Funder: Robert Wood Johnson Foundation
May 2018 | Profile
The California Health in All Policies (HiAP) initiative is a collaborative approach designed to improve the health of Californians by incorporating health, equity, and sustainability considerations into policymaking across sectors. The approach recognizes that chronic illness, climate change, health inequities, and increasing health care costs are interrelated and influenced by policies, programs, and investments across sectors.[i] HiAP, at its core, is an approach to addressing the social determinants of health that are the key drivers of health outcomes and health inequities.
In 2010, Governor Arnold Schwarzenegger established the HiAP Task Force through Executive Order S-04-10. The HiAP Task Force is staffed through a partnership between the Strategic Growth Council (SGC), the California Department of Public Health, and the Public Health Institute. The SGC, established through state legislation in 2008, is charged with coordinating the activities of state agencies and partners to promote sustainability, economic prosperity, and quality of life for all Californians, including but not limited to initiatives such as HiAP.
The 22-member task force includes representation from the following agencies: Air Resources Board; Business, Consumer Services and Housing Agency; Environmental Protection Agency; Government Operations Agency; Governor’s Office of Planning and Research; Labor and Workforce Development Agency; Natural Resources Agency; Office of Traffic Safety; State Transportation Agency; and the Departments of Community Services and Development; Corrections and Rehabilitation; Education; Finance; Food and Agriculture; Forestry and Fire Protection; General Services; Housing and Community Development; Justice; Parks and Recreation; and Social Services.
The executive order initially charged the task force to: (1) collaborate with existing SGC workgroups to identify priority programs, policies, and strategies to improve the health of Californians while advancing the SGC’s goals; and (2) submit a report to SGC outlining recommended programs and policies for consideration, and describing the benefits for health, climate change, equity and economic well-being that may result if the recommendations are implemented.[ii] The SCG then charged the task force with developing plans to implement those recommendations deemed a priority by the task force members and through community engagement. While the SGC provides an overall home for the HiAP initiative, the “backbone staff” are funded by the Department of Public Health and through grant funding provided to the Public Health Institute to support the task force. The seven HiAP staff: (1) serve as conveners and facilitators; (2) ensure that health and equity are embedded in government policies and practices; (3) engage local and community stakeholders; (4) provide consultation and capacity building for state agencies and departments; and, (5) disseminate the HiAP approach to local and state agencies.
The HiAP Task Force’s formal structure encourages cross-agency collaboration and a willingness among all agencies to consider the health implications of policy and program decisions, and also ensures sustainability throughout leadership or administration changes.
Activities of the task force include: (1) reviewing existing state efforts and best practices used by other jurisdictions and agencies; (2) supporting departments to incorporate health and equity considerations into their policy development and day-to-day operations; (3) identifying opportunities and potential barriers to interagency collaboration, and developing strategies that serve multiple departments; and, (4) convening quarterly meetings to solicit input from task force members to advance priority programs and policies. The task force’s programmatic work is organized into Action Plans (i.e., work plans), which are developed using a consensus approach and describe interagency actions and deliverables. The plans’ tasks and deliverables are reviewed on an ongoing basis, and tasks, objectives, and relevant partnering agencies may be updated as governmental goals evolve.
This profile outlines key factors behind the success of California’s HiAP approach, and highlights several policy achievements.
Key Factors for Program Success
Since its inception in 2010, the HiAP Task Force has introduced 12 Action Plans, and seen successful implementation of key policies related to healthy food purchasing, access to green spaces, and active transportation throughout state government. Key contributors to the effectiveness of HiAP include:
- Formal Structure for Collaboration and Sustainability. The establishment of the HiAP Task Force by an executive order created a formal mission and structure for the HiAP approach, encouraging all state agencies to consider a health lens in the development and implementation of policies and programs across California. The HiAP Task Force is comprised of high-level membersof a diverse range of agencies who collaborate with HiAP staff in the conceptualization and implementation of Action Plan goals. The acknowledgement at the gubernatorial level of the importance of considering health in policy and program development, and the creation of the HiAP Task Force through executive order, gives a level of legitimacy to HiAP. This formal structure encourages cross-agency collaboration and a willingness among all agencies to consider the health implications of policy and program decisions, and also ensures sustainability throughout leadership or administration changes.
- Dedicated Staff. The HiAP initiative includes seven full-time staff from the Public Health Institute and the Department of Public Health. These dedicated staff work to ensure that: (1) health, equity and sustainability are considered in the development and implementation of policies and programs; (2) collaboration and engagement occur across agencies and community partners; (3) the programmatic goals of health and other agencies are addressed in a mutually beneficial manner; and (4) structural or process changes are institutionalized throughout relevant state government agencies. HiAP staff have the capacity and resources to formally engage state agency partners through quarterly meetings; identify areas of opportunity and best practices; and ensure that the objectives addressed in Action Plans are met.
