…A health-in-all-policies approach may be one of public health’s most effective tools in raising awareness about social determinants and in bringing nontraditional partners to the table. Linda Rudolph, MD, MPH, a principal investigator on a Public Health Institute project to integrate a health-in-all-policies approach in local jurisdictions around California, noted that reaching across sectors is not new territory for public health. For instance, she pointed to decades of tobacco control work that involved partnering with local businesses and restaurants to change smoking policies, as well as work with traffic engineers to improve road safety.
But where health in all policies diverges, she said, is that it offers a way to institutionalize the consideration of health impacts across systems. Such work is well underway in California, where a 2010 state executive order created the California Health in All Policies Task Force, which brings together 22 state agencies, departments and offices. Among the task force’s projects is work to improve active transportation, promote land-use decisions that increase healthy food options and support green spaces within urban communities, all of which can have positive health impacts.
In 2015, the Public Health Workforce Interests and Needs Survey — a large workforce survey conducted by the Association of State and Territorial Health Officials and the de Beaumont Foundation — reported that 86 percent of respondents believed health in all policies is “somewhat” or “very important” to public health. But just 52 percent had heard of it as an approach.
“If we know that the social, physical and economic environments are fundamentally shaping our health outcomes, then we have to ask what’s shaping those environments,” Rudolph, an APHA member who also serves as director of the institute’s Center for Climate Change and Health, told The Nation’s Health. “And what’s shaping those environments are largely decisions being made by people outside the health sector.”
Fortunately, public health workers are increasingly finding partners in the health care arena, where providers treat the end results of upstream factors. For example, in March, the American Academy of Pediatrics issued new recommendations urging pediatricians to screen patients for poverty and to advocate for public policies that reduce the effects of poverty on children. Benard Dreyer, MD, FAAP, president of the academy and professor of pediatrics at New York University School of Medicine, said that with so many preventive and well-child visits in a child’s first five years, pediatricians are uniquely positioned to intervene and help put children on a healthier trajectory.
“We know that at least 50 percent of health outcomes are due to the social determinants and only 20 percent are due to the clinical care we give them,” Dreyer told The Nation’s Health. “The other 30 percent has to do with health behaviors and many of these are related to social determinants…We know exactly how the social determinants impact children. We see it happening before our eyes every day.”
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