On December 8-9 2015 the National Association of County and City Health Officials (NACCHO), in conjunction with Institute for Public Health Innovation (IPHI), Creating Community Change Consulting, and the Richmond City Health District, conducted Richmond, Virginia’s first Health in All Policies Workshop. Health in All Policies (HiAP) is a change in the systems that determine how policy decisions are made and implemented by local, state, and federal government agencies to ensure that policy decisions have beneficial or neutral impacts on the determinants of health. A recent public health workforce survey conducted by the Association of State and Territorial Health Officials (ASTHO) and the de Beaumont Foundation identified HiAP is an emerging public health trend that roughly half of all public health workers have heard about through various avenues. As an emerging trend, HiAP is often seen as abstract or a “frame of mind” instead of a concrete intervention to address the upstream determinants of health and improve health equity. Richmond’s HiAP workshop illustrated the purpose and goal of Richmond’s HiAP initiative to departmental representatives from across the city in order to gain support and increase awareness among the representatives.
The HiAP workshop was not the first step in Richmond’s HiAP initiative. In 2014 Mayor Dwight C. Jones proposed and the City of Richmond adopted Resolution No. 2014-R262. This resolution identified HiAP as the city’s method for increasing community health and wealth in the coming years. Successful HiAP initiatives require time for community engagement, stakeholder buy-in, and collaborative partnerships across different government agencies.
The City of Richmond began planning a HiAP workshop to bring together representatives from across a diversity of city agencies to gather and discuss what HiAP looks like on the ground, how Richmond residents are effected through decisions made outside of the health sector, and key areas that can be changed as a first step (affordable housing, education, etc.). The workshop included a variety of presentations, group discussions and breakout sessions to engage the participants and allow for input. In total personnel from 22 city departments were present with over 35 participants involved in discussion throughout the workshop. The following city departments participated in the workshop: Fire, Police, Utilities, Behavioral Health, Health Department, Public works, Parks and Recreation, Juvenile Justice, Procurement, Budget and Strategic Planning, IT, Human Resources, Social Services, Planning, Schools, Office of Community Wealth Building, City Council, Library, Transportation, Human Services, Housing Authority, and Economic Development.
In addition to the wide spectrum of participants, Mayor Jones provided the HiAP workshop’s opening address, signifying the support for and importance of the HiAP initiative, and the priority of health outcomes across the city government.
The workshop was largely successful due to the number of participants and departments represented within those participants. In order to have a successful HiAP initiative, sectors outside of health must participate in the process and, more importantly, understand why they are being asked to participate in the process. It was clear from the beginning of the workshop that the audience understood how their work impacts health and importance of health equity as opposed to health equality.
One limitation of the workshop was the strategic planning. The City of Richmond has an incredible amount of buy-in from cross-sectoral partners and momentum to enact real change in the policy development process. However, due to political limitations it is unclear what will come after the workshop and what department or organization will become the central figurehead of the HiAP initiative.
Richmond will be the city to watch as local HiAP initiatives continue to emerge across the United States. In the aftermath of the workshop, Richmond is left with the following questions to think about as they move forward with their HiAP work. How will Richmond continue to harness the momentum from their government and translate that momentum into actionable change? What will happen when Mayor Jones reaches his term limit and the leadership changes? These are all questions that will be answered in time, for now Richmond has achieved something few other cities have with their HiAP resolution and workshop, and for that they should celebrate their success.