Updated April 2020
Governors can control costs, advance their priorities, and enhance lives by improving the social and economic conditions that make up 80 percent of the factors affecting their residents’ health. Governors are uniquely positioned to maximize state resources to address the conditions affecting health by leading cross-agency and public-private collaborations, leveraging siloed state resources, and advancing evidence-based health policy approaches.
The National Academy for State Health Policy (NASHP) and the de Beaumont Foundation have developed a set of practical, real-world tools to help governors and their teams address their policy priorities by improving health.
Tools
What Influences Health
Health is more than medical care — it is shaped by neighborhoods and schools, by air, water, and environment, and by opportunities to learn, work, and thrive. Evidence bears this out. Some states’ counties are healthier than others, life expectancy varies greatly between subway stops, and health is determined far more by life conditions than by clinical care. Click here for more information about how the conditions in which residents live, work, play, and age affect their health. State agencies already make large investments in the ways people live, learn, and work. Governors can ensure all agencies row in the same direction to help all residents to live healthy, safe, and productive lives.
NASHP: Six Slides to Help State Legislators Improve Health, May 2019. Eighty percent of what affects health – such as housing, education, and income – is beyond the reach of clinical care, yet drives those costs higher. These six slides can give state legislators insights into what they need to know to promote prevention, ease health care costs, avoid lost productivity, and make their states among the healthiest.
NASHP: Governors’ 2020 State of the State Speeches Look Upstream to Address Health-Related Inequities, February 2020. In early 2020, NASHP examined 39 governors’ state of the state speeches to identify their social and economic health-related priorities, including education, housing, jobs, opioids, and the environment in a blog and chart to highlight their upstream health- and prevention-related plans.
Infographics and Evidence
Social Determinants of Health: Know what Affects Health, January 2018. This CDC website contains a range of federal data sources, research, and other tools on the non-clinical factors that affect health.
County Health Ranking and Roadmaps, 2019. How healthy are the counties in your state? How do they compare to one another? A project of the Robert Wood Johnson Foundation, this interactive map displays county level data on a range of factors, including education levels, obesity rates, access to clinical care, air and water quality, and length and quality of life.
Health Inequalities in Boston by Train Stops, 2015. In this blog post, Boston University School of Public Health Dean Sandro Galea shares a series of maps of the Boston subway system showing which stops have higher rates of premature death, homicide, low birth weight, diabetes, and other factors.
Mapping Life Expectancy: Short Distances to Large Gaps in Health, September 2015. This tool from the Robert Wood Johnson Foundation contains life expectancy infographics for New Orleans, Minneapolis, Washington, DC, and other cities.
Life Expectancy, Death, and Population Density in Chicago, 2010. This map shows the significant disparities in life spans in different parts of the city.
State Strategies to Improve Health
NASHP: How States Are Improving School Safety – a Critical Social Determinant of Health, February 2020. Safe and supportive schools are critical social determinants of health – children who attend schools with few health resources and more violence experience worse physical and mental health, which can impact learning and future success. Governors across the country are taking steps to promote a healthy, supportive, safe, and secure school learning environment by expanding mental health services and through other initiatives.
NASHP: States Are Advancing Healthy Food Policies in 2020, February 2020. State leaders are using a range of strategies – from covering healthy meals under Medicaid to leveraging their roles as large food purchasers for state facilities – to reduce food insecurity and expand access to nutritious food. Learn how states across the country are promoting healthy diets to improve overall wellness and reduce health care costs.
NASHP: States Take Action to Improve Health through Housing, August 2019. State policymakers know housing is critical to health, and effective supportive housing programs can improve lives and lead to a reduction in costly hospitalizations. State leaders across the country are taking executive and legislative actions to improve health through housing, this blog highlights some of their initiatives.
NASHP: How States Addressed Health-Related Social and Economic Factors in 2019, December 2019. During 2019, NASHP tracked the progress of many state initiatives to address the social and economic factors that influence health. In this blog, NASHP retrospectively examines how governors and legislatures promoted cross-agency collaborations and leveraged siloed state resources to better address the social determinants of health.
