BOX 4-1
Examples of Non-Health Policies with Health Effects

Federal agricultural subsidies are enacted with agricultural, economic, and trade objectives in mind, but their effects on health are significant. Similarly, transportation planning may have as a primary objective the optimal way to facilitate goods movement or to commute between home and work, but related issues must be considered, including local economic development that may be enhanced or impaired by public transportation, road design and other physical features (access to public transportation); community functioning (e.g., when a busy highway divides a neighborhood); and health, which may be positively or negatively impacted depending on the extent to which transportation planning considers whether to encourage and facilitate pedestrian and bicycle traffic.

(2009) reported that adults ages 40 to 64 with only a high school education are more than three times more likely to die from diabetes than those who have graduated from college. Educational attainment determines whether individuals can obtain good jobs and whether they acquire the knowledge, health literacy, and other tools needed to make informed choices about their health.

Income is another important factor. Certainly, low-income individuals are less likely to have health insurance, but income also affects health by enabling families to live in healthy neighborhoods and housing and to afford nutritious groceries, fitness clubs, copayments for doctor’s visits, and prescription medications. Income is a health determinant in all social classes, not just for the poor. Americans with incomes that were 201 to 400 percent of the poverty level had shorter lives and a greater likelihood of fair or poor health than were those with incomes more than 400 percent of the poverty level (Braveman and Egerter, 2008). Woolf and colleagues (2007) reported that 25 percent of all deaths in Virginia would have been averted if the entire state experienced the mortality rate of those living in the five most affluent counties and cities.

Place affects health—neighborhood and community environments exert their own health influences, independent of the risk factors associated with individuals and households. Research links social and economic features of neighborhoods “with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease, as well as with mental health, injuries, violence and other important health indicators” (Cubbin et al., 2008). People living in poor neighborhoods with inadequate housing, high levels of crime, high density of alcohol outlets, and a scarcity of fresh food retailers are more likely to



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