Session 3128.0
Creating Health Equity:
Going Beyond the Health Gap,
the Mental Health Gap, and the Climate Gap
Advancing equity through health in all policies:
opportunities and obstacles in implementation
Jme McLean, MCP, MPH, Associate Director, PolicyLink
American Public Health Association Annual Conference
Boston, MA | November 4, 2013
Definitions
-
Health
in All
Policies
(HiAP)
HiAP is a horizontal, complementary policyrelated strategy with a high potential to
contributing to population health. The core of
Health in All Policies is to examine
determinants of health, which can be
influenced to improve health but are mainly
controlled by policies of sectors other than
health.
– World Health Organization
HiAP is a collaborative approach to improving
the health of all people by incorporating
health considerations into decision-making
across sector and policy areas.
– APHA, Public Health Institute,
CA Department of Public Health
2
Definitions
Equity means just and fair inclusion.
The goals of equity must be to create
conditions that allow all to reach their
full potential.
In short, equity creates a path from
hope to change.
- PolicyLink
3
Presentation Objective
Identify three
strategies for
addressing
equity through
Health in All
Policies (HiAP)
implementation
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PolicyLink is a national
research and action
institute advancing
economic and social
equity by
Convergence Partnership
Healthy People, Healthy Places
The Sustainable Communities
Initiative (HUD-DOT-EPA)
PROMISE NEIGHBORHOODS
INSTITUTE
Lifting Up What Works.®
ALLIANCE FOR
Boys and Men of Color
6
PolicyLink is a national
research and action
institute advancing
economic and social
equity by
Lifting Up What Works.®
7
Three Strategies for Equitable HiAP
Strategy
1
Create opportunity by
improving transparency
Strategy
2
Foster both vertical and
horizontal collaboration
Strategy
3
Seek equity in both the
process and outcomes
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City of Richmond, CA
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City of Richmond, CA
Higher rates of heart
disease, cancer and stroke
among Richmond residents
Higher than average
asthma hospitalizations
among Richmond children
Richmond shows highest
diabetes mortality rates
Richmond shows second
highest rates for
hospitalization related to
substance abuse and
mental health
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City of Richmond, CA
City of Richmond, CA
Projected Timeline for HWE Implementation
2006
2007
2008
2009
Development
Review
2010
2011
Adoption and Launch of Implementation
Actual Timeline for HWE Implementation
2006
2007
2008
2009
2010
2011
Development
Review
Launch of Implementation
Adoption of
HWE
City of Richmond, CA
2009
2010
2011
…. Continued Implementation and Expanded Efforts
2012
2013
2014
opment
Review
Launch of Implementation
Adoption of
HWE
Richmond Health Equity
Partnership & HiAP
HiAP
Ordinance
City of Richmond, CA
Obstacles related to “healthy policy” implementation:
• Availability of information regarding when and how communities can
engage in local government activities and decisions
• Differences in departmental information and activities…
– …connected with or informed by community health outcomes
– …related to community engagement and information on community
assets and resources
• Mixed perceptions:
– Among departments regarding adversarial community engagement
– Among communities regarding closed communication with agencies
– Among agencies or departments regarding interagency collaboration
• Differing expectations regarding among engaged parties (agencies,
departments, funders, communities)
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City of Richmond, CA
Opportunities related to “healthy policy”
implementation:
• Common interests among diverse stakeholders to address city challenges,
including community health and equity
• Strong political leadership
• Financial resources available to support interagency collaboration
• Internal champions (elected and administrative)
• Active and engaged advocates (both individual and organizational)
• Environment supportive of change
• Wealth of local resources (human, political, financial, intellectual)
15
Citywide
Systems and
Policies
Neighborhood
Improvement
Strategies
Community
Engagement
Framework for Healthy and
Equitable Policy Implementation
Data,
Information,
and Tracking
16
Three Strategies for Equitable HiAP
Citywide
Systems and
Create
Policies opportunity
Strategy
1
by
improving transparency
Community
Strategy
Engagement
2
Neighborhood
Foster both vertical
and
Improvement
Strategies
horizontal collaboration
Strategy
3
Seek equity in both the
Data,
process
Information, and outcomes
and Tracking
17
California HiAP
