New study—A 50-state assessment shows bright spots in the use of policies that reduce health inequities. Results show what states are doing well and what states can improve.
New York, NY. (June 5, 2017)- New research from The New York Academy of Medicine offers state policy makers an excellent tool—a scorecard that shows the use of policies that can reduce health inequities, as well as promising approaches to policy change. The study, “Identifying Policy Levers and Opportunities for Action Across States to Achieve Health Equity,” will be featured in the June 2017, special Equity issue of Health Affairs.
Efforts to advance health in the United States increasingly take place at the state level. For this reason, public health experts are in need of evidence and guidance about the most effective methods of maximizing resources, reducing rates of chronic illness and reducing health disparities.
To find out what’s working around the country and what policies states can enact to “do more and do better,” lead study author, Julia Berenson, a research associate in the Academy’s Center for Health Innovation, along with José Pagán, PhD, Center director, Yan Li, PhD, Center research scientist, and Julia Lynch, PhD, a political scientist at the University of Pennsylvania, measured indicators, across 50 states, related to the use of evidence-based policies that address issues linked to health equity.
They looked at: l. Cigarette excise tax rates; 2. State’s Medicaid expansion status and the size of its coverage gap; 3. The percentage of four-year-olds enrolled in state-funded pre-kindergartens; 4. Minimum wage levels; and 5. The presence of state-funded housing subsidy programs, homelessness prevention and rapid rehousing programs.
While the scorecard revealed significant variation in state performance in enacting any or all of the five, key policies, there were promising examples of states taking action to achieve health equity. “We found that eight states excelled, with cigarette excise taxes at $3.00 and above, for example, a level that likely lowers smoking rates. Thirty-one states and the District of Columbia also adopted the Affordable Care Act Medicaid expansion that closes coverage gaps, facilitates access to clinical care, and may close health gaps,” Berenson said.
A smaller number of states—five—enacted policies to increase children’s access to early childhood education (having 50 percent of four-year-olds enrolled in state-funded pre-K).
There was also great variation found in states enacting minimum wage laws aimed at lifting people out of poverty, with only seven states and the District of Columbia having such a policy. Last, thirteen states and the District of Columbia have enacted comprehensive housing policies that can help to improve access to high-quality and safe housing which can have a positive impact on health.
“The scorecard provides a powerful tool for policy makers seeking ways to address health inequities in their communities through a Health Across All Policies approach. It identifies feasible, effective measures that states can use to address five key policy areas critical to achieving health equity,” said Jo Ivey Boufford, MD, president of the Academy.
Berenson explained that by pointing out examples of different approaches to addressing health inequities, the study would help policy makers see the possibilities for new approaches in their state. “Even leading states can find ways to do better,” she said. “New York, for instance, adopted the Medicaid expansion and also applied for and received a grant to test a new payment and care delivery model to improve health care access and quality.”
The goal is that the scorecard will be used to advance the national conversation of creating healthier and more equitable communities.
About the Academy
The New York Academy of Medicine advances solutions that promote the health and well-being of people in cities worldwide.
Established in 1847, The New York Academy of Medicine continues to address the health challenges facing New York City and the world’s rapidly growing urban populations. We accomplish this through our Institute for Urban Health, home of interdisciplinary research, evaluation, policy and program initiatives; our world class historical medical library and its public programming in history, the humanities, and the arts; and our Fellows program, a network of more than 2,000 experts elected by their peers from across the professions affecting health. Our current priorities are healthy aging, disease prevention, and eliminating health disparities.
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