leveraging multiple actions with a shared goal has a cumulative effect. It also encourages agencies to cooperate in the development of initiatives and to coordinate funding streams. For example, the Sustainable Communities Regional Planning Grant Program is a collaborative effort of the Department of Housing and Urban Development, the Department of Transportation, and the Environmental Protection Agency to support planning for community improvement and address, among other issues, public and environmental health concerns.

Another effort under way is the Health in All Policies movement. Health in All Policies refers to the consideration of “health, well-being and equity during the development, implementation and evaluation of policies and services” (WHO, 2010, p. 2). It recognizes that policies that affect health often are not “health policies” per se; rather, policies in all sectors of society can affect the health of the population. For example, a study undertaken by the University of North Carolina (Bell and Standish, 2005) showed the positive impact on the dietary habits of surrounding African American communities when political and business decisions were made to relocate and facilitate access to supermarkets. The recent Institute of Medicine (IOM) report For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges (IOM, 2011b, p. 9) recommends that “states and the federal government develop and employ a Health In All Policies (HIAP) approach to consider the health effects—both positive and negative—of major legislation, regulations, and other policies that could potentially have a meaningful impact on the public’s health.”

Linked to the Health in All Policies concept is the health impact assessment, defined by the World Health Organization (WHO) as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (European Centre for Health Policy, 1999, p. 4). Health impact assessments provide an assessment of the health effects of a policy prior to its implementation. Dannenberg and colleagues (2008) surveyed the use of health impact assessments in the United States and cited 27 examples, including one that examined the socioeconomic effects of an after-school program in Los Angeles; another that examined how a rental voucher program for low-income families in Massachusetts impacted housing affordability, housing stability, and the neighborhood environment; and another that looked at the effects of a community redevelopment project on physical activity. A recent report of the National Research Council (2011) describes the growing popularity of health impact assessments in the United States and proposes a framework for organizing and explaining their necessary elements.

An example of a legislative effort focused on health system improvement is the American Recovery and Reinvestment Act (ARRA) of 2009.

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