The State of States: How Governors Plan to Address Health-Related Social and Economic Factors in 2019

View a chart comparing the issues each governor addressed.

Governors’ state of the state and inaugural addresses provide critical insights into their policy proposals that impact the health of their residents. Last week, the National Academy for State Health Policy (NASHP) highlighted the health care issues governors raised in their 2019 addresses. This week, NASHP examines the social and economic issues raised – such as poverty, violence, housing, education, and addiction — that heavily impact the health and well-being of Americans.

By early February, 2019, 47 governors, including 20 newly elected, had outlined policy priorities in their speeches.* Of the health-related social and economic factors identified in their speeches, governors most commonly mentioned plans to address education, jobs, and infrastructure, followed by opioids and the environment. Other topics included violence prevention, child welfare, justice, equity, and cannabis. Nine governors discussed plans to develop new government structures to coordinate services efficiently.

Given that health is shaped by myriad conditions in which people live, work, and age, it is not surprising that many topics interrelate and cross sectors. For example, governors who mentioned plans to address workforce training and job readiness touched on both education and employment as key issues.

Of the 34 governors who addressed education, many highlighted early education, student health and mental health, student debt relief, and increased resources for schools:

  • New Mexico Gov. Michelle Lujan Grisham: “I reject the false choice of today’s children or tomorrow’s budget. We must dramatically increase our Pre-K and educational investments today and provide sustainable revenue for the long term. I have also proposed an expansion of the Working Families Tax Credit, which we know creates a ladder out of poverty, providing child care programs so parents can continue to get meaningful support even as they do the hard work to transform themselves and their family’s fortunes for the better.”
  • Ohio Gov. Mike Dewine: “Our plans to intervene early in the lives of at-risk kids, to address their physical and emotional needs, and to give them better, higher-quality educational opportunities — all will be undertaken in the faith and hope and confidence that these children will flourish and grow and that their lives will be forever changed by the things that we do. Education is the key to equality and to opportunity.”

Of the 33 governors who addressed jobs, many focused on workforce readiness, public employee and teacher wages, and minimum wage:

  • Nebraska Gov. Pete Ricketts: “The first pillar is making sure we’re connecting Nebraskans to great paying jobs and that they’ve got the skills to be able to take those jobs. … As previously announced, I am recommending the creation of the Nebraska Talent Scholarships program to help our community colleges, state colleges, and the university system attract even more students in targeted programs from engineering to health care with over 2,100 new scholarships. Additionally, I am recommending the expansion of the Developing Youth Talent Initiative to connect more middle school students to opportunities in manufacturing and IT with an additional $1.25 million annually. This program has already impacted 7,000 students, and this expansion will help reach even more.”
  • New Hampshire Gov. Chris Sununu: “I will be proposing the state’s single largest ever investment into workforce training — a $24 million one-time investment — to grow our state’s nursing and health care workforce and double the number of those graduates in New Hampshire schools.”

Seventeen governors mentioned plans to address the opioid epidemic. This analysis specifically focuses on the preventive aspects of their plans, including efforts to address mental health:

  • Vermont Gov. Phil Scott: “In my first budget address, I talked about the most undeserving victims of our opioid crisis: the children born to addiction. That day — two years ago — I vowed we would not fail them. This budget continues to support our investments in prevention, treatment, recovery, and enforcement. And with an increased investment of $2 million to the Family Services Division, we can give these children more of the support, hope and opportunity they deserve.”
  • South Carolina Gov. Henry McMaster: “Last year, I declared a statewide public health emergency, mobilizing the full power of the state’s emergency infrastructure in response to the growth of opioid addiction and abuse. And I signed what must be the most comprehensive set of laws in the country addressing this crisis across the spectrum of law enforcement, education, and health care…. For instance, our doctors are now required to educate minors and their families on the dangers of opioids before prescribing them; the Department of Health and Environmental Control is issuing tamper-proof prescription pads; the anti-overdose drug Narcan is more readily available; and initial prescriptions are now limited to seven days. I also established the Opioid Emergency Response Team, which in June released a plan consisting of recommendations on physical and public education, prevention and response, treatment and recovery, and law enforcement approaches.

Twenty-one governors mentioned infrastructure issues, from high-speed internet to active transportation, to bridge and road repairs. Georgia Gov. Brian Kemp promised to bring high-speed internet to rural areas and Kansas Gov. Laura Kelly promised, “In the coming days, we will build an interconnected, strategic plan for rural economic development that leverages our communities’ unique assets. That means developing infrastructure.”

