Issue Category: Sick Leave

Combating COVID-19: Why Paid Sick Leave Matters to Controlling its Spread

This webinar highlights recommendations made in TFAH’s Ready or Not and Promoting Health and Cost Control in States (PHACCS) reports on the important role of paid sick leave in combating infectious diseases, as well as other complementary evidence-based policies that can be adopted by federal, state and local governments and by employers.

Presenters focused on pending federal legislation, states that have adopted laws regarding paid leave, and businesses that are expanding these benefits. In addition, they discussed the potential short-term uses of the recently approved supplemental budget to assist individuals without paid leave when confined to their homes.

Recommended for anyone working in public health, advocacy, school health, community-based organizations, businesses, labor unions, hospitals, health systems, insurers, policy staff, and local and state health officials.

10th Anniversary of the ACA: A Time to Reflect on its Impact and Refocus Efforts on the Act’s Purpose and Goals

COVID-19 has shown how important it is to fully fund the ACA created Prevention and Public Health Fund

March 23, 2020

This tenth anniversary of the enactment of the Affordable Care Act (ACA) is an appropriate time to measure its impact and recommit to its purpose.  Prior to the ACA, more than 44 million non-elderly adults were uninsured. By 2016, that rate of uninsured people reached a historic low as approximately 20 million Americans gained access to health insurance coverage under the ACA including 12 million adults who gained coverage due to Medicaid expansion.[1]

The ACA was transformative legislation in at least three ways. It offered Americans access to medical care when they were acutely ill and when they needed ongoing treatment for a chronic condition (78 percent of U.S. adults 55 and older have at least one chronic condition[2]). In addition, millions of Americans gained access to preventive care such as vaccinations and health screenings.   Thirdly, it helped advance health equity by narrowing – although not eliminating – the gaps in access to high-quality care experienced by people of color due to economic disadvantage and systemic discrimination.

Prior to the ACA, Black Americans were 70 percent more likely to be uninsured than Whites and the uninsured rate for Latinos was nearly three times the uninsured rate for Whites[3]. After the ACA became law, Latinos had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell by 8 percent for Asian Americans and Black Americans during the same period.[4]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among low-income individuals and within specific vulnerable populations.[5] A study by the National Bureau of Economic Research found that Medicaid expansion is associated with reduced mortality.[6]  According to the study, states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[7]

Furthermore, the ACA created the Prevention and Public Health Fund (PPHF) and allocated $2 billion annually as an “expanded and sustained national investment in prevention and public health programs”. Unfortunately, much of the PPHF funding has been reallocated to other programs outside prevention and public health. On this 10th anniversary of the passage of the ACA, Congress should redouble its efforts to ensure the Prevention Fund is fully funded and that those funds are directed as intended, to prevention and public health programs.

As the COVID-19 pandemic has put in the spotlight, individual health is often linked to community health. The Prevention and Public Health Fund’s intended purpose and emphasis: sustained investment in the nation’s public health infrastructure would, if fully realized, strengthen our national readiness for health emergencies. A level of readiness that the COVID-19 pandemic has shown to be seriously inadequate.

While this 10th anniversary of the Affordable Care Act is a time to recognize and applaud its significant impact, it is also a time to shine a spotlight on the fact that over 27 million Americans remain without access to healthcare due to being uninsured.  Ensuring that all Americans have access to healthcare is a priority of Trust for America’s Health and must be a national priority.

 

[1] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[2] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[3] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[4] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

[5] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[6] Sarah Miller et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” National Bureau of Economic Research working paper, August 2019, https://www.nber.org/papers/w26081.

[7] Ibid

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response

(Washington, DC) – A cross-sector group of 55 public health, health, labor, business and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately upon declaration of a public health emergency. Fourteen days aligns with the currently recommended quarantine period for COVID-19. Furthermore, and beyond the COVID-19 response, the coalition recommends that the new law require all employers, regardless of their size, to allow workers to earn up to seven days of paid sick leave for use when they or a family member is ill or for preventative care.

