Promoting Prevention through Healthy Public Policy Elizabeth Rigby, Ph.D. The George Washington University erigby@gwu.e

1. Promoting Prevention through Healthy Public Policy Elizabeth Rigby, Ph.D. The George Washington University erigby@gwu.edu • Prepared for: • Dialogue on Diversity • 2013 Health Care Symposium and Fair • May 15, 2013

2. Health Care in U.S. The problem: • Rising rates of chronic disease • Aging population • Escalating health care costs

3. Health Care in U.S. • We are not getting what we are paying for

4. Health Care in U.S. Policy options: • Increase access to health care • Improve quality of health care • Reduce incidence of disease

5. Health Care in U.S. Policy options: • Increase access to health care • Improve quality of health care • Reduce incidence of disease

6. Prevention as Health Policy

7. But… also Non-Health Policy • Much of prevention policy occurs outside the health sector, for example: • Make all workplaces smoke free • Provide paid family and medical leave • Increase the minimum wage • Expand youth development programs to improve high school graduation rates • Encourage zoning that enables physical activity, e.g., high-density mixed use zoning • Institute pricing policies to reduce road congestion

8. Leads to a Paradox of Governance

9. Health in All Policymaking (HiAP) • Aims to overcome paradox of governance • Calls for cross-sector policymaking to promote healthy public policies regardless of domain • At federal level, HiAP aims to: • Coordinate current policy efforts across agencies • Call attention to health impacts of non-health policies • Expand responsibility for health to a broader set of actors, and government as a whole

10. Key HiAP Effort: National Prevention Council • Inter-agency Council created by ACA • 17 federal agency/department heads • Chaired by Surgeon General, staffed by DHHS • Charged with: • Coordinating and leading prevention, wellness, and health promotion efforts across the Federal government • Institute of Medicine: “Highest profile HiAP action in the federal government”

11. Early Work of Prevention Council • Developed a National Prevention Strategy: • 4 Strategic direction • 7 Priority areas

12. Example from Prevention Strategy • Priority Area #3: Healthy Eating

15. Funding Prevention • The ACA took another important step forward in prevention by creating the Prevention and Public Health Fund • Represents the nation’s first mandatory funding stream dedicated to public health programs • Must be used “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs” For more information, see: Forsberg & Fichtenberg (2012). The Prevention and Public Health Fund: A critical investment in our nation’s physical and fiscal health. Washington, DC: American Public Health Association. Available at: http://www.apha.org

16. Use of Prevention Funds • Used for community prevention, clinical prevention, public health infrastructure and training, and research and tracking • Allocated throughout the United States • But, budget crises make the Prevention Fund’s future uncertain