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Ap pplying a Hea g alth Le to D ens Decision Making in n No on-Hea alth Se ectors Workshop Sum W mmary Th heresa Wizemann, Ra apporteur Roundtabl on Popu le ulation Hea alth Improv vement Public Health Practice Boa on Population Health and P ard e PR REPUBLIC CATION CO OPY: UNCOR RRECTED PROOFS

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and The California Endowment (20112338), the California HealthCare Foundation (17102), Health Partners, Health Resources and Services Administration (HHSH25034015T), Kaiser East Bay Community Foundation (20131471), The Kresge Foundation (101288), the Mayo Clinic, Missouri Foundation for Health (12-0879-SOF-12), the National Association of County and City Health Officials (2013-010204), Nemours, New York State Health Foundation (12-01708), Novo Nordisk, and the Robert Wood Johnson Foundation (70555). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number 0-309-0XXXX-X Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2014. Applying a health lens to decision making in non-health sectors: Workshop summary. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS

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PREPUBLICATION COPY: UNCOR R C O RRECTED PROOFS

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The Natio onal Academy of Sciences is a private, nonprofit, self y f-perpetuating society of distinguished sccholars engaged in scientific and engineering research, dedic n d r cated to the fur urtherance of sc cience and technology and to their o use for the general welfar Upon the au re. uthority of the charter granted to it by the C d Congress in 186 the Academ has 63, my a mandate that requires it to advise the federal govern t nment on scien ntific and technnical matters. D Ralph J. Cic Dr. cerone is presiden of the Nation Academy of Sciences. nt nal The National Academy of Engineeri was establ y ing lished in 1964 , under the ch harter of the NNational Acade emy of Sciences, as a parallel organization of outstanding engineers. It is autonomou in its admin o o us nistration and in the selection of its members, sharing with the National Academy of Sc o , A ciences the resp ponsibility for advising the f r federal governmen The National Academy of Engineering also sponsors engineering pr nt. f rograms aimed at meeting na d ational needs, encourages educa ation and researrch, and recog gnizes the supe erior achievem ments of engine eers. Dr. C. D. Mote, ident of the Na Jr., is presi ational Academ of Engineeri my ing. The Institu of Medicin was established in 1970 by the Nationa Academy of Sciences to se ute ne b al f ecure the servi ices of eminent members of app m essions in the examination o policy matte pertaining to the health of the propriate profe of ers public. The Institute acts under the res s sponsibility giv to the Nat ven tional Academ of Sciences by its congres my ssional charter to be an adviser to the federal government and, upon its o a own initiative, to identify issues of medica care, al research, and education. Dr. Harvey V. Fineberg is pr a D Institute of Me resident of the I edicine. The Nation Research Council was organized by th National Ac ademy of Scie nal o he ences in 1916 to associate the broad o e community of science and technology with the Ac y a y cademy’s purp poses of furtheering knowledg and advisin the ge ng federal gov vernment. Fun nctioning in acccordance with general polici determined by the Acade ies d emy, the Counc has cil become th principal op he perating agency of both the National Acad y N demy of Scien nces and the N National Acade emy of Engineerin in providing services to th governmen the public, a the scient ng g he nt, and tific and engin neering commu unities. The Counc is administe cil ered jointly by both Academi and the Inst ies titute of Medic cine. Dr. Ralph J. Cicerone a Dr. h and C. D. Mote Jr., are chair and vice chair respectively, of the Nationa Research Co e, r, al ouncil. www.natio onal-academie es.org PR REPUBLIC CATION CO OPY: UNCOR RRECTED PROOFS

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PLANNING COMMITTEE ON APPLYING A HEALTH LENS TO DECISION MAKING IN NON-HEALTH SECTORS1 PAMELA RUSSO (Chair), Senior Program Officer, Robert Wood Johnson Foundation TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health DAWN ALLEY, Office of the Secretary, U.S. Department of Health and Human Services MARICE ASHE, Founder and Chief Executive Officer, ChangeLab Solutions JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation PHYLLIS W. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation MARTIN JOSÉ SEPÚLVEDA, Fellow and Vice President, Health Research, IBM Corporation AARON A. WERNHAM, Director, Health Impact Project, Pew Charitable Trusts IOM Staff ALINA B. BACIU, Study Director COLIN F. FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice Consultants THERESA WIZEMANN, Consulting Writer 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS v

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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE ISHAM (Co-Chair), Senior Advisor, HealthPartners, Inc., and Senior Fellow, HealthPartners Institute for Education and Research. DAVID A. KINDIG (Co-Chair), Professor Emeritus, University of Wisconsin School of Medicine and Public Health TERRY ALLAN, President, National Association of County and City Health Officials, and Health Commissioner, Cuyahoga County Board of Health GILLIAN BARCLAY, Vice President, Aetna Foundation RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy, and President, Kaiser Foundation International, Kaiser Foundation Health Plan, Inc. DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours GEORGE R. FLORES, Program Manager, The California Endowment MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE R. GOLD, Visiting Scholar, New York Academy of Medicine, and Professor, City College of New York GARTH GRAHAM, President, Aetna Foundation PEGGY A. HONORÉ, Director, Public Health System, Finance and Quality Program, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services ROBERT HUGHES, President and Chief Executive Officer, Missouri Foundation for Health ROBERT M. KAPLAN, Director, Office of Behavioral and Social Sciences Research, National Institutes of Health JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation PAULA LANTZ, Professor and Chair, Department of Health Policy, The George Washington University School of Public Health and Health Services MICHELLE LARKIN, Assistant Vice President, Health Group, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Professor and Director, Hopkins for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health JEFFREY LEVI, Executive Director, Trust for America’s Health SARAH R. LINDE, Rear Admiral, U.S. Public Health Service, Chief Public Health Officer, Health Resources and Services Administration SANNE MAGNAN, President and CEO, Institute for Clinical Systems Improvement PHYLLIS D. MEADOWS, Associate Dean for Practice, Office of Public Health Practice, School of Public Health, University of Michigan, and Senior Fellow, Health Program, The Kresge Foundation JUDITH A. MONROE, Director, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention JOSÉ MONTERO, President, Association of State and Territorial Health Officials, and Director, New Hampshire Division of Public Health Services 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS vii

