By NCSL Health Program Staff
States continue to move forward on their public health priorities. NCSL works with states as they craft legislation to improve their health systems and public health initiatives.
This two-part blog series highlights 10 active public health issues in state legislatures, with examples of policy actions underway in states to improve their public health systems and the health status of the residents of their states.
Reducing health disparities remains a common theme that runs through many public health initiatives, addressing differences in health status among various groups of people, including ethnic minorities and rural residents. Within the 10 topics listed, lawmakers also address some of the social determinants of health, such as improving access to care, promoting wellness through personal responsibility, fostering economic success and providing services that support healthy lifestyles.
Check out Part 1.
Improving Public Health Data Systems
State legislators focus on policies that address health outcomes measurement, health quality measures and data issues, through establishing and funding state data systems that accurately capture the health and outcomes of specific demographic groups. Legislative actions include:
- Authorizing and funding All Payer Claims Databases,
- Authorizing and funding strong data systems through the state public health department,
- Using data to target resources to the highest need areas, such as for localities with high rates of diseases or conditions such as teen pregnancy rates or high rates of premature births.
Reducing Maternal and Infant Mortality, and Improving Maternal/Infant Health Outcomes
State legislatures continue to address access issues for pregnant women, including health insurance coverage and access to care. Evidence shows improved health outcomes, and cost savings to states with continuity of coverage and care for pregnant women and new moms. Legislation tends to focus on:
- Expanding maternal obstetric coverage and postpartum screening coverage through the Children’s Health Insurance Plan (CHIP).
- Expanding health insurance coverage in the post-partum period.
- Funding initiatives to reduce and/or treat maternal depression.
- Making pregnancy a “life qualifying event” on the state health insurance exchanges.
- Offering “baby boxes” to help address infant mortality.
Legislators have access to evidence that shows the positive relationship between access to health and social services for mothers and infants during this first year and more long-term benefits, including cost savings.
Preventing Adverse Childhood Experiences
Adverse childhood experiences (ACEs) refer to stressful or traumatic experiences during childhood (e.g., child abuse and neglect, parental substance abuse, etc.). Research shows such stresses can increase risk for many negative health and well-being indicators throughout life and even affect life expectancy. A 1997 CDC/Kaiser Permanente study found that almost two-thirds of the study participants had at least one type of ACE and more than 20 percent had three or more ACEs. Preventing adverse childhood experiences is gaining attention in statehouses across the country. As of March 2017, at least 38 bills specifically mentioning ACEs were passed or pending in at least 18 states. These include bills:
- Appropriating funds for ACEs prevention.
- Establishing task forces or study committees.
- Requiring or encouraging health care providers to use an ACE screening tool with their patients.
Exemptions for Vaccine Requirements
States report an increase in proposed and enacted legislation around religious and personal exemptions that require children to have vaccinations for school attendance. With children going back to school in the fall, state immunization policies gain increased attention.
Addressing the Legalization of Marijuana
All but 4 states have some sort of legal access to cannabis products on at least a low-THC level. Nine states and territories have legal adult use, and 29 states and 3 territories have medical cannabis programs. Challenges to states include:
- Implementing voter-led initiatives.
- Gathering and tracking data related to the impacts of legalization (health, crime, youth prevention, public consumption).
- Using reliable data.
- Testing and ensuring the safety of cannabis products.