A growing movement in public health is looking at psycho-social, political, and economic conditions’ influence on health. This has been termed an “upstream approach” in line with a public health story about people falling off a waterfall in a river. In this story, one rescuer leaves the scene to run upstream when the number of people falling becomes nearly too much to deal with. The other rescuers yell at him asking where he is going. His reply is that he is going upstream to find out why all these people are falling in the river in the first place. In the story, saving people right before they fall off the waterfall is equivalent to health care or medical care while going upstream to determine the cause of so many people coming down the river is public health. By going upstream, we can save resources through prevention rather than treatment. The very upstream causes of illness are the social determinants of health.

Social determinants of health are the aspects of our social and economic environments that indirectly influence individuals health; The causes of the causes.

According to the CDC, social determinants of health are the “conditions in the places where people live, learn, work, and play ‘that’ affect a wide range of health risks and outcomes.” Downstream determinants of health are those that are more “temporally and spatially close to health effects” (1) such as behavior or environmental exposure to toxins, while upstream determinants are those factors that lead to such behavior or exposure such as socioeconomic status and education. Organizations that have substantial influence on society and societal resources impact social determinants of health. They do so through allocation of resources, influence on the psycho-social and physical environments, and enactment and enforcement of policies that support individuals and families. Such policies may reallocate resources, or simply align incentives with desirable outcomes. The workplace is one such organization.

Social determinants of health are the aspects of our social and economic environments that indirectly influence individuals health. They are sometimes called the causes of the causes. These include access to basic needs like healthy food, healthcare, safe neighborhoods, educational and economic opportunities. Also, more abstract things like the culture and social environment of the workplace. Social norms are the socially acceptable means of conducting ourselves in group settings. Examples of social norms are the acceptability of excessive alcohol consumption among young American adults despite its negative health consequences, or the pattern of using work breaks to take walks in some workplaces. Social determinants of health are often more nuanced in the way they influence health. In contrast to physical determinants of health, such as environmental exposures to toxins, social determinants are things that aren’t always so glaring in their influence on our health. They tend to be more “upstream” in their influence on individual and population health. Nevertheless, they have a profound impact on health outcomes.

… adults find purpose and social belonging through their work …

The workplace is an important contributor to health through its impact on determinants of health. An individual’s work influences both downstream and upstream determinants of health. For example, upstream determinants include the types of and amount of resources an individual has access to. This includes income, but also health benefits, financial planning resources, education and skill-building opportunities, and social resources. A case could be made that each of these types of resources not only affects the employed individual, but also their families. An individual working for a company that offers financial planning solutions may be more equipped to prepare for their children’s future education, for example. Of course, investing in the future is only possible if adequate resources are available for a family’s current financial demands. Downstream determinants of health impacted in the workplace include the physical work environment and the behaviors individuals engage in.

Many adults find purpose and social belonging through their work. The workplace can provide a social network, a sense of purpose, and psychological well-being (8; 12; 17). Strong social connections indirectly impact health for many reasons. Not only does our psychological well-being have the potential to impact our physical health, but our social networks provide a sort of currency that we can draw upon in difficult times (6). An example of this includes employees helping a colleague move over the weekend.

Healthy, happy employees tend to be more productive and have higher levels of loyalty to their employer.

The workplace can also influence disease conditions through psychological stress (14). A lack of trust within the workplace, either in coworkers, management, or the organization may lead to threat appraisals and subsequent higher stress levels (10). Stress can have deleterious effects on health through reduced immune function and increases individuals’ propensity toward unhealthy coping mechanisms, such as substance use and unhealthy eating patterns, that can have cumulative negative health consequences (18).

Work also determines the physical environments that an individual will occupy, both during and outside of working hours. The workplace may pose environmental hazards or expose employees to risks they otherwise wouldn’t encounter. The Bureau of Labor Statistics reports that, in 2017 alone, there were 5,147 fatal work injuries and 2.8 million non-fatal reported workplace injuries in the United States (2 {workplace injuries}; 3 {workplace deaths}). Injuries and deaths from workplace accidents have a significant influence on familial economic status and access to resources and other important social factors for the family (9). Again, the resources available to us also determine where we will live and therefore the environments we will occupy outside of the workplace.

benefits include … reduced absenteeism, increased productivity, reduced turnover intentions, reduced healthcare costs, reduced injuries, quicker return-to-work after injury, and increased innovation.

Our income from our job determines the type of neighborhood we will live in, the stores we frequent, and the schools our children attend. Our neighborhoods can create social resources and a sense of community, or they can instill fear and pose real dangers in the case of high crime. Where we live, and our economic status determine what types of foods are readily available to us, and the schools our children attend can have an influence on their future creating inter-generational cycles of poverty and health status. The psycho-social and physical environment of the workplace can have profound influence on long term health outcomes. Employers have an integral part to play in providing an environment conducive to health for their employees, their families, and their communities.

There are benefits to business outcomes that can be realized by addressing social determinates of health in the workplace: taking care of employees. Examples of benefits to business outcomes from investing in employee’s health and well-being include reduced absenteeism and increased production (5), reduced turnover intentions (11; 13), reduced healthcare costs (16) reduced injuries through increased safety training transfer (4), quicker return to work after injury (7), and increased innovation (15).

