Table 1 Summary of Health Impact Reviews reviewed in the study sample

(Budget Proposal, 2007) Education

Would provide grants to school districts or partners increase dropout services for at-risk students.

The program has the potential to decrease health disparities if it is designed to reduce health disparities among minority students.

(Budget Proposal, 2007) Education

Would provide funding for the Office of Superintendent of Public Instruction for Financial Incentives to Attract Excellent Teachers for Hard-to-Staff Schools and Subjects to improve students’ test scores by hiring experienced teachers in low-performing schools.

The program could reduce health disparities among a large population of minority students if the salary incentives were focused in those communities.

(S.H.B. 1675, 2008) Disaster preparedness and recovery

Would require state agencies to provide bilingual or multilingual notices of public health, safety, or welfare risk when 5% or more of the residents in an affected area speak a language other than English and have limited English proficiency.

The bill had the potential to reduce health disparities faced by limited English proficiency populations, likely to be Hispanics and Asian and Pacific Islanders, resulting from emergencies and disasters.

(S.H.B. 2884, 2007, 2008) Education

Would limit the use of chemical, mechanical, and physical restraint against students in public schools. The bill would also have added a requirement research-based, school-wide, positive behavior intervention supports are included in classroom management trainings.

The health impact would be limited given the infrequently used discipline practices this bill addresses.

(H.B. 3221, 2007–2008) Economic policy

Would establish a ten-member financial services intermediary, which would work with financial institutions and community-based asset building coalitions to improve access to mainstream financial products, establish individual development accounts, and offer financial education for low-income individuals.

The bill could reduce health disparities for low-income communities.

(Budget Proposal, 2009) Health care and social services

Would eliminate the General Assistance-Unemployable program and reduce funding for subsidized health care for children in poverty, and the universal vaccine program and HPV vaccine.

The budget cuts would disproportionately impact low-income families, racial and ethnic minority communities, and women, which would likely lead to an increase in health disparities experienced by these groups.

(Implementation of Core 24 High School Graduation Requirements, 2009) Education

Would increase graduation requirements from 19 to 24 credits for high school students, including three years of math, more English, and a career concentration.

The request for an HIR was withdrawn.

(H.B. 1341, 2009) Education

Would remove state assessment as a pre-requisite for high school graduation, and would dedicate subsequent savings to assessing incentive programs for students to meet state standards and pursue higher education.

More research is needed to understand the connection between school exit exams and health determinants such as dropout and graduation rates.

(S.H.B. 1680, 2013) Education

Would incorporate opportunities to close the educational achievement gap by addressing disciplinary strategies, educator cultural competency, subgroup academic achievement, and occupational pathways.

The bill has the potential to positively impact student achievement and health among minority students by addressing educational and social needs.

(S.S.B. 6439, 2014) Education

Would update and enforce training requirements for anti-harassment, intimidation, cyberbullying, and bullying policies for implementation by district Compliance Officers.

The bill has the potential to reduce bullying and adverse health outcomes experience by those disproportionately impacted by bullying, including LGBTQ youth and students experiencing both under and overweight issues.

(H.B. 2451, 2014) Health care and social services

Would expand the list of acts that constitutes unprofessional conduct by a licensed health care provider to include performing sexual orientation change efforts on a patient under the age of 18.

The bill has the potential to mitigate harms and improve health outcomes among LGBTQ patients.

(Budget Proposal, 2014) Health care and social services

Requests 25% of the funding needed to build five community health centers to provide care to 42,300 patients.

Health disparities may be reduced among this population by increasing their access to culturally and linguistically appropriate health care.

(S.B. 5571, 2014) Health care and social services

Would require the Department of Social and Health Services to increase awareness of mental health illness and its consequences through a public awareness and education campaign targeted at those who disproportionately experience negative mental health outcomes, stigma, and barriers to care.

