The effort, led by researchers at the Johns Hopkins Bloomberg School of Public Health, A study on the effectiveness of health records in influencing legislative decisions It provided compelling insights into usefulness and potential improvements. Health Politics, Policy and Law Journal; The study explored feedback from legislators, staff, subject matter experts, and practitioners involved in piloting health notes in a range of legislative jurisdictions.
The study, led by Stéphanie Carignan, collected the perspectives of various actors involved in the legislative process to identify the strengths of the Health Note and areas for improvement. Survey results showed that the majority of respondents found the Health Note easy to understand and the level of detail appropriate. Legislative staff noted the clarity and depth of the Note, stating, “The level of detail is appropriate and… [legislative] Members were amazed to find that it had over 90 footnotes, which is a good sign that it was well researched.”
However, challenges were noted, particularly regarding the timing and format of the Health Notes. Respondents suggested that introducing these notes earlier in the legislative process could strengthen their impact, giving policymakers more time to understand and use the information effectively.
The study uncovered cases where health notes played a pivotal role in shaping legislative outcomes. For example, in Indiana, legislators shared their health notes with their colleagues, influencing their votes and perceptions on proposed bills. This highlights the potential for health notes to bridge the understanding gap between health impacts and policy decisions.
Conversely, some respondents highlighted the limitations of current practice, noting that health notes are sometimes not aligned with the broader political debate surrounding a bill, diluting their impact. These insights point to an opportunity to refine the content and delivery of health notes to better integrate them into legislative timelines and priorities.
Respondents generally supported the Health Note’s methodological rigor and acknowledged its reliability and objectivity in assessing the health impacts of bills. Suggested future improvements included broadening the scope of the analysis to include demographic-specific effects and incorporating a more accessible format such as an executive summary or infographics.
Based on stakeholder feedback, recommendations to improve the effectiveness of Health Notes include:
- Introduce a health note early in the legislative process
- Provide supporting material, such as an executive summary, to facilitate understanding
- Expanding the focus to include specific demographic impacts, especially as they relate to equity considerations
- Streamlining the review process to meet the rapid legislative timeline
“Despite challenges, research confirms that the Health Notes are an important step toward ensuring evidence-based policymaking that prioritizes public health outcomes,” Carignan said. “By addressing feedback and implementing improvements, the Health Notes can further provide lawmakers with the critical information they need to advance health equity and informed policy decisions.”
Despite the positive feedback, challenges remain in institutionalizing the Health Note within a legal framework. Potential barriers to widespread implementation include resource constraints and varying degrees of legislative buy-in. Furthermore, the study emphasized the need to continually refine and adapt the Health Note to meet changing legislative needs and priorities.
This study highlights the transformative potential of health notes in integrating health considerations into non-health policy areas. This work is transitioning to the new Health in All Policies Research Center at Johns Hopkins University, and its findings will guide future efforts to increase the utility and impact of health notes in legislative decision-making processes across the country.
