Find Programs and Policies that Work

Finding specific programs and policies

When you have decided on priority areas to focus on in your community, you can look below for examples of programs and policies that have been shown to be effective in addressing specific health factors and focus areas. These examples of actions have been found to be effective--they are programs and policies that you might consider as possible strategies for improving health in your community. However, they may or may not be appropriate for your community. They are offered as a starting point and as possible ideas not as recommended strategies.

If you have a particular program and policy in mind that is not listed here, you can use one or more of the general sources of evidence listed under the Materials to Help tab to search for other programs and policies. 

Health behaviors

Tobacco use

• Make all workplaces smokefree, including restaurants and bars.
• Increase the tax on cigarettes and other tobacco products, e.g., municipal, county, state or federal legislation that raises the excise tax on tobacco products: increasing the cost reduces demand.

Diet and exercise

• Label foods to show serving size and nutritional content: availability and awareness of nutritional information content may decrease calorie consumption.
• Limit access to non-nutritious food in schools, e.g., by limiting the types of foods that can be sold for fundraisers or by not allowing sale of foods in vending machines.
• Make water available and promote consumption of water in place of sweetened beverages.
• Provide point-of-purchase prompts to highlight healthier alternatives such as fruits and vegetables.
• Use competitive pricing, e.g., higher prices for non-nutritious foods than for nutritious foods.
• Institute school policies that increase activity such as expanding school-based physical education classes, active recess, and walking or biking to school.
• Provide point-of-decision prompts for use of stairs: motivational signs placed on or near stairwells, elevators, and escalators encourage individuals to use stairs.
• Promote exercise and recreation in communities, e.g., by allowing evening access to school recreational facilities.
• Increase access to fitness centers and athletic facilities: access can be increased in a number of ways, including physical access/location accessibility and reduced costs or sliding scale fees to improve economic access.
• Institute workplace incentives for physical activity.
• Reduce health insurance premiums for fitness club members.
• Implement breastfeeding programs to increase breastfeeding initiation, exclusive breastfeeding, and duration of breastfeeding.
• Implement multi-component interventions that target both diet and physical activity: multi-component interventions include combinations of activities and support such as nutrition education, prescriptions for aerobic/strength training, training in behavioral techniques, self-help materials, specific dietary prescriptions, group or supervised exercise sessions, and pedometers.

Alcohol use

• Institute policies and informational campaigns for those who provide alcohol, e.g., responsible beverage service training, alcohol age compliance checks, restrictions on drink specials that encourage over-consumption, enhanced enforcement programs to initiate or increase the frequency of retailer compliance checks for laws against the sale of alcohol to minors in a community, and dram shop liability laws that hold retail establishments liable for the results of serving minors and intoxicated patrons.
• Reduce alcohol availability by reducing outlet density (applying regulatory authority through licensing or zoning processes) or by limiting days/times of alcohol sales (policies limiting days and hours of purchase may be made at the state level and, where not prohibited by state pre-emption laws, at local levels).
• Introduce school- and community-based prevention programs such as instructional programs, peer organizations such as Students Against Destructive Decisions (SADD), social norming campaigns, and restriciting alcohol advertising placement.
• Increase alcohol excise tax: these taxes are implemented at the state and federal level, and are beverage-specific (i.e., they differ for beer, wine, and spirits). They are usually based on the amount of beverage purchased, not on the sales price, so effects can erode over time due to inflation if they are not adjusted regularly.
• Use sobriety checkpoints where law enforcement officers can stop drivers to assess their level of alcohol impairment (officers must have reason to suspect a driver has been drinking before testing).
• Regulate provision, possession, consumption, and purchase of alcohol for and by minors, such as policies to address many aspects of underage drinking including furnishing alcohol to minors, underage possession of alcohol, underage consumption of alcohol, and underage purchase of alcohol.
• Implement multi-component interventions with community mobilization, including many components such as sobriety checkpoints, training in responsible beverage service, education and awareness-raising efforts, and limiting access to alcohol.

Unsafe sex

• Offer condom availability programs that provide condoms free of charge or at a reduced cost and that can be implemented in a variety of settings.
• Implement individual-, group-, and community-level HIV behavioral interventions.
• Provide partner counseling and referral services for HIV-positive people and their sexual or needle-sharing partners.
• Offer comprehensive risk reduction programs that promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections.
• Implement service learning programs, i.e., youth development programs that include a volunteer component (often linked to academic instruction)and that may include a health curriculum but also address nonsexual factors.

