Neighborhoods, Work, and Health: Forging New Paths Between Social Determinism and Well-Being.

Tribalism in America and our polarized body politic has, sadly, become part of our daily digest. Is it possible that place-based discrimination will be shown to be an even more powerful impediment to our collective well-being than other formidable health influencers like race or income? If so, how would such a social diagnosis inform strategic planning in health promotion? Waddell and Reed wrote about "possible causal pathways" that show the interaction effects, both positive and negative, between work, health, and well-being. That businesses have focused on individual choices, rather than social influences, is not merely a philosophical leaning of the private sector. Individualism has dominated collectivism in the health care, health research, and health promotion sectors as well. Of the $36 billion approved this year to fund the National Institutes of Health, most will go to biomedical research and a paltry $11 million will be allocated to worksite health promotion. Similarly, in spite of the training of public health professionals about the primacy of social determinants as a predictor of well-being, health education and behavior research over the past 2 decades has overwhelmingly focused on individual interventions and interpersonal characteristics. A new federal survey of worksite health promotion in America shows modest growth in the past decade in the number of companies sponsoring comprehensive approaches to worksite health promotion. However, of the 5 elements constituting a comprehensive approach, the greatest gain in the past two decades has been the increase in companies offering a supportive social and physical environment. This editorial argues that we must think more deliberately about the causal chain that links neighborly social support and collective well-being if we are ever to solve for related issues like obesity, mental illness, and addiction.