The document summarizes information about Health in All Policies (HiAP) and its implementation in different jurisdictions. It provides definitions of HiAP as an approach to integrate health considerations in decision making across sectors to improve population health. It discusses the history and spread of HiAP globally and in the US at federal, state and local levels. Specific examples are given of HiAP strategies, tactics and implementation in Polk County, Florida, Santa Cruz County, California and other areas. The roles of different actors in adopting and operationalizing HiAP are also outlined.

1. PSUS 6230 UP:
SUSTAINABLE COMM DESIGN STUDIO:
PLANNING FOR HEALTH POLICY IN THE
21ST CENTURY
NOVEMBER 19,2015
HIAP AND HIA
SANDRA WHITEHEAD, PHD

2. Health in All Policies (HiAP)
•HiAP is defined as an approach (a set of strategies) to
integrate health considerations in decision making across
different sectors that influence health
•HiAP emphasizes the need to collaborate across sectors to
achieve common goals
•It is a collaborative approach that integrates and articulates
health considerations into policy making across sectors, and
at all levels, to improve the health of all communities and
people

3. History of HiAP
•Emerging in 2006, HiAP was a major theme during the Finnish Presidency of the EU with the goal
of strengthening existing legislation that required ensuring human protection in the formation
and implementation of policies
•It sought to create large, horizontal systems change that changed how all of government
functioned
•This was a stronger approach than the earlier, project-based efforts of inter-sectoral action of
the 1970s and the incrementalist, process-driven efforts of the healthy public policies
movement
•Since 2006, HiAP has spread across the globe
•HiAP approaches are now seen in the United States at the federal, state, and local levels

4. Roles in HiAP
Federal, State, Local, Government role:
•Adopt a Health in All Policies approach in the policy-making process in order to ensure that
policies made outside of the health sector have positive or neutral impact on the determinants
of health
•Provide funding, training, and technical assistance for local health departments (LHDs) to ensure
that they can assume a leadership role implementing a HiAP approach at the local level and
determine the best strategies for implementing HiAP locally
Local health departments role:
•Take a leadership role to implement HiAP at the local level, including identifying the best
strategies for implementing HiAP in the jurisdiction
•Assume a prominent role educating local, state, and federal policymakers about the value of
HiAP

5. HIA and HiAP
•HiAP is the framework within which HIA is used
•The underlying values of both are the same
•HIA is a strategy to implement HiAP
• Focus on community engagement and inclusion
• Use a health lens as a decision support for non-health decisions
• Uses data and root cause analysis to choose strategies and tactics
to affect health outcomes
• Employs inter-sectoral partnerships

6. https://youtu.be/U0qiGxO05WQ

7. Strategies Tactics Opportunities Assessment or
decision support tools
Topics
• Built
environment
• Economic
opportunity
• Air/ water/ soil
quality
• Children’s
environmental
health
• Sustainability
• Environmental
Justice
• Climate change
• Food
environment
• Sanitation
• Vector control
1. Developing and
Structuring Cross Sector
Relationships
2. Incorporating Health
into Decision Making
Processes
3. Enhancing Workforce
Capacity
4. Coordinating Funding
and Investments
5. Integrating Research,
Evaluation and Data
Systems
6. Synchronizing
Communications and
Messaging
7. Implementing
Accountability
Structures
• Hiring “backbone”
staff
• Cross-sector
trainings on health
• Cross-sector
taskforce
• Data sharing
agreements
• MOUs
• Executive orders
• Ordinances or
laws
• Hiring of “non-
traditional” staff
• Streamlining
development
procedures
• Brownfields/ land
reuse
• Comprehensive plans
• Sustainability plans
• Zoning ordinance
updates
• Transportation/
redevelopment/ land
use projects
• Site design
• Site location
• Climate change
action plans
• Proposed ordinance,
law, or policy
• Strategic plan
• Community
health
assessment/
community health
improvement
plans
• Health impact
assessment (HIA)
• Health community
design checklists
or indicators

8. 1. Developing and Structuring Cross Sector
Relationships
2. Incorporating Health into Decision Making Processes
3. Enhancing Workforce Capacity
4. Coordinating Funding and Investments
5. Integrating Research, Evaluation and Data Systems
6. Synchronizing Communications and Messaging
7. Implementing Accountability Structures
Strategies

