Improving population health requires much more than high-quality, affordable health care. Health outcomes in the United States lag behind those in most developed countries by a wide margin, despite the fact that the United States spends substantially more on health care than its peers. As important as health care quality and access is, the last several decades have shown that health outcomes are the product of many factors beyond health care. The business sector plays a critical role in many determinants of health. While the health care system has primary responsibility for health care quality and access and, to some extent, for health behaviors, it has more limited roles in the social and physical environments. Improving the health of communities and individuals is important to core business objectives. Better community health can contribute to the bottom line in many ways beyond reducing health care costs. Also important is the link between employee well-being and profitability. The business community understands the health care and education connection. The poor health of our children will lead to rising health care costs, which will then exhaust the resources for education.
The Business Sector's Influence on Health Determinants
The business sector usually strives to maximize the value of health care dollars invested in the workforce because lower costs or better outcomes generally translate to a healthier and more productive workforce and a more successful enterprise. Business can also influence health care through purchasing requirements. Such requirements can specify the health care product they are purchasing and mandate that health care providers must practice evidence-based medicine. The focus is primarily on controlling the cost of services provided to employees and their dependents while ensuring an acceptable level of quality. Some larger employers also directly provide employee health services. The business case for focusing on health behaviors has been to foster employee wellness, which is seen as improving productivity in the short run and reducing health care costs in the long run. With respect to social and economic factors, the strongest business contribution may be in employment itself, both in the employment-to-population ratio and the contribution to individual and family income. There is also growing realization by employers that K-12 and early childhood education programs in their communities contribute to business profitability in the short and long runs. In terms of the physical environment, some industries have substantial responsibility in areas of air and water quality and in community land use planning.
The Importance of Multisectoral Partnerships
Although there is growing understanding that fundamental population health improvement will require multisectoral partnerships, the specific role of employers in such partnerships has been less well explored. While corporate social responsibility plays an important motivational role, more traction will be possible if improving health can be linked to corporate bottom-line performance. Improving the health of the community where a company is located can contribute to achieving corporate business goals. No single sector is solely responsible for health improvement. Businesses can lead or play strong supporting roles in community multisectoral partnerships. It follows from a multideterminant understanding of health that no one organization or sector is totally responsible for improving health outcomes. For the business sector, the relationship of core corporate objectives to each of the determinant areas is different than for the health care sector, since businesses have less control over what is necessary to improve health. Meaningful improvement requires collective action by sectors not used to working together. Many sectors do not understand how activities in their sector are important to and impact the overall goal of improving health. In some communities, because of their prestige, political clout, and financial resources, businesses can be the super integrator across the stakeholders. Businesses must partner with others to achieve health improvement in communities and thereby reap the advantages for their workforces and overall well-being of business activity.
Shared Value and Corporate Objectives
Michael Porter observed that the “solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges. Social responsibility commitments of businesses can often lead to enhanced company reputation and customer loyalty. Large employers with stable, older workforces may see greater bottom-line return than employers with younger, high-turnover workforces.
Steps to Assist Businesses in Community Health Improvement
What steps need to be taken to assist businesses to take a more active role in community health improvement? How do we get to that future from where we are today? What are the gaps and the barriers?
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Set galvanizing goal targets: Extend a meaningful invitation from those currently engaged in improving population health to business regarding their views, needs, and involvement. There is no shared understanding of who “owns” the health improvement space in communities.
Engage in education efforts for CEOs and others in the C-Suite: One useful tool might be a population health primer from a business perspective or an action kit for business involvement. Such efforts would need to be built into existing channels of information for businesses, such as a Conference Board or Business Roundtable.
Sponsor convenings with broader community partners: It is important to engage community partners but were much less certain about how to do so is not certain.
Promote “Triple Aim” collaboration with business: The Triple Aim is a policy framework developed by the Institute for Healthcare Improvement. It advocates the simultaneous improvement of patient experiences of care (including quality and satisfaction), reduction in per capita health care costs, and improvement of population health. Although most Triple Aim sites define their populations by the service areas of health care delivery systems, several initiatives have adopted a regional approach and are defining their populations geographically.
Identify permanent revenue streams for carrying out these activities: In addition to corporate contributions, businesses can partner with others in obtaining foundation or government grants for activities. In addition, many experts argue that as much as 25 percent of current health care spending is ineffective, improving neither outcomes nor quality. Capturing these dollars for reinvestment in more effective programs and policies within and outside of health care will not be easy, but nevertheless should be a high priority for both public- and private-sector leaders. Consideration should be given to setting aside a community share from savings anticipated under the implementation of accountable care organizations, which are designed to provide higher-quality care in a more efficient manner. Also, as uncompensated care burdens are reduced under health reform, community benefit resources required by the Internal Revenue Service for nonprofit tax-exempt status could be redirected from charity care into broader health-promoting investments.
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