5. Blue Cross & Blue Shield of MN Vayong_Moua@bluecrossmn.com
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Making Connections for a Healthier
Iowa: Your Place at the Table
John Peterson, City of Ankeny
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. 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. 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. 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. 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. 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. 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. 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.
44. 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.
46. 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
47. 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.
48. 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…
49. 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.
50. 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
53. 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
55. 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
56. 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
57. • 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
58. 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