9. • Hiring “backbone” staff
• Cross-sector trainings on health
• Inter-disciplinary taskforce
• Data sharing agreements
• MOUs
• Executive orders
• Ordinances or laws
• Hiring of “non-traditional” staff
• Streamlining development procedures
Example Tactics

10. • Brownfields/ land reuse plans
• Comprehensive plans
• Sustainability plans
• Zoning ordinance updates
• Transportation projects
• Climate change action plans
• Proposed ordinance, law, or policy
• Strategic plan
Examples of Opportunities

11. • Built environment
• Economic opportunity
• Smoking in parks
• Children’s environmental health
• Sustainability
• Environmental Justice
• Climate change
• Food environment
Example Topics

12. Characteristics of Successful Collaboration

13. Examples of HiAP early adopters in the
United States
•Federal level: The National Prevention Strategy
•State level: California’s Health in All Policies Task Force
•Local level:
• 1. King County’s Equity and Social Justice Ordinance in Washington State
• 2. Denver’s Environmental Public Health Policy in Colorado
• 3. San Francisco Department of Public Health’s Program on Health, Equity, and
Sustainability, which “supports San Franciscans working together to advance
urban health and social and environmental justice through ongoing
integration of local government and community efforts and through valuing
the needs, experiences, and knowledge of diverse San Francisco residents”

15. California’s HiAP Task Force
• Created by Executive Order S-04-10 in 2010
•The HiAP Task Force is housed under the
Strategic Growth Council
•Brings together 22 state agencies, departments,
and offices, with a common goal of working
together to support a healthier and more
sustainable California
• Five Key Elements
◦ Promote health, equity, and sustainability
◦ Support intersectoral collaboration
◦ Benefit multiple partners
◦ Engage stakeholders
◦ Create structural or procedural change

16. •HiA”p” Comprehensive Plans Integrating Health:
Polk County, FL
•LHD-led HiAP: Santa Cruz, CA
•Integrating Joint Use: Franklin Regional Council,
MA
•Moving from HIA to HiAP: Kitsap, WA
Examples of HiAP in Action

17. HiAp: Polk County, Florida
• Urban sprawl
• Not enough
opportunities for
physical activity
• Many choices for
unhealthy food
• Aging population

18. 7. Lakeland –Winter Haven, Florida
According to Gallup, the Lakeland –Winter Haven Fla. metro area has the
potential to save more than $150 million in health care costs if its obesity rate
dropped to 15%. In 2010, 37.6% of its residents suffered from obesity, racking up
more than $279 million a year in medical bills.
#7 America’s Fattest Cities

19. Public health and planning can change the built
environment to improve health outcomes
•People in walkable neighborhoods exercise more and are
less likely to be overweight or obese
•People who eat more fruits and vegetables are healthier
and tend to be less overweight and obese
•People are happier and healthier when they are socially
connected
Guiding Principles

20. • Starting in 2007, Polk County
began adding health
language to its comp plan
• In 2009, health
considerations were
implemented in the
amended land development
regulations
Changing the Comprehensive Plan

22. • In 2010, implementation of universal health
consideration began throughout the county
• Of the 17 municipalities in Polk County, 16 have
adopted county standards for parks, complete
streets, school siting, location and limitation on fast
food and alcohol outlet density, zoning to
encourage active places, and many more health
promoting policies
Polk County HiAp

23. Changing the Comp Plan in Polk

24. “Building a Healthier Polk” is a group of community
partners brought together by Polk Vision with the goal of
reducing obesity (BMI > 30) from 37.6% of the adult
population (2010) to the State average of 27.2%. This
effort began with a community forum that included over
70 community stakeholders and today has more than
120.

