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Health in All Policies (HiAP)

Many factors influence individual health beyond clinical services, including socioeconomic status, education, housing, nutrition, and more. Given this, optimizing the nation’s health requires coordinated, shared responsibility across various sectors, and these efforts must be reflected in the programs, activities, and initiatives of the entire executive branch of government. While the U.S. Department of Health and Human Services has a substantial responsibility in advancing the health of the nation, other federal departments and agencies can also have a significant impact on disease prevention and health promotion. Health in All Policies (HiAP) is a strategy that considers the factors that influence health across all levels of policymaking to improve health outcomes.

In this study, the Bipartisan Policy Center explores how three executive branch departments—the U.S. Department of Education (ED), U.S. Department of Treasury (Treasury), and U.S. Department of Labor (DOL)—currently implement a HiAP approach and how these departments can build on these efforts. The report is not meant to be an exhaustive examination, but it does highlight specific examples from these departments, and it offers considerations and
recommendations to those departments and to the Executive Office of the President of the United States to expand on this approach.

The ED has begun integrating health into its policymaking through various programs and initiatives, including the Promise Neighborhoods program, which mitigates family and community poverty to improve health and overall school performance. The ED can continue to influence and advance health through the Every Student Succeeds Act, which sets K-12 public-education policy for states and schools across the country.

  • The ED should integrate health and wellness within existing guidance on needs assessments and evidence-based interventions to provide
    support for issues related to student behavioral and mental health needs and chronic absenteeism.
  • In consultation with the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention, the ED should
    develop better guidance for states that have included chronic absence as a measure of school quality, given that it is strong proxy measure for
    various health conditions.
  • The ED should support efforts to increase access to school health providers such as psychologists and social workers, as these providers help
    address the needs of the whole child.

The Treasury’s activities influence health in many ways, most notably through tax policy. An impactful example is the Low-Income Housing Tax Credit, which provides tax credits to private investors to support the development of affordable housing, contributes to social, economic, and educational benefits for communities and families and also helps reduce homelessness. The department has a similar opportunity to optimize health through community benefit requirements for non-profit hospitals to maintain tax-exempt status. Provisions of the Affordable Care Act now require institutions to complete a community health needs assessment every three years and to develop a community implementation plan.

  • Congress should require community benefit implementation plans be made public.
  • The Internal Revenue Service should partner with the U.S. Department of Health and Human Services to develop guidance that assists
    hospitals in connecting the needs assessment with evidence-based implementation strategies.
  • The Internal Revenue Service should consider including community building spending activities under the community benefit spending
    category to maximize opportunities for hospitals to address the broader determinants of health.

The DOL’s policies influence American workers’ ability to perform at work and at home. A crucial factor in performing at work and at home is health. Past DOL initiatives have been quite successful, including the DOL’s Trade Adjustment Assistance Community College and Career Training program, which created a path to economic stability and better health outcomes for nearly 500,000 students in the United States. One way the DOL supports stable employment is by allowing a variety of employment and educational training grants to cover supportive services, such as child care and transportation. However, there is significant variability in the language surrounding supportive services and the guidance therein.

  • The DOL should clarify and, where possible, standardize supportive-services opportunities across all of their grants.
  • The DOL should consider increasing funding flexibility in grant programs so that grantees can provide additional supportive services based
    on individual community needs.

All executive branch departments should consider adopting a HiAP approach with respect to policymaking whenever feasible. The current administration could build on the prior administration’s National Prevention Strategy, which 17 federal departments developed to prioritize health and quality of life for all Americans. Alternatively, the current administration could support a similar HiAP approach in several different ways.

  • The Office of Management and Budget could ask that departments integrate a HiAP approach into their quadrennial strategic plans as well as
    into their annual budget submissions.
  • The Office of Information and Regulatory Affairs within the Office of Management and Budget could require departmental regulatory proposals
    to include health impact assessments, where applicable.
  • The White House Domestic Policy Council could convene leaders from select departments to establish a HiAP council. The U.S. Department of
    Health and Human Services could provide technical assistance to the council regarding the determinants of health and the evidence-based
    policies that support them.

These options would catalyze a more robust and comprehensive approach to HiAP across the executive branch. Health is impacted by not only health care but also by a plethora of societal factors. The time is ripe for all federal policymakers to appreciate their respective roles in creating a healthier America.

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