Addressing social determinates of health in the workplace helps to foster healthy communities in which individuals, families, and organizations can thrive.

How an employer can foster a healthy work environment and be a component of a healthy community depends on several factors. Among these are the business needs of the organization, the available resources the organization can allocate, the political climate where the organization is located, and the specific needs of the employees and the communities they occupy. An employer may choose to offer childcare services to employees, increase pay, education assistance programs, flexible schedules, health education programs, or other resources to help employees balance the demands of work and family.

Healthy, happy employees tend to be more productive and have higher levels of loyalty to their employer. When individuals feel safe and valued, they tend to share their ideas more readily. This increased collaboration is good for teams and companies. Employees who believe their leaders are genuinely concerned about their safety and well-being tend to participate in safety programs at a higher rate. Addressing social determinates of health in the workplace helps to foster healthy communities in which individuals, families, and organizations can thrive.

References and Further Readings


  1. Braveman P., Egerter, S. and Williams, D. R. (2011). The Social Determinants of Health: Coming of Age. Annual Review of Public Health, 32. 381-398
  2. Bureau of Labor Statistics, (2018). Employer-Reported Workplace Injuries and Illnesses (Annual) News Release. 2017 data. Released 11/08/2018 https://www.bls.gov/news.release/archives/osh_11082018.htm
  3. Bureau of Labor Statistics, (2018). National Census of Fatal Occupational Injuries in 2017. Released 12/18/2018 https://www.bls.gov/news.release/pdf/cfoi.pdf
  4. Burke, M. J., Chan-Serafin, S., Salvador, R., Smith A., & Sarpy, S. A. (2008). The role of national culture and organizational climate in safety training effectiveness. European Journal of Work and Organizational Psychology, 17(1), 133-152.
  5. Call, C., Gerdes, R., & Robinson, K. (2009). Health and wellness research study: Corporate and worksite wellness programs: A research review focused on individuals with disabilities(Government Contract Number: DOLU089428186). Gaithersburg, MD: Social Dynamics, LLC. Retrieved from http://www.dol.gov/odep/research/CorporateWellnessResearchLiteratureReview.pdf
  6. Campbell, K. E., Marsden, P. V., Hurlbert, J. (1986). Social Resources and Socioeconomic Status. Social Networks 8(1) 97-117
  7. Carroll, C., Rick, J., Pilgrim, H., Cameron, J., Hillage, J. (2010). Workplace Involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disability and Rehabilitation, 32(8). 607-621
  8. Cohen, S. (2004). Social Relationships and Health. American Psychologist, 59(8). 676-684
  9. Dembe, A. E. (2001). The Social Consequences of Occupational Injuries and Illnesses. American Journal of Industrial Medicine, 40. 403-417
  10. Ford, M. T., and Huang, J. (2014). The health consequences of organizational injustice: Why do they exist and what can be done? In Leka, S., & Sinclair, R. R., (Eds.) Contemporary Occupational Health Psychology (35-50). West Sussex, UK. John Wiley & Sons, Ltd.
  11. Jiang J., & Shen, H. (2018). Supportive organization environment, work-life enrichment, trust and turnover intention: A national survey of PRSA membership. Public Relations Review, 44(5). pp681-689
  12. Lopez, S. J., Pedrutti, J. T., & Snyder, C. R. (2018). Positive Schooling and Good Work: The Psychology of Gainful Employment and the Education That Gets Us There (CH 15). Positive Psychology: The Scientific and Practical Explorations of Human Strengths Fourth Edition. Las Angeles: Sage
  13. Minor-Rubino, K., & Reed, W.D. (2010). Testing a moderated mediational model of workgroup incivility: The roles of organizational trust and group regard. Journal of Applied Social Psychology, 49(12), 3148-3168.
  14. Moure-Eraso, R., Flum, M., Lahiri, S., Tilly, C., & Massawe, E. (2006). A review of Employment Conditions as Social Determinants of Health Part II: The Workplace. New Solutions, 16(4) 429-448
  15. Niesen, W., De Witte, H., & Battistelli, A. (2014). An Explanatory Model of Job Insecurity and Innovation Work Behavior: Insights from Social Exchange and Threat Rigidity Theory. In S. Leka & R. R. Sinclair (Eds.), Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice Volume 3 (18-34). West Sussex: Wiley.
  16. Ozminkowski R. J., Dunn R. L., Goetzel R. Z., Cantor, R. I., Murnane, J., & Harrison, M. (1999). A Return on Investment Evaluation of the Citibank, N.A. Health Management Program. American Journal of Health Promotion, 14, 31– 43.
  17. Ryff, C. D., & Singer, B. H. (1998). The Contours of Positive Human Health. Psychological Inquiry, 9, 1-28.
  18. Wichianson, J. R. (2009). Perceived Stress, Coping and Night-Eating in College Students. Stress and Health, 25. 235-240. doi:10.1002/smi.1242