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MARY PITTMAN, President and Chief Executive Officer, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic BRIAN SAKURADA, Senior Director, Managed Markets and Integrated Health Systems MARTIN JOSÉ SEPÚLVEDA, Fellow and Vice President, Health Research, International Business Machines Corporation ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition Institute of Medicine Staff ALINA B. BACIU, Study Director COLIN F. FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice PREPUBLICATION COPY: UNCORRECTED PROOFS viii

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REVIEWERS This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Chisara N. Asomugha, Centers for Medicare & Medicaid Services Peggy A. Honoré, U.S. Department of Health and Human Services Elizabeth Rigby, George Washington University Kenneth D. Smith, National Association of County and City Health Officials Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Susan J. Curry, The University of Iowa. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS ix

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CONTENTS ACRONYMS ......................................................................................................................................................xiii 1 INTRODUCTION ............................................................................................................................................. 1 Organization of the Workshop and Summary ................................................................................................... 2 2 HOW SOCIAL POLICIES SHAPE HEALTH ................................................................................................. 3 The Central Role of Place in Shaping Health ................................................................................................... 3 Effects of Social and Economic Interactions .................................................................................................... 5 Discussion ......................................................................................................................................................... 7 3 HIGHLIGHTS FROM THE WORK OF FEDERAL AGENCIES ................................................................... 9 Environmental Protection Agency .................................................................................................................... 9 Department of Transportation ......................................................................................................................... 11 Department of Defense ................................................................................................................................... 12 Housing and Urban Development ................................................................................................................... 14 Discussion ....................................................................................................................................................... 15 4 HIGHLIGHTS FROM THE WORK OF STATE AND LOCAL GOVERNMENTS ..................................... 19 Healthy Transportation in Massachusetts ....................................................................................................... 19 Healthy Community Development: Cuyahoga County, Ohio......................................................................... 20 Linking Health and Education: Healthy Schools Campaign ........................................................................... 23 A Recipe for Healthy Places: Chicago ............................................................................................................ 25 Discussion ....................................................................................................................................................... 26 5 WORKING ACROSS SECTORS TO IMPROVE HEALTH ......................................................................... 29 Health Impact Assessments ............................................................................................................................ 29 Cross Sector Collaboration at the Community Level...................................................................................... 31 Health in All Policies: California’s Experience .............................................................................................. 32 Discussion ....................................................................................................................................................... 36 6 CLOSING REMARKS.................................................................................................................................... 41 Population Health and Equity ......................................................................................................................... 41 Constituencies and Cross-Sector Collaboration .............................................................................................. 41 The Critical Role of the Convener .................................................................................................................. 42 Spread and Scale ............................................................................................................................................. 42 Metrics and Evidence...................................................................................................................................... 43 Building a Movement ..................................................................................................................................... 43 A REFERENCES ............................................................................................................................................... 45 B AGENDA........................................................................................................................................................ 49 C BIOSKETCHES OF SPEAKERS AND PLANNING COMMITTEE MEMBERS ....................................... 53 PREPUBLICATION COPY: UNCORRECTED PROOFS xi

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ACRONYMS ACA Patient Protection and Affordable Care Act ACPHD Alameda County Public Health Department CCT conditional cash transfer CDC Centers for Disease Control and Prevention DOT U.S. Department of Transportation DoD U.S. Department of Defense EEC Equity and Excellence Commission EIS environmental impact assessment EITC earned income tax credit EPA U.S. Environmental Protection Agency FTE full-time equivalents GIS geographic information systems HEAL Healthy Eating, Active Living HFFI Healthy Food Financing Initiative HHS U.S. Department of Health and Human Services HIA health impact assessment HiAP Health in All Policies HSC Healthy Schools Campaign HUD U.S. Department of Housing and Urban Development IOM Institute of Medicine ISI Information Sciences Institute MAP-21 Moving Ahead for Progress in the 21st Century MassDOT Massachusetts Department of Transportation NRC National Research Council NCQA National Committee for Quality Assurances ORD Office of Research and Development PHI Public Health Institute PTA Parent-Teacher Association RCT randomized controlled trial RWJF Robert Wood Johnson Foundation PREPUBLICATION COPY: UNCORRECTED PROOFS xiii

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xiv APPLYING A HEALTH LENS TO DECISION MAKING IN NON-HEALTH SECTORS SHC Sustainable and Healthy Communities STEM science, technology, engineering, and mathematics TIGER Transportation Investment Generating Economic Recovery UNICEF United Nations International Children's Emergency Funds USDA U.S. Department of Agriculture USEPA U.S. Environmental Protection Agency USICH United States Interagency Council on Homelessness PREPUBLICATION COPY: UNCORRECTED PROOFS