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Environmental health and public health preparedness staff work closely together to respond to natural disasters and climate change—learn how in this report.

Commonalities of State-Level HiAP Groups State-Level HiAP Initiatives, Cross-Sector Health Equity Programs, Health in All Policies Strategy, Integrating Health in State Policies, Collaborative Health Policy Development, social determinants of health, department of public health, improving population health, public health institute, social service, address the social determinants, cross sector collaboration, local health departments, health impact assessment, health disparities, incorporate health, community health, population health improvement, state and local governments, American public health, community based organizations, centers for disease control, health considerations, health inequities, long term, ASTHO, Association of State and Territorial Health Officials Kerry Wyss Learn how public health agencies are implementing cross-sector partnerships to improve their work and incorporate health equity. States and localities are developing cross-sector or health in all policies (HiAP) working groups to address the drivers of health from both within and outside of public health and health care. These groups bring together decision-makers from different sectors to explore policies and programs that aim to improve public health and address health inequities. These partners can include government agencies, community-based organizations, educational institutions, businesses, and other stakeholders. This document outlines some of the components, partners, and roles/responsibilities of many of these groups, so they can be replicated across the nation to tackle complex public health challenges at the state and local level. Get the Report (PDF) website yes

These states are connecting public health and transportation to improve access to healthcare—learn how in this report.

Implementing Health in All Policies in the Climate Space ASTHO, Association of State and Territorial Health Officials, HiAP lens, Health in all policies, climate change, climate space, flooding and rain, extreme weather, extreme heat, wildfire damage, seven strategies, Texas workgroup, national disaster operational workgroup, Washington state department of health, emergency preparedness and response, hiap implementation, Wisconsin department of health services, new mexico taskforce, interagency climate change taskforce, climate action teams, Climate and Health Capacity Survey, HiAP Task Force; Climate Change Commission, Resilience Initiative Kerry Wyss, Ali Aslam ASTHO | A Health in All Policies approach can help public health agencies better address the impact of climate change on population health and well-being. Each year, we face hurricanes, floods, extreme heat events, destructive wildfires, as well as other natural disasters and homeland security threats that test the resiliency of state, territorial, and freely associated state agencies and the communities they serve. To address the health threats posed by natural disasters and by climate change, more health agencies are integrating a Health in All Policies (HiAP) approach. This cross-sector approach can make these climate efforts more effective and impactful, and help promote health equity and optimal health. This report outlines strategies for health agencies to apply the HiAP lens and utilize cross-sector collaboration to optimize their climate and health responses. Get the Report (PDF) website yes

Supporting Resilience in Rural Areas Through Cross-Sector Partnerships ASTHO, Association of State and Territorial Health Officials, rural health, public health, public health partnerships, health in all policies, government agencies, community organizations, academic institutions, rural populations, infrastructure improvement, healthcare systems, environmental determinants, climate change, sustainable practices, environmental challenges, extreme weather, environmental health risks, protective factors, engaging rural partners, building trust, idaho department of health and welfare, michigan department of health, health equity, austin climate equity plan, healthy start oregon, kansas department of commerce, wisconsin broadband access, chesapeake housing mission Ali Aslam The key to making rural communities more resilient is for public health to partner with community organizations, governmental agencies, and other critical partners. Working across sectors of government agencies, community organizations, businesses, and academic institutions is critical to address public health challenges in rural communities. Using a Health in All Policies (HiAP) approach helps public health agencies better address the interconnected social, economic, and environmental determinants of health impacting rural communities and improve community well-being. HiAP brings together a multitude of perspectives to develop holistic strategies that can support infrastructure improvements, sustainable land use practices, diversified economic opportunities, safer and healthier home environments, and robust health care systems in rural communities. Through community leadership and collaboration, this cross-sector approach can enhance the capacity of rural communities to build resilience, adapt to climate change, and foster long-term sustainability to improve public health outcomes. Learn how states are implementing HiAP strategies to improve health in their rural communities in this report. Get the Report (PDF) website yes

This report, based on findings from ASTHO’s 2022 Environmental Scan, dives into how Health in All Policies strategies can promote health equity.

This report identifies and breaks down seven core value areas that emerge from taking a health in all policies approach to policymaking and programming.

