PSUS 6230 UP: SUSTAINABLE COMM DESIGN STUDIO: PLANNING FOR HEALTH POLICY IN THE 21ST CENTURYNOVEMBER 19,2015

HIAP AND HIA

SANDRA WHITEHEAD, PHD

Health in All Policies (HiAP)•HiAP is defined as an approach (a set of strategies) to integrate health considerations in decision making across different sectors that influence health

•HiAP emphasizes the need to collaborate across sectors to achieve common goals

•It is a collaborative approach that integrates and articulates health considerations into policy making across sectors, and at all levels, to improve the health of all communities and people

History of HiAP•Emerging in 2006, HiAP was a major theme during the Finnish Presidency of the EU with the goal of strengthening existing legislation that required ensuring human protection in the formation and implementation of policies

•It sought to create large, horizontal systems change that changed how all of government functioned

•This was a stronger approach than the earlier, project-based efforts of inter-sectoral action of the 1970s and the incrementalist, process-driven efforts of the healthy public policies movement

•Since 2006, HiAP has spread across the globe

•HiAP approaches are now seen in the United States at the federal, state, and local levels

Roles in HiAPFederal, State, Local, Government role:

•Adopt a Health in All Policies approach in the policy-making process in order to ensure that policies made outside of the health sector have positive or neutral impact on the determinants of health

•Provide funding, training, and technical assistance for local health departments (LHDs) to ensure that they can assume a leadership role implementing a HiAP approach at the local level and determine the best strategies for implementing HiAP locally

Local health departments role:

•Take a leadership role to implement HiAP at the local level, including identifying the best strategies for implementing HiAP in the jurisdiction

•Assume a prominent role educating local, state, and federal policymakers about the value of HiAP

HIA and HiAP•HiAP is the framework within which HIA is used

•The underlying values of both are the same

•HIA is a strategy to implement HiAP• Focus on community engagement and inclusion•Use a health lens as a decision support for non-health decisions•Uses data and root cause analysis to choose strategies and tactics

to affect health outcomes• Employs inter-sectoral partnerships

https://youtu.be/U0qiGxO05WQ

Strategies Tactics Opportunities Assessment or decision support tools

Topics

• Built environment

• Economic opportunity

• Air/ water/ soil quality

• Children’s environmental health

• Sustainability • Environmental

Justice • Climate change • Food

environment• Sanitation• Vector control

1. Developing and Structuring Cross Sector Relationships

2. Incorporating Health into Decision Making Processes

3. Enhancing Workforce Capacity

4. Coordinating Funding and Investments

5. Integrating Research, Evaluation and Data Systems

6. Synchronizing Communications and Messaging

7. Implementing Accountability Structures

• Hiring “backbone” staff

• Cross-sector trainings on health

• Cross-sector taskforce

• Data sharing agreements

• MOUs • Executive orders • Ordinances or

laws • Hiring of “non-

traditional” staff • Streamlining

development procedures

• Brownfields/ land reuse

• Comprehensive plans• Sustainability plans• Zoning ordinance

updates• Transportation/

redevelopment/ land use projects

• Site design • Site location • Climate change

action plans • Proposed ordinance,

law, or policy • Strategic plan

• Community health assessment/ community health improvement plans

• Health impact assessment (HIA)

• Health community design checklists or indicators

1. Developing and Structuring Cross Sector Relationships

2. Incorporating Health into Decision Making Processes

3. Enhancing Workforce Capacity

4. Coordinating Funding and Investments

5. Integrating Research, Evaluation and Data Systems

6. Synchronizing Communications and Messaging

7. Implementing Accountability Structures

Strategies

• Hiring “backbone” staff

• Cross-sector trainings on health

• Inter-disciplinary taskforce

• Data sharing agreements

• MOUs

• Executive orders

• Ordinances or laws

• Hiring of “non-traditional” staff

• Streamlining development procedures

Example Tactics

• Brownfields/ land reuse plans

• Comprehensive plans

• Sustainability plans

• Zoning ordinance updates

• Transportation projects

• Climate change action plans

• Proposed ordinance, law, or policy

• Strategic plan

Examples of Opportunities

• Built environment

• Economic opportunity

• Smoking in parks

• Children’s environmental health

• Sustainability

• Environmental Justice

• Climate change

• Food environment

Example Topics

Characteristics of Successful Collaboration

Examples of HiAP early adopters in the United States•Federal level: The National Prevention Strategy

•State level: California’s Health in All Policies Task Force

•Local level: • 1. King County’s Equity and Social Justice Ordinance in Washington State

• 2. Denver’s Environmental Public Health Policy in Colorado

• 3. San Francisco Department of Public Health’s Program on Health, Equity, and Sustainability, which “supports San Franciscans working together to advance urban health and social and environmental justice through ongoing integration of local government and community efforts and through valuing the needs, experiences, and knowledge of diverse San Francisco residents”

California’s HiAP Task Force• Created by Executive Order S-04-10 in 2010

•The HiAP Task Force is housed under the Strategic Growth Council

•Brings together 22 state agencies, departments, and offices, with a common goal of working together to support a healthier and more sustainable California

• Five Key Elements◦ Promote health, equity, and sustainability

◦ Support intersectoral collaboration

◦ Benefit multiple partners

◦ Engage stakeholders

◦ Create structural or procedural change

•HiA”p” Comprehensive Plans Integrating Health: Polk County, FL

•LHD-led HiAP: Santa Cruz, CA

•Integrating Joint Use: Franklin Regional Council, MA

•Moving from HIA to HiAP: Kitsap, WA

Examples of HiAP in Action

HiAp: Polk County, Florida

• Urban sprawl

• Not enough opportunities for physical activity

• Many choices for unhealthy food

• Aging population

7. Lakeland –Winter Haven, Florida

According to Gallup, the Lakeland –Winter Haven Fla. metro area has the potential to save more than $150 million in health care costs if its obesity rate dropped to 15%. In 2010, 37.6% of its residents suffered from obesity, racking up more than $279 million a year in medical bills.