The group is also proposing tax relief or interest free loans to be made available for small businesses that provide sick leave benefits during a public health emergency and that employees be allowed to take leave if schools or places of employment close due to a public health emergency. Furthermore, employees should be allowed to use leave to care for family members and should be protected from job loss or any other forms of reprisal if they comply with public health or medical advice to stay home.

Multiple health studies have found that the absence of paid sick leave has been linked to or has exacerbated infectious disease outbreaks in the past. In dealing with the current novel coronavirus, the experience of other countries indicates that aggressive social distancing measures can help slow the spread of the virus. Yet for the 34 million individuals who do not have access to paid sick leave, staying at home may not be a realistic option. Many individuals without paid sick time earn low wages, and a disproportionate percentage work in the service industry. Just 30 percent of low-wage workers in the private sector have access to paid sick leave, compared to 93 percent of higher-wage workers.

“Everyone has a role to play in managing the COVID-19 outbreak. Immediate passage and fast implementation of a national paid sick leave law will allow all workers to follow the directions of their communities’ public health officials. It is critical to mitigation efforts that people be able to stay home from work if they are sick or if they may have been exposed to the virus without facing the impossible choice of their health or their financial stability,” said John Auerbach, President and CEO of Trust for America’s Health.

A letter outlining the recommended policy actions was delivered today to Vice President Mike Pence, Senate Majority Leader Mitch McConnell, (R-KY), Senate Minority Leader Charles Schumer, (D-NY), House Speaker Nancy Pelosi, (D-CA), and House Republican Leader Kevin McCarthy (R-CA).

Organizations signing-on to the letter were:

American Lung Association
American Medical Student Association
American Public Health Association
American School Health Association
American Sexual Health Association
American Society of Tropical Medicine and Hygiene
Antibiotic Resistance Action Center, George Washington University
Asian & Pacific Islander American Health Forum
Association for Prevention Teaching and Research
Association for Professionals in Infection Control and Epidemiology
Association of Maternal & Child Health Programs
Association of Public Health Laboratories
Association of Schools and Programs of Public Health
Center for Global Health Science and Security Georgetown University
Center for Public Policy Priorities
Center for Science in the Public Interest
Children’s Environmental Health Network
Clean Habitat Inc
Colorado Association of Local Public Health Officials
Council of State and Territorial Epidemiologists
de Beaumont Foundation
Florida Institute for Health Innovation
Georgetown University Center for Global Health Science and Security
Green & Healthy Homes Initiative
Health Resources in Action
HIV Medicine Association
Immunize Nevada
Infectious Diseases Society of America
Liver Health Initiative
March of Dimes
National Association of County and City Health Officials
National Association of School Nurses
National Coalition of STD Directors
National Council of Jewish Women
National Fragile X Foundation
National Health Care for the Homeless Council
National Network of Public Health Institutes
National Organization for Women
NERDS RULE INC
NW Unangax Culture
NYU School of Global Public Health
PATH
Peggy Lillis Foundation
People’s Action
Prevention Institute
Public Health Institute
Public Health Solutions
Rollins School of Public Health
Safe States Alliance
Shriver Center on Poverty Law
Society for Public Health Education
Sumner M Redstone Global Center for Prevention and Wellness
Trust for America’s Health
Washington State Department of Health
Washington State Public Health Association
Women’s Law Project

# # #

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.  Twitter: @healthyamerica1

TFAH’s Dr. J. Nadine Gracia’s Testimony before House Committee on Homeland Security, Subcommittee on Emergency Preparedness, Response, and Recovery. COVID-19 Response

Dr. J. Nadine Gracia, Executive Vice President and Chief Operations Officer of Trust for America’s Health (TFAH), provided testimony during the Community Perspective on Coronavirus Preparedness and Response before the Subcommittee on Emergency Preparedness, Response, and Recovery of the House Committee on Homeland Security. Dr. Gracia’s testimony highlights TFAH’s policy recommendations to strengthen our nation’s preparedness for public health emergencies and improve the national response to the novel coronavirus.

