Today, every American community is sitting at a crossroads, as local governments continue to address the health crisis of COVID-19 while grappling with the financial realities of maintaining operations.
The health and economic challenges of the COVID-19 pandemic (as well as calls for reallocation of policing resources in light of new examinations of the cumulative impacts of racism on health), require communities to take a hard look at their investment choices for health not just in response but in planning for recovery.
While some communities may take a more traditional route of only investing further in health care services, there is an opportunity to take a more holistic approach and address the multitude of factors that have contributed to the devastation of COVID-19—namely by taking a Health in All Policies approach.
According to the U.S. Centers for Disease Control and Prevention, “Health in All Policies” is a collaborative approach that integrates and articulates health considerations into policymaking across all sectors to improve the health of all communities and people. Health in All Policies is an approach that recognizes that 80 percent of health is determined outside of the clinical setting, namely through behavioral and environmental factors. And yet, while there have been rhetoric and important actions over the years in communities trying to pursue a Health in All Policies approach, the strategy often does not meet its goal; it is often thwarted by the crisis of the day and the challenges of our government structure. That silos departments which we know influence health ranging from public safety to the environment. COVID-19 could again be the crisis that takes communities away from this approach, or it could be the crisis that propels the realization that the only way for sustained impacts on health and well-being over the long-term is through a holistic strategy.
80 percent of health is determined outside of the clinical setting, namely through behavioral and environmental factors.Share on Twitter
Prince George's County, Maryland is an important example of a community at the crossroads. Faced with health investment choices that will determine the county's future, the County Council commissioned an independent study of what will be required to follow through on Health in All Policies. The RAND report organizes information by the key drivers of health and well-being (not just the outcomes of health services) and outlines what structures and actions are needed to take the path for Health in All Policies.
The health challenges observed in Prince George's County mirror those of the rest of the United States, such as the inappropriate use of emergency services for non-urgent needs, the compounding of social vulnerabilities that place some populations and geographies at greater risk, and disconnects among county services that address health factors. The report offers a roadmap for true Health in All Policies implementation in three areas: First, we articulate a framework for designing governance structures that will center health in all county decisions, including how policies are designed and assessed for their impact on health, how government departments will share accountability for health, and so forth. Second, we provide a template for how the county can align investments toward the factors that truly influence health, attentive to those health activities that are happening in nontraditional sectors, such as mental health services provided through the Department of Corrections. This kind of investment mapping will help the county think holistically about budgeting, shedding redundancies in expenditures, and ensuring there are no gaps in health investments that matter. Finally, the report argues for a better system that can actually monitor and evaluate the factors that influence health, linking resources to health outcomes and better assessing inequities before these problems result in the kind of health disparities observed in the COVID-19 pandemic.
Only time will tell how communities, including Prince George's County, evolve and whether the county meets the opportunity that this terrible crisis offers. However, in a world of uncertainty, stress, and risk, Health in All Policies offers an option for facing these challenges head-on in ways that once and for all acknowledge and act on the multitude of factors influencing health and which impact society today.
Anita Chandra is vice president and director of the RAND Social and Economic Well-Being division and senior policy researcher at the nonprofit, nonpartisan RAND Corporation. Ashley M. Kranz is a health policy researcher at RAND.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.