Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


Increasingly, people recognize that social factors, such as poverty, the living environment, and educational status, substantially affect health outcomes. A “health in all policies approach” (HiAP) seeks structural reform of policymaking to require purposeful consideration, across an interconnected range of public sector actors, of the health equity and justice policy-level considerations of these factors. With the election of Donald J. Trump as 45th President in the United States, however, the U.S. entered a world where the math of the day is division and subtraction, rather than addition or multiplication. And yet, hope in HiAP remains through examples of innovative approaches at the local level, which shift the conversation from a federal “but/so” (subtract and divide) approach to a local “and (especially)/because” (add and multiply) approach.

This articles illuminates the critical role for local communities in building toward HiAP, the integral role of cross-sector policy in this work, and its importance for enduring, equity-enhancing, sustainable health. Specifically, it addresses these issues through relevant case examples drawn from the Memphis experience. These local initiatives illustrate how identifying and addressing social determinants of health—and working towards a HiAP approach—suggest all hope is not lost. Hope remains through application of a different math that builds from addition to multiplication to a whole greater than the sum of its parts. However, it also suggests that the federal government still matters. HiAP is not a panacea to protect against “Trump-like” storms. Yet, through thoughtful, continued local action and vigilance, HiAP presents a critical opportunity to signal key values—and build supportive collaborations and enduring structures—that withstand these storms.