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A Roadmap for Health in All Policies Collaborating to Win the Policy Marathon Acknowledgments Erica Padilla-Chavez (Monterey County Health Department, CA), Carrie S

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A Roadmap for Health in All Policies Collaborating to Win the Policy Marathon Acknowledgments Erica Padilla-Chavez (Monterey County Health Department, CA), Carrie S A Roadmap for Health in All Policies Collaborating to Win the Policy Marathon Acknowledgments Erica Padilla-Chavez (Monterey County Health Department, CA), Carrie S. Cihak (Office of King Written by Rebecca Johnson (program director), County Executive, WA), Matias Valenzuela (Office Tina Yuen (senior planner) and Heather Wooten of Equity and Social Justice, King County, WA), (vice president of program strategy). Additional Gabino Arredondo and Shasa Curl (City Manager’s support from Erik Calloway (senior planner), Office, Richmond, CA), Michael Osur and Salomeh Saneta deVuono-powell (program director, senior Wagaw (Riverside County Department of Public staff attorney, and planner), Aysha Pamukcu Health, CA), Sally Lacy (Richmond City Health (senior staff attorney) and Katie Michel (legal District, VA), Stephanie Nathan, (Merced County fellow). All are affiliated with ChangeLab Solutions. Department of Public Health), Colleen Bridger Reviewed by Karen Ben-Moshe (Public Health (Orange County Health Department, NC), Matt Guy Institute/California Department of Public Health) and (Pueblo Triple Aim, CO), and Jordan Bingham and informed by the work of the California Health (Public Health Madison & Dane County, WI) in All Policies Task Force.41 Informed by additional review of policies and Informed by interviews and reviews by Shannon practices from California HiAP Task Force;33 Mace Heller (Baltimore City Health Department Chicago, IL;25 Denver, CO;24 King County, WA;42 Office), Valerie Rogers (formerly of Baltimore City Massachusetts;43 Merced County, CO; New Orleans, Health Department, MD), Erica Salem (Chicago La;39 Rancho Cucamonga, CA;31 Richmond, CA;22 Department of Public Health, IL), Nanette Yandell Richmond, VA;44 Vermont;45 and Washington, DC46. (formerly of Del Norte County and Adjacent Tribal This roadmap was developed by ChangeLab Lands Building Health Communities, CA), Tina Solutions with funds received from the California Zenzola, Shelley Saitowitz, and Lindsey McDermid Endowment. (Health and Human Services Agency, County of San Diego, CA), Jerome Tinianow (Denver Office © 2018 ChangeLab Solutions of Sustainability, CO), Max Gibson (formerly of Jefferson County Public Health, CO), Molly Design by Wick Design Studio Hansen (Jefferson County Public Health, CO), Illustrations by Ethos3 Contents 2 Introduction 5 Using the HiAP Roadmap 6 Warming Up: Using Policy to Build the Foundation for Successful Collaboration 12 Ready, Set, Go: Starting the Conversation 18 Hitting Your Stride: Selecting a Strong HiAP Policy for Your Community 23 Crossing the Finish Line: Moving Toward Whole of Government 24 References changelabsolutions.org 1 Introduction What happens when all the government agencies decisionmaking across government agencies in a town, county, or state work together to build and policy areas. We use HiAP to describe this healthier communities? approach to focus on strategies and actions that will improve health equity. They make sure families can find and afford healthy food. They build parks so that there are But here’s a little secret: At its core, Health places for kids to play. They design streets and in All Policies is about practicing a “whole of trails so people can get around comfortably government” approach to solving our biggest on foot and by bicycle. They plan and develop social and environmental challenges — those neighborhoods with homes that are safe, well problems that are so big and knotty that no one maintained, and affordable for all residents. They group can fix them on their own. Fundamentally, protect people from being exposed to polluted HiAP is about good governance. air and water. They find innovative solutions to improve schools and create jobs. And ultimately, Yet many communities struggle with this approach, they build communities where all people feel and for good reason. It’s hard. We live and work empowered and connected to their neighbors, with bureaucratic structures, history, practices that local institutions, and the place they call home. keep us isolated, operating in our separate silos. Libraries over here, sheriff’s office over here, and It’s impossible to make this vision a reality unless public health department over there. We speak everyone works together. Behind the scenes, different technical jargon. We’re accountable to government agencies must collaborate. That different outcomes — even when we share the means identifying shared goals and maximizing same boss! resources. It means coordinating tasks and investing in big solutions. It means harmonizing Collaborating for health is like running a relay policies, plans, and systems. marathon. You can’t do it without practice, and you That’s what it takes to build a healthy community. can’t do it alone. Government agencies need to This type of community is an all-in community. strengthen their collaboration muscles so they can work together effectively. How