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Advancing Healthy Communities in Washington State - SPH Success Story

Monday, November 19, 2012   (0 Comments)
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Advancing Healthy Communities in Washington State


Prior to 2008, chronic disease prevention at the Washington State Department of Health (DOH) looked like many other state health departments; programs for each disease and each risk factor received separate funding and conducted independent community interventions. While some programs were recognizing a need for public health to shift from individual-focused interventions to a policy, environment, and systems (PES) change approach, this notion wasn't widespread. It was also unclear whether majority of the public health workforce had the knowledge, skills, and resources to make this paradigm shift. A training needs assessment was done in 2008 based on the 21 health policy and environmental change competencies outlined in DHPE's 2006 document, Public Health Solutions Through Changes in Policies, Systems, and the Built Environment: Specialized Competencies for the Public Health Workforce1. This assessment was telling, and provided a foundation for transforming chronic disease prevention in Washington State.


In 2009, DOH began the integrated Healthy Communities program; a community based program aimed at preventing chronic disease by reducing three major preventable risk factors – poor nutrition, lack of physical activity, and tobacco use or exposure. Local health jurisdictions were funded to use a policy, environment, and systems change approach because these changes are generally more sustainable, reach a greater number of people, and have the biggest impact on the health of communities.

Five small local health jurisdictions were identified to take part in Cohort 1 of this program. County selection took into account those with the highest rates of cancer deaths, heart disease, stroke, diabetes, smoking, obesity, and lack of access to healthy food. They also had the lowest rates of physical activity, fruit and vegetable intake, and cancer screening (breast, cervical, colorectal). Other criteria included high poverty rates, lower education levels, and poor access to healthcare. These counties received funding and technical assistance provided by a DOH consultant and subject matter experts. They were also required to attend several workshops in order to build their capacity to use the PES approach. Although successful in making community-based changes, the first year was challenging for local health jurisdictions and the DOH. An evaluation revealed a need to revamp the training program and provide a more structured framework aimed at increasing knowledge and skills in PES change.

The following year, DOH restructured the Healthy Communities training plan around the Shaping Policy for HealthTM framework. Cohort 1 was required to attend the Domain 2 and the next group of seven local health jurisdictions (Cohort 2) jumped into Domain 1. Trainings were also open to other local health jurisdictions that were not part of this integrated Healthy Communities program. Both cohorts continued to receive extensive technical assistance from the DOH. They were also required to attend other workshops around developing partnerships and grant writing. The goal of this comprehensive approach to training and technical assistance was not only to improve capacity to develop and implement PES initiatives, but also to help counties compete more effectively for local, state, and federal funding. In 2012, DOH hosted Domains 1, 2 and 3 of Shaping Policy for HealthTM and opened the workshops up to tribes, community partners, and other state agencies.


Washington State has hosted 20 Shaping Policy for HealthTM workshops since September 2010, with two more yet to occur this year. The pre/post knowledge assessments conducted by DHPE during each of the workshops revealed knowledge gains by most participants. Epidemiologists at the Department of Health also conducted an evaluation to see if Washington's comprehensive approach was actually increasing the capacity of local health jurisdictions to do this work. The proposed theory of change was that training and technical assistance builds skills, skills lead to competence (confidence), increased competence leads to increased capacity, increased capacity leads to taking action to making PES change. Using pre/post surveys, DOH measured self-reported confidence in the skills needed to implement the integrated Healthy Communities program. Trends show an increase in the competency of the public health workforce after participating in the Shaping Policy for HealthTM workshops and receiving technical assistance.

Counties have also made PES changes while participating in the Healthy Communities program. Cohort 1 identified 26 PES initiatives and achieved 20 of them in a one-year period. Examples included: establishing a local farmer's market, establishing a smoke-free hospital campus, and passing local ordinances to make community events and a local park smoke-free. Cohort 2 identified 24 initiatives to accomplish and are currently in the process of implementing them.

Although there is much work ahead, chronic disease prevention in Washington State has begun to transform. The integrated Healthy Communities program has broadened to a statewide initiative—Healthy Communities Washington: Healthy People in Healthy Places—and resulted in an entirely new office at the Department of Health. These efforts helped position the Department of Health to be competitive for and receive federal Community Transformation Grant (CTG) funding, as part of the Affordable Care Act. CTG is now a major source of funding for Healthy Communities Washington.

[1] Emery, J., & Crump, C. (2006). Public Health Solutions Through Changes in Policies, Systems, and the Built Environment: Specialized Competencies for the Public Health Workforce. Washington, DC: Directors of Health Promotion and Education.


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