Government

How is government related to health?

We know that a person's zip code is a stronger determinant of their health than their genetic code. Things like schools, jobs, income, community safety, discrimination, and housing play an important role in health.

Government has the power to influence many of these drivers by:

• Setting, implementing, and enforcing policies and programs that impact the root causes of health.
• Delivering services and programs that impact health.
• Providing information to educate residents and constituents about important issues.
• Mobilizing support and resources to address issues related to health.

What can government do to build healthy communities?

Use policies and systems to make lasting change

The County Health Rankings model shows that policies and programs impact a variety of health factors. Those factors, in turn, influence how long and how well we live. Government is a key decision-maker for more than half of the strategies listed in What Works for Health.

Policy change happens at all levels of government, but the scope varies. For example:

• Federal government creates laws and policies that apply throughout the country (e.g., issues like immigration and civil rights).¹
• State government takes on any powers not explicitly reserved for the federal government (e.g., law enforcement activities and laws that affect family relations such as marriage, divorce, and adoption).
• Local government is responsible for many of the policies that affect everyday life (e.g., speed limits on streets, rules for zoning and development, public school funding, and public safety staffing). Local governments include counties, cities, villages, and towns.²

Use data to drive action

Government at all levels collects and uses data to make decisions. Making data accessible to the public encourages engagement.

The following are a few examples of how state and local governments are making data available to residents. All were recently highlighted in a report from The National Academies Press on the findings from the Committee on Community-Based Solutions to Promote Health Equity in the United States.

• Virginia Health Opportunity Index provides dashboards for counties, legislative districts, and health districts. The interactive site helps drive and evaluate community efforts.
• Boston, MA: Analyze Boston is the City of Boston's open data hub to find facts, figures, and maps. Boston’s open data portal includes data from many sectors relevant to health and health equity (e.g., hospital locations, healthy corner stores, crime incident reports, and economic indicators).
• Travis County, Texas: The Community Advancement Network Dashboard presents data according to goals. For example, the goal of “Being safe, just, and engaged” includes data related to crime, jail bookings by race and ethnicity, and voting.
• Fort Collins, CO: Community Performance Measurement Dashboard includes quarterly summaries related to a Culture of Health that advances health equity. The dashboard looks at things like transportation, economic health, environmental health, community safety, and more.² 

Advance health equity

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

As a country, we have achieved significant health improvements over the past century. We are safer in our cars and have better workplace standards. Fewer people smoke. We've reduced the spread of infectious diseases. But when you look closer, within each state across the country there are significant differences in health outcomes according to where people live, learn, work, and play. It is clear that not all Americans have the means and opportunity to be their healthiest.

A Health Impact Assessment (HIA) is a key tool for understanding the potential health implications of a proposed policy. Equity is a core value of HIAs, and communities have used these assessments to advance equity in the decision-making process. They help to maximize health benefits while minimizing risks. Some government agencies use HIAs as they consider new policies or programs. See examples and learn more about the HIA process at the Health Impact Project.

Start at home

Government at all levels is often a major employer in communities. Government agencies set internal policies that impact the health of the people they employ. For example, as employers, these agencies can set internal policies to ensure:

• Their employees earn a living wage.
• Their employees have access to quality health care.
• The work environment supports healthy choices.

Learn more about what employers can do to impact the health of their workforce in What Works for Health.

How can you connect with government?

Why connect with government?

Building relationships with those in government is an important step in changing the way power is distributed in communities. When you connect with government in a meaningful way, you can bring more power to those most affected by poor health outcomes.

Do your research

• Understand the rules. Take time to learn how decisions are made and by whom so you can tailor your ask to the key players.
• Find the changemakers in government. Look for:
  • Policymakers who are able to get legislation passed.
  • Policymakers and government leaders who have a media and/or social media presence -- this can tip you off to who is introducing and sponsoring legislation. Start following people on social media.
  • Policymakers and government leaders who are out in community doing something. The people who show up are also likely to make change happen.
• Gather information to understand how to best engage with decision-makers. The Decision-Maker Analysis tool (from Working Partnerships USA & Community Catalyst) helps you identify who can give you what you want, what their “rules” are, which specific individuals are key decision-makers, and how you may influence them. It walks you through the types of questions you’ll want to answer about individual decision-makers.

Get connected

Start with the gatekeepers. These are the people who control who gets access to key decision-makers. This might be:

• A legislative aide or assistant to an elected official.
• Department heads or supervisors within government agencies. These non-elected department leaders often do the work, have a voice, and last longer than a 2- to 4-year elected term. They are important to know.  
• The person everyone seems to know.

Elected officials have limited time. Here are some tips for getting connected: 

• Build relationships first. One way to do this is to be a resource. Offer to share your content and context expertise around key issues.
• Once you’re ready to make an ask, be direct. What action do you want the elected official to take?
• Make your communication actionable. Create communication materials that they can quickly absorb or easily hand off to another person to take action.

What’s in it for them?

Elected officials

• Mission. Most policymakers want what's best for their community. It is in their best interest to see improved health outcomes in the communities they serve.
• Connection. You can provide a greater understanding of and connection to their constituents.
• You are a resource. Connecting with content experts provides elected officials access to information.
• Ego. Everyone likes to look good in front of others. By providing elected officials with information, you allow them to look like an expert.
• Accountability. You are the person who elects them, so they want to be sure they are responding to your concerns.

Department staff

• Mission. Making a difference in communities is core to the mission of most who work in government. They want their work to be successful and the community to be better for it.
• Community voice. Connecting with you gives them a greater connection to the community they serve.

Citations

1. Annenberg Classroom. Tenth Amendment. www.annenbergclassroom.org/page/tenth-amendment. Accessed October 24, 2017.
2. National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/24624.