The health of Americans has been declining for decades, with adverse impacts distributed inequitably across U.S. society.1 Improving health, and focusing on the most vulnerable populations, will not only boost health outcomes and social well-being, but also strengthen the economy and help to build a strong, equitable future.
To improve and restore the health of Americans, policymakers should make long-term, sustained investments to prevent disease, promote health, and prepare for and respond to continuous and urgent health threats. By addressing social determinants of health—such as income, education, housing, employment, transportation, environmental conditions, and neighborhood conditions—policymakers can improve health, reduce racial disparities, and contribute to economic mobility.
This fact sheet and accompanying report outline 10 priorities for improving the nation’s health.
1. Stop the spread of COVID-19
COVID-19 has ranked among the top three leading causes of death in the United States throughout most of the pandemic. It has affected mental health, resulted in long-term illness and disability, and caused economic disruption, with a disproportionate impact on women, older adults, disabled individuals, residents of congregate care settings, and people of color.
To minimize the impact of COVID-19, policymakers must:
- Continue investing in national and global response and readiness.
- Employ multiple layers of protection for communities, rather than focus only on individual risk.
- Monitor trends and remain prepared to address future surges, while centering equity and identifying early signals that indicate a need for stronger prevention strategies.
2. Invest in public health infrastructure
The public health system significantly affects health, with increased spending leading to outcomes such as reductions in low birth weight, food-borne illnesses, rates of sexually transmitted diseases, and death. Yet the system is both inconsistently funded and chronically underfunded, which has led to a lack of resources for disease prevention, health promotion, response to emergent threats, workforce shortages, and underdeveloped data systems.
Policymakers can strengthen public health infrastructure by taking the following steps:
- Establish adequate, flexible, and sustained annual funding.
- Pass federal efforts such as the PREVENT Pandemics Act to improve the nation’s preparedness.
- Implement workforce initiatives that encourage workers’ entry and retention.
3. Address the opioid and substance use epidemic
Drug overdoses are the leading cause of rising mortality rates among young and middle-aged adults, largely due to opioid misuse. The opioid crisis is a national security, law enforcement, and public health challenge in the United States—yet overdoses and deaths are preventable.
Policymakers must fund and prioritize interventions that:
- Address the root causes of addiction, such as systemic inequities, poverty, and the adverse effects of the criminal justice system.
- Fund and expand access to prevention, evidence-based treatment, harm reduction, and recovery through a whole-of-government, cross-agency response.
- Target funding to communities most affected by dependence on opioids and other substances.
4. Mitigate climate change and invest in environmental justice
Climate change is described as the “greatest threat” to global public health.2 Climate change and localized pollution disproportionately affect children, older adults, disabled people, low-income communities, and people of color. Transformative programs are critically needed to stabilize the climate, reduce pollution, improve health, and save lives.
To that end, policymakers must:
- Address environmental racism and center equity and justice.
- Fund transformative programs, such as incentivizing the production of renewable energy and zero-emissions technologies and enacting coastal restorationand resilience projects, to ensure global warming is limited to 1.5 degrees Celsius.
- Reduce the carbon emissions of the health care sector and prepare it to respond to the health impacts of climate change.
5. Reduce poverty and improve economic stability
Economic stability is critical to health, as people who are not steadily employed are more likely to have poor health outcomes. Yet due to centuries of marginalization, disabled people, LGBT people, and people of color are more likely face unemployment and poverty. Interventions to improve economic stability can have lifelong impacts.
Policymakers can take action to reduce poverty and subsequently improve health:
- Improve access to child care services, as proposed in the House-passed budget reconciliation package.
- Permanently expand the child tax credit and earned income tax credit to provide essential support for struggling families.
- Reauthorize the Supplemental Nutrition Assistance Program (SNAP) through Congress.
6. Improve education access and quality
Early childhood development and education are key predictors of adult health and well-being. Access to quality, affordable higher education is also key to improving economic stability and health. An insufficient supply of licensed child care and the underfunding of many schools, especially those in low-income and rural areas and communities of color, threaten access to a quality, affordable education.
Policymakers must fund and prioritize initiatives that:
- Expand subsidies and grants to child care providers to offset pandemic-related revenue losses and increased operating costs.
- Address failing physical infrastructure of schools, including lack of adequate drinking water, heating, ventilation, and air conditioning systems.
- Screen and care for mental health needs in school-based settings.
Reinvest in an accessible higher education system to address centuries of systemic inequities.
7. Improve access to affordable, stable, inclusive, healthy, climate-resilient housing
Housing security is foundational to ensuring people remain both safe and in good health. Yet 1 in 4 Americans struggle with housing availability, quality, affordability, and accessibility.3 Housing instability and homelessness disproportionately affect people of color, LGBTQ+ individuals, disabled people, and justice-involved individuals.
Policymakers must take action through the following steps:
- Expand the housing choice voucher programs to serve more low-income households.
- Pass the White House fiscal year 2023 budget that includes funding to build affordable housing, make improvements to the current public housing stocks, and expand homeownership opportunities.
- Increase the supply of supportive housing units that integrate affordable housing, health care, and other social services for special populations.
8. Improve health care access and quality
Health care access and affordability remains a major problem for many Americans, especially those with low incomes and historically marginalized groups. Expanding access to health coverage, lowering costs for care and treatment, and improving the quality of health care services can improve health and reduce costs.
- Close the Medicaid coverage gap. The House-passed budget would federally extend marketplace subsidies such that those in the coverage gap would qualify for low- or no-cost coverage.
- Cap beneficiary drug spending and limit price increases to improve prescription drug access.
- Increase access to mental health services by ensuring insurance coverage and expanding scope-of-practice laws for mental health professionals and by enforcing parity standards.
9. Reinforce social connections and community safety
Social connections and interactions serve as important protection against poor health and well-being and aid in coping with toxic stress. Negative interactions, such as living in environments where discrimination, prejudice, violence, and stigma are prevalent, create toxic stress that leads to negative health outcomes. In addition, social systems, such as policing and voting, are riddled with inequities that further marginalize people of color and perpetuate health disparities.
Policymakers can improve community relations and advance population health through the following actions:
- Support alternatives to policing, such as community-based intervention programs that empower and center communities.
- Invest in research that addresses gun violence as a public health epidemic.
- Enact legislation that protects the voting rights of marginalized communities.
10. Advance racial equity and inclusive policies
Systemic racism, discrimination, and structural barriers contribute to preventable health conditions and related economic burdens, leading to racism being declared a serious public health threat.4 Gaps in addressing the social determinants of health have a disproportionately negative impact on people of color, those with disabilities, LGBTQI+ communities, and other marginalized groups.
Policymakers must advance racial equity and inclusive policies through the following steps:
- Commit to reduce racial and economic inequities that the pandemic exacerbated.
- Prioritize the most vulnerable and harmed communities when investing in policies that affect social determinants of health.
- Partner with and center the needs of affected communities and address the root causes of racism and inequity.
New policies must target all the drivers of health and recognize the intersectional nature of these issues. Policymakers’ failure to address any of these issues has ramifications for other areas of society, limiting the opportunity to take meaningful steps toward improving health and health equity.