Toolkit: Upstream Health Priorities for New Governors

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. Explore the four categories and tools below for resources that can help governors and their teams improve health.

Virginia Gov. Ralph Northam, a physician, knows firsthand the importance of investing in policies that keep people healthy. He has endorsed this toolkit, writing, “In addition to disease prevention, we can help slow the growth in the cost of health care spending by making strategic investments in housing, nutrition, education, jobs, and transportation, factors that contribute to good health and quality of life.” Read his endorsement letter .

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.


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, 2018. 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 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.

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.

Gov. Malloy Appoints Vicki Veltri to Lead State’s Office of Health Strategy: New State Office Combines Existing State Healthcare Resources into Centralized Agency, January 2018. This State of Connecticut press release makes the case for forming a new agency to lead cross-sector work to improve health.

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

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?

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.

NASHP Chart: Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States, 2016. To assist state policymakers seeking to maximize their leverage by working across state agencies to promote health, NASHP compiled this chart of funding sources that state agencies use to address social determinants, such as stable housing, safe and prosperous neighborhoods and communities, access to healthy food, physical and mental health care, income support, and transportation.

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: 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, 2018. 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.

VA Gov. Ralph Northam recommends NASHP toolkit: Upstream Health Priorities for New Governors, December, 2018. As a physician, Gov. Northam knows firsthand the importance of preventive medicine and investing in policies that keep people well.  In recommending NASHP’s tool, he wrote, “In addition to disease prevention, we can help slow the growth in the cost of health care spending by making strategic investments in housing, nutrition, education, jobs, and transportation, factors that contribute to good health and quality of life.”


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

Fostering Futures, 2017. A Wisconsin First Lady worked with the Wisconsin Department of Children and Families to better recognize, understand, and address the effects of trauma on the lives of children and families.

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

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, December 2018. 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, December 2018. 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.