The bill has the potential to decrease health disparities among the target group by increasing knowledge of mental health issues, decreasing stigma, and educating the community about positive behavior changes, such as seeking help.

(S.S.B. 6554, 2014) Health care and social services

Would require personal emergency response system companies to provide the location and known medical conditions of their costumers when requested by first responders during an emergency.

The bill could improve health outcomes during an emergency for older adults, individuals with disabilities and chronic conditions, and individuals with limited mobility.

(Amendment #910 to S.B. 6552, 2014) Education

Would improve student success by increasing instructional hour and graduation requirements.

As shown on the BOH HIR website, a full HIR was not completed following the request form, “Board of Health staff are currently working with the requestor to establish a completion date for this review. This is expected to be a long-term project.”

(H.B. 2321, 2014) Labor and employment

Would create two new mid-level dental professions to practice under supervisions of dentists and in specified care settings.

The bill could improve oral health and health outcomes for low-income communities of color and those with chronic conditions.

(S.B. 6170, 2014) Labor and employment

Would require disciplining authorities specified by the state legislature to adopt rules requiring health professionals to receive cultural competency continuing education identified by the Department of Health.

The bill had the potential to decrease health disparities by improving health and health care outcomes for diverse patient populations.

(H.B. 1080, 2015) Education

Would restore funding to the health professional loan repayment and scholarship program fund.

The request for an HIR was withdrawn after the Health Professional Loan Repayment and Scholarship Program Fund was refunded in the 2015–2017 operating budget.

(H.B. 1295, 2015) Education

Would require high-needs schools without 70% of free or reduced-priced meals to offer breakfast after the bell that meets federal standards. Training for implementation of this program would be provided by the Office of the Superintendent of Public Instruction.

The bill could narrow educational and income gaps, and decrease health disparities in these schools.

(H.B. 1671, 2015) Education

Would authorize health care practitioners to administer, prescribe, and dispense opioid overdose medication to any person who may be present at an overdose - law enforcement, emergency medical technicians, family members, or service providers.

The bill has the potential to reduce the number of deaths from opioid overdose.

(H.B. 1449, 2015) Natural resources and energy

Intended to prevent and improve the state’s ability to respond to oil spills.

The bill could decrease water and public health risk factors related to oil spills, particularly for communities of color, low-income communities, and populations with lower levels of educational attainment.

(S.B. 5346, 2015) Health care and social services

Would require personal emergency response system companies to provide the location and known medical conditions of their costumers when requested by first responders during an emergency.

The bill could improve health outcomes during an emergency for older adults, individuals with disabilities and chronic conditions, and individuals with limited mobility.

(S.B. 5870, 2015) Health care and social services

Would expand the list of acts that constitutes unprofessional conduct by a licensed health care provider to include performing sexual orientation change efforts on a patient under the age of 18.

The bill could mitigate harms and improve health outcomes among LGBTQ patients.

(H.B. 1674, 2015) Criminal justice

Would provide the Department of Social and Health Services with custody of youth convicted as adults who expected to complete their term of confinement before their 21st birthday (and Department of Custody if they finish after their 21st birthday); Would require youth convicted as adults to access the same services and programming as youth convicted in juvenile court.

The bill has the potential to reduce recidivism for youth offenders, which could lead to a decrease in health disparities for this population.

(S.B. 6029, 2015) Labor and employment

Would increase the state minimum wage annually with the rate of inflation, and increase at inflation plus 3% during years when per capita personal income increased over the year before and when it was higher than the per capital personal income for the country.

The bill could increase income and improve related health effects for low-wage workers.

(H.B. 1356, 2015) Labor and employment

Would require employers with five or more full-time employees to provide paid sick and safe leave to employees for reasons related to closure of the employee's place of business or childcare, and purposes related to domestic violence, sexual assault, and stalking.

The bill has the potential to improve financial security, decrease the transmission of communicable disease, improve health outcomes, and decrease health disparities by income, educational attainment, race and ethnicity, and geography.

