Health in All Policies: A View from California

Transcription

1 Health in All Policies: A View from California Linda Rudolph, MD, MPH L. Rudolph & Associates Julia Caplan, MPP, MPH Public Health Institute September 6, 2012

2 Overview 1) Why We Need Health in All Policies 2) What Is Health in All Policies? 3) California s HiAP Task Force 4) Key Lessons Learned 5) New Resource Available

3 Why We Need HiAP

4 Today s Health Challenge Chronic disease accounts for >75% health care costs (U.S.) Injuries are leading cause of death for people ages 1-44 Tobacco, poor diet, and physical inactivity cause 1/3 of deaths Health inequities persist Obesity rates high, threaten life expectancy Source: 2007 Death Statistical Master File

5 What Determines Health? Health is largely determined by the economic, social, physical, and services environments in which people live, work, study, and play. These environments shape opportunities to make healthy choices and access to resources for health. Promoting healthier environments has a large impact on the health of individuals and communities; this is especially important in disadvantaged communities which often have unhealthy environments across many dimensions. - World Health Organization Commission on Social Determinants of Health

6 Why We Need Health in All Policies

7 Why We Need Health in All Policies Photo courtesy of Paul Krueger

8 Why We Need Health in All Policies

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10 Insert slide on climate change

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12 We All Have a Role to Play Decisions made by non-health agencies play a major role in shaping environments Consideration of health allows agencies to make more informed policy and program decisions and to identify win-wins

13 We Need a New Approach Current decision-making tends to be Siloed Focused on a single goal or mandate Top-down Short-term in orientation Unable to address wicked problems

14 What Is Health in All Policies?

15 A Bit of History 1978 World Health Organization Declaration of Alma-Ata 1986 WHO Ottawa Charter for Health Promotion 1988 WHO Conference on Health Promotion, Adelaide, Au 2000 National Health Strategy, New Zealand 2001 Public Health Act, Quebec, Canada 2003 WHO Commission on Social Determinants of Health 2006 Finnish Presidency Health Theme, European Union 2007 State Strategic Plan, South Australia 2009 Partnership for Sustainable Communities, US 2010 California HiAP Task Force 2010 National Prevention, Health Promotion, and Public Health Council 2010 Adelaide Statement on HiAP, South Australia 2011 For the Public s Health: Revitalizing Law and Policy to Meet New Challenges, Institute of Medicine 2011 Rio Political Declaration on SDOH, Brazil

16 Health Perspective Healthy Public Policy

17 Health in All Policies Inter-sectoral action for shared societal goals (e.g. equity) Health implications explicitly considered in policy-making and planning processes Shared goals/strategies that address health determinants win/win cobenefits strategies Health as a shared goal across government

18 One Definition of HiAP Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas.

19 Some Examples Thailand Quebec South Australia Massachusetts Washington State California NEPA Chicago, Galveston, NYC, Sonoma, Monterey, San Diego, and many more

20 California s Health in All Policies Task Force

21 EXECUTIVE ORDER S WHEREAS the Strategic Growth Council (SGC) was established to enhance collaboration between state agencies. WHEREAS policies related to air and water quality, natural resources and agricultural land, affordable housing, infrastructure systems, public health, sustainable communities, and climate change all significantly influence the physical, economic, and social environments in which people live, shop, work, study, and play WHEREAS to improve health outcomes, agencies should collaborate with each other to ensure that health is considered when policies are developed. NOW, THEREFORE, I, ARNOLD SCHWARZENEGGER, Governor of the State of California, by virtue of the power vested in me by the Constitution and statutes of the State of California, do hereby order effective immediately: 1. The SGC shall establish a Health in All Policies (HiAP) Task Force to collaborate with existing SGC working groups to identify priority programs, policies, and strategies to improve the health of Californians while advancing the SGC s goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainable communities, and meeting the state s climate change goals. 2. The Task Force shall be facilitated and staffed by the California Department of Public Health 3. shall submit a report to the SGC outlining recommended programs, policies, and strategies for consideration, and the report shall also describe the benefits for health, climate change, equity, and economic well-being that may result if the recommendations are implemented. IT IS FURTHER ORDERED that the agencies and departments under my direct executive authority shall cooperate in the implementation of this Order.

