How employers can spark a movement to help us live longer and healthier lives

Beyond the health ramifications, there is a competitive advantage and business case for employers to lead such a movement. To have the greatest impact, employers should think beyond their traditional role of offering health insurance to employees. And that will likely require employers to consider the broader health needs of their employees and how that extends to the communities they live in. This might include investing in workforce initiatives such as improving access to health care beyond the offering of health insurance, focusing on mental health, improving health literacy, enabling financial literacy and wealth management, and encouraging as well as incentivizing healthy habits. It’s important for organizations to also look at their impact beyond the workforce by recognizing the role their products and services can play in the drivers of health for consumers.

Employers have a growing responsibility to create a healthy and positive work environment that aims to improve employees’ physical, mental, social, and emotional health both within and beyond the workplace. Such workplace initiatives can increase employee productivity and retention—and help improve the overall success of the business. In recent years, some organizations have begun investing in employee health and well-being, but it may be time to be more strategic, intentional, and innovative. Employers generally have the potential to foster human sustainability by promoting the collective long-term well-being of workers, organizations, and society.⁵ After all, if you have employees, your organization is a health organization.

Because the tools and innovations needed to help achieve this already exist, employers can begin making an impact today. One starting point is empowering employees to modify their behaviors and make better choices to improve their health. There is evidence that lifestyle modifications like following a healthy diet, creating social connections, engaging in appropriate exercise, managing stress, and reducing smoking can dramatically change, or even reverse, the progression to diabetes, heart disease, and certain other conditions.⁶ Wearables and digital tools help enable changes, especially when they’re paired with coaching and nudging.⁷

Improving access to early screening and services that address mental health and social isolation can contribute to healthier aging. Such a shift also requires providing individuals with health-literacy tools, educational materials, and structural support that address the drivers of health (nonmedical economic, environmental, and social factors that influence health such as access to affordable housing, financial literacy, clean air and water, and healthy food).⁸ Employers are well-positioned to invest in these areas to help improve the health of their employees and surrounding communities.

Employers can be the catalyst for change, but they can’t do it alone. All ecosystem stakeholders—including employers, the life sciences and health care industries, public health, and individuals—should come together. It’s time to invest in longer, healthier lives that cost less—both for individuals and institutions. By emphasizing wellness, prevention, and early detection, we can move away from a treatment-focused health care model to one centered on promoting good health. And as we predicted in Deloitte’s Breaking the cost curve report, such a shift could slow the projected health spending’s growth rate by nearly a third.

It’s the responsibility of stakeholders across all industries to promote healthy behaviors, address health inequities, and take ownership of the problems. In essence, we should all converge around a common purpose: achieving healthier aging for all.

How can employers act as catalysts for healthy aging?

During the COVID-19 pandemic, employers prioritized the health and well-being of their workforce, and that focus remains in the spotlight as the great resignation, staffing shortages, and retention issues are still critical impacts on businesses across all industries. If employers continue to prioritize their employees, a focus on enabling healthy aging can evolve efforts beyond simply checking the box on wellness initiatives. Employee wellness can be a strategic asset: Healthy employees could be positioned to make the best work-related contributions.

An argument might be made that improving healthy living falls to the life sciences and health care sectors—after all, those are the industries that we frequently turn to for scientific breakthroughs, prevention, early detection, and changes to care delivery. While investments in innovation, science, and technology will likely always be needed, the scope is changing. In our vision of the Future of Health, we’ll move away from traditional disease care to a model based on prevention and most importantly, the promotion of healthy living. Along with this vision, we believe that employers likely have the most opportunity to influence these factors today.

In our national survey of 1,000 US consumers, 70% said they need some level of financial and social support to live longer, healthier lives.⁹ Financial resources, affordable healthy food, care access, internet, digital tools, and other social support are among the needs identified by the consumers we surveyed.¹⁰ When we drilled down to specific needs, we found that 21% of consumers need financial resources while only 9% need access to a care plan for disease prevention.¹¹ Employers may be best positioned to offer support across all of these areas of consumer need, particularly financial literacy, wealth management, and other financial tools.

