The Stew BLOG

What Will Spark Businesses to Address Socio-Economic Levers for Community Health?

Ben Bulkley, CEO of Trellis Rx | 04/14/2017

This week’s Finance Friday blog was authored by our guest, Ben Bulkley, CEO of Trellis Rx, which builds hospital- and provider-based specialty pharmacies dedicated to human-centered design.


What will it take for business leaders to align their sizable talents, relationships, and investments with other stakeholders to address socio-economic levers for the good of community health? Businesses depend on a healthy population for productive employees and engaged customers. When four out of five people on an employer’s health plan are not employees, there’s little doubt businesses know community health is important. Yet for such an important business driver, community issues are often not a key priority shared among the leadership team. Leaders of divisions and regions are inclined to view community health as somebody else’s job or as the item that can fall to the bottom of the priority list.

How do we reverse this attitude so mainstream business teams align their sizable investments in health and community toward the projects with the highest impact on health? Certainly businesses are concerned that the steady rise in the cost of medical benefits is crowding out important investments. But they might not know the best way to address this concern. Blinded by the short-term gains of high-deductible insurance plans and dubious promises of workplace wellness programs, many have yet to understand how much potential there is for socio-economic influences to have substantially greater impact on the health of their community than their investments in medical benefits.

Businesses fund over 40% of the national health expenditure, so they have the potential to leverage enormous influence on how we spend. As Stephen Woolf1 explains, our nation’s spending patterns are a reflection of our “misplaced priorities.”  Michael McGinnis2 estimates that the cause of early deaths (a proxy for health) is distributed among various health determinants: genetics, 30%; social circumstances, 15%; environmental exposures, 5%; behavioral patterns, 40%; and limitations of clinical medicine (not everyone receives recommended services), 10%. And yet 95% of our national health expenditures3 go to clinical medicine, and 5% go toward community-related investments in health.

The good news is that businesses can do a lot to improve these spending patterns, especially if they work together. The return on investment (ROI) of interventions in community health is becoming more clear. In fact, ReThink Health has shown it is possible to model the effect of all the types of interventions to determine what would do the most good for the health of a community. This of course is a normal business practice–invest in the projects with the greatest ROI. For all we invest in health care, why do we not do this?

My experience as an executive and board director might be indicative of how business leaders think about health care and community health. Businesses I’ve had a hand in leading (Aetna; early-stage, venture-backed, mid-cap public companies; and various General Electric units) have big investments in health insurance, and more recently have made investments in employee wellness programs and living wage initiatives: employees are building homes for Habitat for Humanity, volunteer days are accumulating thousands of hours of community service across the globe, and countless local grants and partnerships with community service organizations reflect the businesses’ significant investment. I’ve seen other businesses mobilize matching grants to research foundations or other special interest medical priorities. While the intent of these efforts was not necessarily to achieve the Triple Aim, businesses are nonetheless deploying precious resources directed at the health of the community.

But if I’m being honest, even though I participated in community service activities, the majority of my time and mental energy was directed toward our customers, our employees, and partners; less so the community. Our businesses are in deeply competitive markets requiring the very best of our talents. Our agendas were swamped with priorities. It is true that community service is both team building and community building; but the health of the community was not a mainstream accountability senior leaders were expected to address in their regions, divisions, or functions. The idea of taking on community health as a responsibility that would also drive the health of my business rarely, if ever, crossed my mind.

Since then, however, I’ve learned (from Elinor Ostrom, a ReThink Health founder, and other public health thought leaders) that businesses and other stakeholders coming together to solve these issues would have the greatest impact on community health (and consequently the greatest ROI). If more business leaders understood this, perhaps they wouldn’t be so inclined to think they ought to do the work alone–solving these problems in disconnected projects, with no coordination to accomplish bolder and broader goals and no commitment to addressing the social determinants of health

Engaging in new relationships with community peers, business could together prioritize the most impactful projects unique to their own community, link them to bigger goals, and lead efforts to achieve those goals based on promising methods. It is estimated nearly 40% of deaths are attributable to four behaviors (smoking, poor diet, physical inactivity, and alcohol use); so it stands to reason that businesses–linking their financial strength, political will, creative energies, relationship depth, and operational skills–could have a greater impact than splintered efforts or investments in activities not directed at the biggest problems.

Businesses are the largest sponsor of health spending in the country, so we’ve got the most to gain. We are already investing precious resources in health and community, what we can do differently is link them with the resources of other stakeholders and increase our willingness to invest in community health  in the ways that will truly have the greatest impact. We can have a profound effect on the culture of our businesses and the energy of our communities if only we take the leap.


What do you think? Let us know below or find us on Twitter:  @ReThink Health  @BenBulkley


1Woolf SH. Potential Health and Economic Consequences of Misplaced Priorities. JAMA. 2007;297(5):523-526. doi:10.1001/jama.297.5.523

2J. Michael McGinnis, Pamela Williams-Russo, and James R. Knickman. The Case For More Active Policy Attention To Health Promotion Health Aff March 2002 21:278-93; doi:10.1377/hlthaff.21.2.78


See Table 95