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1 Health in All Policies Task Force Report to the Strategic Growth Council Executive Summary

2 This is the Executive Summary of the Heal th in All Polic ies Task Force Report to the mmary and the full report are available for Strategic Growth Council. The Executive Su download at: http://sgc.ca.gov/workgroups/hiap.html . e Report to the Strat egic Growth Council The full Health in All Policies Task Forc includes: An introduction describing the formation,  purpose, charge, and activities of the Task Force. Recommendations to improve health and sustainability, listed with accompanying  background information, co- benefits, and evidence base.  A condensed list of recommendations collected by the Task Force.  Issue briefs outlining ways in which the actions of government agencies can influence the health of California residents and communities. For additional information about the Health in All Policies Task Force, contact: evention and Health Promotion Center for Chronic Disease Pr California Department of Public Health PO Box 997377, MS 0508 Sacramento, CA 95899-7377 Phone: (916) 445-0661 Email: [email protected] The Health in All Policies Task Force Repor t is not copyrighted. Readers are free to duplicate and use all or part d in this publication. of the information containe Suggested Citation: Health in All Policies Task Force Report to the Strategic Growth Council Executive Summary , Sacramento (CA): Health in All Policies Task Force, December 2010.

3 Acknowledgments k the Task Force members for their The Health in All Policies staff than commitment to engaging in this challeng ing cross-sectoral work, responsiveness ons, and countless hours of discussion, to short deadlines and multiple questi meetings, and review. This is truly their work. California Endowment and the California The Task Force is grateful to The Tobacco Control Branch for thei r generous financial support. Staff from numerous programs within the Department of Public Health contributed their invaluable subject matter expertise to the development of this report. licies Task Force is grateful for those members of the Finally, the Health in All Po ided thoughtful feedback at public public who supported its work and prov ic comment periods. workshops and during publ Health in All Policies Task Force Members Air Resources Board Lynn Terry, Deputy Executive Officer Jamesine Rogers, Air Pollution Specialist Business, Transportation, and Housing Agency Gregg Albright, Deputy Secretary, Environmental Policy and Integration Kathryn Lowell, Deputy Secretary, Health Systems and Life Sciences Department of Community Services and Development Maria Caudill, Legislative and External Affairs Department of Education Cindy Cunningham, Deputy State Superintendent Mary Prather, Education Administrator Department of Finance Karen Finn, Program Budget Manager Department of Food and Agriculture AG Kawamura, Secretary David Pegos, Deputy Secretary, Communications and External Affairs Department of Forestry and Fire Protection (CAL FIRE) Russ Henly, Assistant Deput ection and Improvement y Director, Resource Prot John Melvin, State Urban Forester Department of Housing and Community Development Linda Wheaton, Assistant Director of Local Government Affairs Cathy Creswell, Deputy Director, Division of Housing Policy Development Department of Justice Claudia Polsky, Deput y Attorney General Health in All Policies Task Force Report – Executive Summary | 1

4 Department of Parks and Recreation Nina Gordon, Senior Policy Coordinator Donna Pozzi, Chief, Interpretation and Education Division Eileen Hook, State Park and Recreation Commission Staff Department of Social Services Pete Cervinka, Program Deputy Director, Benefits and Services Charr Lee Metsker, Deputy Director, Welfare to Work Division Department of Transportation (Caltrans) Garth Hopkins, Office Chief, Division of Transportation Planning Marilee Mortenson, Senior Environmental Planner Environmental Protection Agency Cindy Tuck, Undersecretary Andrew Altevogt, Senior Manager Climate Programs Governor’s Office of Planning and Research Julia Lave Johnston, Deputy Director Seth Litchney, Senior Planner Health and Human Services Agency Peter Barth, Assistant Secretary Labor and Workforce Development Agency Douglas Hoffner, Undersecretary Jeff Wyly, Assistant Secretary, Governor’s Initiatives Office of Gang and Youth Violence Policy Nancy Lyons, Chief Deputy Director Office of Traffic Safety Leslie Witten-Rood, Assistant Director Lisa Dixon, Regional Coordinator Strategic Growth Council Staff Heather Fargo, Executive Policy Officer Governor's Office of Planning and Research Anna Marie Young, Assistant Planner, State Clearinghouse Report Authors California Department of Public Health Linda Rudolph, Deputy Director Aimee Sisson, Public Health Medical Officer Julia Caplan, Project Lead Lianne Dillon, Research Scientist Karen Ben-Moshe, Project Coordinator University of Califor nia, San Francisco Mina Mohammadi, Research Assistant Sarah Sattelmeyer, Research Assistant Miranda Walker, Research Assistant Photo Credits phil.cdc.gov y California ; pedbikeimages.com; Network for a Health Photography courtesy of the Health in All Policies Task Force Report – Executive Summary | 2