Seventeen governors mentioned environment goals, including clean water, clean and renewable energy, climate change, and environmental protection:

  • Maine Gov. Janet Mills: “The Gulf of Maine is warming faster than almost any other saltwater body in the world, driving our lobsters up the coast. Our coastal waters are growing acidic, temperatures are fluctuating, and sea levels are rising, endangering our shellfish industry. Our forests are less suitable for spruce and fir and more suitable for ticks. Climate change is threatening our jobs, damaging our health and attacking our historic relationship to the land and sea.”
  • Florida Gov. Ron DeSantis: “Our economic potential will be jeopardized if we do not solve the problems afflicting our environment and water resources. …We will fight toxic blue-green algae, we will fight discharges from Lake Okeechobee, we will fight red tide, we will fight for our fishermen, we will fight for our beaches, we will fight to restore our Everglades and we will never ever quit, we won’t be cowed and we won’t let the foot draggers stand in our way.”

Fifteen governors called for increased access to affordable housing and/or reductions in homelessness:

  • Nevada Gov. Steve Sisolak: “I will be supporting the recommendation to create a new program which will offer $10 million of state tax credits per year for the creation and preservation of affordable housing.”
  • Oregon Gov. Kate Brown: “[W]e can speed up construction of 200 units of permanent housing for the chronically homeless. We also need to help Oregonians who have homes but are struggling with the high cost of rent. When problems arise, they need technical assistance to stay in their homes and not end up on the streets. We can help landlords and tenants navigate this tight housing market.”

Thirteen governors identified a need to prevent gun violence and improve school safety:

  • Delaware Gov. John Carney: “[W]e provided schools with new resources to make them safer, and passed responsible gun safety legislation. This included the Beau Biden Gun Violence Prevention Act.”
  • Mississippi Gov. Phil Bryant: “A problem exists in our schools today that threatens children of all ages. It has become commonly known as the active shooter… I will ask you to pass a comprehensive plan to keep our school children safe. …If you will pass and fund the Mississippi Safe School Act, our parents, teachers and administrators will be allowed to care for our children in a safe and protected environment.”

Seven governors mentioned the need for equity in educational, employment, and other opportunities:

  • Texas Gov. Greg Abbott: “We must ensure destiny is not determined by zip code. Students from the most challenging circumstances can perform at the highest levels. But we have to give them the opportunity to succeed.”
  • Washington Gov. Jay Inslee: “We’re the state that’s going to tear down the systemic barriers to work and education faced by people of color, people with disabilities, veterans and women. …We’re the state that embraces our differences and diversity… We’re the state making sure our government looks like the people it serves.”

Other topics that impact health include efforts to improve the justice system, enhance child welfare, and structure state government more efficiently:

  • Indiana Gov. Eric Holcomb: “We’ll continue to be transparent and accountable on pressing issues like child welfare…. A year ago we had just started a top-to-bottom review of the Department of Child Services (DCS). Now, we are moving full speed ahead on addressing all those 20 recommendations that not only protect children but recognize the difficult work of those who protect them. It’s still early, but the investments we’ve made to increase caseworker salaries and improve the workforce culture are making a difference. The ratio of supervisors to case managers has improved, so there is more time for supportive supervision and coaching. Turnover among frontline staff is down and retention is up, which means more stability between caseworkers and the families they work with. And, fewer children are reentering the DCS system after their cases close.”
  • North Dakota Gov. Doug Burgum: “We’re creating a unified IT Shared Service organization. Already, we have aligned the backend systems of 31 state agencies, saving more than half a million dollars… We created the Office of Recovery Reinvented to promote these [behavioral health] efforts with help from behavioral health professionals and community and tribal leaders.”
  • Pennsylvania Gov. Tom Wolf: “Our differences haven’t stopped us from putting a down payment on criminal justice reform with the Clean Slate bill… I want us to be ambitious in imagining the Pennsylvania we can build together… Where we reform a criminal justice system that treats African Americans and the poor unjustly.”

Governors’ plans to address these social and economic issues have clear implications for their residents’ health. NASHP will continue to track these proposals and other, related state initiatives in the coming year.

* For some states, information from both a governor’s inaugural address and a state of the state address was included in this review. For others, information from only one speech is incorporated due to one of the following reasons: the inaugural address has occurred but the state of the state speech has not yet occurred, the inaugural address served as the governor’s primary policy speech and no state of the state address is planned, or the governor did not have an inauguration and delivered only a state of the state address. As of Feb. 1, 2019, Kentucky, Louisiana and North Carolina governors had not made speeches.