We all know that genetics are an important factor that influence how healthy we are throughout our lifetimes. But more and more, New Jerseyans are realizing that other factors play a significant role as well. Research supported by the Robert Wood Johnson Foundation indicates that our personal behavior and clinical care contribute 30 percent to overall health outcomes, while a combination of social and environmental factors and the physical environment around us contribute 50 percent to our health outcomes. These social and physical drivers of health include income level, as well as the extent to which we live in healthy homes and communities; our ability to play in safe places both indoors and outdoors; the cohesiveness of our neighborhoods; and our ability to access transportation services, healthy food, and a quality education.
Viewing health through the lens of physical and social determinants allows us to better understand the concept of health equity. Health outcomes should not be determined by where we live, how much money we make, whether we have access to healthcare, or what our economic and social circumstances are. Health equity seeks to ensure that all people, regardless of their individual circumstances, have access to the resources they need and a physical environment that allows each and every one of them to live the healthiest life possible. Health equity can only be achieved if we embrace a health-in all-policies approach that seeks to advance collaborative efforts to improve the health of all people by incorporating consideration of health outcomes into decision making across many different sectors, policy areas, and levels of government.
Given New Jersey’s extensive healthcare systems and high median-household income, you might expect the Garden State to be one of the healthiest states in the country. However, the 2017 United Health Foundation’s annual ranking shows that New Jersey ranks 12th among all states for health and wellbeing. How different would life in New Jersey be if we took the time to consider the potential health impacts of decisions in sectors such as transportation, energy, housing and community development, and natural-resource management? What if we thought about how millions of dollars in annual investment in statewide infrastructure affect the long-term health of New Jerseyans? Would more New Jerseyans have access to the systems and conditions that lead to good health and wellbeing if we considered how bills moving through the legislature would affect health if they become law?
One way that New Jersey can more systematically integrate the consideration of health outcomes in different sectors and policy areas, is to expand the use of the practice of Health Impact Assessment (HIA). HIA is a practice that helps communities, decision makers and practitioners to evaluate the potential health effects of a plan, policy, or project before it is adopted, implemented, or built. In this way, HIA allows practitioners to modify their decisions in ways that increase positive health outcomes and minimize negative ones.
HIAs have been conducted all around the country on a diverse set of sectors including land use, transportation, environmental regulations, energy planning, housing and community development, and education. While some HIAs have been conducted in New Jersey, the Garden State is behind other leading states in systematically using HIA to apply a health lens to decisions in other sectors. The Planning Healthy Communities Initiative at the Rutgers Bloustein School has conducted HIAs in New Jersey that assessed the health impacts of road diets and complete streets, natural infrastructure to address flood hazards, bike sharing programs, and recreational access to waterways. These HIAs have led to changes in the design of projects to improve health outcomes for people of all ages, documented how health benefits of specific projects contribute positively to local economies, and identified ways in which proposed infrastructure changes can improve health, such as reduced pedestrian accidents.
In addition to expanding the use of Health Impact Assessments in New Jersey, we have the opportunity to begin an important dialogue in our state about what policies and systems are needed to advance both health equity and the integration of health into millions of dollars of infrastructure investment and sector-specific policies such as energy, housing and community development, education, transportation and environmental protection.