www.iowapha.org/HiAP
www.facebook.com/IowaPublicHealthAssociation
http://twitter.com/#!/iowapha
Public Health Consultant  LTR Consulting  Lina.Tucker.Reinders@gmail.com
City of Ankeny, Iowa  jpeterson@ankenyiowa.gov
Iowa Department of Public Health  kala.shipley@idph.iowa.gov
Blue Cross & Blue Shield of MN  Vayong_Moua@bluecrossmn.com
Health in All Policies
Making Connections for a Healthier Iowa:
Your Place at the Table
Lina Tucker Reinders, MPH

Lina.Tu...
Health in All Polices


What is it?



Why do it?



How do we do it?!?!

Lina Tucker Reinders. IPHA Webinar, "Making C...
HIAP… What is it (officially)?


… a collaborative approach to improving the health of all people by
incorporating health...
HIAP… What is it (really)?


Health is not just negative test results, it’s a complete state of
physical, emotional, psyc...
HIAP… How’d we get here?
1978 – Alma Ata Declaration
introduced the idea of intersectoral
action for health within the con...
HIAP… Why do it?
Why treat people's illnesses without changing what made them sick
in the first place?
Throughout the worl...
Sidebar: equality vs. equity, in pictures

Equality

Equity

Lina Tucker Reinders. IPHA Webinar, "Making Connections for a...
HIAP… Why do it?

How much of where you live is really your choice?
Lina Tucker Reinders. IPHA Webinar, "Making Connection...
HIAP… Why do it?
The US spends by far
the most of any country
on health care.
Our life expectancy is 79
years. Not bad, un...
HIAP… Why do it?
Health is a shared value,
therefore it should be a shared
responsibility.

Yet, health is complex.

(Dahl...
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 ...
HIAP… WIIFMs

(what’s in it for me?)

Sectors and
issues

Why health matters

Economy and
employment

-Healthier people ar...
HIAP… How do we do it?
(keep listening to my brilliant co-presenters, then download the APHA guide!)

Key elements


Prom...
HIAP resources


Health in All Policies: A Guide for State and Local Governments
http://www.apha.org/programs/cba/CBA/hea...
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 ma...
Key Elements of “Health in all Policies”
•
•
•
•
•

Promote health, equity and sustainability
Support intersectoral collab...
Promote health, equity and sustainability

Ricklin, A., et al. 2012. Healthy Planning: an evaluation of comprehensive and ...
Support intersectoral collaboration
• American Planning Association
Center for Planning and Community Health Research
http...
Benefit multiple partners
Outcomes created through collaboration between planners and health
professionals will have a bro...
Engage stakeholders
Planners and Health Professionals need broad participation to
create successful plans and programs. Co...
Create structural or procedural change
The success of “Health in All Policies” relies on a sustained and
structured effort...
Challenge
1.

2.

3.

4.

Do the research- check out the information available through
your County public health office (C...
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
For more information, contact Kala Shipley at
Kala.Shipley@idph.iowa.gov
Health Equity in All Policies (HEiAP)

Vayong Moua, MPA
Senior Advocacy and Health Equity Principal

Center for Prevention...
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 ...
Complete Streets = Complete Communities
MN Activity
> Eagan, Eden Prairie and Savage : HEAL resolutions
> Edina: Vision and mission statements – Comprehensive Pla...
MDH's Health Equity Report
MDH must:
(1) Assess health disparities in the state and explain how they relate to
health equi...
Edina Comprehensive Plan
> Inclusion of Sample Health-in-All Policy

Language in Edina’s Vision Statement

> Edina will be...
Edina Comprehensive Plan
> Inclusion of Sample Health-in-All Policy Language in

Edina’s Mission Statement

> Our mission ...
Health Equity and Transportation
The Transportation prescription
“ For too long now, our transportation decision making ha...
Solutions for Most Vulnerable= Solutions for All

51
Profession

Primary Sector of Work
Health

Public health

Environment

Other

Other

Environmental
health

Education

Plan...
Type of Organization

Organizational Role

Public
agency
Non-profit

Program
coordinator
Manager

For-profit

Other

Other...
Impact of Work on
Community's Health

No impact
Some
impact
Significant
impact
Don't know

Importance of
Community's Healt...
Impact of Other Sectors'
Policies on Your Work

Sectors for Most
Frequent Collaboration
Health

Health
Education

Environm...
• 66.9% highly value cross-sector collaboration
• 87.7% collaborate across sectors monthly or
quarterly
• 56.4% have recei...
Barriers
• Limited time and
resources
• Turf issues (power,
authority)
• Lack of awareness
• Bridging jargon and
understan...
Lina
Tucker
Reinders

