Table 4.

NCCC recommendations related to workplace, ambient, and built environments

Agency	Recommendation
Department of Labor	Expand existing federal protections for mothers in the workplace, including mothers covered under the Fair Labor Standards Act (non-salaried employees) as well as those who are not covered under the Fair Labor Standards Act (salaried employees)
Department of Labor	Develop and disseminate resources to help employers comply with federal law requiring them to provide the time and a place for nursing mothers to express breast milk
Department of Labor	Implement a monitoring system to ensure that employers are complying with federal law that requires they implement lactation support programs
HHS, USDA, NIH, Agency for Healthcare Research and Quality, Center for Medicare & Medicaid Innovation, other federal agencies	Support community-based and community-informed demonstration projects to 1) identify and evaluate the impact of effective, evidence-based breastfeeding support interventions among minority women and women with lower socioeconomic status; and 2) inform implementation and scaling efforts
HHS	Update the 2011 Surgeon General’s Call to Action to Support Breastfeeding to reflect the current landscape of breastfeeding research and provide updated breastfeeding policy and program guidance for the new generation of health care providers, public health officials, women, and families
HHS	Enact and adequately fund a Medicaid incentive payment mechanism to incentivize hospitals and facilities that they provide maternal and newborn services to implement and demonstrate adherence to evidence-based policies, practices, and procedures proven effective in both initiating and increasing the duration of breastfeeding (for example, the Ten Steps to Successful Breastfeeding framework developed by the World Health Organization)
U.S. Congress	Enact national maternity leave legislation to provide mothers with up to 3 months of paid leave, which has been shown to both increase rates of breastfeeding initiation and enhance the duration of breastfeeding; the paid leave provided under this legislation would be distinct from unpaid leave available to employees through the Family and Medical Leave Act
EPA, other agencies	Limit the extent to which federal agency work contributes to individual- and population-level exposure to environmental pollutants and contaminants associated with diabetes and/or its complications; the EPA and the National Institute of Environmental Health Sciences should ensure that environmental protections are in place to limit individual-level and population-level exposure and implement abatement measures, prioritizing those exposures that contribute to diabetes-related disparities
All federal agencies, particularly DOT and HUD	Modify policies, practices, regulations, and funding decisions related to the built environment to prevent diabetes and diabetes complications by enhancing increasing walkability, green space, physical activity resources, and active transport opportunities; priority should be given to those regions and projects that could mitigate the effects of unhealthy built environments on diabetes-related disparities
HUD	Expand federal housing assistance programs to allow access for more qualifying families, such that over a 20-year period, all those who qualify can access subsidized or public housing
IRS	Incentivize developers to place new housing units in areas of low poverty, as data show that moving people from areas of high to low poverty favorably affects prevalence of diabetes
IRS	Mandate that states include neighborhood health parameters (such as availability of health care services, transportation, employment opportunities, education opportunities, food availability, and physical activity resources) in the required IRS Qualified Allocation Plan criteria
IRS	Establish a means to fund or subsidize cost of embedding health services (if needed) in housing developments to incentivize committing space or employing unused space for such services in their plans
HUD	Broaden implementation of indoor smoke-free policies to include subsidized multiunit housing, require that multiunit housing adopt smoke-free policies to provide access to cessation resources, and, in collaboration with the CDC Office on Smoking and Health, work to align these policies with its related policies in public housing to ensure that loss of housing is not an unintended consequence

EPA, Environmental Protection Agency; HHS, Department of Health and Human Services.