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Environmental Health Policy Guides Environmental health is concerned with how interactions between humans and their environments impact human health. The field emerged to protect people from chemical or biological threats in their environment like air pollution and waterborne diseases. More recently, the field focuses on creating health promoting environments, such as homes, workplaces, schools, neighborhoods and communities. Human-environment interactions are complex, and issues are often under the jurisdiction of multiple agencies or organizations. For example, environmental agencies may be responsible for air and water quality and natural resource agencies for energy creation. Therefore, improving overall population health necessitates cross-sectoral collaboration on policies, programs, and projects. Health in All Policies (HiAP) provides a framework for working with other sectors to address these multifaceted issues. In order to promote the cross-sector collaborations taking place at the local, state and federal levels, ASTHO is developing a series of topic-specific, evidence-based policy guides. The guides catalogue policies and programs that link environmental issues that have benefited from a health perspective. These guides are developed with feedback from a range of subject matter experts, CDC, as well as ASTHO’s HiAP Steering Committee and Advisory Groups. website yes

Leveraging Healthy People 2030 to Build Non-Traditional Multisector Partnerships multisector partnerships, healthy people 2030, health equity, health outcomes, social services, health disparities, preventable disease, premature death, health literacy, economic stability, social determinants of health, department of health, improving the health, united states, long term, life expectancies, population health, chronic diseases, prevention and health promotion, health care system, disease prevention and health, health systems, healthy people 2030 objective, subject matter experts, office of disease prevention, personal health literacy, achieving health equity, health problem, population groups, astho, association of state and territorial health officials Corinne Gillenwater, Megan DeNubila-Griffin ASTHO | This toolkit helps public health build and maintain relationships with non-traditional partners across a multitude of sectors. The goal of this toolkit is to help state and territorial health agencies (S/THAs) build non-traditional, non-public health sector partnerships to improve health outcomes and advance health equity. The Healthy People 2030 objectives, aligned closely with the Social Determinants of Health (SDOH) framework and Health in All Policies (HiAP) lens, can serve as the cornerstone of these collaborations. This toolkit is implementation-focused, providing partnership-building and -sustaining skills that are rooted in Healthy People 2030 tools and success stories and can be operationalized for community needs. Overall, this toolkit encourages S/THAs to implement these described strategies in their own public health practice to: Establish and maintain partnerships within and across sectors at the state and territorial level to create a shared vision of health. Respond to public health priorities collaboratively and strategically. On This Page Using Healthy People 2030 in Non-Traditional Partnerships to Improve Public Health Types of Non-Public Health Sector and Non-Traditional Partnerships for Consideration Foundations of Strong Partnerships Sustainability of Partnerships 10 Steps for Strong Public Health Multisector Partnerships Conclusion Additional Resources website yes