5 Stakeholder Advisory Group Bay Area Regional Health Inequities Initiative (BARHII), Bob Prentice Breakthrough Communities, Carl Anthony, Paloma Pavel California Pan-Ethnic Health Network, Marty Martinez, Ellen Wu California Rural Legal Assistance, Phoebe Seaton Central California Regional Obesity Prev ention Program, Genoveva Islas-Hooker Partnership for the Public’s Health, Julie Williamson PolicyLink, Judith Bell, Jme McLean boelata, Jeremy Cantor, Larry Cohen, Leslie Mikkelsen Prevention Institute, Manal A Public Health Institute, Matthew Marsom Public Health Law & Policy, Marice Ashe, Robert Ogilvie, Heather Wooten Regional Asthma Management and Prevention, Joel Ervice, Anne Kelsey-Lamb The California Endowment, George Flores, Judi Larsen, Marion Standish Key Informants and Contributors American Farmland Trust, Serena Unger Marin County Department of Health and Human California Coalition for Rural Housing, Rob Services, Rochelle Ereman Wiener Pesticide Watch California Department of Mental Health, Penny PolicyLink, Chione Flegal, Rubén Lizardo, Knapp Shireen Malekafzali, Marc Philpart California Department of Public Health, Kathy Prevention Institute, Rachel Davis, Xavier Dervin Morales, Sandra Viera California Food Policy Advocates, Ken Hecht, Public Health Law & Policy, Robin Salsburg, George Manalo-LeClair Nicole Schneider California Park and Recreation Society, Jane Rails to Trails Conservancy, Laura Cohen Adams Regional Asthma Management and Prevention, California ReLeaf, Joe Liszewski Brandon Kitagawa California State Controller’s Office, Ruth Holton- Sacramento Food Bank and Family Services, Hodson Jeremiah Rhine California WALKS, Wendy Alfsen Safe Routes to School National Partnership, California WIC Association Deb Hubsmith, Jessica Meaney Center for Civic Partnerships, Nicole Hara, Joan Samuels and Associates, Rajni Banthia Twiss San Mateo County Health System, Edith Center for Urban Forest Research, Greg Cabuslay McPherson San Mateo Public Health Department, Scott City of Berkeley, Public Health Division, Kate Morrow Clayton Selma Abinader & Associates, Selma Abinader, City of Fullerton, Al Zelinka Suzanne del Mazo Clean Water Action Soil Born Farms, Jared Clark Community Alliance with Family Farmers, Dave TransForm, Stuart Cohen Runsten Berkeley, University of University of California, Domus Development, LLC, Meea Kang California, San Francisco, Laura Gottlieb Healthy Places Coalition, Heather Kuiper University of California, Berkeley Center for Institute for Local Government, Yvonne Hunter, Cities and Schools, Deborah McKoy, Steve Sanders Jeff Vincent Local Government Commission, Scott Clark, a, Davis Sustainable University of Californi Judy Corbett Agriculture Research and Education Program, Gail Feenstra Health in All Policies Task Force Report – Executive Summary | 3

6 Background California faces critical problems that will shape the futures of our children and ages, fiscal challenges, an aging population, grandchildren. Climate change, water short he compelling issues facing and increasing health inequities ar e but a few examples of t me, California – and the nation – faces unprecedented levels of the state. At the same ti 1 chronic disease, which now accounts for over 75 percent of all deaths in California and 2 75 percent of all U.S. health care expenditures. Obesity and overweight, which increase chronic disease risk and contribute to lost productivity, cost California an 3 estimated $21 billion in 2006. Health is a critical component of sustainable communities, and is directly linked to the goals of the Strategic Growth Council (SGC). For example, when Californians consume through consumption of fruits and local produce they enhance their own health tural lands. Policies that support active vegetables and help preserve California’s agricul incorporate more health-promo transportation help Californians ting physical activity into their lives, while also reducing greenhous e gas emissions and other harmful co- pollutants. Infill developm ent can help to reduce urban sp rawl, reduce greenhouse gas emissions, and support location-efficient housing that promotes active transportation h economic and health benefits. and allows workers to reap bot Good health is also critical for economic sustainability, increas ing workforce participation and productivity, and slowing the ongoing rise in medical care ex penditures, which diverts resources from other State priorities such as educat ion or investments in green energy. The health of California’s popu lation is largely determined by the physical, social, economic, and service environments in whic h we live, learn, work, and play – collectively referred to as the “social determi nants of health.” While medical care is vitally important, it contributes only a small portion (between 10 - 15 percent) to our 4 overall health and longevity. The social determinants of health have a far greater 5,6,7 impact on how long and how well we live than medical care. Environments impact health both directly – for example, through ai r pollution or contaminated soil or drinking advantaged communities often have fewer water – and indirectly. People in dis ficantly worse health outcomes. Efforts to resources for health, which is reflected in signi change health behaviors are most effectiv e when they address the environments in 8 However, public health agencies alone cannot which people make their daily choices. change these environments since responsibilit y for the determinants of health generally falls under the realms of housi ng, transportation, education, ai r quality, parks, criminal ,11 9,10 Thus, for public health justice, and employment agencies, to name just a few. agencies to achieve their mission – to improve the health of the population – they must work collaboratively with the many government agencies, businesses, and community- based organizations which are best pos itioned to create healthy communities. 12 have been described as “wicked” problems. The complex problems California faces They are multi-factorial with many interdependencies, difficul t to fully define, lacking a clear solution, and not the responsibility of any single organization or government department. Such problems require a new policy paradigm and innovative solutions that reach across organizational silos and promote co-benefits. Health in All Policies, or Health in All Policies Task Force Report – Executive Summary | 4

