Abstract
The objective of health in all policies (HiAP) is straightforward: integrating health and equity considerations into policies across all sectors of government will transform systems and environments in ways that support healthier, more equitable outcomes. However, pursuing that objective is complex and achieving those outcomes takes time.
 This article examines three communities (Minneapolis, MN, Seattle, WA, and Richmond, CA) which have been pursuing HiAP long enough to achieve meaningful policy, systems, and environmental change. We identify when and how each community employed five key strategies for effectively adopting and implementing HiAP. And we present policies each community has adopted with examples of outcomes these initiatives have achieved. The purpose of this assessment is to set realistic expectations for how long it may take to achieve HiAP and to identify themes that could help other communities realize this level of progress more quickly and efficiently.
 Based on our assessment of these communities, we conclude that it is not uncommon for it to take ten years or more to integrate health and equity into a substantial and coordinated set of policies across government agencies and departments. However, we also see that each step taken toward HiAP makes subsequent steps easier. And as more policies include health and equity concerns, the entire system does become more effective at improving health and equity outcomes. Finally, we show that that integrating health and equity across a range of plans and policies does shape decisions, lead to actual community transformation, and improve community health outcomes.
Highlights
The Long Road to the “All” of HiAP. What does it look like when a community has successfully integrated health and equity in all policies (HiAP)? And how long does it take to get there? There are countless examples of communities across the country drafting plans, adopting policies, and building projects with the intention of improving community health and equity
There are many lessons to learn about HiAP by examining these communities; some show common ways to use planning or capital improvement projects as a vehicle for opening discussions about the importance of HiAP; some show the type of early wins that HiAP initiatives can lead to
At different points in their journeys, each community has employed the following five key strategies for effectively adopting and implementing HiAP (ChangeLab Solutions, 2015): For this review, we identify the genesis of each case study initiative and present how each initiative evolved over time
Summary
What does it look like when a community has successfully integrated health and equity in all policies (HiAP)? And how long does it take to get there? There are countless examples of communities across the country drafting plans, adopting policies, and building projects with the intention of improving community health and equity. Engaging and envisioning, convening and collaborating or, as Seattle did, tracking and analyzing data are all strategies that can help get through these sticking points] Another action that emerged during the comprehensive planning process, the Office of Sustainability & Environment initiated an Equity & Environment Initiative (EEI) in April 2015.[convene & collaborate] Many communities negatively impacted by the environment are underrepresented communities with significant health disparities and poor health outcomes so the City established the EEI to connect the City’s race and social justice work with environmental justice. [convene & collaborate] The team identified four strategies for the CHWE to pursue [make a plan] 1) operationalize health and equity in the regular processes, daily practices, and ongoing policies of the City of Richmond 2) improve the physical environments in Richmond to improve health choices and outcomes and reduce disparities 3) track and monitor changes in community and health conditions 4) engage the community to ensure relevance and impact. The funding Richmond received for senior housing and creek restoration is an example of how having a plan and showing coordinated commitment to health and equity can make communities more competitive for various state and federal funding sources.]
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