Clinical care

Access to care

• Provide health insurance coverage for all.
• Expand scope of practice for dental hygienists, i.e., expand the types of settings where dental hygienists may practice independently of a dentist.
• Expand scope of practice for nurse practitioners, i.e., expand the types of services nurse practitioners may provide and the settings where they may practice independently of a physician.
• Expand use of community health workers by improving role definition and education curricula and increasing funding.
• Recruit health care professionals from minority groups.
• Require provider training in cultural competency
• Establish medical homes, an approach to providing comprehensive primary care for children, youth, and adults in a setting that facilitates partnerships between individual patients, their personal physicians, and (when appropriate) patients' families.
• Increase use of telemedicine as a way for patients to access qualified health and mental health professionals.
• Encourage enrollment in existing programs such as Medicaid via outreach/education and expedited enrollment.

Quality of care

• Promote adoption of electronic health/medical records.
• Link electronic health records across systems.
• Provide chronic disease management programs that include a variety of approaches to care such as disease registries and patient and clinician reminders.
• Provide case management programs involving assignment of a single person (case manager) who coordinates all aspects of a patient's care, e.g., providing information to multiple providers, seeing that the patient receives services in a timely manner, etc.
• Reduce inappropriate care through patient shared decision making, by providing incentives for providers to educate patients about treatment alternatives through decision aids that help people understand options and consider the personal importance of possible benefits and harms.
• Institute standardized quality/performance measurement and reporting, e.g., publicly releasing performance data stimulates quality improvement activity at the hospital level.
• Implement payment reform to change incentives toward quality.

Social and economic factors

Education

• Expand early childhood development programs, e.g., HeadStart, SmartStart, Child-Parent Centers, High/Scope Perry Preschool, Incredible Years, HIPPY (Home Instruction Program for Preschool Youngsters), universal pre-kindergarten, and DARE to Be You.
• Comprehensive K-12 school reform to improve achievement
• Youth development programs to improve high school graduation rates: broad programs that work to improve youth outcomes, including graduation rates, through a collaboration of school, home, and community approaches.
• Career Academies--small learning communities within large high schools in low-income, urban areas that usually focus on a specific field and provide preparatory, technical, and occupational courses to connect coursework to job opportunities.
• Mentorship-model programs to improve high school graduation rates, e.g., Check and Connect and the Valued Youth Program (VYP): Check and Connect is a dropout prevention program for high school students with learning, emotional, and/or behavioral disabilities. Students are assigned a "monitor" who works with them year-round as a mentor, advisor, and service coordinator. Through VYP, students gain experience and skills as a mentor to younger students.
• Programs to help dropouts attain GED certificates
• Targeted programs to improve college enrollment

Employment

• Offer youth apprenticeship programs.
• Implement or expand Workforce Investment Act: a one-stop delivery system as the access point for employment-related and training services, including Welfare-to-Work, vocational-rehabilitation, and other supports. Programs are usually run through local Workforce Investment Boards.
• Implement Bridge to Employment programs, i.e., partnerships that provide support for basic education (e.g., ESL, GED) and job training, including financial and childcare support, to eligible participants.
• Implement Career Pathway programs, which promote education opportunities that guarantee employment and promotion for eligible participants in high-growth industries.
• Implement comprehensive, employment earnings supplement and/or work support programs that include multi-faceted efforts to improve employment and earnings.
• Community revitalization and economic development

Income

• Increase minimum wage.
• Raise benefit amounts for Supplemental Security Income programs.
• Increase earnings supplements for the working poor, e.g., the State Earned Income Tax Credit (EITC) can be administered in a number of ways, including as part of a welfare-to-work program, with an earned income disregard policy, and providing work expense allowances. EITC is intended to make work pay and reward low-wage work by reducing the tax burden and supplementing wages with a refundable credit.
• Provide paid family and medical leave.
• Expand unemployment insurance: the Unemployment Insurance program is administered by states under federal guidelines. Eligibility, amount, and duration of benefits are determined by each state.

Family and social support

• Offer support/training programs for new parents.
• Offer support groups for home care providers.
• Implement parental school involvement programs.
• Provide outdoors community building programs, e.g, Project Venture is an outdoor experiential youth development program designed primarily for 5th- to 8th-grade American Indian youth. It aims to develop the social and emotional competence that facilitates youths' resistance to alcohol, tobacco, and other drug use. The program is based on traditional American Indian values such as family, learning from the natural world, spiritual awareness, service to others, and respect; it has a positive, strengths-based approach.
• Provide youth empowerment and leadership training programs, e.g., Project ACHIEVE is a comprehensive school reform and improvement program for preschool through high school that focuses on students' academic, social-emotional/behavioral, and social skills outcomes; school-wide positive behavioral support systems and school safety; positive classroom and school climates; and community and parent outreach and involvement.
• Offer drop-out prevention programs, e.g., Reconnecting Youth: A Peer Group Approach to Building Life Skills (RY) is a school-based prevention program for 14- to 19-year-old students. RY teaches skills to build resiliency against risk factors and control early signs of substance use and emotional distress; the program targets youth who demonstrate poor school achievement and high potential for school dropout.
• Integrate service-learning into school curriculum.
• Encourage inter-generational mentoring.
• Create education, meal, and social programs for older adults.