- Supporting Community Level Action. A critical component of the HiAP approach is the integration of a health lens into policymaking across state government. While the state creates and interprets laws, develops guidance for local and regional planning, administers grants to local communities, and makes decisions that affect the health and well-being of citizens across the state, these actions are all intended to have an impact in communities and localities. The HiAP initiative is focused on embedding health, equity, and sustainability into government decision-making, data collection, grant-making and departmental guidance. To ensure the health and equity lens is realized at the community level, HiAP provides technical assistance to state departments around: (1) integrating health and equity considerations into community grant opportunities; and (2) including health and health equity in guidance issued by the state.
The HiAP Task Force has facilitated a number of cross-agency, statewide initiatives. Below are highlights from initiatives focused on: healthy food; active transportation; and creating violence free and resilient communities.
Farm to Fork strategies make it easier for state institutions, such as schools and the Department of Corrections, to purchase locally grown produce, thereby increasing access to healthy foods and supporting a sustainable local farming community.
Poor diet is one of the leading causes of death in California, and contributes to obesity, heart disease, high blood pressure, and cancer. The focus on healthy food seeks to make changes in food policy and consequently health outcomes through efforts related to healthy food procurement and farm-to-fork policies. For example, the task force’s procurement work strives to make it easier for state institutions, such as schools and the Department of Corrections and Rehabilitation, to purchase healthier food and/or locally grown produce, thereby increasing access to healthy foods and supporting a sustainable local farming community. This work resulted in the development of nutrition guidelines for Adult California Correctional Facilities to help support the purchase of healthier food within the correctional system.
Through the task force, the Office of Farm to Fork developed a toolkit to help schools and farmers support farm to school programs, and a report summarizing best practices for local food procurement among K-12 school districts and California colleges and universities.
The task force’s active transportation work is centered on the aspirational goal of providing all Californians options to safely walk, bicycle, or take public transit to school, work, and essential destinations. The 2014-2016 Active Transportation Action Plan objectives seek to increase the capacity of state agencies to promote: (1) complete streets (which require local entities to consider the needs of all users of streets, roads, and highways); (2) safe and accessible active transportation in school environments and in long-range transportation; (3) active transportation as an option for state employees and visitors to state office buildings; and (4) the identification of strategies to collect data, monitor progress, and evaluate outcomes for transportation programs. One key outcome to date is the California Transportation Commission and the Department of Transportation’s partnering with HiAP staff and other stakeholders to develop a health and health equity section of the Regional Transportation Plan Guidelines, which are used by regional planning agencies across the state.
Violence Free and Resilient Communities
The HiAP Task Force recognizes that effective violence prevention must address the root causes of violence, including poverty, alcohol and substance abuse, and urban disinvestment. The Action Plan to Promote Violence-Free and Resilient Communities seeks to build state agency capacity to address the drivers of violence and promote communities that are safe and violence free. This dovetails with the recognition among California agencies that the goals related to public health, supporting infill (building up not sprawl) and transit-oriented development, and increasing active transportation (walking, biking, and public transportation) cannot occur without addressing crime, violence, and fear of violence in communities. Elements of the Action Plan focus on: (1) increasing awareness of, and policy changes based on, an understanding of adverse childhood experiences and trauma-informed systems; (2) addressing the built environment to support safe and affordable community development for California’s most vulnerable residents (e.g., homeless, survivors of intimate partner violence); (3) building capacity among state agency staff about the intersection of violence prevention and their work.
The cross-sector collaboration formalized by the task force has helped to embed the lens of health, equity, and sustainability in both the development and implementation of policies, guidance, programs, grant making, and evaluation.
Through HiAP and task force activities, numerous multi-agency collaborations have been initiated which foster healthy communities and infuse health and equity into the government decision-making process at both the state and local level. The cross-sector collaboration formalized by the task force has helped to embed the lens of health, equity, and sustainability in both the development and implementation of policies, guidance, programs, grant making, and evaluation.
Another important achievement includes increased coordination and communication across agencies and departments, an improved understanding of each agency’s processes and languages, as well as the identification of mutually beneficial outcomes. For example, the creation of the Food Procurement Work Group’s nutritional guidelines resulted in reviewing and updating bid specifications for approximately 45 food contracts. This resulted in a reduction in sodium and other nutrition improvements for people housed in state correctional facilities.
The HiAP Task Force has also created long and short-term interagency work groups to promote healthy eating (such as the Food Procurement Workgroup) and healthy environments (such as the Land Use, Schools, and Health Workgroup), as well as established the Office of Farm to Fork to promote policies and strategies to improve access to affordable and healthy food.