HI-5 Project Aims to Advance Health Impact in 5 Years

In recent years, the United States has experienced reductions in public health resources at all levels and continuing changes to the health system. These factors make it increasingly important that state and local decision-makers are proficient identifying and implementing high-impact, cost-effective approaches to address the drivers of poor health and high costs. To better support partners and decision-makers in these efforts, the Centers for Disease Control and Prevention (CDC) developed the Health Impact in Five Years (HI-5) Initiative. The HI-5 Initiative shifts the focus beyond traditional clinical approaches to health and explores social and environmental approaches that improve population health and health equity. 

I am proud to work on a project at the CDC Foundation as a project lead related to advancing the HI-5 Initiative. Our role is to identify necessary supports in the development, enactment and implementation of policies that support the HI-5 interventions and to consider how public health practitioners and other stakeholders can engage in the policy process. In partnership with the Robert Wood Johnson Foundation, we are

• working with stakeholders to synthesize, translate and disseminate lessons learned from states and communities that have implemented three social and economic interventions featured in HI-5;
• identifying resources and supports needed for additional states and communities to advance these interventions through policy strategies; and
• highlighting research gaps related to these interventions.

One HI-5 intervention to address the social determinants of health is earned income tax credits (EITC). Earned income tax credits are income tax credits levied at the federal, state and local levels that benefit low- and moderate-income working individuals and families. EITCs have been credited with keeping more families and children above the poverty line than any other federal, state or local program. In addition, evidence demonstrates that EITCs are associated with reductions in infant mortality, preterm births and improvements in birthweight and maternal mental health.

The CDC Foundation hosted an exploration meeting on EITCs in June and invited several state and local jurisdictional experts who have successfully implemented EITCs in their state, as well as those looking to learn more about this intervention.

Jennifer Sullivan, a senior policy analyst with the Center on Budget and Policy Priorities, attended the June meeting. Following the meeting, she said, “The Earned Income Tax Credit is not only one of the most effective policy tools we have for reducing poverty, but it’s also a critical lever for improving health. It was powerful to be in a room with state health officials, budget experts and community leaders who recognize this and are committed to working together to expand and improve state EITCs.”

Lee Norman, MD, is the secretary for the Department of Health and Environment for Kansas, and he offered a different and important perspective on the EITC meeting. “I’ve been a physician for many years, and I’ve learned that medical care alone only goes so far,” according to him. “Social determinants, including income, are necessary to achieve optimal health. Earned Income Tax Credits are important to this discussion, and honestly, it was new to me. It is not something taught and learned in medical training, but now I know.”

We are grateful to the Robert Wood Johnson Foundation for their support of this project. Through this work, we hope to provide public health professionals with the evidence, policy-related skills and capacity to consider and implement those policy approaches that improve health across communities.