Advancing Healthy Communities in Washington State - SPH Success Story
Monday, November 19, 2012
Advancing Healthy Communities in
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
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.
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
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.
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.