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PERSPECTIVES FROM THE FIELD:
A HEALTH APPROACH TO MUNICIPAL DECISION-MAKING: 

THE GOLD STAR IN HEALTH

Lauren Skowronski, BA, MSW; Karen Lowrie, PhD; Leigh Ann Von Hagen, AICP, PP

1

could and should do to contribute to a sustainable 
future.  Launched in 2009, Sustainable Jersey (SJ) is 
a network and movement of municipalities, schools 
and school districts working collectively to bring 
about a sustainable New Jersey, and acting with 
state agencies, non-profit organizations, foundations, 
academia and industry. The program culminates in 
a prestigious certification award to municipalities 
and schools that have documented meeting a set 
of rigorous standards. Sustainable Jersey provides 
tools, training and financial incentives to support 
communities as they pursue sustainability programs. 

Collaborative Effort to Improve New Jersey’s 
Health 
Recognizing that municipalities needed direction on 
health issues, in 2019, Sustainable Jersey organized a 
cross-sector task force of more than 80 stakeholders 
and experts in public health, health care, social 
service, prevention, mental health, housing and 
planning. 

In July 2021, after a two-year effort of collaborative 
research, strategy development and program 
implementation, the Health Task Force developed the 
Gold Star Standard in Health1 that includes standards 

Introduction
As the COVID pandemic has put a renewed focus 
on public health infrastructure, people have a 
renewed appreciation for the important role that 
the government plays in building and supporting 
good health outcomes. Much of what determines 
a person’s health and wellness is based on the 
environmental and social conditions where they live 
and work. The pandemic revealed striking disparities 
in health outcomes that are clearly linked to these 
uneven conditions. (Perry et al, 2021; Lopez et al, 
2021)

Local governments have a great deal to do with 
creating and sustaining the conditions that support 
health and health equity. Municipalities exercise 
important roles in public education, land-use planning 
and zoning, transportation planning, environmental 
management, housing, infrastructure investments, 
recreational programming, provision of open and 
green spaces, police and public safety, and economic 
development (Northridge and Freeman, 2011; WHO, 
2010). 

In the state of New Jersey, Sustainable Jersey 
researches best practices for what local governments 

 1https://www.sustainablejersey.com/actions/gold-star-standards/health-gold/

https://www.sustainablejersey.com/actions/gold-star-standards/health-gold/


Perspectives from the Field Skowronski; Lowrie; Von Hagen  

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and levels of performance that municipalities can 
implement to build a culture of health and advance 
health equity. 

The Health Gold Task Force includes members 
from the Camden County Department of Health 
and Human Services, Edward J. Bloustein School 
of Planning and Public Policy, the Housing and 
Community Development Network of New Jersey, 
New Jersey Association of County and City Health 
Officials, New Jersey Chapter of the American 
Academy of Pediatrics, New Jersey Department of 
Environmental Protection, New Jersey Department of 
Health,  New Jersey Health Care Quality Institute, New 
Jersey Local Boards of Health Association, New Jersey 
Partnership for Healthy Kids, New Jersey Prevention 
Network, New Jersey Public Health Association and 
more. 

Individual working groups focused on tackling priority 
issues such as access to healthy food, land use, 
housing, and municipal governance. Each working 
group brought dozens of additional content experts 
to the table in order to develop new standards, 
update existing Sustainable Jersey “actions”, and 
identify available resources to help local governments 
implement these initiatives in communities across the 
state.

Maplewood Township Health Officer Candice 
Davenport served on the Health Gold Task Force. 
She explained, “A healthy environment creates a 
healthy person and vice versa. If we are engaged and 
present in our relationship with our environment 
and surroundings, then we will be moved and take 
action on its behalf. This is the basis of the Sustainable 
Jersey Gold Star in Health. It’s a first step to help 
municipalities implement large scale efforts to 
impact health behavior and make systemic changes.” 
She added, “Towns that are working towards 
Sustainable Jersey goals are really ensuring that their 
communities are resilient and healthier for future 
generations.”

Health Gold Star Standard 
In order to be eligible to apply for the Gold Star 
Standard in Health, a municipality must be approved 
and have received points for designated “actions,” 
or standards. To assist municipalities, each action 
contains a description outlining why the action 
is important, who should lead and be involved, 
projected costs and timeline, what to do and how to 
do it, documentation to submit, successful models, 
and a list of resources that can assist in completing 
the action. Sustainable Jersey staff and content 
expert volunteers are on hand to assist towns in the 
implementation process.

The foundational Local Health Assessment and 
Action Plan action is a required first step where a 
municipality will assess and prioritize addressing the 
health needs and contributing conditions existing 
within the community. A robust dive into existing 
demographic and local health data, and a community 
engagement process are key to this assessment 
process. 

Using a health lens, a newly established stakeholder 
committee will review existing conditions that may be 
contributing to poor health outcomes, for example, 
lack of access to healthy food, potential exposure 
to harmful lead contamination, unsafe conditions 
in parks and recreation areas, lack of opportunities 
for movement across town by bicycle or on foot, 
etc. Where available, such data will be compared 
at neighborhood levels in order to assess where 
strategies to remedy such needs and conditions 
should be prioritized.