7 HiAP, is a collaborative approach that has been used internationally to address just these kinds of issues. A HiAP approach recognizes that health and prevention are impacted by policies that are managed by non-health government and non-government egies that improve health will also help to meet the policy entities, and that many strat objectives of other agencies. The World Health Organization, European Union, South Australia, Finland, and other Western nations are all explor ing ways to implement HiAP. Although it does not use the term HiAP, the Surgeon General’s National Prevention, Health Promotion, and Public Health Council also brings together cross-sectoral agency leaders to address health and prevention. The Health in All Policies Task Force prov ides a venue for people with many different perspectives to come together and ask: How can California’s health sector help to advance the goals of other sectors whose work will have a huge impact on ecosystem and economic sustainability and thus on human health and survival? And ate a health lens as they address their simultaneously, how can other sectors incorpor California’s population is own wicked problems, so that as healthy, productive, and resilient as possible? HiAP harnesses t he power that agenc ies and departments can bring through their areas of expertise, fo cuses on co-benefits and win-win strategies, in bringing people t and explores and uses health as a linking factor ogether from across 13 sectors to address some of the bigges t issues that face our society. The Health in All Policies Task Force California’s Health in All Policies Task Fo rce was established by Executive Order S-04- 10 of Governor Arnold Schwarzenegger on F ebruary 23, 2010, under the auspices of the SGC. The Task Force was charged with ident ifying priority actions and strategies th while also advancing the other goals of for State agencies to improve community heal vember of 2010, representat ives from 19 California the SGC. Between April and No agencies, departments, and offices came toget her in multiple individual and group Task Force meetings, participated in public wo rkshops, and received written comments from a diverse array of stakeholders. These State leaders have developed a broad-ranging set of recommendations on feasible strategies and actions to promote health while also meeting other objectives of the SGC. The Task Force defined a healthy community as one that meets the basic needs of all residents, ensures quality and sustainability of the environment, provides for adequate levels of economic and social developmen t, achieves health and social equity, and assures social relationships that are supportive and respectful (see inside back cover). The Task Force also identified the following aspirational goals, which provide a structure ontained in this report: for the recommendations c  All California residents have the option to safely walk, bicycle, or take public transit to school, work, and essential destinations.  All California residents live in safe, healthy, affordable housing.  All California residents have access to plac es to be active, including parks, green space, and healthy tree canopy.  All California residents are able to live and be active in their communities without fear of violence or crime. Health in All Policies Task Force Report – Executive Summary | 5

8 All California residents have access to  healthy, affordable foods at school, at work, and in their neighborhoods.  California’s decision makers are informed about the health consequences of various policy options during the policy development process. Health in All Policies Recommendations The recommendations put forth in this Executive Summary and the full Task Force report are geared at improvi ng the efficiency, cost-effectiveness, and collaborative nature of State government, while promoti ng both health and other goals of the SGC. They address two strategic directions: 1. Building healthy and safe communi ties with opportunities for active affordable housing; places transportation; safe, healthy, to be active, including parks, green space, and healthy tree canopy; the ability to be active without fear ss to healthy, affordable foods. of violence or crime; and acce lens in public policy and program 2. Finding opportunities to add a health development and increase collaborati on across agencies and with communities. e to “identify priority programs, policies, Executive Order S-04-10 calls for the Task Forc and strategies to improve the health of Ca lifornians while advancing the SGC’s goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure systems, promoting public health, planning sustainabl e communities, and meeting the state’s climate change goals.” t address public heath. The following table All of the recommendations in this repor ions and identifies the links between the contains the full text of recommendat recommendations and the ot her goals of the Strategi c Growth Council. The following symbols are used in this table to identify the links between each recommendation and SGC goals:  Increasing the availability of affordable housing  Meeting the state’s climate change goals  Protecting natural resources and agricultural lands  Improving air and water quality  Improving infrastructure systems Planning sustainable communities  Health in All Policies Task Force Report – Executive Summary | 6