How much healthier can we all be?

To determine whether Americans may be able to live longer, healthier lives, Deloitte’s health and life actuarial teams modeled life spans and health spans in the United States based upon publicly available data. The teams identified the top 10 drivers of death and disease, which account for 70% of today’s deaths. For each, they conducted an extensive literature review to understand the underlying causes of disease and then leveraged public research, current innovation, and assumptions regarding change in behavior and structures that can be made by 2040. This combination of prevention and earlier detection resulted in predicted improvements in both life span and health span (See “Appendix: Methodology” for more details.).

To provide context around our projections and gain insight into how stakeholders can help achieve the vision for healthier aging, we conducted interviews with 10 industry leaders including health economists, geriatricians, gerontologists, and aging experts.

The analysis shows substantial potential gains in life span and health span by 2040 (figure 1), specifically a 19.4-year improvement in health span. The proportion of years spent in good health is projected to potentially increase from 85% to 95%. The modeling suggests that nearly everyone may be able to live to be nearly 90 years old and in good health for most of those years. Because unhealthy years can be temporary and occur at any stage of life (not just at the end of life), these health span improvements can occur throughout a person’s entire life, potentially resulting in an overall percentage of healthier years.

More years and more healthy years could be gained for everyone–people of all ages. The people in younger age categories will likely benefit the most and experience the full impact of a healthy lifestyle, structural changes, and innovation. However, those in older age brackets still can gain a great deal by living more years and gaining more healthy years. It is counterintuitive that someone in an older age bracket today could live well beyond the average. This is due to that person having surpassed the typical causes of death in each age bracket, leaving the opportunity for life span to be extended even further with today’s tools. Shifting to the Future of Health today could impact everyone positively (figure 2).

If we act now, we may be able to close the health span gaps across races and ethnicities

Both life span and health span today are on the decline for all groups, but certain groups declined more rapidly in the past few years and a significant gap exists across races and ethnicities. For example, according to our analysis, Black Americans have an average life span of 72.7 years with a health span below 60 years; and American Indian or Alaskan Natives have an average life span of 68.3 years and a health span below 54 years. On the other hand, white Americans live an average of 78.5 years and have a health span of 66 years; Asian Americans have an average life span of 84.6 years and have a health span of 77.5 years; and Hispanics have an average life span of 78.9 years and a health span under 69 years.

Applying the same Future of Health model to address health inequities, we estimated the impact of closing the gap on life span and health span. The result is that Black people and American Indian or Alaskan Natives stand to gain 24 years and 28 years of health span, respectively (figure 3). To help achieve this healthier aging, it will likely require significant changes including empowering healthy behaviors and lifestyles, investing in the drivers of health, and focusing on wellness and prevention.

If the current trajectory continues, everyone could live longer but the health span gap across certain groups of people could widen. Given the cost of not addressing these gaps—Deloitte projected the cost of inequities today at US$320 billion and it could reach US$1 trillion in 2040—organizations may have more reason than ever to invest in change. To prevent the gap from widening further, we should design for equitable aging. Such a design likely requires community- and broad-level investments and providing varying levels of support for communities. This will also likely require addressing the systemic and structural flaws that already exist in the system, including racism and bias.

Living longer and healthier lives can cost less

Within our current system, one would expect that living longer and healthier would cost even more. After all, as we age, there is traditionally more spending on health care services.¹⁴ And health care spending has been growing annually for decades with a growth rate of 4.2% most recently in 2021.¹⁵

However, the opposite would occur in the Future of Health. Deloitte’s previous analysis in the Breaking the cost curve report projected a reduction in cost of nearly US$4 trillion if we adopt the Future of Health and focus on prevention, wellness, and empowered consumers. The projected increase in healthy years, therefore, will also potentially see a significant reduction (nearly a third) in health care spending.

