Health in All Policies - Pinellas At this point of the morning we have given you a lot of information about what problems Pinellas County is experiencing, and Dr. Whitehead has introduced a concept to help us transition from talking about problems to talking about solutions. Quinn Lundquist, MPH, CPH Planning and partnerships Manager, DOH-Pinellas July 11, 2018

“We cannot choose our external circumstances, but we can always choose how we respond to them.” Epictetus

Sometimes we might need a little stoic philosophy when stuck in traffic on a hot summer day here in Pinellas, but the reality is most of us here, unless anyone here is over 100 years old, are not the ones responsible for the transportation system we have, or the housing costs, or the income inequality crisis, or the geographic separation of resources. But it’s the system we have.

How Do We Make a Healthy Community? So how do we make a healthy community, not broadly, but specifically right here in Pinellas? (With our unique blend of cities and county government, and recognizing that different sectors typically don’t work together as much as they should)

We are embarking on a new initiative to implement a health in all policies approach here in Pinellas County. What sets our idea apart from the way it has been done in other cities is that we plan on integrating multiple levels of government at the same time while creating a network of representatives from multiple sectors to learn about each other’s work, share data and resources, and come up with mutually beneficial plans and projects. Some of you here are already doing this type of work, and that is great. Keep it up. Some are new to this, which is where this project comes in.

How Do We Accomplish This? 5 Key Elements of a "Health in All Policies" Approach Promote health, equity, and sustainability Support intersectoral collaboration Benefit multiple partners Engage external stakeholders Create structural or process change 1 2 3 The Institute of Medicine says there are 5 key elements to a successful health in all policies approach. I will use this as a framework to describe what we are planning to do here in Pinellas County over the next 3 years. The 5 key elements are: 1. Health, equity and sustainability. The Health in All Policies philosophy holds that health, equity and sustainability are closely linked. Decreasing health disparities and supporting environmental, social and economic sustainability can enhance health 2. Intersectoral collaboration. The basis of the Health in All Policies approach is promoting collaboration among all sectors affecting the social determinants of health. 3. Co-benefits: Benefit multiple partners. To gain buy-in from stakeholders in multiple sectors, leaders need to outline health improvement strategies that will provide stakeholders with benefits in addition to improved population health. 4. Engage stakeholders. Health in All Policies projects need to engage stakeholders such as community members, policy experts and advocates to support the goal of improving health. 5. Create structural or procedural change. Improving population health requires embedding the Health in All Policies philosophy into the structures and processes of government. 4 5 Institute of Medicine, 2013

1. Health, Equity, and Sustainability These values form the core of our initiative Health- a state of complete physical, mental, and social well-being; not merely the absence of disease Equity- paying special attention to why some groups are less healthy than others (i.e., social constructions like racial and ethnic differences, as well as gender, employment, income, or education) Sustainability- ability to meet the needs of the present without compromising the needs of the future Health- a state of complete physical, mental, and social well-being and not merely the absence of disease Equity- paying special attention to why some groups are less healthy than others (i.e., social constructions like racial and ethnic differences, as well as gender, employment, income, or education) Sustainability- ability to meet the needs of the present without compromising the needs of the future These values form the core of our initiative and everything we do revolves around them in some capacity.

2. Intersectoral Collaboration The initiative will fund collaborations to study and improve policies and programs related to: Safe and affordable transportation Opportunities for safe physical activity Affordable nutritious foods Clean air, soil, and water Housing Green and open spaces Health care Clean energy use Schools Greenhouse gases emissions This initiative, funded by the Foundation for a Healthy St. Petersburg, will fund collaborations, many of which will take the form of Health Impact Assessments, to improve policies and programs related to things you see in this first box. Things like safe and affordable transportation, housing, opportunities for safe physical activity, green and open spaces, and clean energy use. These don’t just improve public health outcomes, they contribute to a society that is equitable, prosperous, and efficient. To do this, it requires public health and planning professionals to work outside their comfort zone and interface with people from other agencies and departments to learn what they do and how we can work together. Code enforcement Parks and conservation Engineering Community development Urban planning Housing authority Economic development Public works Architects Transportation planning Zoning & permitting Public safety

3. Multiple Partners Core group: Who What Pinellas County Government County Government City of St. Petersburg City City of Pinellas Park City Florida Department of Health in Pinellas State Agency/Local Health Dept. Foundation for a Healthy St. Petersburg Local Foundation The five partners listed at the top: Pinellas County Government, St Petersburg, Pinellas Park, DOH-Pinellas, and the Foundation form the core of this first local implementation of this concept here in Pinellas. But this group is going to need to work with other partners across sectors in order to collect data, make evidence based recommendations, and stay informed on local policies and projects. DOH Pinellas is serving as a convener and as subject matter expertise for health topics; the Foundation is the funder as part of their transformative grants; Pinellas County Planning Department is responsible for land use planning for the County’s unincorporated residents, which number over 200,000. St. Petersburg is the County’s largest city, and its neighbor Pinellas Park is the 4th largest city in terms of population, and contains portions of a rapidly developing area of the county known as the Gateway region.

4. External Stakeholders Essential for ensuring the work is responsive to community needs. The initiative will involve participation from and collaboration with: Community members Private sector Local policy experts Neighborhood associations Nongovernmental organizations Civic engagement organizations Advocates Multi-sector committees Robust stakeholder engagement is essential for ensuring that this work is responsive to community needs. Stakeholders provide important information about barriers to and opportunities for health and insight into ways in which government agencies and policies may impede or promote health. This project needs support and input from citizens and external organizations. We will be reaching out through our normal means of communication, by email, website posts, and attending community meetings. But your word of mouth is also essential to this spreading around.

5. Structural or Process Change This initiative will promote the values of health, equity, and sustainability as a regular part of government, not only when asked to. Embed or institutionalize this concept into the work of government Consider these values at the early stages of program and policy development Consideration of health, equity, and sustainability in decision-making processes across policy areas and over the long term will require changes in how government decisions are made and how agencies relate to one another as stakeholders. Grant guidance documents Strategic plans Program reviews Required bill analysis Contract requirements

How Do We Accomplish This? Over the next 3 years, this group will: Create new opportunities for cross-sector collaboration Utilize Health Impact Assessments in policy analysis for new projects Identify and showcase champions in cross-agency work Hire and train people skilled in multiple subject areas to support specialists Promote “cross-training” of public health and planning staff to learn each other’s languages

Recap 1 2 3 4 5 Promote health, equity, and sustainability Support intersectoral collaboration Benefit multiple partners Engage external stakeholders Create structural or process change 1 2 3 4 To recap what I just went over. The core values of a health in all policies initiative are health, equity, and sustainability. 5

My last quote here serves as a follow-up to my first quote, which was from Epictetus. It read “we cannot choose our external circumstances, but we can always choose how we respond to them.”

Contact Information: Quinn Lundquist, MPH, CPH 727-824-6900 Quinn.Lundquist@flhealth.gov