As Awareness Around the Importance of Social Determinants of Health and Health Equity Increases, State Legislation Follows Suit

February 14, 2019|10:37 a.m.| ASTHO Staff

Policymakers are increasingly recognizing evidence regarding the role that the social determinants of health play in shaping individual and community wellness, health outcomes, and healthcare spending. Public health officials are well positioned to advance population health by creating policy, building partnerships across sectors, and advocating for community-defined priorities. State legislatures are also becoming increasingly active in this space.

As of mid-February, 29 bills in 11 states have been introduced in the current session that explicitly mention the social determinants of health or health-related social needs. These bills originate from Delaware, Hawaii, Illinois, Massachusetts, New Hampshire, New York, Oregon, Pennsylvania, Utah, Washington, and West Virginia.

Many of these bills create advisory boards and workgroups that include public health representatives with a goal of advancing health equity through state policymaking and cross-sector approaches to addressing the social determinants of health. Examples of such bills include the following:

  • The Hawaii Senate introduced S.B. 1121, which would create a working group designed to evaluate and advise on updates to the Hawaii Department of Health’s statutory powers and duties. The updated statute would explicitly include mention of “population-based approaches to public health and prevention” and recognize that health is created outside healthcare alone. The bill language uses the American Public Health Association’s definition of “Health in All Policies” as its foundation.
  • The Illinois General Assembly introduced H.B. 1 to create a Task Force on Infant and Maternal Mortality Among African Americans. The task force would review research across the state and nation that includes data on the social and environmental risk factors for women and infants of color. The task force will also review research to identify effective interventions for addressing the social determinants of health disparities in the state. The Illinois Director of Public Health or the designee would serve on the task force.
  • The New York General Assembly introduced A. 2451 to create a task force that would identify evidence-based and evidence-informed solutions to reduce children’s exposure to adverse childhood experiences (ACEs). The bill instructs the task force to identify social determinants o health and well-being related to ACEs and offer recommendations to eliminate racial and ethnic disparities in the occurrence of ACEs. One task force member would be appointed by the New York State Department of Health.
  • The West Virginia Legislature introduced S.B. 573, which would establish a Minority Health Advisory Team and authorize a Community Health Equity Initiative demonstration program. This advisory team—consisting of healthcare, public health, education, and community representatives—would provide technical assistance to communities on funding sources (e.g., providing grant letters of support), ensure that state government assets are targeted to the most vulnerable populations, and ensure state agencies consider the impact of all policies on minority public health.

An emerging trend across several of these bills is an awareness of the interplay between the social determinants of health and the creation of healthy and resilient communities. Communities are viewed both in terms of geographic community and racial and ethnic communities, and policies are focused on evaluating the effects of policies on existing health disparities.

Other workgroups are focused on building community capacity by assisting with securing grant funding and engaging community members in policymaking recommendations. ASTHO’s 2019 President’s Challenge also recognizes the importance of mobilizing community-led, place-based collectives to achieve improved population health and these bills align closely.

ASTHO will continue to monitor state legislative activity related to health equity and the social determinants of health throughout the current session.

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