This article is reposted from League of Wisconsin Municipalities January 2018 Magazine – The Municipality

Creating a Healthier, More Equitable Appleton

-by Kurt Eggebrecht, Health Officer, Appleton Health Department

Appleton recently became the first community in Wisconsin to pass a Health in All Policies ordinance. At its core, Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas.

Health in All Policies is based on the recognition that our greatest health challenges – for example, chronic illness, health inequities, climate change, and rising healthcare costs – are complex and often linked. Achieving healthy communities requires that we address the social determinants of health, such as transportation, education, access to healthy food, economic opportunities, and more.

University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2018.

University of Wisconsin Population Health Institute.
County Health Rankings & Roadmaps 2018.

As the graph illustrates, most experts agree that approximately 20% of health can be attributed to access to medical care; 30% can be attributed to health behaviors, such as use of nicotine and lack of exercise; and 40% is attributed to socioeconomic factors, such as employment and income. The remaining 10% can be attributed to the built and natural environment, including influences such as air quality, affordable housing, and transit. It’s important, then, to consider the consequences of city planning, transportation, or food systems policies which result in lifelong effects on the health of the whole community. Having a Health in All Policies ordinance builds a culture of health, where health is integrated into decisions made in all sectors of society.

Health is influenced by every aspect of how and where we live. Neighborhood characteristics have significant impacts on health outcomes, in part because they influence an individual’s ability to adopt behaviors that promote health. In Appleton, our efforts to change behaviors that impact health are most effective when we also address the environment in which our residents make their daily choices. For example, people whose neighborhoods lack parks and trail connectivity or have higher crime rates, have less access to safe places to play or walk. Similarly, people in lower income neighborhoods often have less access to affordable, healthy retail food options and have more access to less healthy fast-food outlets. As a result, serious health problems are concentrated in a fairly small number of distressed neighborhoods and the health problems of high-poverty neighborhoods remain substantially more serious than those of our more affluent neighborhoods.

People living in neighborhoods with high rates of poverty often have shorter life expectancies than those who live in neighborhoods with less poverty. We have known for a long time that poor health disproportionately burdens people who live in places that limit their opportunities to live long and well. Parents want to raise their children in neighborhoods with safe parks and quality schools but many do not get to choose where they live.

Economic well-being is one of the most critical determinants of health. Unemployment is associated with poor physical and mental health outcomes. Education is another key determinant of health. People with higher levels of education experience lower risks for most illness and have increased life expectancy. Health and education go hand-in-hand. Education leads to future economic well-being while educational attainment is shaped by health. For example, the physical and mental health of students significantly impacts school dropout rates, attendance, and academic performance.

The Health in All Policies ordinance also speaks to equity. People of color have consistently lower incomes, less household wealth, and lower educational achievement levels than whites. Children of color are more likely to be living in poverty. Even at equivalent income levels, people of color consistently experience significantly higher rates of illness than their white counterparts. These gaps in health outcomes are costly and preventable. The Health in All Policies ordinance is a way to create more equitable opportunities. Equitable opportunity means having a fair chance to lead the healthiest life possible by addressing key drivers of health such as education, employment, and housing.

Why a Health in All Policies Ordinance in Appleton?

We want to reshape the places that shape us – our neighborhoods. The goal of the Health in All Policies is to ensure that all decision-makers are informed about the health, equity, and sustainability consequences of various policy options during the policy development process. This approach brings data and expertise to decisions that shape the living conditions and opportunities for health.

Over time, each department director will work with the mayoral-appointed Health in All Policies team and report on progress and challenges from his or her respective department. Department directors are committed to working with their respective departments to integrate and track health and health equity indicators for his or her department and also commit to attending ongoing health equity training. Health equity means that everyone has a fair and just opportunity to be healthier. This often requires removing obstacles to health such as poverty, discrimination, and providing better access to a quality education and housing, a safe environment, and access to affordable healthcare. Department directors will also assist with the writing of a tri-annual Health in All Policies report. This report will include the status of health and health equity in the City of Appleton and progress of Health in All Policies implementation for the Common Council, city staff, community organizations, residents, businesses, and other governmental agencies within the city. This Health in All Policies ordinance directly aligns with the City of Appleton’s Strategic Plan.

What do we hope to accomplish in Appleton?

The Health in All Policies ordinance in Appleton will open up dialogue between government, key stakeholders, and residents most impacted by gaps in health outcomes. By doing so, we will not only prevent costly, preventable illness, this work will lead to a shared community goal of inclusion. No matter your country of origin, native language, sexual preference, household income, whether or not you have been incarcerated, or live with a disability or pre-existing health condition, you are welcome here. We want to live where residents know we have their backs and their health matters to us and impacts our own well-being. It is in this spirit that meaningful discussions can occur that lead to improvements in the social determinants of health.

Early in our journey, we want to study and act on accessible built environments that promote health and safety, including improved pedestrian, bicycle, and automobile safety, parks and green space, and healthy school siting. Over time, the Health in All Policies ordinance will impact the availability of resources to meet the daily needs of our residents including: safe housing; access to healthy and affordable food; access to educational, economic, and job opportunities that lead to sustainable employment; improved neighborhood safety and reduced crime, violence, and social disorder, like the presence of trash and other forms of blight. Perhaps most important will be trending data on social norms and attitudes such as discrimination, racism, and socioeconomic conditions such as concentrated poverty and the chronically stressful conditions that accompany it.

The Health in All Policies team recognizes that leadership and innovation is not always easy, but we owe it to the people we serve to work together to find the best ways to solve complex problems, and this strategy will help us do this. Investing the time and creativity now to consider how health will be impacted by the decisions we make, will lead to solutions that will be win-wins and move us all toward a shared goal of creating a healthier, more vibrant and equitable Appleton.

About the author:
Kurt Eggebrecht has served as Appleton’s Health Officer since 2000. Prior to his appointment he worked nine years at the Medical College of Wisconsin (MCW) where he managed the health promotion services for employees of Johnson Controls Inc., located in 48 states. Before working at MCW Kurt worked eight years at the Milwaukee Health department where he established the wellness program for management staff of the city. Kurt received his undergrad degree from UW La Crosse and his master’s degree from the University of Virginia, both in Community Health Education.

Contact Kurt at [email protected]

Learn more about the Legacy Community Alliance for Health.