9 I. PROMOTE HEALTHY COMMUNITIES I.A. Active Transportation I.A1. Utilize data to improve co mmunity planning and increase active      transportation. a. Use available tools and data (e.g., the California Household Travel Survey, Model, and regional models) to enhance California Statewide Travel Demand community and transportation planning and understand health impacts of transportation options and mode shifts. i. Map and assess transit and non-motorized transit access to essential destinations (e.g., parks, schools, health care facilities), including inequities in transportation access. Determine inequities by demographics such as income, race, and ii. disability and encourage use of this data by Metropolitan Planning Organizations (MPOs) and Regional Transportation Planning Agencies (RTPAs) in transportation planning models. iii. Assess and predict the health impacts associated with increases in active transportation and decreases in motorized transport. I.A2. Support active transportation through im plementation of “com plete streets.”     a. Encourage all State-funded road infrastructure projects to address safety and mobility of all users, including bicyclists , pedestrians, transit users, and motorists, appropriate to the function and context of the facility. b. Encourage all State employees invo lved in roadway design, planning, programming, construction, operations , and maintenance to participate in functionally appropriate “complete streets” training. c. Explore additional appr oaches to amending the CEQA Guidelines Environmental project’s impacts on all modes of Checklist to reflect a development and non-motorized transportation like transportation, including mass transit walking and biking. I.A3. Incorporate safety considerations of all roadway users into programs,     policies, and community designs. number of low-resource sc hools participating in the a. Support an increase in the State and federal Safe Rout es to School programs. i. Ensure Caltrans District Applic ation Review Committee members are trained in health and environmental ju stice principles that are impacted by Safe Routes to School, and that each committee has members with experience in the area of health and disadvantaged communities to reinforce these principles. Provide additional outreach and assistance to low-resource ii. communities to encourage and enable successful participation in the State and federal Safe Rout es to School programs. b. Analyze the impact of lower spee d limits on injuries, air pollution, and greenhouse gas emissions. c. Explore opportunities to reduce injuries, greenhouse gas emissions, and air pollution through changes in roadway f eatures to encourage slower speeds (e.g., traffic calming).   Infrastructure systems Air and water quality Planning sustainable communities  Health in All Policies Task Force Report – Executive Summary | 7

10 d. Promote legislation to amend the Californ ia vehicle code so that localities can roads, where appropriate. lower speed limits on local ss lower speed limits on e. Convene stakeholders and relevant agencies to discu highways. I.A4. Highlight the opportunities presented by SB 375 to promote active transportation.     a. Incorporate health considerations in Strategic Growth Council (SGC) outreach Sustainable Communities Planning and technical assistance for the SGC’s Grant program, and in SGC metr ics for grant evaluation. ifornia Conference health officers (Cal b. Convene regional workshops with local (Metropolitan Planning Organizations of Local Health Officers) and planners and Regional Transportation Planning Ag encies) to promote and facilitate onsiderations in sustainable community planning. integration of health c I.A5. Incorporate trails and greenways as part of an active transportation system.      I.A6. Promote and encourage active transportation and physical activity for State   employees.  t for State employee use. a. Develop a bicycle flee b. Provide ample covered and secure bicycle storage and on-site showers for employee use in all State buildings (leased and owned). gs or renovations to incorporate designs for health c. Require new State buildin (e.g., prominent/usable stairways). d. Explore shifting parking subsidies to incentives for active transportation and physical activity. e. Facilitate the sharing across agencies of existing resources in support of physical activity, such as exercise areas, showers, bicycle storage, and walking clubs. I.B. Housing and Indoor Spaces I.B1. Encourage sustainable developmen t through healthy housing by offering     incentives and providing State guidance. new and existing housing developments by a. Develop incentives for healthier , siting near grocery stores, parks, promoting universal design, community gardens living, and smoke-free policies in multi- and other resources necessary for healthy family housing developments. I.B2. Explore secure and permanent funding for affordable housing.  a. Develop a permanent source of fundi ng for affordable housing to succeed Proposition 1C program funds. I.B3. Promote sustainable development through smart housing siting.       a. Develop incentives for sustainable housing development by awarding bonus programs or giving dedicated or beneficial funding points in competitive grant consideration for infill and tr ansit-oriented developments. b. Identify barriers to achieving in fill and transit-oriented development and identify strategies to address these barriers. Potential barriers to be evaluated include local zoning and regulatio ns, infrastructure deficiencies, and Affordable housing  Climate change  Natural resources and agricultural land  Health in All Policies Task Force Report – Executive Summary | 8