#7 America’s Fattest Cities

Public health and planning can change the built environment to improve health outcomes

•People in walkable neighborhoods exercise more and are less likely to be overweight or obese

•People who eat more fruits and vegetables are healthier and tend to be less overweight and obese

•People are happier and healthier when they are socially connected

Guiding Principles

• Starting in 2007, Polk County began adding health language to its comp plan

• In 2009, health considerations were implemented in the amended land development regulations

Changing the Comprehensive Plan

• In 2010, implementation of universal health consideration began throughout the county

• Of the 17 municipalities in Polk County, 16 have adopted county standards for parks, complete streets, school siting, location and limitation on fast food and alcohol outlet density, zoning to encourage active places, and many more health promoting policies

Polk County HiAp

Changing the Comp Plan in Polk

“Building a Healthier Polk” is a group of community partners brought together by Polk Vision with the goal of reducing obesity (BMI > 30) from 37.6% of the adult population (2010) to the State average of 27.2%. This effort began with a community forum that included over 70 community stakeholders and today has more than 120.

Policies Encouraging Physical Activity

City of Winter Haven

• Fitness by the Fountain

• Has a fleet of 12 kayaks for citizen usage

• City hosted eco-tours

Healthier Together in Santa Cruz CountyAchieving Health Equity through the Santa Cruz County Health in All Policies Initiative

Healthier Together in Santa Cruz County

Made possible through a grant from the National Association of County & City Health Officials (NACCHO) and CDC’s National Center for Environmental Health

Overview of Santa Cruz’s Approach

•Establish and convene a cross sectorial HiAP work group with a focus in the southern part of Santa Cruz County

•Establish branding, webpage, flyer

•Educate the group on HiAP, health equities, social determinates of health

•Draft Strategic Plan

•Identify goals, objectives and outcomes

•Participate in HIA training

•Educate the greater community, stake holder and elected officials

• Convene a cross-sector, collaborative task force

• Educate members about the role policies play in health

• Choose policy domains that can be changed

• Implement accountability structures: metrics

Tactics for Implementing HiAP in Santa Cruz

Santa Cruz’s Areas of Focus•Economic Opportunities

•Health

•Housing

•Land

•Parks

•Public Safety

•Socio-Political

•Sustainability-Environmental Health

•Transportation

Articulating Joint

Use

Defining terms,

explaining benefits,

value added from

written agreements

Planning

Considerations

What to look for in a

site, planning for costs

Resources

Guides, toolkits, websites

Joint Use DefinedJoint Use (shared use / community use)

=

opening public buildings and grounds at times they are usually closed

so that community residents can exercise and engage in other recreational activities

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Community Health Benefits

Opening facilities to the broader community encourages residents to adopt healthier lifestyles by ensuring convenient access to safe places to play and exercise

In communities without many resources and facilities that are open to the public, expanding access to schools and municipal buildings that already exist can have a significant impact on community health and connectedness

Individual Health Benefits

Active residents are less likely to suffer from chronic illnesses tied to poor diet and sedentary behavior

Youth Development Benefits

•Youth engaged in activities and exercise in safe environments have less opportunity to make unhealthy or potentially dangerous decisions about how to spend their time outside of school

Economic Benefits• Joint use maximizes the use of existing community resources• Joint use strengthens the relationship between the community and the joint use site, and helps to

build support for capital improvements and greater municipal investment

Community Use Policies

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A community or school district policy for joint use is not a joint use agreement that describes a specific use of a specific site

Specific building or district policies help shape the content of the joint use agreement and explain to potential users how to approach the school with a proposal.

The details of the specific arrangement between the school and the community group, such as who will open the gymnasium and supervise the children, must still be negotiated

Joint Use Agreements

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Written Agreements

Verbal/Informal

The exact contents of an agreement might differ based on site and activity, but some common elements include:

• Scheduling

• Cost

• Maintenance

• Liability

• Security

• Expectations are concrete and clear

• Odds of misunderstanding are reduced

• Allows arrangements to continue even if a decision-maker leaves or changes position

An Ideal Space Is:

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Familiar

• Community members more likely to take advantage of joint use in familiar spaces

• For families/children, schools are an ideal site

Accessible

• Safe to get to if walking

• Sufficient parking if driving

• Handicap accessibility

Well-maintained

• After-hour/weekend use means that users will sometimes arrive or leave in the dark

• Clearly-marked signs and pathways and be well-lit both indoors (if applicable) & out

Secure• Be able to quickly and easily secure it before and

after the shared use hours

• If only one part of a building is used, ideally it would be relatively easy to block off the rest of the building

Equipped• Accessible restrooms and Potable water

Costs Associated with Joint Use

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• Increased expense for maintaining equipment and grounds

• Cost of extra hours and responsibilities for custodial staff.

• Staff to supervise activities during joint use hours and/or staff to run programming

• Security improvements or extra equipment

HIA and HiAP•Communities often start with one and move to the other

•Commonalities include:• Community centered approach

• Inter-sectoral partnerships

• Data driven decision making

• Outcomes are measured and reported

• Communication about health outcomes and risks

• Creates structural or procedural change

HiAP is More than a State of Mind•Actionable: focuses on community needs

•Brings partners together to improve conditions in the community

•Is time based and uses metrics and milestones to measure progress

•Involves a wide array of non-health partners to change systems and policies