do government agencies collaborate to build This roadmap offers guidance to anyone who is inspired by a vision of a healthier, more equitable healthier communities? community for all. It focuses on using policy to Government agencies collaborate by embracing build and institutionalize the public sector’s ability Health in All Policies (HiAP). Health in All Policies to collaborate across departments, agencies, and is a transformative, collaborative approach to offices. improving a community by incorporating health, sustainability, and equity considerations into changelabsolutions.org 2 Poor nutrition Chronic disease accounts for costs Physical inactivity accounts for $71 billion $2.3 trillion in medical expenses in health care $117 billion each year.21 expenses annually.22 in medical expenses each year.20 Health inequities cost $229 billion each year.9 Why should the public sector work together to create healthier communities? When people are healthy, society benefits. Healthier workers are more productive, have fewer Another contributing factor is the significant 1 sick days, and have decreased health care costs. health inequities in our country9: Similarly, healthier students learn better and are more likely to graduate from school.2 And healthy • African Americans are far more likely to die older adults live longer and require substantially as infants and to die from heart attacks and less health care.3 stroke.10 Prevention pays. Policies that make communities • Hispanics are more likely to be hospitalized for 10 healthier have shown a significant return on a preventable cause. investment by reducing health care costs,4 creating • Low-income populations are more likely to jobs,5 and increasing tax revenue.6 Researchers suffer from asthma, to be hospitalized for have even suggested that more than 50% of the preventable causes, and to be diagnosed with economic growth in the United States during the diabetes.10 20th century was the result of improvements in We all want to do what is best for our health population health.7 and the health of our families. But our Despite these advances, in 2015, life expectancy environments — including our social and economic declined for the first time in 40 years. And from environments — and the policies that shape those 2010 to 2015, life expectancy was stagnant.8 One environments make it difficult to meet basic health reason for this plateau is the rise in chronic disease recommendations. For example, when people can and chronic disease risk factors. walk, bike, or take public transportation to work or school,15-18 they can be physically active every day. • In the US, 4 in 5 adults are not getting the But many people live and work in places that do recommended amount of physical activity.11,12 not have the basic infrastructure to make walking and biking convenient or safe.19 Too often, our Nearly 9 in 10 adults are not eating enough • environments don’t help us be healthy. fruits or vegetables.13 • More than half of all people in the United This doesn’t just affect our physical and mental States have at least one chronic disease, such health — it affects our bottom line. It drains the as diabetes, heart disease, or cancer.14 strength of our entire community. changelabsolutions.org 3 Why focus on government? Government is uniquely positioned to change these trends. Government does what private businesses, organizations, and community residents cannot do alone: It makes decisions that apply to the entire community, decisions that affect everyone’s health. Government agencies can expand public transit But many government agencies work in isolation systems, build and maintain parks, and support and do not regularly consider how their programs small businesses. They make decisions about and policies could support, or undermine, health. where grocery stores are located, where affordable These bureaucratic habits limit government’s housing is built, and where businesses can ability to share resources, maximize efficiency, operate. They decide how our streets are designed and reach communities with the highest burden and what transportation options are available of disease. By changing their approach, these in different neighborhoods. Ultimately, these agencies can create better, stronger, and more decisions contribute to our common good. equitable communities. Even government departments and agencies that, This roadmap provides concrete guidance and on the surface, do not seem to affect health — inspiration from people who have done this hard like the personnel department or the budget and important work. It can help you win the Health office — have a role to play. For example, a city in All Policies marathon and put your community personnel department can create a system to on the path to a healthier future. train all government employees on how their work affects residents’ overall health and well- being and how to incorporate health, equity, and No matter what your community needs, sustainability into their agency’s activities and this roadmap can help. It provides policies. Similarly, a county budget office can strategies that you can work on today, ensure all county agencies consider health by and it identifies future tasks to help requiring them to explain in their budgets how you plan next steps.
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