26. Policies Encouraging Physical Activity
City of Winter Haven
• Fitness by the Fountain
• Has a fleet of 12 kayaks for citizen
usage
• City hosted eco-tours

27. Healthier Together in Santa Cruz County
Achieving Health Equity through the Santa Cruz County Health in All Policies Initiative
HealthierTogetherinSantaCruzCounty
MadepossiblethroughagrantfromtheNationalAssociationof County&CityHealthOfficials(NACCHO)andCDC’sNational
CenterforEnvironmentalHealth

28. Overview of Santa Cruz’s Approach
•Establish and convene a cross sectorial HiAP work group with a focus in the
southern part of Santa Cruz County
•Establish branding, webpage, flyer
•Educate the group on HiAP, health equities, social determinates of health
•Draft Strategic Plan
•Identify goals, objectives and outcomes
•Participate in HIA training
•Educate the greater community, stake holder and elected officials

30. • Convene a cross-sector, collaborative task force
• Educate members about the role policies play in health
• Choose policy domains that can be changed
• Implement accountability structures: metrics
Tactics for Implementing HiAP in Santa Cruz

31. Santa Cruz’s Areas of Focus
•Economic Opportunities
•Health
•Housing
•Land
•Parks
•Public Safety
•Socio-Political
•Sustainability-Environmental Health
•Transportation

34. Articulating Joint
Use
Defining terms,
explaining benefits,
value added from
written agreements
Planning
Considerations
What to look for in a
site, planning for costs
Resources
Guides, toolkits, websites

35. Joint Use Defined
Joint Use (shared use / community use)
=
opening public buildings and grounds at times they are
usually closed
so that community residents can exercise and engage in
other recreational activities
35

36. 36
Community Health Benefits
Opening facilities to the broader community encourages residents to adopt healthier lifestyles by
ensuring convenient access to safe places to play and exercise
In communities without many resources and facilities that are open to the public, expanding access to
schools and municipal buildings that already exist can have a significant impact on community health
and connectedness
Individual Health Benefits
Active residents are less likely to suffer from chronic illnesses tied to poor diet and sedentary behavior
Youth Development Benefits
•Youth engaged in activities and exercise in safe environments have less opportunity to make unhealthy
or potentially dangerous decisions about how to spend their time outside of school
Economic Benefits
• Joint use maximizes the use of existing community resources
• Joint use strengthens the relationship between the community and the joint use site, and helps to
build support for capital improvements and greater municipal investment

37. Community Use Policies
37
A community or school district policy for joint
use is not a joint use agreement that
describes a specific use of a specific site
Specific building or district policies help shape the
content of the joint use agreement and explain to
potential users how to approach the school with a
proposal.
The details of the specific arrangement between the
school and the community group, such as who will open
the gymnasium and supervise the children, must still be
negotiated

38. Joint Use Agreements
38
Written Agreements
Verbal/Informal
The exact contents of an agreement
might differ based on site and
activity, but some common elements
include:
• Scheduling
• Cost
• Maintenance
• Liability
• Security
• Expectations are concrete and clear
• Odds of misunderstanding are
reduced
• Allows arrangements to continue
even if a decision-maker leaves or
changes position

39. An Ideal Space Is:
39
Familiar
• Community members more likely to take
advantage of joint use in familiar spaces
• For families/children, schools are an ideal site
Accessible
• Safe to get to if walking
• Sufficient parking if driving
• Handicap accessibility
Well-maintained
• After-hour/weekend use means that users will
sometimes arrive or leave in the dark
• Clearly-marked signs and pathways and be well-lit
both indoors (if applicable) & out
Secure
• Be able to quickly and easily secure it before and
after the shared use hours
• If only one part of a building is used, ideally it would
be relatively easy to block off the rest of the building
Equipped
• Accessible restrooms and Potable water

40. Costs Associated with Joint Use
40
• Increased expense for maintaining equipment and grounds
• Cost of extra hours and responsibilities for custodial staff.
• Staff to supervise activities during joint use hours and/or staff
to run programming
• Security improvements or extra equipment

42. HIA and HiAP
•Communities often start with one and move to the other
•Commonalities include:
• Community centered approach
• Inter-sectoral partnerships
• Data driven decision making
• Outcomes are measured and reported
• Communication about health outcomes and risks
• Creates structural or procedural change

45. HiAP is More than a State of Mind
•Actionable: focuses on community needs
•Brings partners together to improve conditions in the
community
•Is time based and uses metrics and milestones to
measure progress
•Involves a wide array of non-health partners to
change systems and policies