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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.

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

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

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

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

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.

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.

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.

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.

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.

Health in All Policies Evaluation Tool for State and Local Health Departments ASTHO, Association of State and Territorial Health Officials, social determinants of health, promote health equity, highest level of health, united states, health inequities, improved health, health outcomes, influence health, health in all policies task force, national association of county and city health officials, department of public health, achieve health equity, advance health equity, local public health, health care system, local health departments, public health institute, public health professionals, community health workers, health including, health in all policies (hiap), evaluation tool, state and local health departments, health equity, public health practice This tool provides several strategies for health agencies to incorporate Health in All Policies into their programs. State and local health departments are investing in Health in All Policies (HiAP) as a strategy to incorporate health equity into local decision-making processes. HiAP encourages engaging partners from diverse backgrounds—such as transportation, housing, education, and environment, and other sectors—to address the root causes of health disparities that are deeply intertwined with social, economic, and environmental factors. Many health departments are seeking to evaluate the benefits of investing in integrating HiAP into their public health practice. To support the development of robust evaluations, ASTHO—in partnership with the National Association of County and City Health Officials (NACCHO) and with funding provided by CDC's National Center for Environmental Health—developed this HiAP Evaluation Tool for local and state health department to provide structure and guidance for evaluating HiAP initiatives. Get the Resource (PDF) website yes

Health in All Policies can be a successful strategy to expand collaboration between state and territorial agencies and other partners, but the terminology used in programs focused on these efforts can differ. While equity is often a prominent part of these efforts, it is not always included in the program title. ASTHO partnered with the Kansas Health Institute to host listening sessions to better understand how these efforts are framed and deployed.