NASHP: States Take the Lead to Address Climate Change, December 2019. From seasonal allergies to heart and lung disease, the changing climate poses serious health consequences for vulnerable populations, including children, pregnant women, and the elderly. To address climate change, 25 governors have joined the US Climate Alliance to advance the Paris Agreement agenda and many are creating policies that encourage multi-sector collaboration to reduce carbon pollution and promote clean energy.
NASHP: Minnesota and Indiana Governors Work to Improve Social Equity and Health in Every Zip Code, July 2019. Learn about the innovative policies that Minnesota and Indiana leaders are implementing through executive orders, legislation, and budget appropriations to improve health and reduce disparities in every community.
NASHP: Across the Nation, State Leaders Are Tackling the Global Issue of Environmental Protection, May 2019. State leaders are recognizing that the connection between the environment and human health is important — not only when air pollution triggers asthma, toxins contaminate water, or climate change propels tick- and mosquito-borne diseases – and taking action.
NASHP: States Take Action to Improve and Expand Early Childhood Education, June 2019. State policymakers recognize the link between early childhood education and better health, higher educational attainment, and improved socioeconomic status in adulthood and are looking upstream and making investments.
NASHP Chart: Health in All Priorities, December 2018. Governors oversee a range of health-related programs and agencies that can often remain siloed, with different sectors working independently toward similar goals. This chart shows how a range of policy priorities affect health, who in state government may be working on them, and the types of tools and resources may already exist within state government.
NASHP: Six Slides to Help New Governors Improve Health, November 2018. Eighty percent of what affects health – such as housing, education, and income – is beyond the reach of clinical care, yet drives those costs higher. These six slides can give governors and their transition teams insights into what they need to know to promote prevention, ease health care costs, avoid lost productivity, and balance budgets to make their states among the healthiest.
State Approaches to Reducing Health Disparities, June 2017. This resource includes a pie chart showing that social and economic factors, the physical environment, and healthy behaviors are responsible for 80 percent of the modifiable factors affecting health.
Trust for America’s Health: Promoting Health and Cost Control in States: How States Can Improve Community Health & Well-being through Policy Change, February 2019. This report outlines a set of state policy recommendations to improve health and reduce health care costs.
Organizing Teams and Resources
Governors have decisions to make about how best to build health priorities into the structure and make-up of their transition teams, cabinets, and agency leadership. Understanding where work on health is currently taking place across state government — including in departments of transportation, education, housing, finance, agriculture, insurance, and attorneys generals’ offices — is essential to new executives, as is understanding the relationships those agency players have with the legislature, external stakeholders, communities, and one another.
Organizing a Team
NASHP: Organizational Models to Advance Health, December 2018. Governors have decisions to make about how best to build health priorities into the structure of their transition teams, cabinets, and agency leadership. Some states have successfully implemented a single office to orchestrate work related to health, such as Ohio’s Office of Health Transformation. Others rely on a single point of authority like a health and human services commissioner to keep all agencies on message, accountable, and rowing in the same direction. This chart lists organizational choices to help states decide how best to embed a focus on health and prevention into the structure of government.
Sample Cross-Sector Job Description: Minnesota Department of Transportation (DOT) Safe Routes to School Planner. This detailed job description explicitly links the goal of this DOT position to advancing public and population health and education.
Identifying Priorities
Upstream Priority: The Role of Social Determinants in Promoting Health, February 2020. In this slideshow, Greg Moody, former director of Ohio’s Office of Health Transformation, describes the impact that social determinants have on health outcomes and life expectancy. He also makes the case that where states invest is just as important as how much they invest to address upstream factors, and identifies directing spending upstream as a strategy to improve health.
Upstream Priority: The Role of Social Determinants in Promoting Health, February 2020. In this slideshow, Greg Moody, former director of Ohio’s Office of Health Transformation, describes the impact that social determinants have on health outcomes and life expectancy. He also makes the case that where states invest is just as important as how much they invest to address upstream factors, and identifies directing spending upstream as a strategy to improve health.
