December 2021 Volume 6 Issue 1 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 2 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 3 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 4 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