The Impact of Healthcare Policy on Public Health Outcomes

The International Organisation for Economic Co-operation and Development (OECD) estimated that the United States spent almost 17% of national income (GDP) on health care in 2019.¹ The Commonwealth Fund, a private foundation focused on promoting "a high-performing, equitable health care system," observed that "The United States spends twice as much per person on health as the average of peer nations."²

However, as the Peterson Center on Healthcare and Kaiser Family Foundation reported in October 2023, "The United States has a lower life expectancy than peer nations and has seen worsening health outcomes since the onset of the COVID-19 pandemic."³

Why is that? Many people have asked that question and are working to improve the alignment between healthcare expenditures and public health outcomes. This blog post will explore the drivers of healthcare policy in the U.S., the interconnected nature of healthcare and public health policy, and their impact on population health and health equity. We'll also examine the role of data and research in shaping health policy and improving health outcomes.

Healthcare policy refers to the set of rules, regulations, laws and guidelines that govern the organization, delivery, financing and quality of healthcare services within a healthcare system or society. These policies shape the structure and function of healthcare systems, influence the allocation of resources and impact the delivery of healthcare services to individuals and communities.⁴

While healthcare policy focuses on the delivery of medical care and services to individuals, public health policy takes a broader perspective by addressing the underlying determinants of health, working to promote health and preventing disease and injury at the population level.⁵

Though public health and healthcare policy approach their goals differently, they share the goal of promoting well-being and improving population health. Further, healthcare policy impacts population health by influencing who has access to care and how it's delivered.

The United States healthcare delivery system mirrors our federalist organization of government, with oversight divided between national, state and local lawmakers and agencies. However, these entities do not shape health policy in a vacuum.

Healthcare providers, insurers and drug manufacturers shape policies through lobbying efforts. Public opinion, expressed through the ballot box and other channels, and non-profit research organizations also influence U.S. healthcare policymakers.

Just as no single entity is responsible for making policy, several different groups fund the provision of health care services. The funding equation is just as complicated as the policymaking picture. Private health insurance, usually employer-sponsored, covered about one-third of U.S. health expenditures in 2018. Public money and direct consumer expenditures covered the other two-thirds in roughly equal proportions.⁶

Two courses in Kent State's online Master of Public Health program's Health Policy and Management specialization help untangle the complexities of the U.S. healthcare system. Health Care Systems examines the conceptual underpinnings of health policy and the history and structures of the system. The Public Health Policy, Law and Ethics course expands on the systematic review of concepts and introduces the legal and ethical frameworks surrounding health care and public health.

The World Health Organization says, "Effective health systems governance is essential for ensuring that healthcare services are accessible, equitable, efficient, affordable and of high quality for all."⁷ Similarly, the Public Health National Center for Innovations (PHNCI), a working group of public health professionals in the United States, has said the primary focus of public health practice is to “protect and promote the health of all people in all communities."⁸ Find more information about the essential functions of public health in this blog post.

Put another way, the goal of public health practice is to improve population health and promote health equity. As such, it encompasses the concept of universal health coverage, one of the United Nations Sustainable Development Goals (SDGs). The SDGs were adopted in 2015, with 2030 as the target year for completion.⁹

According to the World Health Organization (WHO), "The Sustainable Development Goals stress that quality is a key element of universal health coverage (UHC). SDG target 3.8 calls on countries to achieve UHC, including financial risk protection alongside access to quality essential health care services." That same WHO publication notes that one in 10 patients in high-income countries is harmed while hospitalized, and seven percent of hospitalized patients acquire an infection during their hospital stay.¹⁰

These statistics show that there is room to improve the quality of care in even the wealthiest countries, including the United States. Another area where the U.S. can improve is removing financial barriers to healthcare and approaching universal healthcare coverage. According to the U.S. Department of Health and Human Services, only 89.8% of the population had health insurance in 2022.¹¹

Improving healthcare coverage across the population is one of the 23 leading health indicators of the Healthy People 2030 initiative at the Department of Health and Human Services. The Healthy People initiative was created in 1980 and "sets measurable objectives to improve the health and well-being of people nationwide." The goals are revised at the beginning of every decade to reflect current public health challenges and priorities.¹²

