Understanding the policy levers needed to build a Culture of Health

10.30.2017
Commentary
A crowd of tourists and locals at Faneuil Hall

Starting this month, nine new P4A research teams will embark on projects to illuminate how policies and laws (at the local, state, and national levels, and in the private sector) can help improve population health, well-being, and equity.

Recent studies tell a bleak story about our nation’s health. Compared to people living in other advanced democracies, Americans spend more on health care, but experience poorer health and shorter lives. And for the first time in a decade, life expectancy in the US has decreased.

Despite the magnitude of the problem, we can’t help but feel optimistic. Digging into the hundreds of submitted proposals, we sensed a growing energy from researchers and practitioners to unite around the values and beliefs integral to a Culture of Health, and to better understand how to use policy and system levers to make a difference in people’s overall health and well-being.

Our newest grantees are joining a dynamic community of researchers that approach issues from multiple lenses and disciplines. The studies are rigorous, with an emphasis on equity. With topics including paid family leave laws, substance use interventions, and vaccine exemptions, our newly funded research projects represent truly innovative thinking on some of the most urgent issues of our time. It’s our pleasure to introduce you to them.

Our new grantees

Housing assistance is a scarce benefit, and research on the impact of federal low-income housing programs on health outcomes remains highly limited.  Boston University School of Social Work, led by principal investigators Thomas Byrne, PhD, and Daniel P. Miller, PhD, will explore whether the monetary value of housing assistance has an impact on health outcomes, and if this impact varies across federal housing assistance programs.

The US is one of three industrialized countries without universal access to paid sick leave. In addition to concerns about inequality, worker well-being, and productivity, a lack of paid sick leave also contributes to the spread of disease, when ill workers are forced to choose between their health and their job. Cornell University, led by principal investigators Nicolas R. Ziebarth, PhD, and Catherine Maclean, PhD, will evaluate the impact of state-level sick pay mandates on coverage rates, other non-mandated fringe benefits, and the spread of infectious diseases.

Childhood vaccines play a major role in minimizing the incidence of vaccine-preventable disease. While all states accommodate medical vaccine exemptions, certain states also allow for waivers on the basis of religious or philosophical objections. George Washington University, led by principal investigators Avi Dor, PhD, and Ali Moghtaderi, PhD, will assess the impact of state vaccine mandates and exemptions on childhood immunization coverage.

Starting January 1, 2018, New York State’s Paid Family Leave Act—a new state law mandating that employers provide paid family leave benefits through an employee-paid insurance policy—will be effective. Health Research, Inc. and New York State Department of Health, led by principal investigators Barbara A. Dennison, MD, and Pinka Chatterji, PhD, will assess the impact of New York State’s new paid family leave law on maternal and infant health outcomes, equity, and the business community.

“Complete Streets” policies enable safe access for pedestrians, bicyclists, transit users, and motorists of all ages and abilities, and have the potential to impact equity by creating activity-friendly environments in communities experiencing large social, economic, and health inequities. Partners for a Healthier Community, Inc. and Tufts University, led by principal investigators Kathleen Szegda, PhD, MPH, MS, and Erin Hennessy, PhD, MPH, will investigate whether “Complete Streets” policies lead to changes in the built environment, the economic environment, the social environment, and health/health behaviors.

As more states and localities consider increasing minimum wages, the effects of these policies on health will become even more pertinent. University of California, Berkeley, led by principal investigators Sylvia A. Allegretto, PhD, and Michael Reich, PhD, will examine the effect of minimum wage variation on infant mortality and prenatal care, as well as outcomes for low-wage workers such as body mass index, and the risk of chronic health conditions.

Within the last several years, views on substance use have shifted, with law enforcement recognizing it as a public health issue, rather than a purely criminal justice issue. Many cities are piloting harm reduction interventions, including the city of Chicago. University of Chicago, led by principal investigator Harold Pollack, PhD, will evaluate and test the expansion of a program piloted by the Chicago Police Department to redirect low-level drug offenders to treatment, rather than to jail and prosecution.

Supporting children’s healthy weight

This year, special supplementary funds were available for research on actionable policies that support children’s healthy weight and/or reduce childhood obesity. The following projects are now underway:

Medicaid and the Supplemental Nutrition Assistance Program (SNAP) currently comprise nearly a quarter of US expenditures on children. The programs have the potential to significantly reduce health and socioeconomic disparities, yet little is known about the impact of these programs on later generations’ health and well-being. University of California, Davis, led by principal investigators Marianne Page, PhD, and Chloe East, PhD, will study the impact of Medicaid and SNAP on the health and well-being of subsequent generations.

In spring 2017, a discount variety store chain began a pilot program enabling 10 of its North Carolina stores to become authorized vendors of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). If adopting a corporate policy to implement a federal nutrition assistance program presented a sustainable business practice, discount stores could radically improve access to healthy food and beverages for low-income communities. University of North Carolina at Charlotte, led by principal investigators Elizabeth Racine, DrPH, RD, and Elizabeth Mumford, MHS, PhD, will assess the economic viability for discount stores in underserved areas to become authorized WIC vendors.

 

By studying policies and laws in the realms of housing, workforce, health care, urban planning, criminal justice and more, our researchers are helping to grow an evidence-base for levers across multiple sectors that have an outsized impact on health and well-being. We’d like to thank all this year’s applicants for their unique ideas and proposals. P4A will launch another open call for proposals in 2018, with more details available in the coming months. Be sure to sign up for our newsletter for all the latest news!

Find our full list of ongoing research projects here.

Photo credit: Jorge Salcedo / Shutterstock.com

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