11 multiagency mitigation requirements. c. Develop recommended processes for balancing multiple public policy rmit processing and siting of transit- objectives affecting air quality and the pe oriented development. d. Identify research needs and support re search and demonstration efforts to mitigate adverse environmental and public health impacts in residential areas proximate to major urban roadwa ys and transportation corridors. I.B4. Ensure that all workers and school -children enjoy smoke-free environments.   a. Amend Health and Safety Code (H&S) Section 104420(n)(1) and H&S Code Section 104420(n)(2) to require all sc hool campuses to be tobacco free, expand the definition of tobacco to include other non-prescription nicotine ode Section 104420 to update the delivery devices, and amend H&S C definition of a Local Ed ucation Agency (LEA) to include direct-funded charter schools. b. Create smoke-free workplaces that will protect all groups of workers and create an environment that increases smokers’ chances of successfully quitting by eliminating provisions in Labor Code Section 6404.5 that permit rooms, tobacco shops and private smoking in hotel lobbies, hotel banquet s, workplaces with five or fewer smokers’ lounges, warehouses, break room employees, and businesses defin ed as “owner operated.” I.C. Parks, Urban Greening, and Places to be Active  I.C1. Support urban greening and access to green spaces.    a. Promote increases in tree canopy through communication, education, and outreach regarding multiple co-benefits of trees, in cluding promoting use of existing tools and guidance for selection of trees for urban fo restry with regard to fire hazard, drought tolerance, wate r use, allergenicity, and improved air quality. b. Encourage fruit trees and community gardens, including through the use of grants; investigate the use of specialt y crop block grants for this purpose. c. Conduct a statewide assessment of existing tree canopy cover, then develop achievable targets for each jurisdiction and quantify the anticipated benefits associated with meeting the tar get, including health benefits. d. Explore the development of policies to establish markets for the ecosystem services of trees. e. Explore the use of easements to expand the availabili ty of land for trails and greenways, where appropriate. f. Expand programs to provide access to parks for disadvantaged communities. I.C2. Improve wildfire-relat ed air quality and safety.     a. Convene a forum to explore rela tive risks of controlled burns/fuels management and wildfires. b. Foster interagency collaboration to strengthen general plan guidance related to wildland fire risks and development in wildland and wildland/urban interface areas; continue to work with local governments and Fire Safe Councils to ies for addressing wi ldland fire risks; educate landowners on their responsibilit and continue to seek stat e and federal funding for fuels reduction projects. Air and water quality  Infrastructure systems  Sustainable communities planning  Health in All Policies Task Force Report – Executive Summary | 9

12 I.C3. Take stronger actions to prevent a nd control invasive species which pose uding agriculture and forests.   a threat to all ecosystems, incl  ation and outreach to stakeholders that a. Foster interagency collaboration on educ emphasizes the importance of prevention to reduce the number of invasive species introduced. b. Develop mechanisms that allow for early public health input into response options when an invasive species threat is detected. I.C4. Encourage joint use of facilities throughout communities in California.   s/superintendents regar a. Provide guidance to school district ding existing state law that provides liability protection. b. Incorporate incentives for joint use in funding and construction of new changes to allow for the use of State schools. Specifically, explore statute onal facilities/spaces and to allow joint use bond funds for outdoor recreati lity in fulfilling the requir ed 50 percent local share local partners more flexibi match for use of these joint use funds. space lands, and recreational facilities c. Encourage the joint use of parks, open between schools and communities for purpos es of moderate to vigorous physical activity, gardening, and other recreation opportunities. d. Explore the feasibility of allowing jo int use of State properties for community gardens. impact of tobacco waste.  I.C5. Reduce the environmental  a. Encourage interagency collaboration to test and develop messaging that raises environmental level interventions to awareness and motivates policy, system, and reduce the harmful public health and environ mental impact of tobacco waste in California. I.D. Violence Prevention I.D1. Build violence prevention capacity statewide by supporting community- level efforts to engage and convene stakeholders to develop data-informed prevention actions, including through training to promote effective community   engagement and joint action. I.D2. Disseminate existing guidance on Crime Prevention through Environmental Design.   I.D3. Analyze State violence prevention spending in the ten California communities that have the highest rates of violence and develop on in those ten communities, drawing recommendations for State agency acti from evidence-based approaches.   I.D4. Expand the Governor’s Office of Gang and Youth Violence Policy to become a comprehensive clearinghouse on violence prevention that will develop and distribute cr ime prevention education a nd training materials as   well as provide training and tec hnical assistance to communities. I.D5. Work with foundati on, private sector, and State agency partners to increase resources for a Probation Resource Center to support probation departments’ efforts to impl ement evidence-based practices.    Climate change  Affordable housing Natural resources and agricultural land  Health in All Policies Task Force Report – Executive Summary | 10

