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Health in All Policies
September 16, 2015 Directors of Public Health Nursing 2015 Fall Conference
Julia Caplan, MPH, MPP and Linda Rudolph, MD, MPH
Public Health Institute
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Introductions and Overview
Today’s Goals
• Increased understanding of – Health in All Policies
– Links between health, equity, and climate change
• Share tools for building cross-sectoral partnerships
• Ideas about how PHNs can use a HiAP approach in your own communities
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Agenda
1. Introduction & Overview
2. Government Functions
3. Root Cause Mapping Exercise I
Short break & map walk-about
4. Root Cause Mapping Exercise II
5. Collaboration & Communication
6. Cross-Program Opportunities
7. Discussion & Closing
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Agreements
• Try on the process
• Step up / Step back
• There is no wrong way to do HiAP
• Have fun!
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Creating Healthy Communities
What is a Healthy Community?
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What is a Healthy Community?A Healthy Community provides for the following through all stages
of life:• Meets basic needs of all
– Safe, sustainable, accessible and affordable transportation options– Affordable, accessible and nutritious foods and safe drinkable water– Affordable, high quality, socially integrated and location-efficient housing– Affordable, accessible and high quality health care– Complete and livable communities including quality schools, parks and recreational facilities, child care, libraries, financial
services and other daily needs– Access to affordable and safe opportunities for physical activity– Able to adapt to changing environments, resilient, and prepared for emergencies– Opportunities for engagement with arts, music and culture
• Quality and sustainability of environment– Clean air, soil and water, and environments free of excessive noise– Tobacco- and smoke-free– Green and open spaces, including healthy tree canopy and agricultural lands– Minimized toxics, greenhouse gas emissions and waste– Affordable and sustainable energy use– Aesthetically pleasing
• Adequate levels of economic, social development– Living wage, safe and healthy job opportunities for all, and a thriving economy– Support for healthy development of children and adolescents– Opportunities for high quality and accessible education
• Health and social equity• Social relationships that are supportive and respectful
– Robust social and civic engagement– Socially cohesive and supportive relationships, families, homes and neighborhoods– Safe communities, free of crime and violence
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Rudolph 2013 10
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Rudolph 2013 13
Social Determinants of Health
Social Determinants of Health
• Education• Income• Inequality• Race & ethnicity• Early child
experiences• Social support• Employment• Social & cultural
environments
• Built environment• Housing• Transportation• Green space• Food environment• Stress• Gender
“It is unreasonable to expect that peoplewill change their behavior easily when somany forces in the social, cultural, andphysical environment conspire against
such change.”
- Institute of Medicine
Rudolph 2013
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Place Matters
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What are Health Inequities?
Preventable differences in health outcomes that are the result of the systematic and unjust distribution of social determinants or conditions that support health.
http://www.cdc.gov/healthycommunitiesprogram/overview/healthequity.htm
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Where’s Public Health?
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Transportation
Agriculture
Arts
Housing CommunityDevelopment
Transportation
Labor & Workforce
Energy
Environment
Public Works
Public Health
We all have a role to play in creating healthy communities.
• Environments in which people live, work, study and play impact health
• Decisions made by “non-health” agencies play a major role in shaping environments
• Consideration of health allows agencies to make more informed policy and program decisions and to identify win-wins
a collaborative approach to improving the health of all people by incorporating health considerations into
Health in All Policies is…
decision-making across sectors and policy areas. Source: Rudolph, L., Caplan, J., Ben-Moshe, K., & Dillon, L. (2013). Health in All Policies: A
Guide for State and Local Governments. Washington, DC and Oakland, CA: American Public Health Association and Public Health Institute.
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Health in All Policies: 5 Key Elements
1. Promotes health, equity, & environmental sustainability
2. Supports intersectoral collaboration
3. Benefits multiple partners
4. Engages external stakeholders
5. Creates structural or process change
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Co-benefits
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California Health In All Policies Task Force
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Report to the Strategic Growth Council
Active transportation
Housing and indoor spaces
Parks, urban greening, and
places to be active
Community safety through
violence prevention
Healthy food
Healthy public policy
Active Transportation Co-Benefits
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Active Transportation Co-Benefits
• Increases– Physical activity– Social capital
• Avoidable increases– Bike/ped injuries
• Reduces– Respiratory & CV
disease– Diabetes & cancer– Depression & stress– Osteoporosis
• Reduces– Infrastructure costs– GHG emissions– Air pollution– Noise– Community severance
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Role of Government
What does government do?