Health in All Policies a Key Component
Understanding how municipal policy and 
programming decisions affect the health of those who 
live, work, and play within the community is essential 
for future planning and goal-setting. Building a 
culture of health by incorporating this health lens into 
municipal operations is a critical goal of the Gold Star 
Standard in Health.



Perspectives from the Field Skowronski; Lowrie; Von Hagen  

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To this end, a new action, Integrating Health into 
Municipal Decision-Making2 will be required of 
all towns applying for the Gold Star in Health.  To 
complete the action, municipal staff must complete 
an HIAP training and use a health impact checklist 
to assess municipal operations and procedures. 
Formalizing this approach through adoption of an 
HiAP resolution or establishing a HiAP Task Force is 
encouraged.   

The HIAP course required for the action is available 
through the Bloustein School of Planning and Public 
Policy at Rutgers, the State University of New Jersey, 
through its collaborative called the Planning Healthy 
Communities Initiative.   The Bloustein course is 
offered as a 6-hr class, with the following learning 
objectives:

• Define HIAP and recognize why and when to use 
the HIAP approach.

• Understand the broader context of health 
influences, social determinants of health and 
health equity.

• Learn how to identify and use data to measure 
progress in health objectives.

• Gain familiarity with Health Lens Analysis, 
Health Impact Assessment (HIA), and other 
emerging tools that can provide evidence-based 
recommendations aimed at enhancing positive 
health impacts and minimizing negative ones.

• Explore opportunities to incorporate health in 
all policies into government decision-making 
processes.

• Understand how to effectively engage 
stakeholders in collaborative and inter-sectoral 
efforts to promote health.

• Review the resources available to local 
government and residents who wish to include 
health consideration in community planning.

The class agenda features four parts and includes 
a mix of presentations and group exercises.  Topics 
include definitions of HIAP and health equity, finding 
and using data and mapping tools, strategies for 
implementing HIAP through process and policy 
changes and collaborative tools, and fostering 
leadership in building a healthy community.  
Participants engage in discussion around key 
questions and also perform a break-out group around 
social determinants of health and using a health lens 
to examine a real or hypothetical project or program.

Participants told course evaluators that they learned 
how to use data and mapping tools to support 
decision-making, and programming, how to identify 
partners and champions in the community, and the 
importance of understanding health as a “shared 
value.”  One noted that the class spurred a motivation 
to pass a local HIAP resolution, and several relayed 
their commitment to looking at projects through 
a deeper health lens.  A local health department 
director commented that the class helped her to gain 
“a better perspective of how [health departments] 
can work together to promote the importance of 
health initiatives and the inclusion of health issues/
matters in our local policy discussions and decisions.”

Together, the Gold Star in Health and Bloustein 
HIAP course will provide local governments with 
the understanding and support to ensure health is 
considered in the development of programs and 
policies moving forward in order to ensure healthy 
and more equitable communities. 

For more information on the Gold Star in Health, 
visit bit.ly/GoldStarHealth. For more information on 
Bloustein’s HIAP course, please see phci.rutgers.edu, 
or contact authors.

2https://www.sustainablejersey.com/actions/#open/action/595

https://www.sustainablejersey.com/actions/#open/action/595


Perspectives from the Field Skowronski; Lowrie; Von Hagen  

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References:

Lopez L, Hart LH, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021;325(8):719–
720. doi:10.1001/jama.2020.26443

Northridge, M.E., Freeman, L. Urban Planning and Health Equity. J Urban Health 88, 582–597 (2011). https://
doi.org/10.1007/s11524-011-9558-5

Perry, Brea L., Brian Aronson, Bernice A. Pescosolido (2021). Pandemic precarity: COVID-19 is exposing and 
exacerbating inequalities in the American heartland. Proceedings of the National Academy of Sciences Feb 
2021, 118 (8) e2020685118; DOI: 10.1073/pnas.2020685118.

World Health Organization (WHO. Unmasking and overcoming health inequities in urban settings. World 
Health Organization, 2010.

CORRESPONDING AUTHOR
Karen Lowrie, PhD
Rutgers University
33 Livingston Ave.
New Brunswick, NJ 08901
848-932-2937
eac@ejb.rutgers.edu

CHIA Staff:

Editor-in-Chief 
Cynthia Stone, DrPH, RN, Professor, Richard M. Fairbanks School of Public Health, Indiana University-Purdue 
University Indianapolis

Journal Manager 
Angela Evertsen, BA, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University 
Indianapolis

Chronicles of Health Impact Assessment Vol. 6 Issue 1 (2021) DOI: 10.18060/25989
© 2021 Author(s): Skowronski, L.; Lowrie, K.; Von Hagen, L.
       This work is licensed under a Creative Commons Attribution 4.0 International License

https://doi.org/10.1007/s11524-011-9558-5
https://doi.org/10.1007/s11524-011-9558-5

