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How has Health Impact Assessment been used? Findings from a new study

Health is impacted by multiple factors outside the direct control of the public health and health care system, such as education, income, and the conditions in which people live, work, and play. Health impact assessment (HIA), provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. Conducting a HIA involves using an array of data sources and analytic methods, gathering input from stakeholders, and providing recommendations on monitoring and managing potential health impacts.

A new study, published this month in the Journal of School Health, systematically identified 20 HIAs conducted in the United States between 2003 and 2015 on issues related to prekindergarten, primary, and secondary education. The HIAs were conducted to examine (1) school structure and funding, (2) transportation to and from school, (3) physical modifications to school facilities, (4) in-school physical activity and nutrition, and (5) school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies.

Results suggest that HIA can serve as a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities. Health impact assessments should be used when: (1) there is a decision that has the potential to affect environmental or social determinants of health, but the potential health impacts are not being considered; (2) there is sufficient time to conduct an analysis before the final decision is made; (3) the assessment can add value to the decision-making process; and (4) there are stakeholders, data, and resources to support the process.

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Healthy Schools Collective Impact: Reaching the Bold Goal, Together

One of the things that has become clear in our work with systems change broadly and collective impact specifically is that no one program or organization can address large-scale issues on its own. Put another way, our impact goes further when we work together toward a common agenda.

Over the past nine months, Spark has been serving as the backbone for the Healthy Schools Collective Impact (HSCI) initiative. HSCI’s bold goal is for all Colorado K-12 public schools to provide an environment and culture that integrates health and wellness equitably for all students and staff by 2025.

Talk about creating meaningful change!

School systems work hard to address needs of all students; however, many do not have the capacity or resources to address student health and wellness consistently. This go-it-alone approach can often result in inequitable, duplicative, and siloed approaches and resources.

This is where collective impact comes in.

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Healthy Schools Collective Impact is changing how schools in Colorado approach school-based health and wellness by bringing stakeholders together in a structured way to support schools and get them the health and wellness resources they need to engage the whole child and, in turn, bolster academic achievement.

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With the support of Spark as the backbone, HSCI members have been working hard to lay the foundation for change, including:

  • Engaging stakeholders from statewide systems that impact health and wellness in schools and districts, including policy, professional development, research, and marketing/communications/engagement.
  • Working with diverse stakeholders, including work groups (focused on nutrition, physical activity, behavioral health, and student health services), to create the HSCI Theory of Change, a living document that serves as a plan for the work.
  • Informing The Colorado Health Foundation’s Creating Healthy Schools funding opportunities, to address equity and align funding with the Theory of Change.
  • Establishing a new structure for HSCI that emphasizes the inclusion of voices of a diverse set of key stakeholders, with a specific focus on ensuring end-users (students, educators and families) have a seat at the table.
Moving from planning to action

With this solid foundation, our next step is to take the group from planning to doing by instilling a sense of trust and urgency, and providing the tools, data, and space for innovation that HSCI needs to achieve their bold goal. For many groups, even those that aren’t working in a collaborative context, this can be the hardest step. However, from our work with other collaborative initiatives we have found it can be helpful to keep the following in mind:

  • Remember that “partnerships move at the speed of trust”: Building a truly collaborative effort takes trust and building trust can take time. That said, groups can take steps to build authentic partnerships by developing mutual respect, fostering active and inclusive participation as well as equity, sharing power, and finding mutual benefits.
  • Experiment – find the small wins: Often, groups can be so focused on the big win they lose momentum because that big win seems so far away. Finding opportunities to experiment and achieve small wins allows groups to see the incremental change they are making in the world, often with a smaller investment of time and resources, so they can move from “oh dear, that didn’t work” to “yes, we can do it (one little piece at a time)”.
  • Evaluate, learn, adjust, repeat: Leveraging real-time data, making the time for learning from that data, and then collectively interpreting the learning can help organizations steadily shift their strategies in response to changes in their environment, thereby improving outcomes.

Systems change can be daunting – but achievable – particularly when stakeholders come together around a common agenda, and then trust, experiment, learn, and adjust as they move forward.

Do you have any tips for moving collaborative work forward? What are your experiences with finding small wins in a collective impact setting? Share with us in the comments or click here to share a case study, tip, trick, or tool!