Promoting Health and Cost Control in States (PHACCS)

The PHACCS project focuses on state level policies that can be adopted and implemented to promote health and control cost growth.

TFAH’s Promoting  Health and Cost Control in States (PHACCS) initiative focuses on state-level policies that can be adopted and implemented to promote health and reduce costs.

The United States is spending more and more on healthcare services to treat disease but Americans aren’t getting any healthier. At the same time, spending on the drivers of good health – quality housing, healthy foods, and education – is stagnant or at risk of going down. While the healthcare sector plays a critical role in improving health outcomes, studies show that only 10 to 20 percent of health is determined by medical care. A person’s health is also shaped by their environment and the conditions they encounter in their everyday life. Unfortunately, for too many Americans, poverty and other barriers make it difficult to lead a healthy lifestyle.

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 and lack of access to quality resources in a community are often the result of decades worth of interrelated policies. Unfortunately, as long as there are differences in access to opportunities, there will continue to be differences in health across population groups. Groups of people who are marginalized or disadvantaged often have worse health than those who do not experience such disadvantages. And though individual behaviors play a role in health, many of the choices people make depend on the opportunities available to them.

States are uniquely positioned to take action and adopt innovative approaches to help communities thrive and help residents live healthier lives. To assist state decisionmakers, Trust for America’s Health (TFAH) developed the Promoting Health and Cost Control in States (PHACCS) initiative, to pinpoint evidence-based policies and provide state leaders with information on how to best promote healthy lifestyles and control costs.

Through Phase I of 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 economic impact data. Through a rigorous selection process, TFAH identified six major goals and 13 evidence-based recommended policies 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.


Goal 1: Support the Connections Between Health and Learning
1a. Universal Pre-Kindergarten Programs
Policy Brief | PowerPoint Slides

1b. Enhancing School Nutrition Programs and Standards
(Policy brief coming soon) | PowerPoint Slides 
Goal 2: Employ Harm-Reduction Strategies to Prevent Substance Misuse Deaths and Related Diseases
2a. Syringe Access Programs
Policy Brief | Legal Analysis | PowerPoint Slides
Goal 3: Promote Healthy Behavior
3a. Smoke-Free Policies
Policy Brief | PowerPoint Slides
3b. Tobacco Pricing Strategies
Policy Brief | Legal Analysis | PowerPoint Slides | Webinar Recording
3c. Alcohol Pricing Strategies
Policy Brief | PowerPoint Slides 
Goal 4: Promote Active Living and Connectedness
4a. Complete Streets
Policy Brief | PowerPoint Slides | Legal Analysis (coming soon)
Goal 5: Ensure Safe, Healthy, and Affordable Housing for All
5a. Housing Rehabilitation Loan and Grant Programs
(policy brief coming soon) | PowerPoint Slides
5b. Rapid Re-Housing Programs/Housing First
Policy Brief | PowerPoint Slides 
Goal 6: Create Opportunities for Economic Well-Being
6a. Earned Income Tax Credit
Policy Brief | PowerPoint Slides

6b. Earned Sick Leave
Policy Brief | PowerPoint Slides
6c. Paid Family Leave
Policy Brief | PowerPoint Slides 
6d. Fair Hiring Protections (Ban the Box)
Policy Brief | PowerPoint Slides 

In February, 2019, TFAH released the first PHACCS report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change, detailing the 13 recommended policies identified by this initiative. The report includes descriptions of each policy, summaries of health and economic evidence, case examples and considerations for implementation.

Moving forward, TFAH will build upon Phase I of PHACCS by educating and assisting state policymakers and key stakeholders interested in adopting and advocating for the PHACCS policies.

TFAH will engage in the following activities through December 2020:

  • Update and maintain the PHACCS report and develop other helpful materials, such as policy briefs.
  • Develop policy surveillance data sets for all PHACCS recommended policies.
  • Host a set of regional meetings to engage with key state-level stakeholders and build support for the PHACCS recommended policies.
  • Regularly convene state-policy focused organizations to improve coordination and collaboration.
  • Establish a Learning and Action Collaborative to support state decision makers and influencers through the provision of strategic advice technical assistance, regular communication and other education efforts.
  • Develop a sustainability and action plan to determine the next steps for the PHACCS initiative.