Formulated by an advisory committee made up of experts from academia, government, non-profits and industry, the mission of Healthy People 2030 is "to promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people." The initiative is guided by seven foundational principles, including “achieving health and well-being requires eliminating health disparities, achieving health equity and attaining health literacy.”¹³

Healthy People 2030 does not fund or administer public health interventions or programs. Instead, it sets measurable objectives for the leading health indicators and provides systematic reviews of progress, or the lack of it, toward achieving those goals. It also provides research and evidence-based policy resources to other parts of the public health infrastructure. Addressing the Social Determinants of Health is a core focus of the Healthy People 2030 initiative.¹⁴

Social determinants of health are the conditions in which people are born, live, work and age, which affect their health and quality of life. These determinants are grouped into five categories: income, education, health care access and quality, environment and community. Each of these dimensions can positively or negatively impact one’s health. For example, if people live in a "food desert" with limited access to healthy foods, it raises their risk for diet-related diseases such as diabetes.

Healthy People 2030 has created a group, the Social Determinants of Health Workgroup, to specifically address these health inequalities driven by the social determinants of health. The group members are experts in areas outside of healthcare, like economics and health disparities. They are addressing social determinants of health by allocating the appropriate resources to improve health. These resources include safe and affordable housing, quality education, healthy foods and local health and emergency services.¹⁵

Viewing public health through the lens of social determinants offers practitioners and policymakers valuable insights for mitigating adverse health effects at the population level. This important framework is the subject of one of Kent State's core Master of Public Health courses, Social Determinants of Health Behaviors. The class explores the dynamic interplay between individual behaviors and community structures and examines systems approaches to addressing a range of public health challenges, including substance abuse, physical inactivity, poor dietary practices, unsafe sexual behaviors, violence, and mental health.

These are two notable examples of the numerous public health programs and initiatives that have supported better population health in the United States.

Mitigating the health risks of tobacco use is one area where public health research and interventions have had a positive impact. Tobacco-related diseases include heart disease, laryngeal, oral and esophageal cancer, and low birth weight.¹⁶ Public health authorities have been able to significantly reduce tobacco use with smoke-free laws, cigarette excise tax increases and more effective graphic warning labels.¹⁷ This approach has contributed to significant declines in smoking rates and improvements in public health.

Historically, nationwide immunization programs have supported significant public health improvements. Beginning in 1948, polio outbreaks swept the United States, affecting about 16,000 victims, primarily children, each year. The viral disease attacks the nervous system and can lead to paralysis and death. Dr. Jonas Salk famously developed a vaccine in 1955, and by 2020, no cases were reported for the year in the U.S. ^{18, 19} The Centers for Disease Control estimates that childhood vaccinations prevent an estimated four million deaths worldwide every year.²⁰ One of the Healthy People 2030 objectives is to increase vaccination rates in both children and adults through vaccine distribution efforts, school immunization requirements and public awareness campaigns.²¹

Data-driven decision-making ensures that public health policies are grounded in scientific evidence and are tailored to the specific needs and priorities of communities.²² As the Healthy People 2030 emphasis on measuring leading health indicators illustrates, gathering and keeping the correct data in focus can guide effective policymaking.

Population health data can provide insights into health trends and risk factors, guide resource allocation and program planning, shape effective responses to emerging health threats, and help evaluate intervention effectiveness.

However, the data must be effectively managed and analyzed to provide those insights. The Quantitative Methods in Social and Behavioral Sciences course is available as an elective for all Kent State online MPH degrees and required for the Social and Behavioral Sciences specialization. The course introduces the essential quantitative methods in social and behavioral scientific research, provides insights into the selection of analytic techniques for different applications and examines the interrelated roles of scientific theory and the design of socio-behavioral research studies.

If you want to contribute to policy solutions to public health challenges—locally, nationally, or globally—Kent State University's flexible, affordable online Master of Public Health and Bachelor of Science in Public Health can help you build the knowledge, skills, and professional network to make your impact. Schedule a call with an admissions outreach advisor today to get started.