The health and wellbeing of your people has a lot to do with social factors related to their life experience. Get ideas on leveraging total rewards to help all your people thrive.

Authors: Diane Bober Ruby Hamacher


Beginning early in life, challenges can become embedded in people's lives that may continue to hinder their ability to thrive at home and at work.

Social determinants of health (SDOH), also known as social drivers of health, are conditions present in the environments where people are born, live, learn, work, play, worship and age. And they're linked to a range of risks and outcomes related to health, functioning and quality of life.1

Interest in the connection between these drivers and employee wellbeing is growing, now that the concept of wellbeing has expanded beyond physical health to embody the emotional, financial and career aspects.

Social determinants of health are economic stability, education, healthcare quality, neighborhood and community

Disparities in access to resources for health and wellbeing in the context of SDOH include such basics as nutritious food and safe housing. Beyond immediate needs, equitable access to opportunities such as education and jobs is a key factor for sustained improvement.

SDOH-focused initiatives offer help to all employers — not just the largest or most innovative — looking to compete more successfully for talent. In fact, multiple studies indicate that a demonstrated commitment to social fairness and equity can provide a sizable advantage. One survey found that perceptions of a more fair employee experience improve employee performance by up to 26% and employee retention by up to 27%.2

An organization's selection of compensation, benefits and personalized support services can strongly influence workforce wellbeing, which naturally carries over to productivity and healthcare cost trends. What's also important to consider is that employer decisions have a wider reach  —  they affect the experiences not just of employees, but also their families and the communities where they work, live and serve.

From an SDOH standpoint, a clear and complete view into these experiences and the underlying circumstances requires a rigorous review to identify risks and unmet needs. This information helps to redirect priorities and investments to continuously improve outcomes. Intentional listening efforts that capture employee feedback through surveys and data analysis, and consideration of external factors, will help employers understand where to start and how to make a difference.

The importance of sincerity and substance

Integrating SDOH goals and objectives into the organizational strategy establishes a better framework for optimizing total rewards. And communicating this focus contributes to a durable brand identity in the minds of prospective as well as current employees, customers and business partners.

A visible commitment to investing in solutions to SDOH challenges is much likelier to return the best results. But making realistic commitments, and then honoring them, is essential.

Empowering employees with clear and meaningful benefits information and access

A solid understanding of benefits among the workforce sets the foundation for an effective employee value proposition. From evaluating options to enrollment decisions and appropriate utilization, people require different levels of support. Providing benefit tools that assist with a range of needs, along with communications that help engage employees and their dependents in the process, promotes the value of these benefits.

Wage-based cost sharing and health plans that account for individual challenges to saving for medical expenses consider the interests of lower-income employees. Health savings accounts (HSAs) can be a strong asset when consumer-directed health plans are offered. Informing members about funding, expense eligibility and tax advantages encourages enrollment. But underfunded or underutilized HSAs can lead to care avoidance, which puts employees at greater risk of increased costs from more advanced health issues.

Employee navigation tools and decision support are designed to boost healthcare literacy, influencing choices that optimize the patient care experience and health outcomes. Once appointments are made, providing medical transport services helps to ensure they're kept.

Proactive health management can contain costs by curbing the need for care. Efforts to keep health plan members up to date on preventive measures are one example that has significant downstream savings potential. Likewise, the availability of expanded coverage for mental and behavioral health services promotes earlier intervention.

Efforts to keep health plan members up to date on preventive measures are one example that has significant downstream savings potential.

Other measures focus on both efficiency and quality. Narrow networks provide an end-to-end community that combines personal engagement and care coordination, and telehealth is designed to deliver more immediate and convenient services. Both of these options often fill the need for a specific area of expertise or a preference for a healthcare professional with a certain ethnic background.

The link between levels of wellbeing and day-to-day stress, such as financial concerns

Finances are increasingly one of the top stressors in the US, along with inflation.3 In response, employers are ramping up support for financial wellbeing. Nearly 9 in 10 (87%) offer at least one resource to their employees.4 Providing a selection that meets common needs across career stages addresses different preferences. Examples include financial literacy education for learning effective debt management and saving habits, qualified advice on preparing for retirement and tips on controlling lifestyle creep as income increases.

Lifestyle spending accounts (LSAs) have been available for a while, but recently gained traction. The delay was due to other priorities, like diversity, equity and inclusion (DEI) initiatives, personalized benefits, talent competition, and needs related to remote work and a multigenerational workforce.

