(Washington, DC – July 29, 2021) – This report, part of TFAH’s Promoting Health and Cost Controls in States initiative, reviews five policy areas: access to healthcare, economic mobility, affordable housing, safe and healthy learning environments for children, and health-promoting excise taxes, and, based on an extensive review of the evidence, recommends federal and state-level policies to improve health outcomes, advance health equity and reduce healthcare spending. America’s chronic disease and health disparities crisis require policy interventions targeting structural racism and the social determinants of health, the report concludes.
Today, nearly half of all Americans have at least one chronic disease, and that number is growing. In addition, the COVID-19 pandemic starkly illuminated the ways in which social and economic conditions and inequities – often deeply rooted in communities due to historical and current day structural racism and discrimination – greatly increase health risks and burdens for some populations groups, including many communities of color. According to the CDC, hospitalization rates during the height of the COVID-19 pandemic were 3.3 times higher for American Indian/Alaska Natives and approximately 3 times higher for Blacks and Latinos as compared to the hospitalization rate for whites.
“The COVID-19 pandemic put a spotlight on the role that social and economic conditions play in health and gives policymakers an opportunity to build an improved social supports and public health system,” said J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health. “Focusing solely on individual behavior will not solve America’s health crisis. Building healthy and thriving communities and advancing health equity require improving the social and economic conditions that shape health. Only then will everyone have a fair and just opportunity to enjoy optimal health.”
The social determinants of health are factors beyond traditional healthcare that significantly impact health including where you are born, live, work, play, go to school, and age. Data show that these factors impact a wide range of quality-of-life outcomes and health risks. For example, where you live, has a measurable impact on overall health status and longevity. Furthermore, inequities limit access to health resources and educational and economic opportunities that can lead to poor health.
Policy decisions can drive improvements in the social conditions in communities or they can perpetuate inequities. Policies do not need to be deliberately discriminatory to exacerbate inequities. For example, tying school funding to local property taxes leaves schools in lower income communities with fewer resources than higher income neighborhoods.
The report identifies policies that, if implemented, can create the conditions in people’s lives that support optimal health.
Recommended policy actions in each category includes:
Goal: Supporting Access to High-Quality Healthcare Services
Recommendation: Adopt Medicaid Expansion. States that have adopted Medicaid expansion experienced the largest reductions in the number of uninsured persons. In 2018, the uninsured rate among low-income, non-elderly adults in states that expanded Medicaid eligibility was about half that of the uninsured rate in states that did not expand the program. Increased access to healthcare saved lives and was associated with a reduction in total state spending on traditional Medicaid.
Goal: Promoting Economic Mobility
Recommendation: Expand the Earned Income Tax Credit. The earned income tax credit (EITC) is a tax credit offered to eligible low-income workers to enhance their economic security. EITC policies, both federal and state, help lift millions of working families out of poverty and reduces the severity of poverty for millions more.
Goal: Ensuring Access to Affordable Housing
Recommendation: Expand the Low-income Housing Tax Credit Program. Decades of research has demonstrated a connection between safe and secure housing and good health. The low-income housing tax credit (LIHTC) provides tax incentives to encourage developers to build affordable housing. Since the LIHTC program was created approximately 3 million quality homes have been developed to serve working families, older adults, people with disabilities and those at risk of homelessness. Despite this success, the need for affordable housing remains high across the country.
Goal: Promoting Safe and Healthy Learning Environments for Children
Recommendation: Increase access to high-quality early childhood education programs. Research demonstrates the many ways in which safe and supportive school environments put children on healthy developmental pathways. High-quality early childhood education programming, such as Head Start and pre-K can have long-lasting positive impacts on children throughout their lives. Early childhood education centers and schools are also critical sources of nutrition for millions of children through the National School Lunch and School Breakfast Programs and provide access to healthcare for millions of students via school-based health centers.
Goal: Using tax policy to encourage healthy choices
Recommendation: Tax unhealthy products, like tobacco and sugar-sweeten beverages. Such taxes can be a win-win for localities, encouraging healthy choices and raising local revenue that can be reinvested in health-promotion and prevention programs.