Research shows that a person’s health, including their ability to make healthy choices, is impacted by where they live, their income, their educational attainment, and other factors. Differences in the availability of such opportunities are often driven by multiple policies outside the health sector, but which have health impacts.

Addressing barriers to good health through policy action and cross-sector work is key to creating the community conditions that allow people to enjoy optimal health. States are uniquely positioned to adopt innovative approaches to help communities thrive and allow residents to live healthier lives, even as the federal policy environment grows more complex and state budgets tighten. To support state decisionmakers and community advocates, Trust for America’s Health (TFAH) developed the PHACCS Initiative to identify and highlight evidence-based policies and provide state leaders with information on how to best promote good health and reduce costs.

At a time when 42 percent of all U.S. adults are living with two or more chronic health conditions— often linked to social, economic, or environmental barriers to good health—changes in the federal policy and budget landscape have reduced funding and governmental expertise devoted to protecting and improving Americans’ health.

At the same time, funding for health promoting programs in other sectors, such as those addressing quality housing, healthy foods, and education, is also under threat. Working across sectors and at all levels of government to implement policies and programs that advance drivers of good health is now more critical than ever.

For the PHACCS initiative, Trust for America’s Health reviewed over 1,500 policies, programs and strategies from national databases, focusing on those with both promising health outcomes and positive economic impact data. Through a rigorous selection process, TFAH identified six major goals and 13 evidence-based recommended policies and programs for state policymakers to explore as they consider how to best use their state’s resources to improve the health and well-being of their residents

PHACCS Reports: Recommendations for Evidence-based Policies  

The first PHACCS report published in 2019, Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change, details the initiative’s 13 recommended policies. The report includes descriptions of each policy, summaries of their health and economic evidence, case examples, and considerations for implementation.

Published in 2021, the second PHACCS report, Levering Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity, expands on the first report by providing in-depth reviews of policies and programs within five issue areas: access to healthcare, economic mobility, affordable housing, safe and healthy learning environments for children, and health promoting excise taxes. The report identifies additional policies that, if implemented, can create the conditions in people’s lives that support optimal health. The report identifies the main components of the policy area, provides case examples, and recommends action steps for policymakers.

NEW PHACCS Report to be Released in December 2025: Updates on PHACCS Policies and Policy Environment

This third report in the PHACCS series, titled Advancing Policies that Create Conditions for Good Health: Opportunities, Barriers, and Strategies, to be published in December 2025, provides insight into how states are faring in their pursuit or implementation of these policies. The report details a federal policy environment that has changed drastically since the PHACCS initiative launched, and how those changes are affecting efforts to implement state policies that address drivers of good health. The report also summarizes input from organizations and government partners about strategies they found to be effective in advancing these policies. Lastly, the report shares updates on federal administrative and legislative decisions in 2025 that may affect states’ ability to implement health-promoting policies.

Specifically, the report is divided into three sections:

Section 1: Creating Conditions for Good Health: A Changing Policy Environment

Outlines recent major federal policy wins that have supported states in advancing PHACCS policies, as well as current federal and state policy decisions that complicate their ability to advance them. The section also includes some state initiatives that have developed a modified strategy to continue their work amid federal uncertainty, and those that have had to revoke their efforts.

Section 2: Creating Conditions for Good Health: What’s Working for States

Summarizes the themes we heard from organizations and government partners about strategies they found to be effective in advancing PHACCS policies, as well as challenges they’ve encountered. This section highlights the resilience and creativity of state and local partners to define wins in the context of their political environments and pursue them accordingly. It also features examples and anonymized quotes about state initiatives and how they’ve navigated the pursuit or implementation of these policies.

Section 3: Creating Conditions for Good Health: Progress and Highlights of PHACCS Policies

Includes trends in several policy areas highlighted by the 2019 and 2021 PHACCS reports noting that more states adopted these policies in recent years. The report revisits the health benefits of each policy, highlights recent federal policy changes in those areas, summarizes proposed federal policy and budget changes that may affect states’ capacity to adopt and implement these policies, and features states’ experiences adopting or implementing these efforts.

Date published: November 2025