LSAs are set up to fund and administer the everyday needs of employees without requiring employers to manage additional reimbursement. And they handle multiple SDOH concerns through a single program. The amount and frequency of contributions to an LSA and the scope of eligible employee needs can also be customized. All of these capabilities make them a logical candidate for fine-tuning total rewards.

Often focused on food insecurity and nutrition, exercise, transportation or medical services, LSAs help boost the extent and value of whole-person care. Coverages for employees can be highly specialized to needs and preferences, such as behavioral health visits, meal subscription services, dietitian counseling or even dance classes. Importantly, LSAs are able to create a continuous experience inside and outside of work. Within the parameters set, employees have some latitude in how to spend funds to meet their needs.

Finding efficiency in their day through flex scheduling, remote work or childcare accommodations can be a very effective stress reliever for employees. And sometimes remote arrangements may help overcome logistical challenges or allow neurodivergent employees to do their best work. Keeping employees connected to the mission from any location is key to workforce and organizational success.

In many geographic areas, housing instability remains an issue.5 Competitive wages and programs that help to offset rising housing costs are part of the solution, but employers may also gain traction by influencing local markets and working within the community. Investments in environmental health protect current and future employees from undue health risks while promoting a positive public image.

Creating synergy with SDOH goals through a commitment to DEI

While the nuances of the relationship between SDOH and DEI range from obvious to complex and unseen, there's significant overlap. Marginalized and minority populations have long suffered a disproportionate burden on their health and wellbeing. Inclusive benefits require a multifaceted design that considers generational, racial, cultural and educational backgrounds as well as neurodiversity. A focused analysis of unique demographics and local pressures will inevitably highlight opportunities to make benefits attractive  —  and useful  —  for a wider talent pool.

Operationally, DEI and SDOH come together to recognize individual strengths and different approaches to getting work done. Workforce equity programs address both SDOH concerns and attraction and retention issues. They also support entry or reentry into the workforce, and internal structures help to ensure employees have equal opportunity for promotions and wage increases. All in all, retaining organizational knowledge while building a culture of inclusion can be a powerful competitive advantage.

Progress, not perfection

Gaps are likely to remain despite an employer's best efforts, and it's important to avoid selective inclusion. Emphasizing some employee groups or SDOH concerns and setting others aside can diminish the investment value. When informed by insights from a benefits preference survey, a transparent approach and a commitment to ongoing improvement will help optimize results. There's also the practical matter of adhering to regulations at each level, increasing the strategic need for information and processes.

Emphasizing some employee groups or SDOH concerns and setting others aside can diminish the investment value.

Decisions about SDOH should be truly transformative because performative efforts alone won't be successful. Equally important is educating employees about available resources — connecting them with practical solutions for overcoming real-world obstacles at the right time. An inclusive benefits review will help employers to determine, prioritize and meet employee needs, while improving health and wellbeing for all.

Author Information


1"Social Determinants of Health," US Department of Health and Human Services, accessed Nov 2022.

2Kropp, Brian, Jessica Knight and Jonah Shepp. "How Fair Is Your Workplace?" Harvard Business Review, 14 Jul 2022.

3"Stress in America 2022: Concerned for the future, beset by inflation," American Psychological Association, Oct 2022.

4"2022 Workforce Trends Report Series: Financial Wellbeing," Gallagher, Jan 2023.

5"Housing Instability," US Department of Health and Human Services, accessed Nov 2022.


Gallagher Fiduciary Advisors, LLC ("GFA") is an SEC Registered Investment Advisor that provides retirement, investment advisory, discretionary/named and independent fiduciary services. GFA is a limited liability company with Gallagher Benefit Services, Inc. as its single member. GFA may pay referral fees or other remuneration to employees of AJG or its affiliates or to independent contractors; such payments do not change our fee. Securities may be offered through Triad Advisors, LLC ("Triad"), member FINRA/SIPC. Triad is separately owned and other entities and/or marketing names, products or services referenced here are independent of Triad. Neither Triad, Arthur J. Gallagher & Co., GFA, their affiliates nor representatives provide accounting, legal or tax advice. GFA/Triad CD (4983836)(exp102024)

As a Registered Investment Advisor, Gallagher Fiduciary Advisors, LLC is required to file Form ADV Part I and Part 2A with the SEC. Part 2A of Form ADV contains information about our business operations for the use of clients. A copy of the Form ADV Part 2A can be requested by contacting the Gallagher Fiduciary Advisors, LLC Compliance Department.