area, you may have an easier time finding health care services, but those facilities may be overburdened. Perhaps you live in a transportation, food or pharmacy desert, making it more difficult to see your doctor, find wholesome food choices or fill prescriptions.

Certain health complications also appear at higher rates in cities. For instance, poor air quality and pollution can contribute to asthma or chronic obstructive pulmonary disease (COPD). On the other hand, if you live in a more rural area, you may find that it has fewer health care providers but cleaner air and plenty of healthy food options from local farms.

The geographical effect on health is also associated with the built environment — the features and structures humans have created in an area. For example, obesity rates may be lower in areas with parks, walking trails and gyms, and health outcomes in general benefit when people live in safe, affordable housing.

Embracing Change

Many entities have already taken initial steps toward addressing geography as a social determinant of health. For example, providers have begun to embrace telemedicine technology, which connects people to health services within their own homes. As long as it’s possible to provide a given service remotely, physical proximity to a health care provider is no longer a prerequisite for access to health care.

Additionally, hospitals have implemented strategies and programs to improve housing stability through neighborhood revitalization, home repair and care transition support, according to the American Hospital Association. Other collaborative efforts also aim to improve health outcomes through healthy neighborhoods and families, including Mayors and CEOs for U.S. Housing Investment’s work in using public-private partnerships to support affordable housing and address homelessness.

Community interventions can help improve residents’ health and well-being. For example, Virginia’s community colleges are working with community partners, such as Anthem, to eliminate barriers to academic attainment and, more importantly, to better long-term health outcomes. Anthem Blue Cross and Blue Shield Foundation’s grant will help expand 11 existing food pantries on rural community college campuses in Virginia, and allow three campuses to open pantries benefiting more students and their families.

Some public health initiatives also address geography. The Tennessee Department of Health offered $10,000 in grants in 2017 to all the state’s rural and suburban counties for them to invest in public areas that encourage physical activity, such as playgrounds and sports facilities.

Even payers play a part. The Blue Cross Blue Shield Institute (BCBS Institute), for instance, recently announced its commitment to removing barriers to health in specific neighborhoods: “For some of our members, it can be difficult to get to a physician’s office for treatment, to the pharmacy for much-needed medication, to the grocery store for nutritious food or to a safe place to exercise,” said Scott P. Serota, chairman of the board of the BCBS Institute, in a press release about the institute’s collaboration with Lyft, CVS Health and Walgreens. “We want to help lift these burdens for more Americans.”

How Employers Can Help

On top of these largely provider- and public-health-led initiatives, employers have the opportunity to address social determinants of health — and the link between geography and health in particular. Consider the following strategies:

  • Choose health plans that cover telemedicine services. This ensures that employees can access care when and where they need it.

  • Construct walking trails or provide access to on-site workout areas, fitness classes or a gym to offer employees healthy activities on breaks, at lunch or after work. If this isn’t possible, look for office locations in proximity to these amenities.

  • Offer an employer-assisted housing program or offer to pay for relocation. Both benefits help employees move out of unsafe housing and into healthy neighborhoods that are closer to the office.

  • Provide a mobile care center or on-site visits aimed at distributing immunizations, screenings and basic health care services for employees who live in areas with a shortage of health care providers.

  • Cultivate a community garden where employees can grow healthy produce and herbs.

Addressing geography as a social determinant of health requires collaboration between payers, providers, public health departments and employers. In addressing geography and health in the workplace, employers can enhance employee retention while also cutting costs and improving health outcomes.

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