13 I.E. Healthy Food I.E1. Encourage and expand the availability of affordable and locally grown     produce through “farm-to-fork” policies and programs. increase fresh produce offerings in a. Promote farm-to-school programs to school breakfast and lunch programs. i. Establish a farm-to-school statewide coordinator to facilitate the development of farm-to-school programs. b. Explore methods to make it easier for small/local farmers to consolidate produce supply in order to sell to institutions. c. Promote school and community gar den and orchard programs (including incorporation into learning curriculu m), and explore funding streams to support such programs (e.g., United States Department of Agriculture specialty crop block grants). oduce origin so that purc hasers can select local d. Encourage labeling of pr produce if desired. hat pose barriers to access to locally e. Identify State and local regulations t grown or healthy foods, and recommend changes to: i. rkets and produce vendors to operate in Make it easier for farmers’ ma neighborhoods that lack a ccess to fresh produce. ii. ers to procurement and use of fresh Eliminate contracting and other barri fruits and vegetables by institutions. Make it easier for school cafeterias to serve food grown in school gardens, iii. including through identification of bes t practices for safe use of school- grown food. I.E2. Better utilize State-administer ed food assistance programs to increase consumption of healthy foods, decrease consumption of low-nutrient, high- calorie foods, reduce hunger, and add dollars to the local economy.   e participation of Californians in food a. Modify policies and practices to increas assistance programs. i. Direct Certification: Address data- sharing issues that pose barriers to ligible children in free or reduced-price meal automatically enrolling e programs at school. Single Portal for Applications and Eligibility: Review existing structure ii. and options including im plementing a single portal for all health and human services programs, new system development, or leveraging an existing county eligibility system. iii. Modified Categorical Eligibility for CalFresh (food stamps): Expand Modified Categorical Eligibility to s eniors and persons with disabilities. iv. Simplified Reporting for CalFresh : Implement a 6-month reporting requirement. v. CalFresh Business Process Re-Engineering. b. Support healthier food choices ance programs. through food assist i. Limit use of CalFresh funds for purchase of unhealthy foods and beverages, beginning with requesting a waiver from United States Department of Agriculture to allow Ca lifornia to prohibit the purchase of Sustainable communities planning Air and water quality  Infrastructure systems   Health in All Policies Task Force Report – Executive Summary | 11

14 sugar-loaded beverages with CalFresh dollars. ii. ilot which adds funds to Electronic Implement a healthy food purchase p hen fruits and vegetables are Benefits Transfer (EBT) cards w purchased. y Council comprised of State agencies I.E3. Establish a California Food Polic with food producti and other relevant stakeholders involved on, distribution, th, in order to build a more robust, purchase, promotion, provision, and heal hunger, and promote consumption of sustainable food system, alleviate healthy foods. toward implementation of the The Food Policy Council could work food-related recommendations herein.     I.E4. Leverage government spending to support healthy eating and sustainable    local food systems. a. Adopt a healthy food procurement poli cy, pursuant to Public Contract Code Section 12400-12404, to ensure that foods purchased for consumption or sale on State property (e.g., vending mach ines, institutions, cafeterias, concessioner contracts) meet minimum nutritional standards. i. Establish nutrition standards fo r foods and beverages available in government-run recrea tion centers and parks. ii. legislation to promote healthier Implement and strengthen existing options in vending machines. iii. Enhance vendor and concession policies to support the availability of healthy foods, for example through bid incentives for healthy options and locally-grown produce. Policy re visions should consider potential cost implications. iv. Identify existing best practice s and provide training and technical assistance on implementation of healthy procurement policies. II. PROMOTE HEALTHY PUBLIC POLICY II.A. State Guidance II.A1. Incorporate a health and health e quity perspective in to State guidance, surveys, and technical assistance documen ts where feasible a nd appropriate.       a. Work with agencies to incorporate a health lens in guidance documents, for example:  Office of Planning and Research (OPR) General Plan Guidelines OPR Annual Planning Survey  OPR and Caltrans “complete streets” guidelines  Caltrans guidance documents:  i. Regional Transportation Plan (RTP) Guidelines ii. System Planning Guidelines iii. California Interregional Blueprint iv. Project Initiation Documents  California Department of Housing and Community Development Building Blocks for Effective Housing Elements  es to be identified Additional opportuniti Affordable housing  Climate change  Natural resources and agricultural land  Health in All Policies Task Force Report – Executive Summary | 12

