Health in All Policies for a Stronger Recovery

Read our COVID-19 Response & Recovery blog series

By Nadia Rojas, Tina Yuen & Rebecca Johnson

COVID-19 has urgently demonstrated that everyone needs to live in safe and healthy communities. The people most affected by COVID-19 are communities of color, people with low income, immigrants, and other underserved groups. These groups are most vulnerable in part because of existing laws and policies that affect the fundamental drivers of health inequities. Communities and local governments that take steps to ensure health, safety, housing, food, and economic stability for all of their residents will be helping to prevent the spread of COVID-19 and laying the groundwork for health equity and prosperity for future generations.

To help communities and local governments strengthen their response to COVID-19 and advance health equity, we’re publishing a blog series about policies that they can enact right away. This post is the sixth in the series.

Throughout this blog series, we have discussed individual policy areas in which local governments can respond to the pandemic, including housing and utilities, paid leave protections, protections for food workers, repealing 911 nuisance laws, and equitable enforcement strategies. However, these policies are just the beginning of what local governments can do to address the complex, wide-ranging problems created by COVID-19.

Ultimately, what we need is an all-hands-on-deck response to the pandemic. One way to achieve comprehensive solutions is to use the approach that public health practitioners call Health in All Policies (HiAP). This transformative, collaborative approach to community improvement incorporates considerations like health, equity, and resilience into decisionmaking across government agencies and policy areas. At its core, HiAP is about practicing a whole-of-government approach to solving our biggest challenges — the problems that are so big and complicated that no one government agency, department, office, or group can fix them on its own.

The era of COVID-19 requires every part of government to work together in a coordinated way toward shared response and recovery goals. Every local government agency and institution has a role to play in this effort. Here are just a few examples of the innovative responses of local government departments to the crisis:

Additionally, with budget cuts looming due to reduced tax revenue, it has never been more important for local governments to maximize their resources to meet residents’ immediate and long-term needs. Cross-sectoral government responses create efficiencies through the sharing of limited resources; increased communication; and cross-pollination of best practices and lessons learned.

Recognizing that a coordinated response will result in a stronger response and a quicker recovery, local governments in Dallas, TX; Flint, MI; Chicago, IL; Santa Monica, CA; and Imperial Beach, CA, have taken executive action to create multi-sector task forces or committees that will respond to the immediate and long-term health and economic needs of their residents during the economic recovery. Depending on their focus, these task forces often include representation from the city council, several government agencies, and various non-governmental groups like businesses and nonprofits.

Forming multi-sector task forces is an important first step toward a strong Health in All Policies response. As these task forces form, we encourage decisionmakers to think about who is missing from the group and how every part of government can be leveraged to perform the following crucial tasks for equitable public health and economic recovery:

  1. Improve data collection in order to target response and recovery activities that address inequities. We need to understand who is most affected by COVID-19, including health data about who is most likely to be exposed to or die from COVID-19, which communities and neighborhoods are most affected by the health and economic effects of COVID-19, what policies need to be updated, and where resources need to be allocated. Basing actions on such analysis will help all of us by preventing the spread of COVID-19 and ensuring that limited resources go to the under-resourced and marginalized communities that are most affected by COVID-19.
  2. Identify policies and actions that each agency can initiate, and use task forces to hold different departments accountable for implementing those policies and actions. Government agencies do many things. They collect data, provide services, educate the general population on a range of topics, function as a major local employer, regulate and enforce existing laws, and fund projects and activities. All of these activities can be deployed to support COVID-19 response and recovery activities. As part of an overall COVID-19 response, each department must plan their own response for both the short and long term. The task force can then review those commitments, identify areas where it makes sense to collaborate, and track progress toward meeting shared goals.
  3. Develop and use health equity tools to analyze budgets, programs, and policies in response to COVID-19. With budget shortfalls, it will be critical to design all policies, practices, and procedures to maintain services and promote the emotional, physical, and economic well-being of all residents. By requiring individual agencies to analyze how their budget will help advance health equity, local government leaders can ensure that community goals and public investments are aligned.
  4. Support enrollment in programs aimed at increasing the health, emotional, and economic well-being of residents. Local governments can make it easier for residents to sign up for benefit programs (such as SNAP, WIC, Medicaid/Medicare, TANF, and unemployment benefits) and enroll in economic programs that support small businesses. Localities can take a “no wrong door” approach to communications so that every time someone interacts with government or a relevant community partner, they receive information about benefits and services for which they might be eligible.
  5. Update government contracting systems to support COVID-19 response and recovery goals. Government agencies often contract with businesses for a range of services, such as stocking vending machines, purchasing office supplies, operating cafeterias, cleaning government properties, or providing training to staff. These contracts can be amended to support COVID-19 response and recovery activities. For example, contracts can be altered to require that employees be provided with adequate personal protective equipment, paid a living wage, or given paid sick leave.

Given the frantic pace of responding to both a public health crisis and an economic crisis, taking a HiAP approach can seem like one more item on a never-ending to-do list, especially if there are smaller work groups or committees that are responding rapidly. However, local governments that can effectively strengthen their cross-sector collaboration skills and engage all of their agencies in response and recovery activities will be able to foster greater innovation, ensure healthier communities, and build stronger, more resilient communities.

For more information, check out the Health in All Policies resources offered by ChangeLab Solutions; Health in All Policies: A Guide for State and Local Governments from the Public Health Institute and the American Public Health Association; and, for ideas on actions that different agencies can take, the COVID-19: Location Action Tracker from the National League of Cities.

Please stay tuned for the next installment in this series, which will discuss preemption.

5/21/2020