(H-0915.3/15 draft, 2015) Labor and employment

Would require the Department of Labor and Industries to develop rules creating workload standards for employees performing commercial janitorial services.

Reducing workload and rushing among commercial janitors would likely decrease workplace injury disparities by race/ethnicity, English proficiency, country of origin, education, and income. It is not clear from available studies if the specific standards required in the bill would lead to decreased work intensity and rush.

(S.B. 5459, 2015) Labor and employment

Would require employers to annually provide twelve weeks of family and medical leave insurance to eligible employees for the birth or placement of a child and for a family member’s serious health condition, plus 12 weeks for the employee’s own serious health condition.

The bill could improve financial security; to improve maternal, child, and family health; and to decrease health disparities by income, educational attainment, and race/ethnicity.

(Budget Proposal, 2015) Labor and employment

The 2015–2017 Individual Provider Home Care Contract is a tentative agreement between the State of Washington and SEIU 775 regarding individual providers who have contracted with the Department of Social and Health Services (DSHS) to provide personal care, respite care, or residential services.

Funding would likely improve health outcomes for home care providers, thereby decreasing health disparities by race/ethnicity and income in the state.

(S.H.B. 1458, 2015) Agriculture, food, and drug

Would change the minimum age at which a person may purchase and possess cigarettes, tobacco products, and vapor products from 18 to 21 years old; Modifies the definition of a “vapor product”.

The bill would likely decrease use of tobacco and vapor products among youth and young adults, thereby improving health outcomes. It is unclear how the bill would impact health disparities, though some evidence suggests that the effect on disparities may be neutral.

(H.B. 2307, 2016) Labor and employment

Would require employers to provide reasonable accommodation in employment for pregnancy, childbirth, or pregnancy-related health conditions, unless the accommodation would impose an undue hardship on the employer.

The bill has potential to improve maternal and child health and to decrease health disparities by race/ethnicity and income.

(H.B. 1865, 2016) Education

Would require every board of school directors to provide for screening for near vision acuity in addition to screening already required for distance vision acuity.

The bill has potential to increase the number of students who have near-vision problems detected and treated, which in turn has potential to improve educational, income, and health outcomes for these students, but unclear how the bill would impact treatment and long-term outcomes.

(H.B. 2313, 2016) Agriculture, food, and drug

Would prohibit selling or giving tobacco or vapor products to a person under the age of 21; Modifies the definition of a “vapor product”.

The bill would likely decrease use of tobacco and vapor products among youth and young adults, thereby improving health outcomes. It is unclear how the bill would impact health disparities, though some evidence suggests that the effect on disparities may be neutral.

(S.B. 6149, 2016) Labor and employment

Would require employers to provide reasonable accommodation in employment for pregnancy, childbirth, or pregnancy-related health conditions, unless the accommodation would impose an undue hardship on the employer.

The bill has potential to improve maternal and child health and to decrease health disparities by race/ethnicity and income.

(H.B. 2969, 2016) Agriculture, food, and drug

Would impose a 45% tax on the taxable sales prices of vapor products; create a distributor and retailer license to distribute or sell vapor products in Washington; and require that, at a minimum, 3% of the revenues collected from the vapor products tax be appropriated from the general fund to the Cancer Research Endowment Fund Match Transfer Account.

The bill would likely decrease vaping rates in Washington State, thereby improving health outcomes and decreasing health disparities by socioeconomic status in the state.

(H.B. 2986, 2016) Health care and social services

Would create a premium assistance program for low-income Pacific Islanders living in Washington state under a compact of free association (COFA) to purchase health insurance through the health benefit exchange. The bill would also establish an advisory committee that would lead the development, implementation and operation of the program.

The bill has the potential to increase access and utilization of health care services, which may result in improved health outcomes and reduced health disparities, by increasing the number of COFA residents enrolled in a qualified health plans.