Public Health Prevention and the Determinants of Health

Public Health Prevention and the Determinants of Health

Public Health Prevention and the Determinants of Health

July 17, 2025 (IG10083)

Summary

Federal health policy often focuses on coverage of, and access to, health care services and the treatment of disease. However, numerous economic, social, and environmental policies within the purview of Congress—beyond those directly concerning health care services—influence individual and population health.

A public health model of health promotion and disease prevention prompts policymakers to consider when to intervene in disease progression and which populations to target based on level of risk.

1. Primary Prevention - Universal: For all individuals. To promote wellness and protect against disease onset.

2. Secondary Prevention - Selective: For individuals at a higher risk for developing certain conditions.To enhance protection or reverse progression of early disease.

3. Tertiary Prevention - Indicated: For individuals with a diagnosed condition. To reduce disease severity and mitigate adverse consequences of a condition.

Policymakers can target the factors that influence individual and population health, known as the determinants of health.

Genetics, Environment, Social Circumstances, Individual Behaviors, Medical Care

Factors related to the social and physical conditions in which people are born, live, learn, play, work, worship, and age are known as the social determinants of health. By intervening before the onset of disease, Congress may help prevent

health conditions from occurring and potentially reduce federal spending on medical treatment. Consider the following examples in each of HHS's Healthy People 2030 domains and related policy options for Congress:

Economic Stability - Example: Income levels have been shown to affect health outcomes related to chronic diseases, mental health and substance use disorders, and early mortality.

Congress can influence the economic security of Americans through tax policy workforce programs, or public assistance programs, among other methods. Congress determines eligibility and benefits for tax policies like the Earned Income Tax Credit or the Child Tax Credit (including refundable levels, payment schedules, and phaseout thresholds), public assistance programs such as Supplemental Security Income (SSI) and certain noncash benefits like the Supplemental Nutrition Assistance Program (SNAP). Congress also authorizes workforce development programs through the Workforce Innovation and Opportunity Act and the Department of Commerce's Economic Development Administration programs.

Education Access and Quality - Example: High-quality early childhood education (ECE) is linked to better long-term health outcomes, such as improved cardiovascular and mental health.

Congress can influence early childhood education through federal grant programs such as Head Start, by requiring or encouraging states to expand access to high quality ECE, or through broader tax and economic policies—like the Child and Dependent Care Tax Credit—that may allow families to better afford quality childcare and early childhood education options.

Health Care Access and Quality - Example: Telehealth-based health care services can enhance access to care and improve outcomes related to heart failure, diabetes, obesity, asthma, and certain mental health conditions, among others.

Congress can consider telehealth access and affordability under federal health care laws and programs (e.g., Medicare, laws governing private health insurance). Congress also funds programs that support the expansion of broadband access, such as the Universal Service Fund and the Broadband Equity, Access, and Deployment Program, which may further facilitate access to telehealth services.

Neighborhood and Built Environment - Example: Childhood exposure to lead—even at low levels—can cause damage to the nervous system, delayed growth, or learning and speech problems.

Congress can address lead hazards via existing laws that require federal agencies regulate lead contaminants. Congress could also leverage grant programs that support childhood lead exposure screenings and household lead elimination, such as CDC's Childhood Lead Poisoning Prevention Program and HUD's Office of Lead Control and Healthy Homes programs. Congress could facilitate lead elimination through federal home rehabilitation loan programs authorized in the National Housing Act, or through tax credits for lead removal for homeowners, as some states do.

Social and Community Context - Example: Close interpersonal relationships and connection to community are associated with longer life expectancy and improved recovery from acute health events, such as stroke. In contrast, chronic loneliness is associated with an increased risk of dying prematurely.

Congress could specify investments in public spaces via grant funding—such as through HUD's Community Development Block Grant program or through tax credits such as the Treasury's New Markets Tax Credit program. Congress could also leverage existing human services programs—via discretionary programs such as those in the Older Americans Act or federal health programs like Medicaid—to promote interventions targeting social health.

See, for example, Raj Chetty, Michael Stepner, and Sarah Abraham, et al., "The Association Between Income and Life Expectancy in the United States, 2001-2014," JAMA, vol. 315, no. 16 (2016), pp. 1750-1766. -Taryn Morrissey, "The Effects of Early Care and Education on Children's Health," Health Affairs, April 25, 2019, pp. 165-171. Annette Marie Totten, Marian S. McDonagh, and Jesse H. Wagner, The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic, Agency for Healthcare Research and Quality, AHRQ Publication No. 20-EHC015, Rockville, MD, May 2020, https://eectivehealthcare.ahrq.gov/products/telehealth-expansion/white-paper. Centers for Disease Control and Prevention, Lead Exposure Symptoms and Complications, April 10, 2024, https://www.cdc.gov/lead-prevention/symptoms-complications/index.html. Lisa F. Berkman and Aditi Krishna, "Social Network Epidemiology," in Social Epidemiology, ed. Lisa F. Berkman, Ichiro Kawachi, M. Maria Glymour, 2nd ed. (Oxford: Oxford University Press, 2014), pp. 234-289. HHS, Healthy People 2030, https://odphp.health.gov/healthypeople.

Information as of July 17, 2025. Prepared by Johnathan H. Duff, Specialist in Health Policy; Alexa C. DeBoth, Analyst in Health Policy; Alexandria K. Mickler, Analyst in Health Policy; Kavya Sekar, Specialist in Health Care Policy; Sarah K. Braun, Research Librarian; Alice Choi, Research Assistant; and Brion Long, Visual Information Specialist.