US State Policy Contexts and Population Health

Abstract

This Perspective connects the dots between the polarization in US states’ policy contexts and the divergence in population health across states. Key interlocking forces that fueled this polarization are the political investments of wealthy individuals and organizations and the nationalization of US political parties. Key policy priorities for the next decade include ensuring all Americans have opportunities for economic security, deterring behaviors that kill or injure hundreds of thousands of Americans each year, and protecting voting rights and democratic functioning.

The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

“…24,107,[109][110][111] Given the systematic nature of structural oppression and how deeply embedded it is in the fabric of society, as well as the interconnectedness of policies and their effects, it is also important to recognize how bundles of policies (or linked policy systems) can combine to support population health. 29,62,107,110 Importantly, there is a growing recognition that "all policy is health policy" because even policies that are not directly focused on health and health care affect proximate social determinants of health, such as access to salubrious material and psychosocial resources and exposures to social conditions that place individuals at risk of poor health. 62,67,68 Thus, structural oppression affects health indirectly by leading to unequal and unjust living conditions for oppressed groups.…”

“…State and local health departments should also prioritize collecting data measuring structural oppression in their jurisdictions and incorporating it into their public health research and practice. For concrete examples of policies across a variety of domains and levels that can reduce health inequities, see several studies in this special issue 24,107,109–111 . Given the systematic nature of structural oppression and how deeply embedded it is in the fabric of society, as well as the interconnectedness of policies and their effects, it is also important to recognize how bundles of policies (or linked policy systems) can combine to support population health 29,62,107,110 …”

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

“…[88][89][90][91][92][93][94][95][96][97] In the United States, state policy contexts in which social democratic policy goals, such as strong income supports and wide enfranchisement, are pursued have been found to offer health advantages over states where policies move away from such goals. [98][99][100] Specific policies that fit broadly under the rubric of social democracy, such as OASI, the 2021 expanded Child Tax Credit, and the pandemic unemployment insurance programs, have all been associated with health benefits. [101][102][103][104][105][106][107][108] The space in which social democratic policy operates is by no means small.…”