Kala
Shipley

John
Peterson

Vayong
Moua
www.iowapha.org/HiAP
www.facebook.com/IowaPublicHealthAssociation
http://twitter.com/#!/iowapha
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
Making connections for a healthier iowa   your place at the table slide deck 11.26.13
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Making connections for a healthier iowa your place at the table slide deck 11.26.13

  1. 1. www.iowapha.org/HiAP www.facebook.com/IowaPublicHealthAssociation http://twitter.com/#!/iowapha
  2. 2. Public Health Consultant  LTR Consulting  Lina.Tucker.Reinders@gmail.com
  3. 3. City of Ankeny, Iowa  jpeterson@ankenyiowa.gov
  4. 4. Iowa Department of Public Health  kala.shipley@idph.iowa.gov
  5. 5. Blue Cross & Blue Shield of MN  Vayong_Moua@bluecrossmn.com
  6. 6. Health in All Policies Making Connections for a Healthier Iowa: Your Place at the Table Lina Tucker Reinders, MPH Lina.Tucker.Reinders@gmail.com
  7. 7. Health in All Polices  What is it?  Why do it?  How do we do it?!?! Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  8. 8. 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) Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  9. 9. HIAP… What is it (really)?  Health is not just negative test results, it’s a complete state of physical, emotional, psychological, spiritual and social wellbeing.  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. Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  10. 10. 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-ofgovernment 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 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  11. 11. HIAP… Why do it? 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 Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  12. 12. Sidebar: equality vs. equity, in pictures Equality Equity Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  13. 13. HIAP… Why do it? How much of where you live is really your choice? Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  14. 14. HIAP… Why do it? 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) Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  15. 15. HIAP… Why do it? Health is a shared value, therefore it should be a shared responsibility. Yet, health is complex. (Dahlgren and Whitehead, 1991) Complex problems require systems-based approaches that involve multiple sectors of government and segments of society. Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  16. 16. 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. Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  17. 17. 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. Edited from: Adelaide Statement on Health in All Policies. WHO, Government of South Australia, Adelaide 2010. Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  18. 18. 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! Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  19. 19. 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-Lawand-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+healt h+internet/health+reform/health+in+all+policies  Social Determinants of Health http://www.who.int/social_determinants/en/  ACTION:SDH http://www.actionsdh.org/ Lina Tucker Reinders. IPHA Webinar, "Making Connections for a Healthier Iowa: Your Place at the Table" 11/26/2013
  20. 20. Making Connections for a Healthier Iowa: Your Place at the Table John Peterson, City of Ankeny
  21. 21. 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.
  22. 22. 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
  23. 23. 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.
  24. 24. 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.
  25. 25. 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
  26. 26. 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.
  27. 27. 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.
  28. 28. Challenge 1. 2. 3. 4. 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. Check out the resources available from the Iowa Public Health Association (American Planning Association Center for Community Planning and Health Research) 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. In all you do… try to make the healthy choice the easy/convenient choice.
  29. 29. Making Connections for a Healthier Iowa: Your Place at the Table
  30. 30. National Prevention Strategy
  31. 31. CONSIDER HEALTH IMPACTS IN EACH LEVEL OF THE SOCIO-ECOLOGICAL MODEL
  32. 32. Working Together for Success
  33. 33. Working Together for Success
  34. 34. Working Together for Success
  35. 35. For more information, contact Kala Shipley at Kala.Shipley@idph.iowa.gov
  36. 36. 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 © 2011 Blue Cross and Blue Shield of Minnesota. All rights reserved.
  37. 37. Path Towards Durable Health Improvement
  38. 38. 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.
  39. 39. Complete Streets = Complete Communities
  40. 40. 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
  41. 41. 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.
  42. 42. 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…
  43. 43. 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.
  44. 44. 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
  45. 45. Solutions for Most Vulnerable= Solutions for All 51
  46. 46. Profession Primary Sector of Work Health Public health Environment Other Other Environmental health Education Planner Planning Zoning Health care clinical Student Social services Elected official Engineer Social services Agriculture and food Transportation Economic development Housing Criminal justice
  47. 47. Type of Organization Organizational Role Public agency Non-profit Program coordinator Manager For-profit Other Other Policy maker
  48. 48. Impact of Work on Community's Health No impact Some impact Significant impact Don't know Importance of Community's Health to Work Objectives Not important Somewhat important Very important Don't know
  49. 49. Impact of Other Sectors' Policies on Your Work Sectors for Most Frequent Collaboration Health Health Education Environment Environment Education Social services Agriculture and food Economic development Transportation Social services Planning Agriculture and food Housing Housing Economic development Transportation Planning Zoning Zoning Criminal justice Criminal justice Other
  50. 50. • 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
  51. 51. 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
  52. 52. Lina Tucker Reinders Kala Shipley John Peterson Vayong Moua
  53. 53. www.iowapha.org/HiAP www.facebook.com/IowaPublicHealthAssociation http://twitter.com/#!/iowapha

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