In recent weeks, the political conversation has been animated by talk of a Green New Deal (GND). The idea behind the GND, unveiled last month as a Congressional resolution by Senator Ed Markey and Representative Alexandria Ocasio-Cortez, is to tackle the threat of climate change through a series of wide-ranging reforms. The goals of the GND address not just the challenge of reducing carbon emissions, but the underlying socioeconomic inequities that gave rise to climate change. These goals include overhauling the country’s transportation system, providing universal health care, creating a federal jobs guarantee, and investing in infrastructure. They reflect the plan’s broader call for social and economic justice, workers’ rights, and greater investment in public goods. Through these aspirations, the GND acknowledges that carbon emissions are just the tip of the (rapidly melting) climate change iceberg, that the problem is the sum of deeper, structural challenges, and that solving climate change means using public policy to tackle the problem at every level of society, addressing not just the science of climate change, but the injustice that created the crisis in the first place.
The fight against climate change shares much in common with the work of promoting health. Our health, like our climate, is shaped by our shared social and economic context. We in public health have long known this, which is why improving these conditions has historically been core to our mission. However, our national conversation has not always reflected the true causes of health. Instead, it has focused mainly on the doctors, drugs, and treatments we turn to when we are sick, rather than the socioeconomic conditions that, when properly tended to, keep us well. Over the years, this created a policy landscape where the subject of health was largely limited to the conversation about health care and the latest advances in treatment. And just as improving health is often seen as the exclusive province of scientific innovation—which has distracted us from the core drivers of health—climate change had long been seen as a threat we can simply innovate out of existence, which has allowed us to ignore its structural causes.
During the relatively short time when the GND has been in our political conversation, it has done much to shape the debate around climate change, its true causes, and the multi-sectoral, across-the-board policymaking approach it will take to mitigate this problem. This is broadly encouraging. Yet climate change, for all its importance, is still just a subset of the larger issue of health. The challenge of promoting health includes not just fighting climate change—which, as I have written previously, is a key public health issue of our time—but also addressing gun violence, the opioid epidemic, economic inequality, obesity, and more. For this reason, we should be no less ambitious in our efforts to promote health than we are in our engagement with climate change. We need a Health New Deal (HND).
What would a HND look like? The details of a HND would, of course, be open to debate, but it seems to me that the following three priorities should serve as a basic structure around which the plan’s particulars might take shape.
Plan all public policy with an eye toward health
This builds on what I have written about exhaustively—that health is a product of the social, economic, and environmental conditions in which we live, and which are shaped by public policy. It follows, then, that we should formulate these polices always with health in mind. In 2013, the American Public Health Association published Health in All Policies: A Guide for State and Local Governments. The Health in All Polices approach challenges lawmakers, at all levels of government, to ask themselves, when considering a bill, “How will this affect health, at the foundational level?” They should ask this question even—especially—when the bill has nothing to do with healthcare, and they should answer it with the best available data, and the input of scientists and professionals in medicine and public health. Policymakers should also make regular use of Health Impact Assessments, which measure how a potential program or policy will affect health.
A Health in All Policies approach has already made inroads at the state level. During the current legislative session, no fewer than 29 bills have been introduced in 11 states tackling policy from a health perspective. They include a New York bill to create a task force to find evidence-based solutions that reduce kids’ exposure to adverse childhood experiences, a Hawaii bill that would create a working group to help with updates to the Hawaii Department of Health’s statutory power and duties, so they will be more in line with a population-based approach to health, and a West Virginia bill establishing a Minority Health Advisory Team and authorizing a Community Health Equity Initiative demonstration program. A HND would build on this momentum, to promote a Health in All Policies approach at the national level.
Incentivize the promotion of health across sectors
Each day, lawmakers, CEOs, and other leaders make choices that affect the food we eat, the water we drink, the air we breathe, the buildings we live and work in, the schools we send our kids to, the transportation networks we utilize, and other areas core to our health. Sometimes these choices favor health, sometimes they do not. The difference often lies in incentives. There are many examples of both public and private sector actors shaping incentives to promote health. In 2017, for example, the mortgage funder Fannie Mae unveiled its Healthy Housing Rewards Initiative, which offers discounts to borrowers who incorporate into their properties design features that promote health. The federal government has also taken steps to incentivize improving the conditions that shape health—providing tax credits, for example, for the use of solar energy, and for the construction of rental housing for economically disadvantaged households. A core focus of a HND should be to find new ways of incentivizing health across sectors, and to rethink areas where incentives currently help underwrite poor health (such as federal subsidies for the corn, soybeans, and livestock that are processed into cheap, high-fat foods that contribute to the obesity epidemic).
Change what we talk about when we talk about health
Abraham Lincoln once said, “[I]n this country, public sentiment is everything. With it, nothing can fail; against it, nothing can succeed.” For the policies that promote health to endure, they must be rooted in the shift of public sentiment that comes from changing the conversation about health. A HND would be a powerful tool for driving such change. By addressing the full range of conditions that shape health, it has the power to move the Overton window towards bold, transformative solutions. We have begun to see how the GND is accomplishing a similar shift in the realm of climate change. It has made inequality, social and economic justice, health care, and the importance of public goods part of a conversation that was once limited to technocratic discussions about fuel efficiency and carbon taxes. A HND could likewise inspire new engagement around the issues that are at the heart of health, and provide an aspirational blueprint for our efforts to build a healthier world.
The original New Deal was born out of crisis. It was a response to one of the most significant challenges our country has faced—the Great Depression. President Roosevelt and his allies saw in that crisis an opportunity not just to put unemployed Americans back to work, but, through landmark legislation like the Social Security Act, to enlarge our conception of what public policy can do to better the lives of citizens. A Health New Deal could be similarly transformative, enlarging our understanding of health itself, and what we can do, collectively, to improve it.
I hope everyone has a terrific week. Until next week.
Warm regards,
Sandro
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.