States Partner Across Sectors to Address Lead Poisoning Kayley Humm, Kerry Wyss, Ali Aslam Learn in this brief how three states are using partnerships to improve lead testing and reduce cases of lead poisoning. ASTHO partnered with the National Center for Healthy Housing (NCHH) to provide technical assistance and capacity-building support for lead poisoning prevention efforts in three state health agencies: Maryland Department of Health, North Dakota Department of Health and Human Services, and Arkansas Department of Health. This brief highlights each agency’s strategies for collaborating across sectors along with accomplishments for strengthening lead poisoning prevention capacity in each jurisdiction. Many of these strategies align with those used in a health in all polices (HiAP) approach to lead poisoning prevention. State Examples Maryland Department of Health Maryland adopted a collaborative approach to prevent lead poisoning. The Maryland Department of Health (MDH) has an established lead poisoning prevention program that partners with the Maryland Department of the Environment. The Department of the Environment oversees the childhood lead registry and case management, while MDH focuses on lead testing regulations and Medicaid services. This partnership has been implemented across the 24 local health departments in the state. Maryland enhanced lead case management by providing staff support and tackling complex cases that require additional assistance. In addition to supporting an increase in lead case management activities and lead awareness, ASTHO funding also helped strengthen collaboration and coordination among local health departments, state agencies, and local health care providers. The MDH Environmental Health Bureau also improved efficiency by moving data from the lead registry to MDH for lead surveillance and case management. They also developed and launched sub-county lead testing data as part of their Environmental Public Health Tracking public portal. These activities align with HiAP strategies of developing and structuring cross-sector relationships, coordinating funding and investments, and synchronizing communications. North Dakota Department of Health and Human Services The North Dakota Department of Health and Human Services (NDHHS) made significant strides in building up the state lead program, which recently transitioned from the department of environmental quality to NDHHS. With support from ASTHO and NCHH, NDHHS developed a lead prevention website with a data dashboard, developed a lead screening questionnaire, and built collaborative partnerships. The activities in North Dakota align with the HiAP strategies of developing and structuring cross-sector relationships, synchronizing communications, and integrating research, evaluation, and data systems. Building collaborative partnerships is a key initiative for the NDHHS lead program. Already developed partnerships include stakeholders such as Health Tracks and WIC. Health Tracks developed a newsletter article for their provider network so physicians can stay up to date and aware of the lead program transition and lead testing changes, and WIC will host informational lunch and learns to raise awareness about lead testing within their network. North Dakota is also prioritizing building partnerships with tribal communities. A tribal communications plan was developed with the goal of establishing an effective communication plan between the state of North Dakota and each tribal government for lead-related events. Anticipated outcomes from the communication plan include testing for blood lead levels, conducting environmental assessments on tribal lands, and seeing if a tribal member or government is interested in hosting a lead screening event. Progress has been made with the Standing Rock Sioux Tribe, Turtle Mountain band of Chippewa, and NDHHS is hopeful to establish intertribal meetings with all four governmental tribal representatives. Arkansas Department of Health The Arkansas Department of Health established its lead program in 2011 to support abatement of lead-based paint in residential and commercial properties. With support from ASTHO and NCHH, Arkansas has been using a data-driven approach to gain a more comprehensive understanding of lead exposure burden in the state. These activities align with the HiAP strategy of incorporating health data into decision-making and integrating research, evaluation, and data systems. The Arkansas Department of Health conducts periodic audits on its data system to support access to timely and accurate data. To improve data quality and frequency of blood lead testing reports, the health department is establishing incentive programs to encourage facilities to report cases of elevated blood lead. In addition to conducting outreach to its partners, the Arkansas Department of Health has been working to improve lead case data access and data quality through data mining efforts, case report matching, and migration to a new lead surveillance system. Arkansas has been working to modernize the current reporting system to facilitate automation and promote overall efficiency of data analysis and case identification. Conclusion The collaborative efforts of Maryland, North Dakota, and Arkansas highlight the importance of multi-sector partnerships and data sharing in addressing lead poisoning prevention and align with many of the strategies used in a HiAP approach. Each state implemented tailored strategies that sought to grow collaboration in its unique context. These initiatives highlight the importance of cross-sector collaboration in public health initiatives and may serve as valuable models for other jurisdictions. article yes

Learn about public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

This ASTHOBrief offers a menu of strategies and considerations for organizations interested in incorporating a Health in All Policies and equity-centered approach to the development and implementation of requests for proposals and notice of funding opportunities.

Economic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children. Human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.

As the United States begins to see more wildfires, it is important for health agencies to be ready to address concerns from the public and collaborate with other state agencies to mitigate the health risks of wildfire smoke.

While governments have faced challenges in adopting a Health in All Policies (HiAP) approach to respond to COVID-19, the impact of the public health emergency across sectors such as housing, transportation, and employment has created a unique opportunity for stakeholders to build and strengthen collaborative systems to address the inequities exacerbated by COVID-19.

Nov. 3, 2021, marks the sixth annual One Health Day, a global campaign to recognize and embrace how public health is connected to the health of animals and our shared environment. In this post, ASTHO talks about One Health with Wayne E. Cascio, MD, who serves as the Acting Principal Deputy Assistant Administrator for Research and Development at EPA.

The COVID-19 pandemic has highlighted the intersections of social determinants of health, such as transportation, education, and housing, and their impact on the health of individuals and communities. As the moratorium on evictions ends in many parts of the United States, housing in particular looms as a potential public health crisis. Braiding and layering funding is when government agencies and non-traditional partners collaborate and coordinate to combine different streams of funding to address social determinants of health. This post lists three examples where funding has been successfully braided or layered to support housing needs.

This episode emphasizes the importance of addressing heart disease and stroke prevention through approaches that center on health equity, including systems-level changes, quality improvement, and community development. CDC’s Division for Heart Disease and Stroke Prevention is partnering with ASTHO to support jurisdictions in successfully integrating efforts with healthcare and community partners and implementing best practices and evidence-based policies to identify, control, and improve blood pressure.

This article in Journal Of Women's Health explores the actions of jurisdictions that participated in the Increasing Access to Contraception Learning Community, and how they continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation.

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.

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