(Policy or policy)
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Government Functions
• Data
• Direct Service Provision
• Education & Information
• Employer
• Funding
• Guidance and Best Practices
• Permits/Licenses
• Purchasing, Procurement, Contracts
• Regulation• Research & Evaluation• Legislation & Ordinances• Taxes/Fees• Training and Technical
Assistance
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Root Cause Mapping
Root Cause Mapping
• Opportunity to identify, illustrate, and discuss:
– key factors contributing to community health problems and methods for action
– opportunities for change– overlapping roles that sectors play– frequent root causes– contributing factors with higher / lower health impacts
• Opportunity to identify and involve partner agencies
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Why is Jason Sick?
• Why is Jason in the hospital?
Health Canada
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Why is Jason Sick?
• Why is Jason in the hospital? • But why does he have an infection?
Health Canada
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Why is Jason Sick?
• Why is Jason in the hospital? • But why does he have an infection? • But why does he have a cut on his leg?
Health Canada
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Why is Jason Sick?
• Why is Jason in the hospital? • But why does he have an infection? • But why does he have a cut on his leg?• But why was he playing in a junkyard?
Health Canada
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Why is Jason Sick?
• Why is Jason in the hospital? • But why does he have an infection? • But why does he have a cut on his leg?• But why was he playing in a junkyard? • But why does he live in that neighborhood?
Health Canada
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Why is Jason Sick?• Why is Jason in the hospital? • But why does he have an infection? • But why does he have a cut on his leg?• But why was he playing in a junkyard? • But why does he live in that neighborhood? • But why can't his parents afford a nicer place to
live?
Health Canada
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Why is Jason sick?
• Why is Jason in the hospital? • But why does he have an infection? • But why does he have a cut on his leg?• But why was he playing in a junkyard? • But why does he live in that neighborhood? • But why can't his parents afford a nicer place to live? • But why ...?
Citation: © Her Majesty the Queen in right of Canada, represented by the Minister of Public Works and Government Services Canada, 1999.
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Root Cause Mapping
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OutcomeContributing Factor
Root Causes
Outcomes Behaviors Environment Policies
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Outcome
Contributing Factor
Jason is
sick
Cut on leg
Infection
Root Causes
Playing in
junkyard
Lack of nearby
playground
Fell on jagged steps
Unsafe housing
conditions
Parent’s lack of
knowledge about wound care
Lack of medical
supplies to treat
wound
Poverty
Low literacy
No funds for
purchase
Lack of income
Economic policies
Rental prices
Education
Outcomes Behaviors Environment Policies
Root Cause Mapping: Example
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“Real Life” Root Cause Maps
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Questions?
Root Cause Mapping Activity Instructions
• Small group activity
• Create maps showing the causal relationships between the upstream and downstream root causes for:
– Not enough physical activity
– Excessive consumption of sugar sweetened beverages
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Break & Map Walk-About
Root Cause Map Exercise II
• In pairs, discuss areas on the map where you are already working?
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Report Back & Questions
• What was most interesting about what you learned from this exercise?
• What is one opportunity to expand current work?
• What is one area identified as important for impact, but where people are unsure they could address it?
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Collaboration & Communication
Health in All Policies Relationships
Rely Upon…
Trust
Mutuality
Reciprocity
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Skit:
“Public Health Reaches Out”
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Cross- Program Opportunities
Cross-Program Opportunities
• Small Group Discussion – Break into groups of 2-3
– What is currently happening (or will be happening) in the county?
– How can PH nurses support or leverage those efforts?
• Group Share
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Questions and Closing
Health in All Policies: A Guide for State and Local
Governments • What is HiAP and Why Do We Need It?
• The Nuts and Bolts of HiAP• Getting Started
• Partners and Roles
• Working Together Across Sectors
• Structures to Support HiAP
• Creating Healthy Public Policy
• Talking about HiAP
• Case Study: California HiAP Task Force
• Appendices
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Acknowledgements
• Public Health Institute• California Health in All Policies Task Force• California Strategic Growth Council• California Department of Public Health
With funding from:• The California Endowment
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