• AB 32 – climate change
• SB 732 – Strategic Growth Council
• Executive Order S-04-10 – HiAP
– HiAP Task Force
– California Department of Public Health leads
– Kitchen Cabinet or “Stakeholder Advisory
Group”
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California HiAP
Obstacles related to “healthy policy” implementation:
• Differences in departmental information and activities…
– …connected with or informed by community health outcomes
– …related to community engagement and information on community
assets and resources
• Mixed perceptions:
– Among departments regarding adversarial community engagement
– Among communities regarding closed communication with agencies
– Among agencies or departments regarding interagency collaboration
• Differing expectations among engaged parties (agencies, departments,
funders, communities)
19
California HiAP
Opportunities related to “healthy policy”
implementation:
• Common interests among diverse stakeholders to create healthy
communities
• Strong political leadership
• Financial resources to support interagency collaboration
• Active and engaged advocates (especially organizational)
• Environment supportive of change
• Wealth of local resources (human, political, financial, intellectual)
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Citywide
Systems and
Policies
Neighborhood
Improvement
Strategies
Community
Engagement
Framework for Healthy and
Equitable Policy Implementation
Data,
Information,
and Tracking
21
Three Strategies for Equitable HiAP
Citywide
Systems and
Create
Policies opportunity
Strategy
1
by
improving transparency
Community
Strategy
Engagement
2
Neighborhood
Foster both vertical
and
Improvement
Strategies
horizontal collaboration
Strategy
3
Seek equity in both the
Data,
process
Information, and outcomes
and Tracking
22
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Three Strategies for Equitable HiAP
Strategy
1
Create opportunity by improving transparency
Funders
Invest in strategies for improved
communication and identification of
shared goals across HiAP partners.
Health
Agencies
Share health info with HiAP partners
in relevant formats (utility,
language, geographic scale, etc.).
Other
Agencies
Communicate plans and processes
for decision-making, and how/when
HiAP partners can participate.
Advocates
Build capacity of HiAP partners to
understand and leverage community
assets.
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Three Strategies for Equitable HiAP
Strategy
2
Foster both vertical and horizontal collaboration
Funders
Require inclusion of low-income people
and communities of color in HiAP efforts
as a condition of funding.
Health
Agencies
Share and model strategies for positive
community engagement with HiAP
agency partners.
Other
Agencies
Consider cost-benefit of proactive
engagement before HiAP projects vs.
managing reactions after.
Advocates
Advance HiAP issues by building
internal relationships as well as
applying external pressure.
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Three Strategies for Equitable HiAP
Strategy
3
Seek equity in both the process and outcomes
Funders
Match HiAP objectives with short-term
and long-term time frames for building
power among impacted communities.
Health
Agencies
Challenge conventional wisdom with
data on racial and socioeconomic
inequities and questions about power.
Other
Agencies
Look for shared goals with communities
and identify opportunities to increase
their capacity.
Advocates
Champion both inclusive HiAP processes
as well as policies that promote
inclusion.
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“In order to address health inequities, and inequitable conditions of
daily living, it is necessary to address inequities—such as those
between men and women—in the way society is organized. This
requires a strong public sector that is committed, capable, and
adequately financed. To achieve that requires more than
strengthened government—it requires strengthened
governance: legitimacy, space and support for civil society,
for an accountable private sector, and for people across
society to agree on public interests and reinvest in the value
of collective action. In a globalised world, the need for governance
dedicated to equity applies equally from the community level to
global institutions.”
- World Health Organization (WHO). Closing the gap in a generation: health equity through action on
the social determinants of health. Report of the Commission on the Social Determinants of Health,
WHO, Geneva, 2008.
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Thank You!
www.policylink.org
Jme McLean, MCP, MPH, Associate Director, PolicyLink
[email protected]
American Public Health Association Annual Conference
Boston, MA | November 4, 2013
28