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities

(Washington, DC – March 5, 2020) – Trust for America’s Health, a nonprofit, nonpartisan public health policy organization, applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis.

Emergency funding is critical now for the following:

  • Domestic public health. The supplemental provides essential support to states and local public health departments. This will provide support for their work which includes identifying and investigating cases, isolating and quarantining individuals, screening travelers at airports, ensuring the laboratory capacity to test patients for the virus, coordinating with the health sector to guarantee needed services are available, assessing the needs of those who are most vulnerable because of social, economic or environmental conditions and communicating with the public and healthcare facilities. The breadth of the response is quickly exhausting the funding provided in annual appropriations bills.
  • Healthcare response.  The supplemental provides support to hospitals, health centers and other clinical facilities across the nation have begun to identify, isolate and care for patients with COVID-19.  Among the work of the health care system is training healthcare workers on the identification of COVID-19 cases and on appropriate infection control practices and treatment.  The supplemental includes funding for training, provision of healthcare at community health centers, who serve the most vulnerable Americans, and ensuring the health care sector has appropriate personal protective equipment, necessary clinical supplies and equipment, and surge capacity.
  • Medical countermeasures research and development. The supplemental ensures the U.S. prioritizes development and procurement of COVID-19 diagnostics, vaccines, and treatments. The federal government must be a reliable partner in development of products to combat the virus.
  • Global health security. The supplemental supports global efforts through the World Health Organization, USAID and other agencies to boost the capacity of lower-income countries to detect and control infectious disease outbreaks.  This will protect Americans as well as other countries by decreasing the likelihood of transmission as a result of travel and commerce.
  • Investing in standing reserve funds. The supplemental fully replaces funds spent from the Infectious Disease Rapid Response Reserve Fund and adds money in this fund, so new funding can be immediately accessed if needed to fight COVID-19 and as an investment in protecting Americans from future outbreaks.
  • Replacing funds lost due to transfers. The supplemental includes a requirement to pay back the $136 million transferred between HHS program for the initial COVID-19 response.

The full extent of the outbreak in terms of public health, healthcare and personal costs remains to be seen, but this investment is needed now.  Taking immediate steps to mitigate the effects of the outbreak will save lives and prevent harm.

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

 

TFAH Statement on COVID-19 Preparations

March 3, 2020

Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize the following:


Emergency funding is critical now, with ongoing funding to prevent future emergencies

Congress should quickly approve a supplemental funding package, with significant investments in domestic and global public health, healthcare preparedness and research and development of medical countermeasures. Federal agencies should be preparing to quickly distribute funds to states and local governments, as any delay could cost lives.

Congress and the administration should not rely on transfers between health programs to solve this problem.  TFAH recommends that Congress use the supplemental funding package currently being considered to back-fill programs that have already been cut to transfer funding for the COVID-19 outbreak response. Reprogramming money from other public health initiatives, such as chronic disease prevention, won’t serve the public’s health in the long run.

The emergency supplemental funding should include the following priorities:

