COVID-19 reminds us all how valuable our health really is. Across race, class and political affiliation, we all want bodies and minds that allow us to enjoy the summer sun, an afternoon in the garden, the good company of family and friends. Public policy can help all of us lead our best, healthiest lives, but only if legislators craft public policy with public health in mind. That’s why Ohio lawmakers should make health impact analysis a standard part of their process.
Tracking down and mapping out all the public health effects of a single policy is a complex process with a clear benefit: Health impact analysis would give elected officials a new perspective on how the choices they make shape the lives of the people they represent. That new perspective would be a major improvement to the way Ohio’s laws are made and enforced, since some of our elected officials are unduly influenced by corporate donors and their well-paid lobbyists.
The results are what you’d expect, and what has plagued Ohioans for years: Tax laws that feed insatiable corporations at the expense of public goods that improve public health. Sometimes our leaders write their allegiance to corporations directly into law. For example, under former Gov. John Kasich, Ohio formally established an office (now headed by Lt. Gov. Jon Husted) whose stated mission is to evaluate state government rules for their impact on business. There is no analogous office for evaluating their impact on, for instance, Black maternal mortality rates, or any other health outcomes.
When we craft policy to suit the demands of corporations, we get laws that serve corporate interests. If we gave as much consideration to health impacts, we’d have policies that help people live healthier lives. Recent reporting in the Columbus Dispatch highlights the disparity: The panels that wrote Ohio’s reopening guidelines were controlled by entrepreneurs, with medical experts taking a back seat. (The Ohio Capital Journal’s Tyler Buchanan reported in May on workers getting shut out of the reopening process and the prominent role business leaders were taking above all others.) The consequences for public health are ongoing. The number of deaths in Ohio due to COVID-19 is above 2,900.
The connections between public policy and public health aren’t always intuitive; they require careful attention to the causal chain — the effects that cause other effects, and so on until they impact us at our most basic level: our bodies. An anti-poverty program can help more newborns survive infancy. Better public transit means more kids can ride bikes till the streetlights come on without the agony of asthma. Smarter sentencing for drug-related convictions can reduce the toxic stress that causes heart disease so more moms live long enough to be grandmas.
Every day our leaders make choices whose effects ripple on for years afterward, in our air and water, our hospitals and homes. Legislators need to consider those long-term effects, and that requires in-depth objective research. Policy Matters Ohio has produced two examples of the type of health impact analysis our leaders should use. With a methodology developed by The Pew Charitable Trusts, we created a pair of Health Notes: concise but detailed descriptions of peer-reviewed research on the potential health effects of a bill under consideration.
Our most recent Health Note examined some of the potential health impacts of two bills: Senate Bill 3 and House Bill 1. If passed, the bills would help people access addiction treatment, rather than sending them to prison. At a time when Ohio’s prisons are dramatically overcrowded and COVID-19 kills people in prison at 10 times the rate it kills people on the outside, some of the health benefits of incarcerating fewer people are obvious: Less overcrowding makes social distancing more possible, slowing the spread of the disease to incarcerated people, prison staff, and the families they come home to.
Other health benefits come further down the line: Fewer people in prison means fewer people suffering the health consequences of incarceration. We found strong evidence to indicate that incarceration causes both acute and chronic stress, even well beyond release. Chronic stress strains the cardiovascular and immune systems, increasing risk of heart attack and susceptibility to infectious diseases.
Further still, by increasing opportunities for record-sealing, these bills would eliminate some barriers to employment, giving people a better shot at building themselves back up with meaningful work. This helps them avoid poverty, consequent chronic stress, and the associated increased health risks.
That’s the kind of long-term thinking we need our leaders to use when they consider the health impacts of their decisions. By making health impact analysis a standard part of their decision-making, our leaders can build public health considerations into the processes of governing, just as some of them have done with corporate interests.