The coronavirus pandemic continues to draw an ever-wider range of public policy responses across the United States, from the expansion of unemployment and paid leave benefits to temporary reprieves from student loan payments, evictions, and municipal water service shut-offs. Such actions reflect a recognition that virtually all government branches and agencies can contribute to controlling this deadly disease, softening the blow to Americans’ health and financial well-being, and reducing disparities in health outcomes caused by factors such as race, income, or geography.
Policymakers should apply this same approach to other complex public health problems, such as the rise in pregnancy-related deaths among American women. Coordinated strategies that cut across government agencies and societal sectors should be the rule for, not exception to, responding to COVID-19 and other extraordinary threats.
However, many states lack the skills and leadership structures needed to develop and implement cross-sector plans aimed at improving their residents’ health. Maternal mortality rates, for example, have often been viewed as an issue for health departments and medical institutions to address, despite evidence that transportation, education, and housing policies significantly influence women’s care and outcomes during and after pregnancy.
That’s why the Health Impact Project is supporting work by nine states and the District of Columbia to build interagency relationships so they can leverage those connections to develop strategies to boost maternal and infant health. These efforts also can provide a blueprint for improving other key measures of well-being in the future.
A core part of this work involves analyzing and understanding the factors driving health disparities between different populations. For example, the risk of pregnancy-related death is three to four times greater for black women than white women at all levels of income or education. Research and data on complex health challenges confirm that a range of social determinants of health contributes to gaps in support and care.
In responding to COVID-19, for example, policymakers and advocates have highlighted how the lack of paid sick days affects Americans’ ability to protect themselves and their families from the outbreak and contain its spread. More than 32 million U.S. workers have no such benefits. And many of those people work in the food service and child care industries, which involve significant public interactions that put them at greater risk of exposure to contagious illnesses.
Detailed analyses called health impact assessments (HIAs) conducted at the local, state, and national levels provide evidence that guaranteed paid sick leave can significantly benefit public health. Specifically, studies have found that this benefit could have a strong effect on stopping flu outbreaks from becoming pandemics and in reducing the transmission of disease through restaurants and other community settings.
An HIA in San Francisco showed that paid sick leave can prevent hunger and financial hardship among low-income workers, who would not lose wages during times of illness. Another done in Vermont found that such policies could lower health care costs by reducing unnecessary trips to the emergency room for conditions that are treatable by primary care physicians during regular business hours.
Still, paid sick leave is just one of many interrelated factors that contribute to the health and well-being of workers. Local, state, and national policymakers and organizations looking for effective solutions to complex health challenges such as infant and maternal health or pandemics should seek approaches that cross multiple sectors, including housing, transportation, education, and others.
These issues require combined expertise and resources from across sectors—including some not traditionally associated with health care. With evidence-based, interagency strategies, policymakers at all levels of government can more effectively address the many drivers of their residents’ well-being and provide opportunities for all to be as healthy as possible.
Stacey Millett directs the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.