This would involve increased screening, prevention, and monitoring. These are significantly lower-cost services than the traditional sick care that occurs in our current system, and also results in fewer sick care services due to prevention and early detection.¹⁶

Bringing more healthy years to everyone in the United States

To effect widespread, lasting change, all ecosystem stakeholders—employers, the life sciences and health care industries, consumer and technology industries, public health, and individuals—should come together. It could be possible for everyone in the United States to live longer, healthier lives, but only if organizations and individuals embrace the role they each could be playing to improve health. Achieving healthier years involves providing programs and support to change individual behaviors, making structural investments in the drivers of health (like housing, transportation, and education), and focusing on wellness and prevention.

The Future of Health we envision will be focused on wellness and prevention, but requires employers to assume a new role to drive value in the transformed health ecosystem. To extend the years that our current population can live in good health, however, that future needs to start today—and it turns out that the tools we need to help achieve it already exist.

To achieve systemic change, we should acknowledge that health happens everywhere, whether it’s within or outside the control of the usual health care industry players. On a day-to-day basis, people not only interact with their health care providers and systems, when needs arise, but also with their communities, employers, consumer technologies, and other systemic structures. Of all the major stakeholders that can play an outsized role in adding healthy life years, employers may be the most likely to be major catalysts for change. But they can’t do it alone, so it’s imperative that all stakeholders get involved and act now to improve health and wellness. Here are a few actions to get started:

Redefining employers’ role in health care. Increasingly, all private and public organizations are “health companies,” as much of the US workforce receives health benefits from their employers¹⁷ and conversely, the health and productivity of the workforce generally impacts the organizations’ success. Like post-WWII times when employers began offering health insurance benefits and shaped the current US health care system,¹⁸ employers can now serve as a catalyst for helping people live healthier lives.

The pandemic put a spotlight on workforce health, such that offering well-being support became a central competitive incentive for companies.¹⁹ After the height of the pandemic, today’s workers demand and expect greater health benefits and well-being transparency from their employers.²⁰ It also became clear that these programs often meet the needs of certain groups only and therefore need to be more inclusive and designed equitably.

Investing in the health of employees and the public with an equitable lens can create a more productive workforce with greater contributions to creating value for stakeholders and driving purpose. Helping employees be healthier and more productive can also help boost retention rates.²¹ Thus the employers that make contributing to employee health a priority will likely have a competitive advantage.

Employers are uniquely positioned to help employees improve their health by:

• Ensuring their workforce has improved access, benefits, and support for physical and mental health care services through digital tools and expanded networks.
• Leading efforts to improve health literacy and education for their employees.²²
• Supporting financial literacy, wealth management, and other financial resource tools.
• Investing in prevention, screenings, and care at home as fundamental and integrated parts of the care delivery system. For example, Baptist Memorial Health Care launched BestHealth, an employer-based well-being program focused on helping improve their employees’ health and reduce lost productivity through population health management, health risk assessments, and coaching employees in lifestyle and behavior change in areas such as diabetes management, nutritional improvement, and tobacco cessation.²³
• Creating more awareness of health and well-being by providing employees with preventive and wellness programs such as improving access to healthy foods, providing nutrition counseling, promoting physical activity, and increasing mental health resources.
• Recognizing the role that their own products and investments play in the drivers of health and health equity, and thoughtfully addressing any flaws.²⁴

Empowering individuals to change their behaviors and lifestyles. The tools exist today to help individuals improve their health through behavior and lifestyle changes. This includes structural changes to social, economic, and environmental factors that impact health, also known as the drivers of health.²⁵ Employers and other stakeholders can set individuals on a path toward better health by making investments to improve food deserts, housing insecurity, wealth disparities, climate, and other factors.