15 II.A2. Identify and publicize a comprehensive set of state resources for communities to use in healthy community planning.       a. Collaborate across Task Force agencies to provide and make easily accessible information that allows communities to better understand the reams that are multiple and diverse planning proce sses and funding st ties, including opportunities for available for building healthy communi blending funding from diffe rent sources to create a more comprehensive healthy communities program. e and facilitate healthy b. Provide technical assistance to loca l entities to promot community planning, policies, and pr ogramming, including through the SGC’s Sustainable Communities Learning Network. II.B. Embedding Health in Decision Making II.B1. Incorporate health and health equi ty criteria into State grant Requests and scoring, technical assistance, and for Applications, review criteria opriate. For monitoring/performance measures, where feasible and appr example,       a. Incorporate a health module into the outreach and technical assistance programs of the Strate gic Growth Council. b. Add health criteria to the California Environmental Protection Agency’s annual Environmental Justic e Small Grants program. c. Add per capita VMT reduction and increas ed active transportati on to Office of Traffic Safety grants. fety-related health benefits into Safe d. Incorporate considerations of non-sa Routes to School grants review processes. e. Develop health criteria for di scretionary funds review processes. f. Identify opportunities to incorporat e relevant Task Force recommendations as requirements in future State grant guidelines. II.B2. Continue to provide integrated comments on federal legislative and policy proposals from multiple Californi a agencies, including incorporation of portation Reauthorization, Child Nutrition a health and equity lens (e.g., Trans Protection Agency Greenhouse Gas Reauthorization, Environmental       Regulation). II.B3. Explore appropriate ways to integr ate health analysis into existing State projects and plans.       a. Design and conduct a feasibility study to explore possible methods or approaches for incorporating a health l ens into analyses of a subset of (BCPs), to consider long-term legislation and Budget Change Proposals ture consequences of short-term health and State health-care expendi financial and policy decisions. dentify the range of methods (including b. Use the HiAP Task Force to 1) i for incorporating health perspectives in State Health Impact Assessment) planning, review processes, and guidance; 2) explore appropriate integration of these methods, including how and where to incorporate health perspectives; and 3) consider conc erns of Agencies and Departments, including the need to reconcile competi ng policy priorities, enable efficient processes, and provide input early and upstream in planning processes Air and water quality  Infrastructure systems  Sustainable communities planning  Health in All Policies Task Force Report – Executive Summary | 13

16 where possible. II.C. Data and Research ors, where feasible and appropriate, II.C1. State agencies and their contract should incorporate health and health e quity indicators into data collection nd endeavor to standardize data tools and accountability measures, a elements and indicators to facilitate data collection, sharing, and accessibility.       data collection and survey efforts, where a. Incorporate health issues into State appropriate. b. Develop uniform data elements, data collection tools, and assessment onsistent data collection across State standards related to health, to allow c grants. For example: i. Review available walkabili ty assessment tools and develop one standardized tool for grantees to use across agencies and grant programs, where appropriate. ii. Develop a standard set of meas urement indicators for a healthy ees measure consistent healthy community so that agencies and grant community goals and objectives. c. Enhance data collection and availability of data to allow assessment, analysis, and policy-making that address he alth inequities (e.g., standardized data on race, ethnicity, language, educati on level, income, and other social factors that influence health). d. Include a standard set of core data elements in State data products to facilitate linkages across datasets. II.C2. Increase use of evidence-based practices.       a. Improve efficiency and cost-effectiveness of State-funded programs by providing bonus points to grant and contract applicants using evidence-based practices. b. Identify programs and policy topics that would benefit from additional research into health impacts and cost-effectiveness. II.D. Cross-Agency Collaboration and Expertise II.D1. Foster deeper understanding and collaboration across State agencies.       a. Through the Strategic Growth Council and its State Agency Learning Network, promote and seek resources to facilitate staff-s haring, interagency or inter-department transfer s, and temporary placement of staff in a partner agency (e.g., from Caltrans to Ca lifornia Air Resources Board). b. Agencies should more consciously and consistently invite partner agency staff to participate in training opport unities (e.g., Caltrans Transportation Planning Training Academies, California Department of Public Health training on Health Impact Assessment). but competing public c. Provide opportunities to identify and reconcile important policy goals (e.g., food safety and use of school garden produce; forest management through controlled burns and air quality; open space and land for affordable housing).  Climate change  Affordable housing Natural resources and agricultural land  Health in All Policies Task Force Report – Executive Summary | 14

17 II.E. Community Engagement II.E1. Improve opportunities for substant ive community engagement in State      agency decision-making.  a. Provide training for agencies on community engagement, and share best practices, including use of w ebinars and other technologies. community engagement in State grants b. Provide incentives for meaningful and contracts. c. Encourage non-governmental organization (NGO) and citizen participation by exploring funding opportunities, and increase funding for staff positions/time to support meaningful communi ty engagement processes. d. Look for opportunities for State agenc ies and departments to coordinate outreach and community engagement efforts. e. Encourage broad community participat ion in regional an d local planning processes to ensure that integrated planning processes consider community and stakeholder needs. II.F. Continue the Health in All Policies Task Force II.F1. Continue the Health in All Policies Task Force in order to foster continued dialogue on the impact of d ecisions on health and health equity, and to pursue implementation of recomm endations. Expand participation to      additional relevant agencies.  Sustainable communities planning    Infrastructure systems Air and water quality Report – Executive Summary | 15 Health in All Policies Task Force