  • Domestic public health. States and local jurisdictions have stood up their emergency operations, identifying and investigating cases, isolating and quarantining individuals, screening travelers at airports, ensuring the laboratory capacity to test patients for the virus, coordinating with the health sector to guarantee needed services are available, assessing the needs of those who are most vulnerable because of social, economic or environmental conditions and communicating with the public and healthcare facilities. Attention needs to be paid to those people who seem to be most at risk for serious health complications due to COVID-19 including the elderly and people with underlying health conditions. The breadth of the response is quickly exhausting the funding provided in annual appropriations bills.
  • Healthcare response. Hospitals, health centers and other clinical facilities across the nation are preparing to identify, isolate and care for patients with COVID-19.    They must do so without interrupting the routine and necessary clinical services for those with other healthcare needs.  This will require training for healthcare workers on the identification of COVID-19 cases, and on appropriate infection control practices and treatment.  The health care sector needs resources for some of these activities and to ensure it has appropriate personal protective equipment, necessary clinical supplies and equipment, and surge capacity.
  • Medical countermeasures research and development. The U.S. government should prioritize development and procurement of COVID-19 diagnostics, vaccines, and treatments. This will require special measures to anticipate and plan to meet future need and to determine how to make appropriate services available to all with special attention to those in underserved communities.
  • Global health security. The U.S. must support global efforts through the World Health Organization, USAID and other agencies to boost the capacity of lower-income countries to detect and control infectious disease outbreaks.  This will protect Americans as well as other countries by decreasing the likelihood of transmission as a result of travel and commerce.
  • Invest in standing reserve funds. The supplemental should fully replace funds spent from the Infectious Disease Rapid Response Reserve Fund and add a significant amount of money in this fund, so new funding can be immediately accessed if needed to fight COVID-19 and as an investment in protecting Americans from future outbreaks.

The full cost of the outbreak will become clear in the next few months, but in the short term, a significant investment is needed now. Ongoing monitoring of the course of the outbreak will determine the total amount of additional funding that may be required.


Ensure that core public health is continually funded 

In addition to short-term supplemental funding, Congress must prioritize ongoing investment in public health as part of the annual appropriations process.  The nation’s ability to respond to COVID-19 is rooted in our level of public health investment of the last decade.  That is, being prepared starts well before the health emergency is upon us and is grounded in year-in and year-out investment in public health programs. In addition, our public health system needs a highly skilled workforce, state-of-the-art data and information systems and the policies, and plans and resources necessary to meet the routine and unexpected threats to the health and well-being of the American public.  The nation has been caught in a cycle of attention when an outbreak or emergency occurs, followed by complacency and disinvestment in public health preparedness, infrastructure and workforce between emergencies.  These are systems that cannot be established overnight, once an outbreak is underway.

Science is key to effective response

Science needs to govern the nation’s COVID-19 response, led by federal public health experts – including the CDC and NIH leadership – who have years of experience in responding to infectious disease outbreaks.  Keeping the public fully informed is critically important, if trust is to be retained. Policy decisions – from the federal to the local level – should also be based on the best available science.

Local governments and other sectors must prepare now for various contingencies.

  • Healthcare facilities must plan for a surge of patients. Such planning should include taking steps to ensure continuity of operations if a sizable number of their workforce is sick.  They must prioritize the safety of patients and workers, by using personal protective equipment and by providing adequate training. Healthcare coalitions – in coordination with governmental entities – should offer situational awareness and coordination between facilities.
  • Employers, including those in the healthcare sector, should adopt paid sick days protections for workers to protect the health and safety of other workers and the general public. In addition, they should assure their employees that missing work due to illness will not jeopardize their job.
  • Communities that are considering school or business closures or similar measures should consider unintended consequences and take appropriate action steps. If closings are necessary authorities should assist families for whom such action is especially problematic, such as low- income families and individuals without paid sick leave, and children who rely on school meals for adequate nutrition.  Homebound individuals who need access to health care personnel, equipment and medications may also need additional assistance.

The full extent of the outbreak in terms of public health, healthcare and personal costs remains to be seen.  We do know that taking immediate steps to mitigate the effects of the outbreak will save lives and prevent harm.

Vaccines Prevent Infectious Disease Outbreaks and Protect Communities (August 2019)

Infectious diseases disrupt the lives millions of Americans every year.  Fortunately, vaccines can prevent many of these diseases.  Nonetheless, because the U.S. vaccination rates are lower than they should be, unnecessary illness and even death occurs.

