There are many different elements that determine a person’s health, besides the biology and genetics inherited from family. The physical, social and economic environments we operate in introduce a complexity that entangles things like education level, type of employment/income, social support networks, housing and access to and use of health services. This ultimately influences and determine the personal health decisions we make and lifestyle behaviors we practice. These complex factors can make adopting a healthy lifestyle challenging for many, especially those with chronic conditions such as diabetes and cardiovascular disease.

Employers trying to address chronic disease management face challenges as well. Creating an environment and corporate culture that promotes behavior change and encourages maintenance of healthy behaviors among employees and dependents with chronic conditions is as complex as it is important. Many worksites have a diverse employee population (e.g. culture, age, gender) of varied socioeconomic status all functioning in different roles, contributing to the challenge to create healthy change within an organization. As strategies and initiatives are created to manage chronic conditions, all of these elements must be acknowledged and considered. Also recognize that:

• Managing diabetes/CVD risk requires a high level of patient motivation
• Health literacy is often a factor when it comes to understanding/using benefits, managing medications and following recommendations for diet, physical activity, etc.
• People are often dealing with multiple medications with different side effects
• PBMs purchasing generic drugs will use different manufacturers, which can mean changes to pill size, shape, color that make it very difficult to be compliant