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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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Scaling Change: Market Forces are Part of the Solution

LeverageI’ve been thinking about this issue of how to scale social innovation a lot lately. When I was at the D.C. Presidio Fellowship week, we talked with the Social Innovation Fund. Their focus is on mobilizing public and private resources to find and grow the best community solutions. They identify evidence-based strategies that can make a difference on issues like economic opportunity, healthy futures, and youth development and then fund those innovators to do a lot more of the same.  The Fund is a great model for leveraging the private sector with the public sector to scale change. It builds on what the non-profit sector has always done, focusing on services and supports that are working, and adds the actively engagement of the private sector as part of the solution.

I really appreciate their recognition of the important role the private sector. This recognition is growing – there are an increasing number of models for how public/private partnerships can solve some of the most pressing social issues. For example, the Omidyar Network  invests in a combination of for-profit and non-profit ventures that together can help solve complex problems, like government transparency and financial inclusion, throughout the world. One of their approaches is to combine funding with technical support for the early stages of innovative market solutions, helping expand the scale of social entrepreneurships.

For me, one of the more exciting examples of private sector investment in social change and evidence of the tremendous scaling potential of engaging corporations comes from PepsiCo’s recent work with the Clinton Global Initiative.  They took the following inputs:

PepsiCo’s juice products in India + Clinton Global Initiative’s capacity + small cashew farmers living below the poverty line + highly nutritional cashew fruits + modern agricultural techniques

and created:

A value-added supply chain of over 2,000 small farmers (soon to be over 15,000) who previously could only sell the cashew nut, but are now able to efficiently grow and sell the fruit to PepsiCo where it is used to increase the nutritional value of existing juice products.

CashewTalk about a win-win. It made me want to fly to India to try one of the juices!

The takeaway from this great public/private partnership is to remember that the for-profit sector is built around the concept of scaling in a way the public and non-profit sector just isn’t. We need to leverage that! Businesses seek growth – new markets, new customers, new products. That means they have an ever expanding reach and when we can work with businesses to balance profit with social good, what we care about can grow along with their bottom line.

Next time we start a social change strategy, I propose we start asking questions from day one to help us identify the for-profit partners who have a business reason to be part of the change:

  • Who is already making profit related to the issue we care about and how do they make it?
  • What changes to current for-profit models could change outcomes on this social issue?  Who would benefit from thosePPP changes? How small of a change would make a difference?
  • Where is there potential for profit not yet tapped by anyone?

Just like any other type of social change, engaging a for-profit in a market-based solution to the problem may benefit from starting small and piloting the change. But once you can demonstrate the bottom line benefit, both in profit and in social good, just imagine the scaling potential!

Want more resources on scaling?  Check out the Stanford Social Innovation Review’s special supplement on scaling.

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Why you shouldn’t do this on your own: Making Your Stakeholder Engagement Process Successful

Picture of two men sparring
 Learning from the Coordinated Chronic Disease Project

During my time in the public sector, I observed many stakeholder engagement processes that went really well and led to meaningful change. Unfortunately, I also process observed like this:

Picture of two men sparringParticipants arrive. They have been told it’s an opportunity to provide input to an important planning process. After listening to a 20 minute presentation, audience members sign up to share their input. In three minute comments, audience members rush to get to their main point, largely focusing on their strongly held views. As the staff listen, they feel exhausted by the idea of bridging all these conflicting priorities. The information is mostly left unused in the final plan.

This week’s blog highlights a real life example on how to put your stakeholder engagement process successfully into action so you never have to sit through or participate in a process like the one described above.

Tips to Make your Stakeholder Engagement Efforts Successful

In my last blog, I thought I could do this on my own: Why engaging stakeholders throughout your initiative is so important, I shared what stakeholder engagement is and why it is important. I also offered four tips to make your stakeholder engagement process successful, including defining your stakeholders early in the process, developing a stakeholder engagement plan, developing a communication plan, and using a high-quality facilitator. Please keep your eye out for our upcoming checklist that has a bit more detail about each tip and how to put them into action.

Making it Happen – The Coordinated Chronic Disease State Framework

In 2012, Spark implemented a stakeholder engagement process to develop the Coordinated Chronic Disease State Framework, an initiative led by the Colorado Department of Public Health and Environment.  Here’s how we did it:

noun_341553_ccThe stakeholders were identified. We worked collaboratively with CDPHE to identify a broad range of stakeholders at the state and local level. The stakeholders included local public health, higher education, health care providers and associations, community organizations, state agencies, advocacy organizations, provider and family members, board members, funders, and researchers.

noun_14382A stakeholder engagement plan was developed & implemented. We used a two-pronged approach by hosting seven community forums and convening a State Advisory Team. Over 125 stakeholders attended forums in Montrose, Frisco, Denver, Sterling, La Junta, Alamosa, and Durango. They and the Advisory Team gained a deeper understanding of a coordinated chronic disease approach, provided input on themes and approaches from the community forums and prioritized strategies to include in the framework.

noun_33104_ccA communication plan was developed and implemented. We partnered with the CDPHE Health Communications Unit to develop messages and materials to reach our stakeholders. A monthly newsletter was distributed, meetings were broadcast and archived on-line, a webpage was created on CDPHE’s website, and messages were sent out through Twitter and Facebook.

noun_175971_ccAll meetings were facilitated thoughtfully. Our staff facilitated the community forums and State Advisory Team meetings. Our approach to facilitation established trust and engaged all members. For community forum participants, this was their experience:

 

Participants arrive and have been told that the state is seeking to develop a coordinated approach to chronic disease programming. After listening to a presentation on CDPHE’s chronic disease efforts and a cross-walk of state chronic disease plans, participants self-select into small groups. The groups discuss their vision for the coordination of the chronic disease programming and discuss action steps in five domain areas (community-clinical linkages, health systems, policy and environmental changes, education and communications, and data surveillance). Each group reported their small group discussions out to the large group. They are told how their information will be used by CDPHE and the State Advisory Team before adjourning.

The  Take-Away

Not every stakeholder participation process is going to look just like my example here. Every situation is different, and every set of stakeholders in a particular issue will have their own challenges to face. But I’m hoping that by telling you this story – about how we’ve engaged stakeholders about the Coordinated Chronic Disease State Framework – you might see not only how the change you seek might be advanced by engaging your stakeholders thoughtfully, but also how to accomplish that engagement.

Resources
  • Community Toolbox Stakeholder Engagement Tools: The Community Tool Box is a big fan of participatory process. That means involving as many as possible of those who are affected by or have an interest in any project, initiative, intervention, or effort. In this section, they discuss how to find and involve the right stakeholders and respond to their needs.
  • Brochures on Public Involvement, Environmental Protection Agency: Due to extensive mandates requiring public involvement in environmental processes, the EPA has provided many tools on their website for engaging a broad range of stakeholders. In particular, the brochures are relevant to engaging the public on any issue. They provide steps and information on budgeting for public involvement, identifying people to involve, technical assistance, outreach, using public input, evaluating public involvement, improving public meetings, and overcoming barriers.