18 Challenges, Successes, and Next Steps The Task Force has faced the same challen ges that often make collaborative work resources, limited init ial knowledge of each difficult, such as restricted financial and staff other’s policy areas, and com peting critical priorities. The Task Force made great strides in building trust, developing worki ng relationships, establishing a baseline of icy areas, and identifying the multiple links between knowledge about each other’s pol each policy area, strategic growth, equity, an d health. The Task Force also collected and sifted through an enormous body of informa tion and identified specific areas for further work to advance these co-benefits. The Health in All Policies Task Force Report is a starting point; much work remains to guide implementation of these recommendations . The Task Force intends to work with the SGC in the coming year to identify prio rities among this set of recommendations and to develop action plans and implementation stra tegies. The discussions and work of the Task Force have been exciting and challengi ng, and have demonstrated the power of deeper cross-sectoral engagement to address t he interconnected wicked problems that we confront. To learn more, visit www.sgc. ca.gov/workgroups/hiap.html. 1 State of California, Department of Public Health, Death Records . State of California, Department of Finance, (Sacramento, CA: July 2007). Race and Ethnic Population with Age and Sex Detail, 2000-2050 2 Ross DeVol and Armen Bedroussian, An Unhealthy America: The Economic Burden of Chronic Disease Charting a New Course to Save Lives and Increase Productivity and Economic Growth . (Milken Institute: 2007), http://www.milkeninstitute.o rg/pdf/ES_ResearchFindings.pdf. 3 California Center for Public Health Advocacy, The Economic Costs of Overweight, Obesity and Physical Inactivity Among California Adults (2006). 4 JM McGinnis, P Williams-Russo, and JA Knickman, “The Case for More Active Policy Attention to Health Promotion,” 21, no. 2 (2002): 83. Health Affairs 5 Robert Wood Johnson Commission to Build a Healthier America, What Drives Health , http://www.commissiononhealth.org/WhatDrivesHealth.aspx. 6 A. Mohammed, “Moving Upstream: How Interventions D.R. Williams, M.V. Costa, A.O. Odunlami, and S. That Address the Social Determinants of Health Can Improve Health and Reduce Disparities,” Journal of Public Health Management Practice Suppl, (Nov 2008): S8-S17. 7 Commission on Social Determinants of Health. (2008). Closing the Gap In a Generation. World Health Organization. 8 Karen Glanz and Donald B. Bishop, “The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions,” 31 (April 2010): 399-418. Annual Review of Public Health 9 Nancy E. Adler and K. Newman, ”Socioeconomic Disparities in Health: Pathways and Policies,” Health 20, no. 2 (2002):60-76. Affairs 10 World Health Organization, Adelaide Statement on Health in All Policies (Government of South Australia: Adelaide, 2010). 11 Governance Tools and Framework for Health in All Policies (National Collaborating Centre L. St-Pierre, for Healthy Public Policy, 2008). 12 Horst Rittel and Melvin Webber, "Dilemmas in a General Theory of Planning," Policy Sciences , Vol. 4 (1973): 155–169. 13 Governance Tools and Framework for Health in All Policies (National Collaborating Centre L. St-Pierre, for Healthy Public Policy, 2008). Health in All Policies Task Force Report – Executive Summary | 16

19 What is a Healthy Community? following through all stages of life: A Healthy Community provides for the  Meets basic needs of all affordable transportation options Safe, sustainable, accessible, and o o Affordable, accessible and nutritious foods, and safe drinkable water o Affordable, high quality, socially in tegrated, and location-efficient housing Affordable, accessible, and high quality health care o o Complete and livable communities including quality schools, parks and recreational facilities, child care, li braries, financial services, and other daily needs Access to affordable and safe oppor o tunities for physical activity o Able to adapt to changing environ ments, resilient, and prepared for emergencies o Opportunities for engagement with arts, music, and culture  Quality and sustainability of environment o Clean air, soil and water, and environments free of excessive noise o Tobacco- and smoke-free o Green and open spaces, including healthy tree canopy and agricultural lands Minimized toxics, greenhouse gas emissions, and waste o o Affordable and sustainable energy use o Aesthetically pleasing  Adequate levels of economic and social development o Living wage, safe and healthy job opportunities for all, and a thriving economy o Support for healthy development of children and adolescents o ity and accessible education Opportunities for high qual  Health and social equity  Social relationships that are supportive and respectful o Robust social and civic engagement o Socially cohesive and supportive relationships, families, homes, and neighborhoods o Safe communities, free of crime and violence

20 The Health in All Policies Task Force envisions a California in which: All California residents have the option to safely walk, bicycle, or take public transit to school, work and essential destinations. All California residents live in safe, healthy, affordable housing. All California residents have access to places to be active, including parks, green space, and healthy tree canopy. All California residents are able to live and be active in their communities without fear of violence or crime. All California residents have access to healthy, affordable foods at school, at work, and in their neighborhoods. California’s decision makers are informed about the health consequences of various policy options during the policy development process. Health in All Policies Task Force www.sgc.ca.gov/workgroups/hiap.html

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