Behaviors including what we choose to eat, how much we exercise, and whether we smoke, can have a significant impact on our health, but they’re often impacted by structural challenges like the drivers of health. Social isolation and lack of connection can lead to poor health as well.²⁶ The onus of changing these behaviors shouldn’t be placed entirely on individuals. Instead, encouraging a behavioral mindset shift on top of structural changes can empower a culture of health. By improving health literacy and knowledge, individuals can gain a better understanding of what good health entails.²⁷ Individuals can be incentivized to put that knowledge to good use through the use of tools such as technology-based behavioral nudges. One example is using digital apps, such as weight-management apps coupled with human support, to remind users about their nutrition and diet goals and provide feedback nudges to encourage healthy behaviors.

Trust matters when it comes to influencing people’s behaviors.²⁸ People can have varying levels of trust in clinicians, individuals, organizations, and institutions.²⁹ Therefore, understanding where the public places their trust can be paramount to designing effective behavior-modification strategies. For example, retailers can play a significant role in individuals’ health choices through their food, exercise, and lifestyle products. And innovations that could spur lifestyle changes and consumer empowerment seem to be increasingly coming from unexpected places outside of health care and research. Consumer industries from social media and lifestyle brands to food companies and personal shoppers could possess untapped potential for effective behavioral modification and evidence-based healthy living.

With data increasingly made available in digital tools and shared among stakeholders, the challenges toward maintaining consumer trust may have increased. There could be mounting privacy concerns among those who do not want their employers to know about their health conditions. Similar to how insurers previously would deny coverage to enrollees with pre-existing conditions, employees may be concerned that their health information will be used against them by their employers. And this trend could erode consumer trust if we don’t figure out a way to address it.

There are a few ways that organizations in other industries can converge with the health care industry to empower individuals to make healthier decisions. Consumer industries can increase their use of behavioral nudging on e-commerce sites. For example, Instacart has implemented ads for fresh produce, enabling produce brands to advertise directly to consumers. This approach increases consumer engagement and discovery of brands with healthier options.³⁰ Another avenue is thinking of food as medicine: Bridging the information gap about the healthfulness of specific foods can demonstrate both positive health outcomes and increased food sales for grocers. For example, the Kroger OptUP program is a nutrition scoring system designed to help make choosing healthier food easier and is available to consumers both online and in stores.³¹

Transforming the life sciences and health care industries’ business models. The life sciences and health care industries have traditionally been the most prominent players in people’s health; however, both should undergo significant transformations to help enable healthier lives. To get there, the industries will likely need to shift their mindset from sick care to well care, focus more on care delivery in the home, decrease the burden of costs on the consumer, and improve access to preventive and primary care services. In tandem, we’ll need to see broader structural changes, like changing financial incentives in the industry and properly incentivizing and investing in innovation and the health care workforce.

Creating drug and device pricing models and efficiencies for life sciences companies in research and development that spur investment in innovation will be important. This will require investing in advanced technologies, diversifying clinical trials, and focusing on value. Life sciences companies have seen decreasing returns on their investments in research and development for several years, which could hinder innovation.³²

Adopting payment models and incentives for life sciences and health care organizations to offer coordinated, preventive services will likely be necessary. In addition, it’ll be important to address the shortage of primary care physicians, nurses, and mental health professionals³³ in the health care industry. That could be accomplished by investing in nursing and medical schools to create a supply of talent and by using technology to streamline workflow and processes for health care staff.

Even with the increase in virtual health and digital care delivery, access to health care remains an issue for some people due to factors such as internet availability. Others simply might not prefer in-person care or may have to travel significant distances for it. In addition, the fragmented process for gaining health insurance coverage can hinder the ability to build relationships between patients and their providers and establish continuity of care.

