Opinion: A Roadmap to Better Health in New Jersey

Margaret Koller, Joel C. Cantor | April 25, 2019 | Opinion
New report recommends evidence-based policy options to address gaps in health and well-being across the state

Joel C. Cantor and Margaret Koller
It’s budget season in Trenton. Each year at this time, the New Jersey Legislature works to stretch our tax dollars as far as they can to fund the programs and services that they see as most important. It’s not an easy task.

But as our elected officials hold hearings and debate this year’s priorities, it is also important to take the long view about investing in the well-being of New Jersey residents. To help state leaders sort through priorities for making New Jersey a healthier and more equitable place, not just for today but for the coming years, we and some of our Rutgers colleagues — in collaboration with the Robert Wood Johnson Foundation — recently recommended a series of policy options that, research shows, can boost health and well-being in our home state. The recommendations are the focus of a new report: Building a Culture of Health: A Policy Roadmap to Help All New Jerseyans Live Their Healthiest Lives.

Healthcare is expensive, especially in New Jersey, so we must spend our dollars wisely. In 2014, the most recent year available, we spent nearly $9,000 per person on healthcare for Garden State residents — about 10 percent more than the national average. But wise investments now in where we work, live, and play can not only prevent the need for some of the most costly health expenditures down the road, but can also yield dividends in better health and well-being for New Jerseyans.

Our overall health is based on much more than health insurance coverage and access to care. While these things are critical, research has shown they account for only about 20 percent of our overall health. The other 80 percent of our health is determined by the facts of our daily lives — our income and education levels, our family circumstances, where we grew up and where we live now.

NJ has much to be proud of, but…

The Policy Roadmap shows that even though there is plenty of room to adopt more effective state policies to drive better health, we do have much to be proud of in New Jersey. Health insurance is now more accessible for residents of modest means and the state has comparatively low rates of smoking, teen births, infant deaths, and premature deaths, and high rates of preschool enrollment and high school graduation. These are all important markers of opportunities to achieve good health among New Jersey residents, but they don’t tell the whole story. High-level metrics can sometimes hide distressing realities: significant health disparities — or differences in health outcomes — exist between communities and populations across the state and urgently require our attention. Some examples:

  • Life expectancy varies tremendously depending on where we live. In Mercer County, for example, life expectancy is 87 years in the most affluent community of Princeton, but only 73 years in downtown Trenton. That is a startling 14-year difference between two towns that are only 13 miles apart.
  • While New Jersey’s infant mortality rate is lower than the national average, the maternal death rate is nearly twice the national average. Further, black infants here are more than twice as likely as white infants to die before their first birthdays, while black mothers are more than three times as likely as white mothers to die from pregnancy-related complications.
  • New Jersey’s housing affordability crisis is especially challenging for very low-income families, with nearly three-quarters of them spending more than half of their incomes on housing — leaving very little for other priorities such as food, healthcare, child care, and transportation.
  • More than 900,000 New Jerseyans — one-third of them children — don’t have reliable access to affordable, nutritious food, making it difficult to prevent and/or effectively manage chronic diseases such as obesity, diabetes, and heart disease.
  • Effects of long-standing discrimination

    Disparities like these are all too common and are the result of long-standing discrimination and entrenched inequities. And, while these disparities disproportionately affect the most disadvantaged and marginalized among us, they drive lost opportunity and higher costs for all of society. More importantly, principles of equity and fairness demand that decision makers in government and the private sector consider the most effective solutions. This is why the New Jersey-based Robert Wood Johnson Foundation* joined with a team from the state university to produce the Policy Roadmap. Informed by extensive research and months of conversations with community residents, nonprofit and business leaders, and others from across the state, the report identifies a series of policy options that have proved effective in other places.

    Among our recommendations:

  • Boost the incomes of low-wage residents by maximizing enrollment in and expanding access to the state and federal Earned Income Tax Credit and enforcing the state’s minimum wage increase.
  • Prioritize maternal and child health by, among other actions, increasing the capacity and quality of home visiting programs for new moms and their babies.
  • Expand access to affordable housing for those most in need by, among other actions, increasing affordable housing production and preservation and encouraging organizations such as hospitals and health systems to develop affordable housing.
  • Increase access to nutritious foods in communities and schools by expanding participation in federal food and meal-assistance programs and by improving the availability of fresh, healthy foods in low-income communities.
  • Improve access to health and social services programs throughout the state by leveraging technologies, such as by making program information and applications available via mobile devices.
  • These recommendations may not automatically spring to mind when thinking of ways to foster better health, but that’s exactly what solid evidence shows the policies will do —create more opportunities for better health for more people across the state. We tried to demonstrate, through the recommended policy options, the ways, both obvious and subtle, that health disparities and inequities are present in our public policies and daily lives. No doubt, some of the recommendations would require a larger investment and will take time to move through the system, while others are less resource-intensive or build on current initiatives and could therefore be addressed quickly. In all cases, the longer we delay action, additional costs will be incurred — in terms of peoples’ health and, in some cases, the state’s bottom line.

    In pursuing the recommended policies, we have the chance to make New Jersey a national model of health. We encourage our state leaders step up to the challenge and seize this opportunity.

    *The Robert Wood Johnson Foundation is an NJ Spotlight funder.