‘Health in all policies’ aims to avoid need for care

March 2, 2011

By Daniel Weintraub

Even as Republicans and Democrats fight over the future of health care reform in Washington, California is quietly laying the groundwork for what could be a revolutionary change in the way government policy keeps people from needing health care in the first place.

The effort, known as “Health in all Policies,” is roughly comparable to California’s response to the 1970s energy crisis. While others focused on drilling for more oil, mining more coal or securing alliances with foreign energy producers, California embarked on an aggressive initiative to reduce the state’s use of energy, especially electricity.

The energy efficiency focus sometimes makes California the subject of ridicule, as when it recently adopted new standards for big-screen televisions. But overall, the changes have paid off: Since 1975, electricity consumption per person in the rest of the nation has increased by 50 percent while it has remained nearly flat in California.

That result is credited by many to the state’s strict building codes, appliance regulations and a culture of conservation. Others have cited the state’s favorable climate and its high than average sized households, probably a result of immigration, as factors.

The parallel to health care is clear: Chronic disease, which can often be prevented and can certainly be managed, accounts for 75 percent of all deaths in California and a similar percentage of US health care costs. Obesity, diabetes and heart disease are all correlated with income and geography. Wouldn’t it be better to help people avoid the need for health care rather than simply focusing on making health care more accessible to all?

Recognizing this, former Gov. Arnold Schwarzenegger created the Health in All Policies task force and housed it within the Strategic Growth Council, a panel made up of several cabinet secretaries that looks beyond the narrow agenda of each agency at policies that cut across government.

The task force has put forward 34 recommendations for policy change and is working to refine that list into a number that can be realistically implemented. The idea is to embed a consideration of health into everything the government does.

Much of this will involve land-use policy. For example, building communities that make walking and bicycling not only possible but also attractive alternatives to the automobile can have many benefits.

It increases physical activity, which can decrease heart disease, stroke, osteoporosis, depression and obesity.

It improves air quality, which reduces respiratory and cardiovascular disease.

And it decreases greenhouse gas emissions, which would help the state meet its climate change goals and generally improve public health.

“The environment in which people live, work and play has a huge impact on health,” said Linda Rudolph, deputy director of the state Department of Public Health and a member of the task force. “Place matters a lot.”

Other policy recommendations from the task force include encouraging new housing developments to incorporate community gardens, parks and grocery stores; creating smoke-free workplaces and schools; promoting more public greenery, including urban tree canopies; supporting community-based violence prevention efforts; and encouraging the joint use of school buildings by their neighboring communities.

The bottom line: keeping people healthier longer by adopting smart policy or avoiding bad policy is a lot cheaper than scrambling after the fact to make more doctors, hospitals and drugs available to all.

California has been on the cutting edge of social change many times before. Could this be the next big one?

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