Evidence-Based Approaches to Promoting Health Equity in Retail Food Safety ASTHO, Association of State and Territorial Health Officials, health equity, food safety, health in all policies, foodborne illness, public health, food code, food service employees, food safety resources, safety standards, barriers to food safety, retail food safety, communication barriers, diversity of language, understand and implement, educational resources, culturally respectful, food science, impacted populations, equitable enforcement, best practices, food safety training, community health, conduct inspections, control measures, jurisdiction demographics Heather Tomlinson ASTHO | Public health agencies can incorporate health equity into their food safety work by tailoring their messages and strategies to their communities. Foodborne illness is costly, preventable, and all too common. Public health agencies are responsible for food safety and reducing foodborne illness by educating and inspecting retail food establishments. Several studies have found that independent ethnic restaurants—those that serve food originating from a culture or heritage of certain ethnic groups—had more violations and, as a result, were inspected more frequently than the average. Some of these violations may be related to a misunderstanding of the food code and/or language barriers. Currently, more than one in four food service employees speaks a language other than English at home and 22% of employees have less than a high school diploma. It is crucial that food safety resources and messaging provided by public health agencies be made available to reflect varying languages and literacy proficiencies to ensure accessibility and comprehensibility for all. Achieving health equity, in which everyone has a fair and just opportunity to attain their highest level of health, requires health agencies to evaluate their approaches to food safety so all food establishments can meet retail food safety standards. Addressing Communication Barriers Health agencies should be familiar with the diversity of languages and cultures in their jurisdiction so materials can be tailored to each community’s differing needs. Providing food safety training courses, regulations, and other materials in languages spoken by local restaurant staff can reduce barriers so restaurant operators and workers who don’t speak or read English fluently have access. Having interpreters or multilingual inspectors can drastically improve communication between inspectors and restaurant staff. For health agencies without these resources, inspectors can utilize photos or translation services, such as Google Translate or language lines, to communicate effectively with restaurant operators. Demonstrating proper practices in person or through videos can also help communicate through observation. With more than half of U.S. adults aged 16 to 74 years old reading below the equivalent of a sixth-grade level, food safety educational resources should be developed so that all populations have access to documents written at educational levels tailored for their community. Educational materials should meet plain language accessibility requirements, including limited text in the appropriate language and simple cultural appropriate imagery. Food safety inspectors can carry materials in multiple languages or have online resources they can share with the retail food facility, such as Washington’s Food Worker Manual or FDA’s Educational Posters that provide flyers on common food safety topics. Finally, newly developed resources should include the target audience in development and pilot testing to ensure they are achieving the desired impact. Designing Materials to Support Your Audience Being familiar with cultural norms and communicating in a culturally sensitive way can enhance the delivery of food safety messaging. One study found that produce safety education materials developed for produce growers in the U.S. Virgin Islands were not seen as culturally appropriate. After redesigning the materials based on community feedback, the managers saw improvements in food safety knowledge and hygiene practices among produce growers. These results and similar studies suggest that educators should partner with impacted populations to evaluate the utility of potential interventions before implementation and ensure they are interpreted as intended. In addition to culturally appropriate food safety education materials, agencies can ensure that they meet the practical needs of the retail environment. For example, materials targeted for mobile facilities (i.e., food trucks) may need to be durable and waterproof to withstand operation and transportation. Ensuring Equitable Enforcement at Your Health Agency Health agencies can incorporate concepts such as equitable enforcement and health equity into their staff’s annual training curriculum. Equitable enforcement promotes compliance with law and policy that considers and minimizes harm to people affected by health inequities. ChangeLab Solutions’ guide on Equitable Enforcement to Achieve Health Equity educates policymakers, advocates, and enforcement officials on best practices in the design and development of enforcement provisions to avoid inequitable impacts and promote community health. A study from Michigan State University found that food safety professionals throughout the United States, especially at the local level, encountered a variety of ethnic food establishments and ethnic foods for which they lacked relevant food safety training. The smartphone application, Cultural Food Safety App, offers searchable information on food safety issues and control measures associated with specific culturally based foods. This app can help regulators better understand cultural foods and their production to ensure foods are being safely prepared and be more familiar with what to look for when conducting inspections. Lastly, health agencies can incorporate a Health in All Policies framework into their food safety practices through ASTHO’s Food Safety Guides. ASTHO strongly supports health agencies in promoting a diverse and culturally competent food safety workforce. By assessing jurisdiction demographics, addressing communication barriers, tailoring resources to fit the audience, and building a culturally competent workforce, health agencies can improve equity in their jurisdiction’s food safety programs. 5U18FD007739-02 website yes

Wisconsin is leaning into teamwork to address homelessness and safe housing in the state.

This report explores how the seven strategies for HiAP directly relate to the actions involved in developing State Health Improvement Plans, as both are collaborative by nature and seek to improve health and equity.

This brief highlights how both states are using the Health in All Policies framework to address systemic racism and social inequity between populations of different racial and ethnic groups.

Policymakers seek to prevent the spread of COVID-19 by focusing on non-congregate sheltering and alternative housing for unhoused populations.

Learn how states are leveraging transportation policy to improve health outcomes in this Health Policy Update.

