States spend billions of dollars annually on health care costs, and policymakers increasingly recognize that decisions made in sectors such as transportation, energy, and housing affect those expenditures. To ensure that health is considered in decision-making, leaders in several states have taken up bills to require that local officials, planners, and others evaluate potential health effects through formal public health disciplines.
To better understand this emerging legislative landscape, in 2016 the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, funded a nonpartisan research effort by the Policy Surveillance Program at Temple University. The team developed interactive maps that document state-level bills introduced, enacted, or amended from Jan. 1, 2012, to Dec. 31, 2016, that address either of two main public health approaches:
To be included, bills and laws must either explicitly refer to HIA or HiAP, use the six steps of the HIA process, or include the five key elements of the HiAP approach. According to Temple’s research, from 2012 to 2016, 10 states and the District of Columbia introduced 40 HIA bills, and legislators in California, New Hampshire, and New Jersey enacted or amended a total of three laws. During the same period, 13 states introduced 28 HiAP bills, and eight states and the District of Columbia enacted or amended 19 laws. The interactive map allows users to filter the data in order to learn more about the characteristics of each bill or law. Legislation can be sorted by affected sector and by the bill’s status (enacted or introduced). An adjustable timeline also enables users to pinpoint specific dates.
All the tools created as part of the project are available online:
The tools are intended only to aggregate and organize information, not to assess the quality or feasibility of the bills and laws. Nevertheless, they can help researchers to determine whether and how these types of laws can affect health outcomes; HIA and HiAP practitioners to examine trends and cite legislative examples to build support for these approaches; and policymakers and staff to find examples of legislation that can be adapted, repurposed, or replicated.
Although the public health effects of HIA recommendations or HiAP elements can take years to become apparent, in the future evidence may reveal that these approaches can help contain health care costs and build healthier communities across the country.
Stacey Millett directs the Health Impact Project.