What Does a Health in All Policies Approach to Advance Health Equity Look Like in Practice?

September 21, 2016|4:42 p.m.| Emily Moore

The theme of this year’s ASTHO Annual Meeting, held in Minneapolis, focused on Creating the Future of Public Health. As part of this theme, the first day agenda included several sessions on the 2016 President’s Challenge on Advancing Health Equity and Optimal Health for All. Following welcoming remarks, Gov. Mark Dayton (MN) spoke about his state’s work to improve the health and lives of Minnesotans, as well as looking at decisions through a health lens. A panel session featuring several of his cabinet secretaries followed, facilitated by Dr. Edward Ehlinger, ASTHO’s 2015-2016 president and commissioner for the Minnesota Department of Health. This panel session demonstrated how a state can embrace a Health in All Policies approach to support inter-agency collaboration and better understand the impact of policy and programmatic decisions related to the social determinants of health.

Each commissioner shared their thoughts about how they see their agency’s role in improving health and equity. John Stine, commissioner of the Minnesota Pollution Control Agency, spoke about ways the distribution of clean water and air was not yet equitable in Minnesota and how his agency is working to systematically address this inequity by improving waterways and other resources to allow everyone to benefit equally from these shared natural resources. Shawntera Hardy, commissioner of the Minnesota Department Employment and Economic Development, explained that businesses must have a talented and healthy workforce to be able to grow and increase economic prosperity in their communities.

ASTHO Annual Meeting 2016 Minnesota panel of commissioners

From left to right, Edward Ehlinger, commissioner of the Minnesota Department of Health, Tom Landwehr, commissioner of the Minnesota Department of Natural Resources, Mary Tingerthal, commissioner of Minnesota Housing, John Stine, commissioner of the Minnesota Pollution Control Agency, Charles Zelle, commissioner of the Minnesota Department of Transportation, and Shawntera Hardy, commissioner of the Minnesota Department Employment and Economic Development.

Charles Zelle, commissioner of the Minnesota Department of Transportation, said that his department sees health as the end goal of their work to ensure that all individuals have adequate transportation to access services and enable them to lead healthy lives, while also maintaining the health of the environment. Tom Landwehr, commissioner of the Minnesota Department of Natural Resources, described how outdoor recreation contributed to health and how his department was working to reach out to communities through nontraditional channels to ensure that these opportunities are available to everyone and to also train individuals on how to do it, if that was a barrier.

Finally, Mary Tingerthal, commissioner of Minnesota Housing, spoke about their work bringing together different stakeholders in inter-agency council to address homelessness, as housing impacts academic achievement in children and the use of emergency rooms and jails among adults.

The commissioners discussed how signing onto ASTHO’s advancing health equity presidential challenge influenced their work. Commissioner Zelle said that signing the pledge elevates the importance of the shared goals across agency and also creates accountability to ensure that decisions and programs work to these goals, while evaluating progress through measures of community impact. Commissioner Hardy shared similar thoughts: “When you put a health lens, you humanize these issues. This is about people.”

Dr. Ehlinger asked his colleagues about whether the focus on a health in all policies approach ever felt to them that he (and the state health department) was getting into “their lane.” Commissioner Hardy said “Yes, but you should,” eliciting laughs from the audience. She noted that with proper signaling and communication between agencies, their team welcomes this contribution of the health lens and health department expertise. In the same vein, Commissioner Tingerthal noted that some of the best work they have done is on projects in which they have had a collective goal and engaged multiple stakeholders. She noted that in this collaboration to reduce the number of homeless veterans, a key to success was understanding each of their roles in serving the population. The commissioners also collaborate with each other during the budgeting period to make sure their priorities and programs align and address shared goals to improve the health and well-being of Minnesotans.  

This panel was a highlight of the first day of ASTHO’s annual meeting and challenged attendees and in particular, other state and territorial health officials, to think about how they could collaborate with their colleagues in state government to address health equity. As Commissioner Hardy shared “Health equity is not an initiative – it’s about how we do business. It’s people’s lives.”

For more information about collaboration in Minnesota and the state’s work in health equity, visit their webpage and ASTHO’s case study, as well as Minnesota’s 2014 report to the legislature, Advancing Health Equity in Minnesota.

Emily Moore

Emily Moore, MPH, is a senior analyst for health transformation at ASTHO, where she supports state and territorial health agencies to advance public health through activities in payment and delivery reform, public health partnership with public and private payers, and population health improvement.