Health, Medicine and Society Program

Health in all policies

Health in all policies. Health is fundamental to every sector of our economy. Recent research has shown that many factors outside of health care have a huge impact on health. From agriculture policy that influences the food on our dinner table to national environmental decisions that put us at risk for disease, every choice we make brings us closer to, or moves us further from, our national health goals. Therefore, every policy, large and small, and every decision, personal and political, should take into consideration its impact on health. No compromise should be reached without analyzing its health footprint. From transportation and education to energy and trade, every political decision has a health cost or benefit ? and these costs and benefits should be weighed in every decision. Considered wisely, health could be a powerful economic driver. Our leaders should lead by example, and health is a great place to start.

Factors outside the health care system often play a large role in determining one’s health status; therefore, not all determents of health can be controlled by policies within the health sector. In turn, better health boosts economic growth.

The impact of some policies (i.e., environmental policy) on health has been well documented1. For instance, a strong relationship between outdoor air pollutants and asthma has been established – power plants, emissions from chemical plants and oil refineries, diesel emission particulates and certain pesticides have all been found to produce environmental triggers for asthma. Efforts to reduce downtown traffic congestion in Atlanta during the Olympic Games resulted in decreased traffic density, which was associated with a prolonged reduction in ozone pollution and significantly lower rates of childhood asthma events.2

A 2002 study found that the costs to society of environmentally attributable diseases in children was $54.9 billion - $43.4 billion of which was attributable to lead.   Food, marketing, housing, and environmental policy all play a role in reducing this threat to children:

  • Ban of use of lead in residential paint by CPSA (1978)
  • Phase out of lead in gasoline by EPA (1986)
  • Eliminate use of lead in domestically canned foods (USFDA)
  • Healthy People 2010 calls for total elimination of elevated blood lead in children

An econometric study by former Harvard researcher demonstrated that strict enforcement of lead abatement statutes reaps enormous dividends, health wise and financially, concluding “although the initial costs of making these units lead safe may seem prohibitive, the costs of not intervening are staggering.3

Linking community planning to goals of increasing population health and decreasing sedentariness can be employed. Physical activity can be encouraged by providing sidewalks, safe bike paths, and parks. “The European countries with the highest levels of walking and cycling have much lower rates of obesity, diabetes, and hypertension than the United States. The Netherlands, Denmark, and Sweden, for example, have obesity rates only a third of the American rate, while Germany’s rate is only half as high. Moreover, the average healthy life expectancies in those 4 European countries are 2.5 to 4.4 years longer than in the United States, although their per capita health expenditures are only half those of the United States.”4

Agricultural policy, food policies, and other food- and nutrition-related sectors, such as manufacturing, marketing and trade of foods, can influence the diet of a population. For instance, healthy and nutritious food choices, such as vegetables and fruits, should be made readily available and reasonably priced. Freedom of choice can exist along empowering consumers to make the healthiest choices. The lack of access to affordable, healthy food choices in neighborhood food markets is a barrier to purchasing healthy foods.5 One study by UNC found that African Americans’ intake of fruits and vegetables increased 32 percent for each additional supermarket located in their neighborhood.   Also, more residents in an African American neighborhood limited their intake of fat when they had access to a supermarket compared with residents in a neighborhood without any markets.”6

Finally, smoking can be influenced by a variety of factors and policies, including tax, agriculture, clear labeling, and marketing restrictions. Consumer demand can be lowered while farmers can be incentivized to stop growing tobacco in favor of more healthy crops or land use. Tobacco Trust Funds can be used to help tobacco farmers switch crops. In North Carolina, a growth in wineries has in some cases been attributed to an increasing number of tobacco farmers switching to grapes.7 Maryland paid farmers to give up tobacco. Using monies from the National Tobacco Settlement, from 2002, farmers were paid to stop growing tobacco and many turned their land into other purposes: crops, livestock and other products, including grains; fruits; wine grapes; vegetables, organic and traditional; livestock; herbs, and flowers.8



[1] http://content.healthaffairs.org/cgi/content/full/24/2/339?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=agricultural+policy+and+health&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

[2] Friedman MS, Powell KE, Hutwagner L, Graham LM, Teague WG. “Impact of Changes in Transportation and Commuting Behaviors During the 1996 Summer Olympic Games in Atlanta on Air Quality and Childhood Asthma,” JAMA vol 285:897-905.

[3] Brown MJ. The Costs and Benefits of Enforcing Housing Policies to Prevent Childhood Lead Poisoning. Med Decis Making 22; November/December 2002.

[4] Pucher J, Dijkstra L. “Promoting Safe Walking and Cycling to Improve Public Health: Lessons from the Netherlands and German.” AJPH Vol 93, no. 9 (September 2003):1509-1516

[5] http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/contributing_factors.htm

[6] Communities And Health Policy: A Pathway For Change, Judith Bell and Marion Standish , health affairs 24, no. 2 (2005): 339-342

[7] http://www.tobaccotrustfund.org/

[8] http://www.washingtonpost.com/wp-dyn/content/article/2007/02/28/AR2007022800006.html