Community safety

• Implement community-based crime prevention programs.
• Introduce school-based programs to reduce violence and bullying that teach all children in a school or grade about techniques to prevent or reduce violent behavior and bullying, regardless of risk for or prior demonstration of violent behavior. Programs and content differ by school level.
• Encourage mentoring programs, e.g., the Big Brothers Big Sisters of America (BBBSA) program aims to support all aspects of young people's lives through a professionally supported one-to-one mentoring relationship with an adult. Adults interact with youth in a one-on-one relationship, meeting 2-4 times per month for at least a year. Matches are made and supervised by case managers. There is some variation in the BBBSA program by location; program principles and integrity are maintained through the national organization that oversees recruitment, screening, and matching, and offers supervision and support to mentors.
• Provide therapeutic foster care for chronically delinquent youths: multidimensional Treatment Foster Care (TFC) is an alternative to group home placement, incarceration, or hospitalization for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. Adolescents receive treatment through trained and closely supervised foster parents and continue to attend school in their home community.
• Provide multi-systemic and functional family therapy, an intensive family- and community-based treatment that addresses the multiple determinants of serious antisocial behavior in youth involved in the juvenile justice system. A multi-systemic approach considers the role that family, peers, school, and neighborhood may play in adolescent behavior, and designs interventions to address the particular needs of each youth.
• Wraparound programs provide individualized, comprehensive, community-based services and supports to children and adolescents with serious emotional and/or behavioral disturbances so they can be reunited and/or remain with their families and communities. Family members/natural supports, service providers, and agency representatives collaboratively develop a plan of care, implement this plan, and evaluate success over time.
• Early childhood home visitation to prevent child maltreatment: programs such as the Nurse-Family Partnership (NFP) center around home visits of trained personnel to parents and their children. Parents/caregivers are provided with a combination of information, support, and/or training about child health, development, and care. Visitation may be done by nurses, social workers, paraprofessionals, or community peers.

Physical environment

Environmental quality

• Require vehicle inspection and maintenance as part of vehicle registration programs.
• Retrofit buses to reduce emissions, e.g., install diesel oxidation catalysts--a combination of a muffler and a catalytic converter-type device that reduces emissions.
• Institute pricing policies to reduce road congestion.
• Offer financial and other incentives for energy efficient buildings.
• Promote Energy Star Program energy-efficient consumer products: this federal program promotes energy efficiency in commercial, public, and residential settings by identifying products that meet specified energy efficiency criteria with an Energy Star label.
• Implement or expand Groundwater Stewardship Programs that provide information and tools for pesticide and nitrogen fertilizer users, to help identify risks to groundwater and coordinate resources to limit water contamination.
• Implement or expand the Conservation Reserve Enhancement Program, a voluntary land retirement program that helps agricultural producers protect environmentally sensitive land, decrease erosion, restore wildlife habitat, and safeguard ground and surface water.
• Implement or expand Conservation Tillage or No-till (zero-till) farming that keeps at least one-third of cultivable soil covered with the previous year's crop residue. This protects soil from erosion and infiltration of pesticide and fertilizer into water sources. Using no-till farming, the extreme form of conservation tillage, the soil is not tilled at all.
• Bus pass incentive programs or deep discounting: bus passes offered at free or discounted rates to employees, students, elderly, and people with disabilities. Under deep discounting, a transit agency sells unlimited access passes at significantly reduced prices to all members of a large organization.
• Carpooling and rideshare programs enable commuters to share transportation to work, reducing number of vehicles on the road and total vehicle miles traveled.
• Safe Routes to Schools: a federally supported program that promotes walking and biking to school through education and incentives. The program also targets city planning and legislation to make walking and biking safer.

Built environment

• Develop pedestrian/bicycle master plans that work to increase walking and biking trails and improve connectivity of non-auto paths and trails.
• Encourage zoning that enables physical activity, e.g., high-density mixed use zoning.
• Improve streetscape design to encourage walking, including some or all of the following: street lighting, traffic calming design elements, increased sidewalk coverage, infrastructure projects to increase ease and safety of street crossing, and increased connectivity of pedestrian walkways.
• Reduce alcohol outlet density and/or limit the increase of alcoholic beverage outlet density. Regulation is often implemented through licensing or zoning processes.
• Institute engineering and traffic calming measures to reduce speed, e.g., single-lane roundabouts, sidewalks, exclusive pedestrian signal phasing, pedestrian refuge islands, increased intensity of roadway lighting, and red-light-running cameras. Traffic calming measures include speed bumps, mini-roundabouts, road surface treatment, changes to road lighting, and one-way streets.
• Promote local food systems and farmers' markets.