By Allison Nguyen, MPH, CHES, Community Engagement Coordinator
Florida Department of Health, Hillsborough County

Health in All Policies (HiAP) is a cross-sector collaborative approach that incorporates health, sustainability, and equity into decision making by government agencies. When I joined the Florida Department of Health in Hillsborough County (DOH-Hillsborough) in January 2015, I was charged with becoming the Subject Matter Expert on Health in All Policies, by developing and implementing a strategy for our agency. I built upon my previous community health, local policy, and systems experience from North Carolina and New York to help make this a reality.

After extensive research, including reviewing published and grey literature, and interviews with HiAP practitioners across the US, we determined DOH-Hillsborough would begin by educating government agencies within the county’s four local jurisdictions. In an effort to reach senior leaders, mid-level managers, and colleagues, I started by establishing a partnership with the Hillsborough County City-County Planning Commission, the sole long-range planning agency for all jurisdictions in the county, and the Hillsborough County Metropolitan Planning Organization (MPO), a federally and state-mandated board responsible for transportation policy-making. Through these collaborations, alignments were quickly identified on how HiAP could be integrated to advance current work flow.

First, the Planning Commission staff were beginning a process to incorporate health and the built environment into the Comprehensive Land Use Plan. To move this work forward, we collectively applied for funding from the American Planning Association’s Plan4Health program in the summer of 2015. Although not selected to participate, this helped us better understand what agency could bring to the table, and the available HiAP opportunities for the Planning Commission. This paved the way for other projects, including a walkability assessment during the summer of 2016, and a grant from the Florida Department of Economic Opportunity to engage the community in recommended Health in All Policies for the City of Tampa’s Comprehensive Land Use Plan, which started in fall 2016.

In August 2015, MPO staff and leadership were provided a follow-up presentation linking Health Impact Assessments (HIA) to Health in All Policies. HIA is a systematic process to evaluate the potential health impacts of a proposed policy, plan, program or project, assess how its effects are distributed across a population, and develop recommendations to manage those effects. As a result, the MPO identified a project to pilot the use of HIA, aiming to connect two trails located in a north-south corridor of unincorporated Hillsborough County. The HIA for this initiative went from the fall of 2015 through the spring of 2016, focusing on corresponding indicators, including physical activity, chronic disease prevalence, crime, and other factors. Through presentations made to multiple MPO committees and its Board during this time, awareness of the health impacts of planning continued to grow. In August 2016, the MPO Board’s Policy Committee, a sub-group of the full MPO Board, approved an action that allowed its staff to work with DOH-Hillsborough to draft a Health in All Policies resolution.

A HiAP Resolution
In October 2016, MPO and DOH-Hillsborough staff began meeting to develop this resolution, with a goal to recommend continued use of Health Impact Assessments. This will serve as a non-regulatory statement of the MPO’s position on HiAP, and will help achieve our overarching goal to establish binding HiAP ordinances at the county and city levels. Our intended aim is that these HiAP ordinances will require the use of HIAs for county decisions on projects, programs, plans, and policies, and may also include funding for public health staff within other county agencies and prioritizing projects that reduce health inequities. In the interim, DOH-Hillsborough plans to continue partnering with the Planning Commission and MPO on HIAs and recently-funded HiAP-related grants. In addition, staff will continue conducting outreach and education on the benefits of HiAP and HIA to local departments and decision makers throughout Hillsborough County and the City of Tampa.

HiAP in Your Community
When considering Health in All Policies for your community, the first thing to remember is that this process takes time. Over a year of work led to the initiation of the HiAP resolution with the MPO. Although this is a public health win, it is just one step toward the greater goal. In thinking about how to apply HiAP, it is important to select the option that fits best with your community’s needs. For example, here is Hillsborough County, we took an agency or project-led approach. However, other possibilities we considered included establishing a taskforce centered on HiAP in general or framed around a particular community health issue. We also considered including HiAP in our strategic plan. Alternatively, successful HiAP efforts in other areas first instituted a HiAP resolution or included it in strategic documents such as a Community Health Improvement plan, and then implemented related projects.

In short, there is not one perfect way to implement Health in All Policies, rather it depends on each jurisdiction’s needs and available resources. However, there are important factors to keep in mind when deciding the ideal approach for your community. First, the leading agency should gauge the level of staff capacity (know-how, time availability, funding) and leadership buy-in. They must also measure external support by identifying the local government’s readiness for change and potential allies to help drive policies, projects or taskforces move forward. All in all, Health in All Policies is meant to work across agency and sector silos, which makes collaboration among both external and internal stakeholders the key to success.

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For more information about HiAP work in Hillsborough County, please contact Allison Nguyen at [email protected], or visit DOH-Hillsborough’s Health in All Policies webpage.

To learn about national efforts, visit NACCHO’s Healthy Community Design webpage.