A One Health approach can give health agencies the connections they need to address climate and health.

Learn how state health and transportation agencies are partnering to improve physical access to healthcare.

Interview with Gina M. Raimondo, former governor of Rhode Island, to learn more about a Rhode Island Department of Corrections initiative that helps prevent and treat addiction among incarcerated individuals and other statewide efforts to combat the opioid epidemic.

The Association of State and Territorial Health Officials Challenges Members to Promote Health Equity and Health in All Policies ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) and ASTHO President and Minnesota Department of Health Commissioner Edward Ehlinger have issued the 2016 ASTHO President’s Challenge: Advancing Health Equity and Optimal Health for All. The challenge is based on the Triple Aim of Health Equity, a framework weaving together three core elements of public health practice and policy which recognize that health status is influenced by a host of factors—most of them outside the healthcare system. The 2016 challenge calls upon states and territories to: (1) expand their understanding of what creates health, (2) implement a Health in All Policies (HiAP) approach with health equity as the goal, and (3) strengthen community capacity to create their own healthy future. The challenge encourages states and territories to broaden their approaches to advancing health equity and improving the health of all their residents by adopting the foundational public health practices embodied in the Triple Aim of Health Equity. The challenge will be to use these practices to address a policy, program, or activity issue within their jurisdictions in the next year. “The dominant narrative in America is that health is the responsibility of individuals until they get sick, and then health becomes the responsibility of the healthcare system,” Ehlinger says. “This outdated narrative allows little room for community or social influences, and its deficiency is clear when you look at the health disparities in this country and our overall health outcomes relative to other developed nations.” The challenge specifically targets health inequities that plague a number of groups that have been disadvantaged in America. As the nation becomes more diverse, the impact of unaddressed inequities will become more evident and alarming. According to the U.S. Census Bureau, 50.4 percent of children 1 year of age and younger belong to a minority group as of July 2011. By 2044, a majority of the entire U.S. population will belong to a minority group. Yet research shows that minority populations are disproportionately affected by higher rates of poverty, decreased graduation rates, and food and housing insecurity—factors that decrease their opportunities to be healthy. The new challenge will use three core elements of public health practice that make up the Triple Aim of Health Equity approach to elevate the profile of advancing health equity and creating optimal health for all. ASTHO will support state and territorial health officials and partners who accept the challenge by providing technical assistance and support, sharing best practices and success stories, and facilitating information exchange and opportunities for collaboration around health equity and HiAP approaches. Ehlinger has recently presented on the challenge to CDC, the Institute of Medicine Committee on Community Based Solutions to Promote Health Equity in the United States, and multiple professional groups around the country. “The 2016 ASTHO President’s Challenge recognizes that good health does not begin with treating illness. Our health status arises from our everyday environments, activities, and the people around us,” says Sharon Moffatt, ASTHO interim executive director. “We are proud to work with Dr. Ehlinger to promote health equity and optimal health for all. When we build healthier communities, we all benefit.” In November, U.S. Surgeon General Vivek Murthy joined Ehlinger during the Health Equity in All Policies panel at the American Public Health Association’s 2015 Annual Meeting, where Murthy voiced his support for the new President’s Challenge. “Reducing disparities in health will give everyone a chance to live a healthy life and improve the quality of life for all Americans,” says Murthy. To learn more about the 2016 ASTHO President’s Challenge, visit: www.astho.org/Health-Equity/2016-Challenge. ASTHO Press Release Boilerplate website yes

In this episode, our guests tell us how they put One Health into practice in a state health department, how health departments can connect across agencies to address One Health issues, and what falls under the One Health umbrella.

In 2017, nearly 64,000 children under six had elevated blood lead levels as defined by the CDC. There is no safe blood lead level in children, and even low levels of lead have been shown to affect IQ, ability to pay attention, and academic achievement. To decrease maternal and child morbidity and mortality associated with lead exposure, families need access to systems of coordinated care in order to address their needs related to lead exposure.