Health Departments Making an Impact Using Health in All Policies Strategies

by Laura Fudala

One of my favorite things about working at the National Center for Healthy Housing is meeting new communities from all across the country. Every new group we talk to provides a unique experience:

• We learn about the different challenges communities may face,
• We meet exciting, dedicated, people working to advance healthy housing, and
• We discover new and innovative ways change agents are making huge strides addressing healthy housing issues.

Our work with the latest mini-grant cohort as part of the HiAP + Pb (Health in All Policies plus Lead) Collaborative does not disappoint! As a quick refresh, NACCHO defines “Health in All Policies” (HiAP) as a “change in systems that determine how decisions are made and implemented by local, state, and federal governments to ensure that policy decisions have neutral or beneficial impacts on health determinants.” Bottom line: Health should be an institutionalized consideration in all aspects, processes, and decisions of government. Since 2017, we’ve been working with NACCHO, ASTHO, NEHA, and CDC’s National Center for Environmental Health on a range of initiatives to more intentionally support communities in applying HiAP strategies to lead poisoning prevention work.

The three communities NACCHO, NCHH, and CDC recently had the pleasure of working with have really shown what can be accomplished in a short time with access to flexible funding streams that allow for innovation and space to work with other team members in new ways. The brief segments below do not even remotely capture, the energy, dedication, and grit of these people—they are fierce! But they can begin to shine a light on the successes they’ve had, the challenges they’ve overcome, and the opportunities that are coming.

We hope the following summaries help build support to promote and advance their efforts locally and also inspires others like you, dear reader. Whether you’re looking to take new action in your community, needing to feel reinvigorated in your efforts, or interested in using your funding in flexible, innovative, and impactful ways…you are not alone and NCHH and our partners are here to celebrate you, support you, and help you reach your goals. Reach out today to learn more!

Minneapolis Health Department

At the core, the Minneapolis Health Department designed a project to leverage city health department data and look closely for policy opportunities to advance lead poisoning prevention work and stop using local children as “lead detectors.” Over the course of the project period, Minneapolis dove deep into their existing data to…

• Establish a localized reference level for elevated blood lead level in Minneapolis.
• Understand how existing city policies and interventions are or are not being implemented and identified opportunities to strengthen those policies.
• Develop communication talking points for the health department’s lead program to use with non-health partners in various other settings to advocate for health in all policies.
• Actively create a “culture of evaluation” within the health department to strengthen the department across all activities and program areas.

This work collectively resulted in a clear narrative about the state of lead exposure in Minneapolis, an evidence-based description showing that the lead program is using best practices tailored to the local community when prioritizing lead inspection and outreach activities, and a concrete example of the value of intentionally integrating the practice of data evaluation into program activities. They did a fantastic job in considering health equity and its implications at every stage throughout the project; expertly connecting the dots between housing, health, and related policy; addressing structural inequities and integrating principles of power-sharing in how data is used and shared back with a community; and did it all with deep technical expertise and an honesty and openness that can be challenging to express.

To learn more about Minneapolis Health Department’s specific HiAP + Pb project and their work overall, check out their 2022 grantee impact video, Evaluating Health in All Policies (Childhood Lead Poisoning Prevention), contact…

Mageen Caines
Public Health Data Scientist and Epidemiologist
Minneapolis Health Department
mageen.caines@minneapolismn.gov

…or reach out to the team more broadly at MHDEpi@minneapolismn.gov.

Franklin County Public Health

Centered on a desire to increase safe housing options for local residents, especially for the most vulnerable populations, Franklin County Public Health set out to create a viable pathway and application process for local landlords to request lead-safe housing repair assistance that includes an accountability structure both to protect renters from eviction and to ensure that they are not priced out of their homes post-repairs. Through the existing Regional Planning Commission repair and weatherization process, no mechanism exists for landlord access—only homeowners. As many of their most vulnerable residents rent, they believe that creating this parallel opportunity will begin to address some of the inequities caused by the current structure.

The development of cross-sector relationships was a foundational principle of their work. Although there were challenges in identifying and connecting with new stakeholder and partners, Franklin maintained a focus on building partnerships with landlords, other government agencies, and additional local organizations to include stakeholder voices in the development process, understand the barriers that various stakeholders might face, build early support, increase awareness on how their work impacts public health, and advance the concept that working together will address individual and community health more efficiently and holistically.

Franklin County’s thoughtful, intentional, and authentic collaboration allowed for creation of an initial draft of a home repair application process for landlords that incorporated the needs of their community into the design of the new service. Further, the stakeholder engagement and collaboration will continue the momentum created so far and continue to drive meaningful impact in their community as the effort continues.

To learn more about Franklin County’s specific HiAP + Pb project and their work overall, contact…

Jennie McAdams
Sustainability Supervisor
Franklin County Public Health
jenniemcadams@franklincountyohio.gov

Kent County Health Department

Concerned by the fact that lead poisoning disproportionately affects children from low-income households, children of color, and specific neighborhoods in Kent County and lacking baseline measures of the community’s level of awareness of lead risks and community resources, the Kent County Health Department worked with community members, organizations, and local leaders to develop and conduct a community assessment around lead and health equity within the county through an online survey. The assessment sought responses on community awareness of the hazards of lead exposure, lead risks, and community resources to address both exposures and risks. Kent County hoped this data would provide greater context to the existing gaps helping them to better understand the disparities and community needs.

While this project was already planned for implementation prior to award of the HiAP + Pb mini-grant, this additional, flexible funding allowed for innovations and improvements to the original plan, including the ability to justly compensate community members for their time spent on completing the survey with gift cards. Originally targeting 300 responses as a goal, Kent County deftly navigated multiple technical challenges along the way and still saw close to 1,000 responses before the end of the project period. Their dedication to the work and their community shone through at every turn!

Using several HiAP strategies, Kent County not only gained more feedback from the community to the open survey but also ensured community input was obtained during the design of both the survey and the distribution plan. They approached the entire survey process (from question design, format, dissemination, incentives, monitoring responses and demographics, analysis, et cetera) very thoughtfully and always with the community at the center. Using these approaches improved their ability to distribute the survey and have it available in languages that were inclusive of the community.

Kent County gained many valuable insights from the community on their baseline knowledge surrounding lead and developed stronger relationships with all the organizations involved. These results will guide future programming in outreach and education, drive program improvements surrounding lead poisoning prevention, and support the ongoing continuation of this effort.

To learn more about Kent County’s specific HiAP + Pb project and their work overall, contact…

Andrew Salisbury
Supervising Sanitarian
Kent County Health Department
andrew.salisbury@kentcountymi.gov

Disclaimer: This effort was supported by a sub-grant to NCHH that was awarded to NACCHO by the Centers for Disease Control and Prevention’s National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry through cooperative agreement OT18-1802. The contents of this blog are solely the responsibility of the author and does not necessarily represent the official views of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.

 

Laura Fudala, project manager, joined NCHH in January 2014 as a project coordinator to provide a wide variety of coordination, research, writing, and support functions on multiple NCHH projects. She currently manages a New York State Department of Health contract and an EPA cooperative agreement that together provide coordination, evaluation, technical, training, and/or programmatic support for healthy homes stakeholders such as the New York State Childhood Lead Poisoning Primary Prevention Program and those working to support the launch and growth of large-scale, evidence-based, sustainable asthma home visiting programs.