This article is reposted from Wisconsin Counties Association September 2019 Magazine – Wisconsin Counties

How Counties Play a Critical Role in Advancing Health Equity

–by Marybeth McGinnis, Associate Outreach Specialist, COWS, UW-Madison

Health in All Policies (HiAP) is a framework for recognizing and addressing health inequities by centering the social determinants of health impacts in discussions of wide-ranging policy topics. HiAP incorporates five elements, each of which are crucial for the success of policies across diverse departments and sectors that aim to reduce health inequities:

  • Promote health, equity, and sustainability.
  • Support intersectoral collaboration.
  • Benefit multiple partners.
  • Engage stakeholders.
  • Create structural or process change.

The Legacy Community Alliance for Health is a partnership between Green Tier Legacy Communities, COWS (a UW-based think-tank), and several NGO partners including the Wisconsin Counties Association. Its main objective is to build the capacity of Wisconsin communities to implement a health in all policies approach. Already in its third year, LCAH has helped several communities across the state successfully implement policies and programs that exemplify each of these elements. Counties can bring important value and direction to these projects, especially in partnership with cities. The projects and recommendations for counties below demonstrate in concrete ways how counties and cities can partner to reduce health inequities.

Promote health, equity, and sustainability

In rural Bayfield County, residents who cannot drive or afford a car may face worse health outcomes due to the difficulty of traveling to friends, medical appointments, work, and more. Thus, Bayfield County hosted a transportation summit. The summit incorporated ideas from partners such as Wisconsin Department of Transportation, as well as examples of innovative rural transport, such as in the Japanese town of Nishikata. By recognizing the challenge of transit in rural areas and its inextricable link to health outcomes, Bayfield County initiated an important conversation about health and transit in order to better identify solutions.

Support intersectoral collaboration

Employees of the City of Appleton knew they wanted to incorporate HiAP into the City’s work. While a city resolution would have been easier to pass, employees instead strategized to pass an ordinance. Because Appleton is located in three different counties, this effort involved reaching out to partners in a variety of county organizations and departments, as well as within the City’s own Health Department. All three of the counties’ involvement in the support of the ordinance was crucial in giving the new legislation clout.

Benefit multiple partners

Eau Claire County and the City of Eau Claire cowrote a Health Chapter for the City of Eau Clarie’s Comprehensive Plan that incorporates HiAP. While this was a significant step, these communities had an even greater impact by partnering with a local community group that had received funding to complete an assessment of the community’s health. This was a jumping-off point for County and City staff to engage with HiAP, bring the community into the decision-making process, and benefit other partners.

Engage stakeholders

The City of Fitchburg created its Health Neighborhoods Initiative (HNI) with the aim of developing more grassroots engagement outside of City Hall. However, Fitchburg did not have the funding or personnel to make grassroots engagement work. Luckily, Dane County Department of Human Services heard about Fitchburg’s HNI. The County funded two Neighborhood Navigators who work to engage with residents in places like cultural centers, food banks, and community festivals. The City-County partnership was key, as the County had available funding and the City had connections with the targeted neighborhoods.

Create structural or process change

The City of Wisconsin Rapids plans to support HiAP through its Health Impact Assessment (HIA) Matrix (used to measure the likely health impacts of new developments and city policies) and the HIA Advisory Board (which is tasked with identifying how the city’s work impacts health). The team is compiled of Wood County Health Department staff, City of Wisconsin Rapids staff, and representatives from several community groups. The Matrix and the Board are long-term changes to processes that will better ensure future projects are considered through the HiAP lens.

How Counties Can Lead

  • Reach out to city and town staff, and ask if they have developed a HiAP approach and how the county can be a part of its success.
  • Partner with cities to share funding for more effective and engaging interventions.
  • Prioritize building city-county relationships by devoting personnel time to serving on advisory boards and attending meetings.
  • Bring HiAP to non-health county departments, as it is crucial for those outside of traditional health work understand the impact of transit, work, infrastructure, and more on health inequities.