22 Health in All Policies Task Force Facilitated by

23 What is a Healthy Community? Meets basic needs of all Safe, sustainable, accessible and affordable transportation options Affordable, accessible and nutritious foods and safe drinkable water Affordable, high quality, socially integrated and location-efficient housing Affordable, accessible and high quality health care Complete and livable communities including quality schools, parks and recreational facilities, child care, libraries, financial services and other daily needs Access to affordable and safe opportunities for physical activity Able to adapt to changing environments, resilient, and prepared for emergencies Opportunities for engagement with arts, music and culture Quality and sustainability of environment Clean air, soil and water, and environments free of excessive noise Tobacco- and smoke-free Green and open spaces, including healthy tree canopy and agricultural lands Minimized toxics, greenhouse gas emissions and waste Affordable and sustainable energy use Aesthetically pleasing Adequate levels of economic, social development Living wage, safe and healthy job opportunities for all, and a thriving economy Support for healthy development of children and adolescents Opportunities for high quality and accessible education Health and social equity Social relationships that are supportive and respectful Robust social and civic engagement Socially cohesive and supportive relationships, families, homes and neighborhoods Safe communities, free of crime and violence

24 Aspirational Goals All California residents: have the option to safely walk, bike, or take public transit to school, work, and essential destinations live in safe, healthy, affordable housing have access to places to be active, including parks, green space, and healthy tree canopy are able to live and be active in their communities without fear of violence or crime have access to healthy, affordable foods at school, at work, and in their neighborhoods California s decision makers are informed about the health consequences of various policy options during the policy development process

25 Developing Recommendations Getting input Member agencies Key informants Stakeholder advisory group Public workshops Establishing & applying criteria Consensus building & decisionmaking

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27 Report to the Strategic Growth Council # Topic areas Active transportation Housing and indoor spaces # # # Parks, urban greening, and places to be active Community safety through violence prevention Healthy food Healthy public policy

28 Implementation Priority: Community Safety through Violence Prevention # Disseminate existing guidance on Crime Prevention through Environmental Design (CPTED) Safety is key to meeting SGC goals State-specific guidance Address housing & parks

29 Implementation Priority: Healthy Food # Encourage and expand the availability of affordable and locally grown produce through farm-to-fork policies and programs CDFA-CDE-CDPH Farm-to-Fork Office Leverage government spending to support healthy eating and sustainable local food systems Environmentally preferable purchasing Develop and pilot model state policy

30 Implementation Priority: Healthy Public Policy # Incorporate a health and health equity perspective into state guidance, surveys, and technical assistance documents, where feasible and appropriate General plans and regional transportation plans Incorporate health and health equity criteria into state grant Requests for Applications, review criteria and scoring, technical assistance, and monitoring/ performance measures, where feasible and appropriate Evaluate existing grants with health criteria

31 Some Things to Think About Structure (sponsor, placement, ownership, scope, authority, incentives, accountability) Resources (staff, time, dollars, capacity) Leadership, will, and commitment Facilitation, backbone Collaboration (organizational/professional silos, buy-in, trust, relationships) Equity Community and stakeholder engagement

32 More Things to Think About Conflict Cognitive capacity (complexity of wicked problems, short vs. long term, population-wide vs. subgroup, local vs. global) Data, evidence, tools & methods Institutionalization

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40 Health in All Policies: A Guide for State and Local Governments Coming Soon! Guide to be released in October at APHA Collaborative effort between: American Public Health Association (APHA) Public Health Institute California Department of Public Health With funding from Centers for Disease Control and Prevention and The California Endowment

41 For More Information Linda Rudolph, MD, MPH L. Rudolph & Associates, Strategy & Leadership Consulting Health in All Policies, Climate Change & Health, Healthy Communities Julia Caplan, MPH, MPP Project Lead, California HiAP Task Force Task Force website Health in All Policies Task Force list