June 30, 2020

Social Determinants of Health

Addressing social determinants of health - the circumstances in which people are born and live - is a business and moral imperative.

Full Series

Neighborhoods with limited physical access to nutritious and affordable food (i.e., food deserts) and residential areas with a high-density of high-calorie fast food and junk food (i.e., food swamps) influence food choices and subsequently employee health. Research shows that living in a food desert is linked to a poor diet, as well as a greater risk of obesity.^1-3 On the other hand, in studies of both adults and adolescents, increased access to supermarkets is related to improvements in diet quality, fat intake and fruit and vegetable consumption, although this relationship is not consistent across all studies.⁴ Importantly, research also shows that food swamps - where unhealthy food options inundate healthy ones - have a statistically significant effect on adult obesity rates, even more so than the absence of full-service grocery stores.⁵

Both food swamps and food deserts are more common in low-income neighborhoods and those with higher concentrations of racial and ethnic minorities. While 24% of zip codes in the U.S. don’t have a supermarket, that number increases to 55% in zip codes where the median income is below $25,000.⁶ People who are low-income and racial and ethnic minorities are also more likely than high-income, non-minority groups to live near unhealthy food retailers. Furthermore, studies have provided evidence that fast food restaurants are more likely to locate in areas where there are higher concentrations of racial-ethnic minorities.⁵ In a country like Mexico, where the obesity prevalence is one of the highest in the world, excessive access and exposure to unhealthy food and sugary drinks have been identified as a main contributor to the country’s rising obesity epidemic among adults and children.⁷ 

Food Security

A lack of consistent access to food specifically due to limited money or other resources - referred to as food insecurity - can be detrimental to employee health and well-being because it can diminish dietary quality and disrupt normal eating patterns.¹⁰ Studies show that food insecurity is associated with a number of negative health outcomes in nonsenior adults, including:¹¹

Populations across the globe experience food insecurity, including in high-income countries. Estimates indicate that 17.2% of the world population have experienced food insecurity at moderate levels (i.e., they do not have regular access to nutritious and sufficient food due to lack of money, even if they’re not necessarily suffering from hunger), and 11% of households in the U.S. experienced food insecurity at times in 2018.¹² While food insecurity is closely related to poverty – 35.3% of households below the poverty line experienced food insecurity in 2018 – it’s also important to note that people living above the poverty line experience food insecurity.¹³ There are also racial and ethnic disparities associated with food insecurity, as rates are substantially higher among black and Hispanic households.¹² 

Ideas for Action

Employers can promote access to healthy food by offering nutritious items in on-site cafes and vending machines – and importantly – reducing the cost of these items, especially in comparison to less nutritious items. They should also carefully consider the ratio of healthy to unhealthy items offered and prioritize a higher volume of nutritious food. 
Additional actions employers can take to address food access and affordability issues include:  

Ideas in Action

Example 1

A large employer is making healthy food more affordable for employees through its Grocery Discount Card program. Eligible employees automatically receive a discount card within weeks of enrolling in an eligible medical plan option. Once participants register the card on the program’s website or app, it’s pre-loaded each week with up to $50 in savings on featured healthy foods at participating grocery stores. Employees scan their card or app at the grocery checkout to receive their discounts. 

Employees making less than $50,000 a year receive an additional 25% discount on fresh produce, up to $5/week. Any food item in the fresh produce area of participating retailers qualifies.

The program promotes products that rank in the healthiest top third of the foods in a typical grocery store. The foods are rated within the independent and nationally renowned Guiding Stars^® nutrition guidance system, which is aligned with the dietary guidelines of the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA).

The employer began piloting this program for employees within a 30-mile radius of a participating grocer in Illinois, Minnesota, New Jersey, New York, Virginia, Wisconsin and Washington, D.C. on January 1, 2019. In mid-2019, the program expanded to Maryland.

Example 2

In some global markets, employers provide meal vouchers for their employees or free food in the workplace. For example, in Europe, many programs stem from the end of the WWII, when it was common to provide at least one hot meal a day to bolster the workforce and increase productivity. In Mexico, the Law of Alimentary Assistance for Workers (Ley de Ayuda Alimentaria para los Trabajadores, LAAT) was adopted to promote and regulate the implementation of food assistance to protect workers’ health, improve their nutritional status and prevent diseases linked to poor nutrition.¹⁴

More Topics

Articles & Guides Social Determinants of Health Community Health Equity