States Can Improve Residents’ Health and Reduce Healthcare Spending by Adopting Policies Outside of the Healthcare Sector, New Report Shows


February 21, 2019

Policies that can improve health and save money include: Pre-K and school nutrition programs, syringe access, tobacco and alcohol taxes, paid family leave, the Earned Income Tax Credit and rapid rehousing.

(Washington, DC) — States can improve their residents’ health and well-being, and lower healthcare costs, by implementing a range of policies in sectors beyond healthcare, according to a new report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-being through Policy Change, released today by Trust for America’s Health (TFAH).

The new report analyzes state action on 13 policies outside the healthcare sector that have a long-term impact on health and an evidence base showing their effectiveness. They include: tobacco and alcohol taxes, syringe access programs, universal pre-K and rapid rehousing laws, among others. The wide policy lens of the report, which covers numerous sectors, including taxation, employment, education, housing and transportation, underscores the many economic and social factors beyond medical care that influence health.

In the context of the longest decline in life expectancy since World War I, and, insufficient resources dedicated to preventing health problems before they arise, this new report serves as an urgent call to state policymakers to take concrete steps to improve residents’ health. The report was made possible by financial support from the Robert Wood Johnson Foundation and Kaiser Permanente.

“In the current environment, states have an even more vital role to play in promoting the health and well-being of their residents,” said John Auerbach, President and CEO of Trust for America’s Health. “Our goal in creating this report is to provide state public health officials and policymakers the evidence and business case for the adoption of policies that have been shown to improve community health.”

Policies Analyzed in the Report Number of States with the Policy
Universal Pre-K program* 10 (incl. DC)
School breakfast program 31 (incl. DC)
School lunch program 20
School competitive foods (snacks and drinks) 28 (incl. DC)
Syringe access programs 27 (incl. DC)
Smoke-free laws** 29 (incl. DC)
Tobacco taxes*** 51 (incl. DC)
Alcohol taxes*** 51 (incl. DC)
Complete streets 30 (incl. DC)
Housing rehabilitation loan and grant programs**** 40 (incl. DC)
Rapid re-housing laws 9 (incl. DC)
Earned income tax credit 30 (incl. DC)
Paid sick leave 12 (incl. DC)
Paid family leave 7 (incl. DC)
Fair hiring protections (ban the box) 34 (incl. DC)

The economic benefits of these policies can be substantial. For example:

  • Pre-K education programs can generate $4.63 in benefits to participants, taxpayers, and others in society for every $1 spent on such programs.
  • Expanding syringe exchange programs could return $7.58 for every $1 invested in the long run, by lowering HIV rates and reducing treatment costs. There is no evidence such programs lead to higher drug use.
  • Rapid re-housing programs, which focus on getting homeless individuals into stable housing before addressing other challenges, can reduce hospital admissions and jail bookings. One pilot study found that such an approach saved more than $36,000 in treatment costs per person over the course of a year, nearly twice what the program cost.

“While the healthcare sector plays an important role in providing health services when someone gets sick, many of the factors that keep people healthy are outside the healthcare system and involve where people live, work, play and learn,” said Adam Lustig, Manager of the Promoting Health and Cost Control in States initiative and one of the report authors.  “This report gives state policymakers a menu of evidence-based policies that have been shown to improve individual and community health.”

“I encourage all state policymakers to read this important report.  Doing so will give them access to proven solutions to the challenge of run-away healthcare spending yet so little improvement in health outcomes. To improve Americans’ health, we have to think beyond the healthcare sector and about the many factors that impact health,” said Anand Parekh, MD, MPH, Chief Medical Advisor, Bipartisan Policy Center and a member of the Promoting Health and Cost Control in States Advisory Board.

To create the report, TFAH reviewed approximately 1,500 evidence-based programs and strategies.  The 13 policies ultimately included in the report all:

  • Have a strong health impact and economic evidence of that impact, such as cost avoidance or reduction.
  • Focus on prevention at the population health level, i.e., are designed to prevent illness or injury at the community level rather than the individual level.
  • Focus on primary prevention, preventing an injury or illness rather than treating it.
  • Can be implemented by state legislative action.

The findings show dramatic variability in how states approach these health-promoting policies. For instance, all 50 states plus DC institute tobacco and alcohol taxes. But only nine states and DC have laws in place to encourage universal pre-K programs, which have been shown to set children up for better health later in life. Universal pre-K programs are state funded programs that support pre-K for nearly 50 percent or more of the state’s 4-year-olds. Only six states and DC support paid family leave, even though data show such policies support maternal and child health, and, can save employers money in the long run.

“Action is imperative,” said Auerbach.  “As a nation, we spend trillions of dollars a year on healthcare and yet Americans are getting less healthy.  The solution is two-fold: direct more spending to prevention efforts and address the social determinants of health instead of their impact after someone is sick.”

*states that support state-funded pre-K to nearly 50% or more of the state’s 4-year-olds.
**comprehensive smoke-free as per the American Lung Association
*** rates vary, and higher taxes are generally more effective
**** many states fund such programs in the absence of statewide legislation

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.