Session 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 2 -HiAP is a horizontal, complementary policy- related 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 Health in All Polici es ( HiAP )

Definitions 3 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

Presentation Objective Identify three strategies for addressing equity through Health in All Policies (HiAP) implementation 5

6 PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works. ® PROMISE NEIGHBORHOODS INSTITUTE The Sustainable Communities Initiative (HUD-DOT-EPA) ALLIANCE FOR Boys and Men of Color Convergence Partnership Healthy People, Healthy Places Convergence Partnership Healthy People, Healthy Places

7 PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works. ®

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 Three Strategies for Equitable HiAP 8

City of Richmond, CA 9

10 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

City of Richmond, CA

DevelopmentReviewAdoption and Launch of Implementation Development Projected Timeline for Implementation Actual Timeline for Implementation Review Launch of Implementation Adoption

City of Richmond, CA Implementation Obstacles: Lack of information/understanding among communities regarding when or how to engage with agencies or departments Lack of information/understanding among agencies regarding: – connections between agency activities and health – community assets for improving agency activities and/or health Negative beliefs held within agencies based on past experiences with: – adversarial community engagement – challenging collaboration with other agencies or departments Power gaps and disagreements within agencies or departments Differing expectations among engaged parties (agencies, funders, communities) 13

City of Richmond, CA Implementation Opportunities: Funding available to support interagency collaboration Common interests among diverse stakeholders to address city challenges Wealth of local resources (human, political, financial) Active and engaged advocates (both individual and organizational) Strong political leadership Environment supportive of change 14

15 Citywide Systems and Policies Neighborhood Improvement Strategies Community Engagement Data, Information, and Tracking Framework for Healthy and Equitable Policy Implementation

Citywide Systems and Policies Neighborhood Improvement Strategies Community Engagement Data, Information, and Tracking 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 Three Strategies for Equitable HiAP 16

California HiAP AB 32 – climate change SB 732 – Strategic Growth Council Executive Order S – HiAP – HiAP Task Force – California Department of Public Health leads – Kitchen Cabinet or “Stakeholder Advisory Group” 17

California HiAP Implementation Obstacles: Lack of information/understanding among agencies regarding: – connections between agency activities and health – community assets for improving agency activities and/or health Negative beliefs held within agencies based on past experiences with: – adversarial community engagement – challenging collaboration with other agencies or departments Power gaps and disagreements within agencies or departments Differing expectations among engaged parties (agencies, funders, communities) 18

California HiAP Implementation Opportunities: Funding available to support interagency collaboration Common interests among diverse stakeholders to create healthy communities Wealth of local resources (human, political, financial) Active and engaged advocates (especially organizational) Strong political leadership Environment supportive of change 19

20 Citywide Systems and Policies Neighborhood Improvement Strategies Community Engagement Data, Information, and Tracking Framework for Healthy and Equitable Policy Implementation

Citywide Systems and Policies Neighborhood Improvement Strategies Community Engagement Data, Information, and Tracking 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 Three Strategies for Equitable HiAP 21

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. Three Strategies for Equitable HiAP 22

Three Strategies for Equitable HiAP 23 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.

Three Strategies for Equitable HiAP 24 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.

“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,

Thank You! 26 Jme McLean, MCP, MPH, Associate Director, PolicyLink American Public Health Association Annual Conference Boston, MA | November 4,