For example, the seasonal flu causes much preventable suffering.  The Centers for Disease Control and Prevention (CDC) found an estimated 80,000 people died—among them, 185 children—from seasonal flu in 2017–2018, nearly twice what is considered typical during an average flu year. In addition to the devastating health impacts, it is estimated that seasonal flu costs the nation approximately $87 billion in medical spending and lost work productivity annually.

The U.S. is currently in the midst of its worst measles outbreak in two decades, causing more than 1,000 cases.  With the measles outbreak still growing, it is important to highlight the life-saving impacts of vaccines for people of all ages and take actions to ensure that vaccine use remains a common practice.

Key Findings

  • Vaccines have helped save up to 3 million lives per year worldwide by preventing diseases such as hepatitis B, meningitis, measles and polio. Additionally, researchers say that every dollar spent on vaccination brings back return on investment in health, economic and societal benefits in 94 low to middle income countries.
  • The CDC estimates that vaccination of children born between 1994 and 2018 in the U.S. will prevent 419 million illnesses, help avoid 936,000 deaths, and save nearly $1.9 trillion in total societal costs.
  • In 2018, the CDC reported that the percentage of children under age 2 who had not received any recommended vaccinations quadrupled since 2001.
  • Adult vaccination rates remain far below targets in Healthy People 2020, including for hepatitis B, seasonal flu, pneumococcal, and shingles.
  • Seasonal flu vaccination rates for Americans ages 6 months and older dropped from 47 percent in the 2016-2017 season to 42 percent during the 2017-2018 season. The 2017– 2018 flu season in the United States was the deadliest in nearly 40 years—tragically underscoring the importance of annual vaccination.
  • The World Health Organization has named vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, as one of the top ten threats to global health.

Recommendations

  • Significantly increase support for the vaccine infrastructure, outbreak prevention and response. CDC’s immunization program supports state and local immunization programs to increase vaccine rates among uninsured and underinsured adults and children, respond to outbreaks, educate the public and target hard-to-reach populations, improve vaccine confidence, establish partnerships, and improve information systems. Funding has not kept up with needs as states have to spend immunization dollars to respond to outbreaks, increases in the numbers of those who lack health insurance and vaccines, such as HPV, that are underused. Congress should significantly increase funding for CDC’s immunization program.
  • Raise awareness about the importance of vaccination and improve vaccine acceptance. Government, healthcare providers, health systems and other trusted partners should use varied and targeted media channels to educate people about the importance, effectiveness, and safety of vaccinations. Congress should provide needed resources to the United States Department of Health and Human Services to study the causes for vaccine resistance and to educate clinical providers on methods for improving vaccine acceptance.
  • Minimize vaccine exemptions for schoolchildren and healthcare workers. States should enact policies that enable universal childhood vaccinations to ensure children, their classmates, educators and the general public are protected from vaccine-preventable diseases. This includes eliminating non-medical exemptions and opposing legislation to expand exemptions. States should ensure medical vaccine exemptions are only given when appropriate and are not used as a de facto personal belief exemption in states where those exemptions have been eliminated. Healthcare personnel should also be required to receive all recommended vaccinations of the Advisory Committee on Immunization Practices (ACIP) in order to protect staff and patients, assure continuity of operations in the event of an outbreak and, achieve necessary healthcare infection control. Healthcare facilities should ensure access to vaccines for all staff and contractors and remove barriers for staff receiving vaccines.
  • Ensure first-dollar coverage for recommended vaccines under Medicaid, Medicare, and commercial insurance. Public and private payers should ensure that ACIP-recommended vaccines are fully covered, as cost-sharing can be a significant barrier to vaccination.
  • Increase the pool of providers who immunize. As new vaccines are approved, reaching target populations will be critical. States can expand certain health care providers’ roles and scopes of practice to increase the pool of professionals who give shots, such as pharmacists and paramedics.  All insurance plans should consider including pharmacies and other complementary providers as in-network and receive equal payment for vaccine administration services for their adult and pediatric populations.

 

 

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.”

Notes:
*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

# # #

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.  www.tfah.org