Session 3128.0Creating Health Equity: Going Beyond the Health Gap, the Mental Health Gap, and the Climate Gap

Advancing equity through health in all policies: opportunities and obstacles in implementationJme McLean, MCP, MPH, Associate Director, PolicyLink

American Public Health Association Annual Conference Boston, MA | November 4, 2013

Definitions

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- HiAP is a horizontal, complementary policy-related strategy with a high potential to contributing to population health. The core of Health in All Policies is to examine determinants of health, which can be influenced to improve health but are mainly controlled by policies of sectors other than health. – World Health Organization

HiAP is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sector and policy areas.

– APHA, Public Health Institute, CA Department of Public

Health

Health

in All Policies(HiAP)

Definitions

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Equity means just and fair inclusion.

The goals of equity must be to create conditions that allow all to reach their full potential.

In short, equity creates a path from hope to change.

- PolicyLink

Presentation Objective

Identify three strategies for addressing equity through Health in All Policies (HiAP) implementation

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PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works.®

PROMISE NEIGHBORHOODS INSTITUTE

The Sustainable Communities Initiative (HUD-DOT-EPA)

ALLIANCE FOR

Boys and Men of Color

Convergence Partnership

Healthy People, Healthy Places

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PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works.®

Strategy 1

Create opportunity by improving transparency

Strategy 2

Foster both vertical and horizontal collaboration

Strategy 3

Seek equity in both the process and outcomes

Three Strategies for Equitable HiAP

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City of Richmond, CA

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City of Richmond, CA

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Higher rates of heart disease, cancer and stroke among Richmond residents

Higher than average asthma hospitalizations among Richmond children

Richmond shows highest diabetes mortality rates

Richmond shows second highest rates for hospitalization related to substance abuse and mental health

City of Richmond, CA

City of Richmond, CA

Development Review Adoption and Launch of Implementation

Development

Projected Timeline for Implementation2006 2007 2008 2009 2010 2011

Actual Timeline for Implementation2006 2007 2008 2009 2010 2011

Review

Launch of Implementation

Adoption

City of Richmond, CA

Implementation Obstacles:

• Lack of information/understanding among communities regarding when or how to engage with agencies or departments

• Lack of information/understanding among agencies regarding: – connections between agency activities and health– community assets for improving agency activities and/or

health• Negative beliefs held within agencies based on past

experiences with:– adversarial community engagement– challenging collaboration with other agencies or

departments• Power gaps and disagreements within agencies or

departments • Differing expectations among engaged parties (agencies,

funders, communities)

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City of Richmond, CA

Implementation Opportunities:

• Funding available to support interagency collaboration• Common interests among diverse stakeholders to address

city challenges• Wealth of local resources (human, political, financial)• Active and engaged advocates (both individual and

organizational)• Strong political leadership• Environment supportive of change

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Citywide Systems and

Policies

Neighborhood Improvement

Strategies

Community Engagement

Data, Information, and TrackingFramework for Healthy and

Equitable Policy Implementation

Citywide Systems and

Policies

Neighborhood Improvement

Strategies

Community Engagement

Data, Information, and Tracking

Strategy 1

Create opportunity by improving transparency

Strategy 2

Foster both vertical and horizontal collaboration

Strategy 3

Seek equity in both the process and outcomes

Three Strategies for Equitable HiAP

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California HiAP

• AB 32 – climate change• SB 732 – Strategic Growth Council• Executive Order S-04-10 – HiAP

– HiAP Task Force– California Department of Public Health leads– Kitchen Cabinet or “Stakeholder Advisory

Group”

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California HiAP

Implementation Obstacles:

• Lack of information/understanding among agencies regarding: – connections between agency activities and health– community assets for improving agency activities and/or

health• Negative beliefs held within agencies based on past

experiences with:– adversarial community engagement– challenging collaboration with other agencies or

departments• Power gaps and disagreements within agencies or

departments • Differing expectations among engaged parties (agencies,

funders, communities)18

California HiAP

Implementation Opportunities:

• Funding available to support interagency collaboration• Common interests among diverse stakeholders to create

healthy communities• Wealth of local resources (human, political, financial)• Active and engaged advocates (especially organizational)• Strong political leadership• Environment supportive of change

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Citywide Systems and

Policies

Neighborhood Improvement

Strategies

Community Engagement

Data, Information, and TrackingFramework for Healthy and

Equitable Policy Implementation

Citywide Systems and

Policies

Neighborhood Improvement

Strategies

Community Engagement

Data, Information, and Tracking

Strategy 1

Create opportunity by improving transparency

Strategy 2

Foster both vertical and horizontal collaboration

Strategy 3

Seek equity in both the process and outcomes

Three Strategies for Equitable HiAP

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Strategy 1 Create opportunity by improving transparency

FundersInvest in strategies for improved

communication and identification of shared goals across HiAP partners.

Health Agencies

Share health info with HiAP partners in relevant formats (utility,

language, geographic scale, etc.).

Other Agencies

Communicate plans and processes for decision-making, and how/when

HiAP partners can participate.

AdvocatesBuild capacity of HiAP partners to

understand and leverage community assets.

Three Strategies for Equitable HiAP

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Three Strategies for Equitable HiAP

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Strategy 2 Foster both vertical and horizontal collaboration

FundersRequire inclusion of low-income people and communities of color in HiAP efforts

as a condition of funding.

Health Agencies

Share and model strategies for positive community engagement with HiAP

agency partners.

Other Agencies

Consider cost-benefit of proactive engagement before HiAP projects vs.

managing reactions after.

AdvocatesAdvance HiAP issues by building internal relationships as well as

applying external pressure.

Three Strategies for Equitable HiAP

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Strategy 3 Seek equity in both the process and outcomes

FundersMatch HiAP objectives with short-term and long-term time frames for building power among impacted communities.

Health Agencies

Challenge conventional wisdom with data on racial and socioeconomic

inequities and questions about power.

Other Agencies

Look for shared goals with communities and identify opportunities to increase

their capacity.

AdvocatesChampion both inclusive HiAP

processes as well as policies that promote inclusion.

“In order to address health inequities, and inequitable conditions of daily living, it is necessary to address inequities—such as those between men and women—in the way society is organized. This requires a strong public sector that is committed, capable, and adequately financed. To achieve that requires more than strengthened government—it requires strengthened governance: legitimacy, space and support for civil society, for an accountable private sector, and for people across society to agree on public interests and reinvest in the value of collective action. In a globalised world, the need for governance dedicated to equity applies equally from the community level to global institutions.”

- World Health Organization (WHO). Closing the gap in a generation: health equity through action on the social determinants of health. Report of the Commission on the Social Determinants of Health, WHO, Geneva, 2008.

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Thank You!

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Jme McLean, MCP, MPH, Associate Director, PolicyLinkjme@policylink.org

American Public Health Association Annual Conference Boston, MA | November 4, 2013

www.policylink.org