Health Conundrum: How State Budgets Can Find The Balance Between Social Versus Medical Services, December 2019. Few studies have directly examined the trade-offs that states and local governments are making between social services and health care. The authors discuss results of a Lown Institute report — funded by Well Being Trust — on California spending.
NASHP: How Governors Addressed Health Care in their 2018 State of the State Addresses, 2018. Governors can use their state-of-the-state addresses to signal their commitment to prevention and health as part of building a sustainable budget and healthy future. In 2018, governors highlighted health care issues such as Medicaid, behavioral health, and the opioid epidemic as health policy priorities in their state of the state speeches.
NASHP Q&A: Ohio Implements Value-Based Payment Reform to Improve Population Health, May 2018. Greg Moody, former director of Ohio’s Office of Health Transformation, quietly spearheaded one of the most effective redesigns of a state health care payment system in the country, generating cost savings and improving public health by showing providers how the cost and quality of their care compares with their peers.
Vision Zero, 2018. This North Dakota initiative to reduce traffic fatalities is a partnership between the state highway patrol and departments of health and transportation.
Executive Order Relating to Community-Based Alternatives for People with Disabilities, September 1999. This 1999 Executive Order from Texas Governor George W. Bush began Texas’s Promoting Independence Initiative, which pre-dated the federal Money Follows the Person demonstration program.
Active Living Council of San Antonio, Active Living Plan, 2017. Active living initiatives involve many agencies and sectors, as well as local partners.
New Mexico Tribal Farming Toolkit, 2016. This toolkit showcases New Mexico’s focus on prevention in order to address health issues like food insecurity.
Strategically Using Existing Resources
What are the funding streams available to support investments in the root causes of health? How much money currently is spent across state government to address certain issues? What are the requirements and limitations of each source?
NASHP: Meet Jean, 2016. States steward a variety of funding sources that address the needs of low-income populations. This graphic illustrates the variety of services a beneficiary must navigate in order to access available resources, and how braided funding could offer a coordinated plan of services and supports.
NASHP: Learn How States Can Blend, Braid, and Use Block Grant Funds to Promote Public Health, December 2017. These resources explore how state policymakers are strategizing to reconfigure their programs to address opportunities and challenges that may result from changes to the federal funding landscape, charting a way forward for states interested in coordinating work and resources across programs.
Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, 2014. This example of a Results First analysis answers specific questions about New Mexico’s evidence-based programs regarding the decrease of costs and the improvement of outcomes.
New Mexico Department of Health Progress Report for Quarter 1 of Fiscal Year 2019, 2018. This scorecard provides the basis for New Mexico’s performance-based budgeting system and indicates performance through the use of Strategic Plan measures which document the progress being made by the Department of Health.
Safe Routes to School, 2017. This Minnesota Department of Transportation web page shows how the state braids a range of federal and state funds to support bicycle and pedestrian educational curricula and resources, as well as infrastructure improvements.
Social Impact Bonds, September 2016. The National Conference of State Legislatures collected resources related to states’ use of social impact bonds and other pay-for-performance arrangements to fund health, social service, criminal justice, and other initiatives.
Framing the Message
The following resources can help state leaders craft the right message, use powerful facts and images, and highlight effective local examples.
Framing the Message for State leaders
NASHP: Six Slides to Help State Legislators Improve Health, May 2019. Eighty percent of what affects health – such as housing, education, and income – is beyond the reach of clinical care, yet drives those costs higher. These six slides can give state legislators insights into what they need to know to promote prevention, ease health care costs, avoid lost productivity, and make their states among the healthiest.
NASHP: Governors Tackle the Social and Economic Issues Impacting Health, February 2019. In early 2019, NASHP examined 47 governors’ state of the state and inaugural speeches to identify their social and economic health-related priorities, including education, housing, jobs, opioids, and the environment in a blog and chart to highlight their upstream health- and prevention-related plans.
NASHP: Talking Points by Priority Topic, December 2018. This list of talking points provides a straightforward guide to how action on different government priorities can impact people’s health and how improved health can fit into a variety of priorities.
