New Ways to Think About Non‐Participants Adding a Social Determinants Lens to Your Work

New Ways to Think about Non‐participants Adding a social determinants lens to your work

2019 Healthy Summit Kris Haugen

Poll: How do you struggle with participation?

We have low turn out I seem to draw I wonder if I offer the for events. the same folks. right programs.

1 Pop Quiz

Health is directly correlated with:

A. Healthy lifestyle choices such as exercise and moderate consumption B. Income C. Regular adherence to the Healthy Food pyramid and Surgeon General’s physical activity guidelines.

Interest? Time? Priorities?

Other

PROTECTING, MAINTAINING AND IMPROVING THE HEALTH OF ALL MINNESOTANS Factors? 4

2 “ I have to choose between the heat and electric bill this month. I can’t even begin to think about buying fruits and vegetables.”

Stress Factors Affecting Prioritizing Health

The Consumer Health Mindset Survey, Aon/NBGH/the futures co., 2016.

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Need a new way of thinking?

4 What are Social Determinants of Health?

Conditions in the Economic environment where Stability people are born, live, Built Education learn, work, play, worship Environment and age. Affects: . Health . Functioning Health and Social and . Quality of Life Health Care Community

Economic Stability

▪ Economic Stability ▪Employment ▪ Food insecurity ▪ Housing Instability ▪Poverty

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5 Wages Matter

Low wage workers: ▪ Highest prevalence of unhealthy behaviors and chronic conditions ▪ Highest proportion of health care costs as a percentage of wages

Differences: ▪ Prioritize personal health concerns below other life priorities ▪ Health literacy and health care consumerism skills ▪ Health care use patterns

Living Wages in Washington

▪ Living wage is the hourly rate that an individual must earn to support their family, if they are the sole provider and are working full‐time (2080 hours per year) Minimum wage is $11.50/hour.

King County Grays Harbor County Hourly Wage 1 Adult 1 Adult/1 Child Hourly Wage 1 Adult 1 Adult/1 Child

Living Wage 15.92 30.84 Living Wage 10.22 23.41

Poverty Wage 5.84 7.91 Poverty 5.84 7.91 Wage

http://livingwage.mit.edu/states/53/locations

6 Low Wage Workers Face Benefits Challenges

▪ Wages fail to keep up with benefit costs ▪ Premiums + deductibles = 25% of earnings ▪ 80% of employers offer HDHP option ▪ Rising out of pocket healthcare costs (preventive services still covered)

Multiple Jobs – Who has a “Side Hustle”

Less Free time means: • Less activity • Less time for food prep • Less family time • Less sleep • More social isolation

7 Can You Work and Be Food Insecure? ▪ The majority of working‐age Washingtonians living in poverty are working or actively looking for work. Many work more than one job. Who is Food Insecure in Your ▪ Washington state ranks 10th in Community?

the country in overall wealth – and Look up Free and reduced price lunch: ranks 34th in food insecurity. http://www.k12.wa.us/Child Nutrition/Reports.aspx

WA Hunger Facts

▪ WA Hunger Facts ▪ 1 in 9 struggle with hunger ▪ 1 in 6 kids live in a household can’t put enough food on the table ▪ 1 in 8 live below the poverty line ▪ 1 in 8 relies on SNAP; half are kids

https://www.northwestharvest.org/wa‐hunger‐facts

8 County SDoH Dashboard – the Uninsured

See website for : • Uninsured • Crowded Housing • Limited English • Poverty • Unemployment • Uninsured

https://www.doh.wa.gov/DataandStatisticalReports/HealthDataVisualization/SocialDeterminantsofHealthDashboards/CountySocialDeterminantsofHea lth 17

Education

▪ Early Childhood Education and Development ▪ Enrollment in Higher Education ▪ High School Graduation ▪ Language and Literacy

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9 Education leads to Health and Quality of Life ▪ Highly globalized knowledge ‐ requires postsecondary education for better health and quality of life. ▪ Costs of school is a barrier to many. ▪ What options are available for your employees and their families to get more education?

Social and Community Context

. Civic Participation . Discrimination . Incarceration . Social Cohesion

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10 Health and Health Care

▪ Access to Health Care ▪ Access to Primary Care ▪ Health Literacy

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Chronic Disease by Wages

11 Learn more about your benefits

• Preventive Services • Access to care • HDHP • ER Usage • EAP services and usage • Mental Health benefits • Educational Opportunities

Neighborhood and Built Environment

▪ Access to Healthy Foods ▪ Crime and Violence ▪Environmental Conditions ▪ Quality of Housing

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12 Where we live shouldn’t determine how long or how well we live. In our communities, we all should be surrounded by conditions that enable us to live the healthiest life possible, such as access to healthy food, quality schools, stable housing, good jobs with fair pay, and safe places to exercise and play.

Robert Wood Johnson Foundation 25

Community Access

▪ Food Deserts?

▪ Dental or Medical How can workplaces deserts? contribute to a better built environment at ▪ Places to work? In the walk/actively commute, community? recreate?

13 Social Determinants of Health (SDOH) broaden focus to the community. Wellness program activities often focus on the individual.

A paradigm shift… 27

Make More Health Impact with SDoH

14 How Do You Bake Health into Your Work Culture? 29 29

Programs Policy, Systems & Environmental Change

• Flexible schedule to get away from desk, attend classes, visit Yoga Classes quiet spaces • Yoga class then provides social support for relaxation • Provide maps of safe, scenic walking routes, opportunities to Walking Group walk in groups, and alternatives for people unable to walk • Support/subsidize alternative transportation modes • Create a healthy food environment‐cafeterias, vending, catering and social events Biggest Loser • Build social support with walking tours of cafeteria with chef, grocery store, farmers markets, coop • Host a healthy salad bar potluck

Workplace Examples 30

15 Create or update policies to support employees to:

• Have flex time for family issues. • Work out during the work day. • Have a relaxed dress code to be able to be more active. • Serve healthier food at company functions.

Health in policies 31

Make Healthy Options More Accessible 32

16 Move More 33

Break Time 34

17 Questions to ask

▪ How do the wages you pay compare to living wages? ▪ Who does not have benefits? Why? ▪ Who has language barriers? ▪ Who works multiple jobs? ▪ Who is food insecure? ▪ Who has child care, elder care, parenting issues? ▪ How does your organization support educational opportunities?

Do your employees have hope and prosperity?

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