The health care industry should make fundamental shifts in care practice to expand how and where care is provided equitably. These shifts could include:

• Transforming how health care is financed, incentivized, and delivered from a treatment-based care model to one based on prevention and wellness services.
• Leveraging analytics, predictive/generative AI, and other technologies to better monitor and prevent disease and illness.
• Making data truly interoperable to enable providers to better coordinate care and consumers to take ownership of their health care data and decisions.
• Recognizing scientific innovation and therapeutics development as means to shift basic structures of the industry and spur new care delivery and treatment options (i.e., reimbursement model, plan enrollment structure, preventive screening).
• Utilizing alternative sites of care such as retail clinics to bridge care-delivery gaps and to increase trust if staffed with a diverse workforce. The Deloitte 2022 survey of US health care consumers found that while only 10% of consumers used a retail clinic, 55% would be likely to or maybe would use them for preventive care.
• Addressing the unique care needs of older adults including social isolation, loneliness, and mental health can improve quality of long-term care and health span, and also propel shifts in provider attitudes about ageism and understanding of individual lived experiences.
• Recognizing the health care system’s impact on the environment and making substantive efforts to reduce carbon footprint and waste to improve sustainability and downstream effects on health.

Building community-based ecosystems that drive collaboration. Given the complexity of extending life spans and health spans, there is an increasing need for stakeholders to build innovative ecosystems across all industries. These collaborations can fundamentally change individual company’s business practices for collective benefit, be based in the community, and improve health and wellness for everyone. These ecosystems can also leverage technology in new ways.

Ecosystems provide a way for all stakeholders to interact and provide local solutions in the right place, at the right time, and for the right people.³⁴ Health disparity obstacles to healthier living tend to exist because the solutions are often designed to meet the needs of the average person living in the United States. Instead, we should design hyperlocal, place-based solutions to help enable health for everyone in a specific area.

Structural factors such as a zip code, which influences health outcomes disproportionately (and often can be a proxy for income and historical marginalization), can be well-suited for ecosystem interactions. For instance, unstable housing, often segregated by zip code, is correlated with an average life span decrease of 27 years.³⁵ Combining the expertise of leaders from local public-health housing departments, hospital emergency rooms, and electronic health-record software companies could potentially help address some of the root causes of housing instability. These interactions are important as we can’t put all the onus on the individual to change lifestyle, given that systems and environmental changes are also necessary.

Redefining healthy aging for future generations

The US population is growing older, but not necessarily healthier. However, it can be possible to live longer, healthier lives while seeing reductions in health care spending. When in good health, people can live their lives the way they envision, whether that’s spending quality time with loved ones or pursuing their passions. Employers can create significant change for everyone, but they can’t do it alone. If all stakeholders come together and optimize the tools available today, we could collectively increase the overall health and well-being of generations of Americans so that improved health spans and an equitable future of health is the ultimate outcome.

Definition of HALE

The WHO definition of HALE: the number of years that a person can expect to live in full health, accounting for the years lived in less than full health due to disease and/or injury.

Modeling for life expectancy and HALE

• Identify top diseases and health conditions that drive death and disability: We started by identifying the top ten diseases and health conditions that contribute to about 70% of mortality and disability in the United States.
• Evaluate the opportunity to prevent and better manage the disease/condition: This was followed by an extensive review of published literature to identify what causes the death and condition and assess the potential opportunity to prevent or better manage the disease and condition. We analyzed non-modifiable, genetic, environment, health care quality and access, and lifestyle factors to understand how these drivers caused the disease/condition that led to death.
• Adjust for an equitable baseline: We then looked for differences in mortality between race caused by health inequities. We adjusted the mortality for the American Indian and Black populations by assuming it would reach 80% of the existing gap between the white mortality.
• Quantify the incremental Future of Health opportunity: Using the WHO death data and YLD data for each disease/condition (i.e., 70% of deaths and YLDs), for every age, gender, race, we quantified the incremental Future of Health opportunity on LE and HALE for each disease/condition based on our ability to prevent and improve outcome of disease/condition as a result of Future of Health.
• Extrapolate for other diseases/conditions: We then extrapolated the data for the remaining diseases/conditions (30% of deaths and YLDs) by applying an average percentage for prevention and improved outcomes through better management to the remaining preventable deaths and YLDs.

We applied this model to a panel of the most impactful disease areas on life expectancy and quality of life: