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www.iowapha.org/HiAP www.facebook.com/IowaPublicHealthAssociation
http://twitter.com/#!/iowapha
Health in All Policies Making Connections for a Healthier Iowa:
Your Place at the Table
Lina Tucker Reinders, MPH
Health in All Polices What is it?
Why do it?
How do we do it?!?!
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP… What is it (officially)? … a collaborative approach to improving the health of all people by
incorporating health considerations into decision-making across sectors and policy areas. (APHA, 2013)
… an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity (WHO, 2012)
…aims to improve the health of the population through increasing the positive impacts of policy initiatives across all sectors of government and at the same time contributing to the achievement of other sectors’ core goals (Government of South Australia, 2011)
… informs policy-makers working in and across all sectors, politicians and the public about how policy decisions affect health and health systems, including the distribution of health and equity in health systems (National Institute for Health and Welfare, Finland, 2013)
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP… What is it (really)?
Health is not just negative test results, it’s a complete state of physical, emotional, psychological, spiritual and social well-being.
There isn’t a sector of government or a segment of society that doesn’t have the potential to contribute to – or benefit from – health.
Health in All Policies is decision-making that assures community well-being is considered by all, throughout the process, as a way to increase
the positive and diminish the negative impacts on health.
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP… How’d we get here?
1978 – Alma Ata Declaration introduced the idea of intersectoral action for health within the concept of Primary Health Care
1986 – Ottawa Charter identified healthy public policy as the first of five action areas for health promotion
2006 – HIAP is a major theme of the Finnish presidency of the European Union
2010 – Adelaide Statement on Health in All Policies emphasizes a whole-of-government approach to health
2011 - Rio Political Declaration on Social Determinants of Health affirmed HIAP as an approach for multi-sector responsibility for health equity
Support for HIAP in the US is growing quickly.
The National Prevention Council uses a whole-of-government approach to deliver on its action plan
California HIAP Task Force
2011 Institute of Medicine report recommends broad engagement of people across sectors to consider health outcomes of their policies.
HIAP – A Guide for State and Local Governments (APHA)
NACCHO Environmental Public Health HIAP Project
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP… Why do it?
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
Why treat people's illnesses without changing what made them sick in the first place?
Throughout the world, in the US – and in Iowa – a gradient exists between income and health. Overall, poorer people have poorer health, and when you’re wealthier you’re healthier. (WHO Commission on Social Determinants of Health, 2008)
These inequities are avoidable.
Inequality = differences
Inequity = the unfair, avoidable consequences that stem from inequalities
Sidebar: equality vs. equity, in pictures
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
Equality Equity
HIAP… Why do it?
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
How much of where you live is really your choice?
HIAP… Why do it?
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
The US spends by far the most of any country on health care. Our life expectancy is 79 years. Not bad, until you realize that 32 countries are at or above our LE, spending a mere fraction of what we do. Obviously, there’s more to health than health care. (www.gapminder.org; source data from the World Health Organization)
HIAP… Why do it?
Health is a shared value, therefore it should be a shared responsibility.
Yet, health is complex.
Complex problems require systems-based approaches that involve multiple sectors of government and segments of society.
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
(Dahlgren and Whitehead, 1991)
HIAP… Is it just new jargon?
HIAP is not too different from what a lot of us have been doing all along. The difference is in its purposefulness.
We want to promote health equity (jargon alert!) by identifying the mutual goals that have always existed, yet are approached in silos.
HIAP is not health imperialism. Health is a public good; it benefits all.
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP… WIIFMs (what’s in it for me?)
Sectors and issues
Why health matters
Economy and employment
-Healthier people are more productive at work, can adapt more easily to work changes, and can remain working for longer. -Work and stable employment opportunities improve health for all people across different social groups.
Education and early life
-Poor health of children or family members impedes educational success, limiting abilities to pursue opportunities in life. -Educational attainment directly contributes to better health and the ability to participate fully in a productive society.
Agriculture and food
-Food security and safety are enhanced, and consumer confidence increases when health is considered in food production, manufacturing, marketing and distribution. -Good food and security practices help to reduce animal-to-human disease transmission, and support the health of farm workers and rural communities.
Security and justice
-Rates of violence, ill-health and injury increase in populations whose access to food, water, housing, work opportunities and a fair justice system is poorer -The prevalence of mental illness (and associated drug and alcohol problems) is associated with violence, crime and imprisonment.
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
Edited from: Adelaide Statement on Health in All Policies. WHO, Government of South Australia, Adelaide 2010.
HIAP… How do we do it? (keep listening to my brilliant co-presenters, then download the APHA guide!)
Key elements
Promote health, equity and sustainability
Support intersectoral collaboration
Benefit multiple partners
Engage stakeholders
Create structural or process change
(is that all??!?!)
First step: Get to the table!
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
HIAP resources Health in All Policies: A Guide for State and Local Governments
http://www.apha.org/programs/cba/CBA/health_all_policies
National Association of County & City Health Officials http://www.naccho.org/topics/environmental/HiAP/index.cfm
For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges http://www.iom.edu/Reports/2011/For-the-Publics-Health-Revitalizing-Law-and-Policy-to-Meet-New-Challenges.aspx
Adelaide Statement on Health in All Policies http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf
HIAP – The South Australian Approach http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+reform/health+in+all+policies
Social Determinants of Health http://www.who.int/social_determinants/en/
ACTION:SDH http://www.actionsdh.org/
11/26/2013 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table"
Making Connections for a Healthier
Iowa: Your Place at the Table
John Peterson, City of Ankeny
Irving Zola- The Upstream Parable
“I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I jump into the cold waters. I fight against the strong current and force my way to the struggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank and revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. I jump into the cold waters. I fight against the strong current, and swim forcefully to the struggling woman. I grab hold and gradually pull her to shore. I lift her out onto the bank beside the man and work to revive her with artificial respiration. Just when she begins to breathe, I hear another cry for help. I jump into the cold waters. Fighting again against the strong current, I force my way to the struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay him out on the bank and try to revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. Near exhaustion, it occurs to me that I'm so busy jumping in, pulling them to shore, applying artificial respiration that I have no time to see who is upstream pushing them all in....”
“Health in All Places, A Guide for State and Local Governments”
Planners have a great opportunity to work on the prevention side of public health.
Key Elements of “Health in all Policies”
• Promote health, equity and sustainability
• Support intersectoral collaboration
• Benefit multiple partners
• Engage stakeholders
• Create structural or procedural change
Promote health, equity and sustainability
Ricklin, A., et al. 2012. Healthy Planning: an evaluation of comprehensive and sustainability plans addressing public health. Chicago: American Planning Association.
Support intersectoral collaboration
• American Planning Association
Center for Planning and Community Health Research
http://www.planning.org/nationalcenters/health/
Collaborative efforts with a variety of Federal Agencies, National
Associations and Foundations to create programs and resources.
• Iowa Smart Planning Principles (Iowa Code Chapter 18b)
Principle #1- Collaboration
Governmental, community and individual stakeholders, including those
outside the jurisdiction of the entity, are encouraged to be involved and
provide comment during deliberation of planning, zoning, development,
and resource management decisions and during implementation of
such decisions. The state agency, local government, or other public
entity is encouraged to develop and implement a strategy to facilitate
such participation.
Benefit multiple partners
Outcomes created through collaboration between planners and health
professionals will have a broader positive impact on communities.
Challenges:
1. Language- more effort to get to a common
understanding and presentation
2. Time- more coordination, longer learning curve
for participants
3. Territory/Silos- barriers to collaborative
decision making
Opportunities:
1. Broader levels of support
2. More data/information for decision making
3. Wider network for implementation
Engage stakeholders
Planners and Health Professionals need broad participation to
create successful plans and programs. Collaborative efforts
could enhance the number and contribution of stakeholders
including:
Community members
Policy and issue experts
Businesses
Funders
An example could be a traditional City recreation project that,
with expanded stakeholder involvement, is supported by the
local business community as a “wellness” amenity.
Create structural or procedural change
The success of “Health in All Policies” relies on a sustained and
structured effort:
The relationships, processes and communications
initially created are important and should be
maintained to allow a continued effort on a variety of
projects. This requires a commitment of time and effort
by all parties.
The outcomes of the programs or projects created
through initial efforts should be maintained with policies
or legislation adopted by leadership.
Challenge
1. Do the research- check out the information available through
your County public health office (City, County or Regional
Planning office) and other health (planning) agencies and
organizations.
2. Check out the resources available from the Iowa Public
Health Association (American Planning Association Center
for Community Planning and Health Research)
3. Make the phone call- connect with your public health
(planning) office and other health (planning) related
professionals in your community. You are likely working
toward the same goals and partnering will be a great benefit.
4. In all you do… try to make the healthy choice the
easy/convenient choice.
Making Connections for a Healthier Iowa: Your Place at the Table
National Prevention Strategy
CONSIDER HEALTH IMPACTS IN EACH LEVEL
OF THE
SOCIO-ECOLOGICAL MODEL
Working Together for Success
Working Together for Success
Working Together for Success
© 2011 Blue Cross and Blue Shield of Minnesota. All rights reserved.
Health Equity in All Policies (HEiAP) Vayong Moua, MPA
Senior Advocacy and Health Equity Principal
Center for Prevention, Blue Cross and Blue Shield of Minnesota
November 26, 2013
Path Towards Durable Health Improvement
The Stairway Speech
Health is determined by where we live, learn, work, play, and how we get there!
Physical Connectivity = Social Connectivity = Health for All
Land use, transportation, food system, and zoning policies that healthy communities
Ex. Complete Streets, open/green space, trails, proximity to parks/healthy foods, etc.
Complete Streets = Complete Communities
MN Activity
> Eagan, Eden Prairie and Savage : HEAL resolutions
> Edina: Vision and mission statements – Comprehensive Plan
> Minneapolis: Equity Toolkit
> State of Minnesota: Health Equity Report.
> MDH must report by February 1, 2014 to the chairs and ranking minority
members of HHS and Finance Committees , with jurisdiction over health
policy and finance.
> MDH must consult with local public health, health care, and community
partners on a plan to advance health equity in Minnesota.
> 2013 Laws Ch. 108, HF1233, Art. 12, Sec. 102
MDH's Health Equity Report
MDH must: (1) Assess health disparities in the state and explain how they relate to
health equity. (2) Identify policies, processes, and systems that contribute to health inequity. (3) Recommend changes to MDH policies, processes and systems that would increase MDH leadership in addressing health inequities. (4) Identify best practices for local public health, health care, and community partners to provide culturally responsive services and advance health equity. (5) Recommend strategies for using data to document and monitor existing health inequities and to evaluate effectiveness of policies, processes, systems, and environmental changes that will advance health equity.
Edina Comprehensive Plan
> Inclusion of Sample Health-in-All Policy Language in Edina’s Vision Statement
> Edina will be the preeminent place for living, learning, raising families and doing business in an environment where all people and businesses have the opportunity to thrive, as distinguished by:
> A Livable Environment…
> Effective and Valued City Services…
Edina Comprehensive Plan
> Inclusion of Sample Health-in-All Policy Language in Edina’s Mission Statement
> Our mission is to provide effective and valued public services, maintain a sound public infrastructure, offer premier public facilities and guide the development and redevelopment of lands, all in a manner that promotes fairness and opportunity, eliminates inequities, fosters the growth of a healthy, safe, and vibrant community, and sustains and improves the uncommonly high quality of life enjoyed by all of our residents and businesses.
Health Equity and Transportation
The Transportation prescription
“ For too long now, our transportation decision making has failed to address the
impacts that our infrastructure network has on public health and equity.”
- Congressman James Oberstar
51
Solutions for Most Vulnerable= Solutions for All
Primary Sector of Work Health
Environment
Other
Education
Planning
Zoning
Social services
Agriculture andfood
Transportation
Economicdevelopment
Housing
Criminal justice
Profession
Public health
Other
Environmentalhealth
Planner
Health care -clinical
Student
Social services
Elected official
Engineer
Type of Organization
Publicagency
Non-profit
For-profit
Other
Organizational Role
Programcoordinator
Manager
Other
Policymaker
Impact of Work on Community's Health
No impact
Someimpact
Significantimpact
Don't know
Importance of Community's Health to
Work Objectives
Notimportant
Somewhatimportant
Veryimportant
Don't know
Impact of Other Sectors' Policies on Your Work
Health
Environment
Education
Social services
Agriculture andfood
Economicdevelopment
Transportation
Housing
Planning
Zoning
Criminal justice
Sectors for Most Frequent Collaboration
Health
Education
Environment
Social services
Planning
Agriculture andfoodHousing
Economicdevelopment
Transportation
Zoning
Criminal justice
Other
• 66.9% highly value cross-sector collaboration
• 87.7% collaborate across sectors monthly or
quarterly
• 56.4% have received funding or sought
funding which required cross-sector
collaboration
• 37.0% utilize a process to consider the
fairness of the impacts of sector projects
across population groups
Barriers
• Limited time and
resources
• Turf issues (power,
authority)
• Lack of awareness
• Bridging jargon and
understanding roles
• None
Opportunities
• Greater efficiency;
decreased duplication
• Improved health
• New ideas and
approaches
• None
Lina
Tucker
Reinders
John
Peterson
Kala
Shipley
Vayong
Moua
www.iowapha.org/HiAP www.facebook.com/IowaPublicHealthAssociation
http://twitter.com/#!/iowapha