NASHP: Six Slides to Help New Governors Improve Health, November 2018. Eighty percent of what affects health – such as housing, education, and income – is beyond the reach of clinical care, yet drives those costs higher. These six slides can give governors and their transition teams insights into what they need to know to promote prevention, ease health care costs, avoid lost productivity, and balance budgets to make their states among the healthiest.
County Health Ranking and Roadmaps, 2019. How healthy are the counties in your state? How do they compare to one another. A project of the Robert Wood Johnson Foundation, this interactive map displays county level data on a range of factors, including education levels, obesity rates, access to clinical care, air and water quality, and length and quality of life.
Practical Playbook: Working with Data, 2017. Given the critical role of data—in identifying health problems, in aligning efforts, evaluating progress, and identifying success—these Expert Insights focus on data and metrics, with special sections on using data in this digital era.
North Dakota Department of Human Services (DHS) – Social Determinants of Health, 2018. Pages 2 and 3 show how DHS services and community resources address the social and economic factors that affect health.
Framing the Message for the Public
Alabama’s Single Overriding Communication Objective Worksheet, October 2018. This tool from the Alabama Department of Public Health asks subject matter experts to succinctly state a key message, key facts, target audience, and communication objective to assist in the development of external communications.
Developing Talking Points in Response to a Crisis, November 2018. This tool helped Alabama leaders develop talking points in response to a recent crisis. It analyzes themes in news articles on the crisis, and proposes talking points to address them.
Assessing the Health Benefits of Bicycle Commuting, 2016. This infographic from Minnesota Department of Transportation illustrates the health benefits and cost savings associated with bicycling rather than driving to work.
Five Strategic Initiatives for North Dakota, 2017. This statement of the governor’s priorities ties a range of priorities to health.
Finding Champions
Recovery Reinvented, 2018. This work aimed at preventing, treating, and reducing the stigma of addiction is championed by North Dakota First Lady Kathryn Helgaas Burgum.
One-Pagers on Priority Issues
Whether their priorities are jobs, taxes, education, housing, the opioid crisis, or other issues, governors can control costs, advance their priorities, and improve lives by improving the social and economic conditions that make up 80 percent of factors affecting health. These informative one-pagers provide talking points, go-to resources, and potential cross-agency collaborations that can promote health through a wide range of policy priorities.
Priority Policy Issues
Climate Policy, May 2020. This provides sample talking points state leaders can use to spearhead a multi-sector approach to address changes in health resulting from climate change. Policy initiatives include strategies such as improving air quality, so residents are not at higher risk of COVID-19 mortality as a result of respiratory infections and asthma.
Healthy Food, May, 2020. This provides sample talking points – from covering healthy meals under Medicaid to leveraging their roles as large food purchasers for state facilities – to reduce food insecurity and expand access to nutritious food. Learn how states across the country are promoting healthy diets to improve overall wellness and reduce health care costs.
Education, December 2018. This provides sample talking points that connect education policy to health. It includes state education policy strategies that states might consider to improve health, evidence and resources for state action, and resources, policy tools, and state agencies that address education policy.
Jobs, December 2018. This provides sample talking points that connect jobs to health, including job policy options that states can consider to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address job policy.
Opioids, April, 2020. This provides sample talking points that connect opioid policy to health, including state opioid policy options to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address opioid policy.
Budget, December 2018. This provides sample talking points that connect the state budget to health, including budget options that states might consider to improve health; evidence and resources for state action; and existing resources, policy tools, and state agencies that address the state budget.
Taxation, December 2018. This provides sample talking points that connect tax policy to health, including state tax policy options to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address tax policy.
Infant Mortality, December 2018. This provides sample talking points that connect infant mortality to health, including state infant mortality policy options to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address infant mortality policy.
Housing, April 2020. This provides sample talking points that connect housing to health. It features state housing policy options to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address housing policy.
Emergency Preparedness, December 2018. This provides sample talking points that connect emergency preparedness to health, including state emergency preparedness policy options to improve health, evidence and resources for state action, and existing resources, policy tools, and state agencies that address emergency preparedness policy.
Transportation, December 2018. This provides sample talking points that connect transportation policy to health, including evidence and resources for state action and existing resources, policy tools, and state agencies that address transportation policy.