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ESPHL PROJECT HIGHLIGHTS
VIRGINIA
July 2014
Team Members:
Marissa Levine * Ruthe Gaare Bernheim
Scott Garrett Emmett Hanger William Hazel Joseph Hilbert
Robin Kurz Cynthia Romero **
Sarah Stanton
* Team Leader
** Original team leader Commissioner Romero left government
service on 1/31/2014, as part of a
gubernatorial transition.
For additional information, contact:
Joseph Hilbert
Director of Governmental and Regulatory Affairs Virginia
Department of Health
Phone: 804-864-7006 Email: [email protected]
States policies shape where we live, learn, work, and play, and
impact the publics health. While there is evidence for what works
to improve populations health outcomes, many states lack robust
partnerships capable of
mobilizing stakeholders, re-examining existing legal models, and
innovating through statue and regulation. The Excellence in State
Public Health Law (ESPHL) program sought to strengthen the
relationships among health
policy decision-makers in and among selected states and to
increase the ability of these states to understand how policy could
improve the publics health. States determined their own priorities,
and ESPHL did not pre-
determine states outcomes.
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Virginias team used its participation in the Excellence in State
Public Health Law (ESPHL)* program to explore ways to improve the
process for developing public health policy in Virginia. The team
developed a Model Process for Public Health Policy Development,
using two chronic disease risk factor reduction strategies one
dealing with improved nutrition and another with increased physical
activity. The team also used its participation in ESPHL as an
opportunity to strengthen and expand relationships with a wide
range of public health system stakeholders. Improving nutrition and
increasing physical activity are broad goals. The team narrowed the
scope by focusing on specific strategies. The first chronic disease
prevention strategy was to ensure that foods served or sold in
government facilities and government-funded programs and
institutions (e.g., schools, prisons, juvenile correctional
facilities) meet nutrition standards consistent with the Dietary
Guidelines for Americans. The second strategy was to develop and
institute policies and formal agreements to encourage shared use of
physical activity facilities (e.g., school gymnasiums, community
recreation centers) that address liability concerns of schools and
community groups. Both strategies were contained in the Shared
Agenda for Chronic Disease Prevention, prepared by the Virginia
Department of Health (VDH) in collaboration with more than 60
external stakeholders in 2012. Virginias team was broad based, and
the functioning of the team was strengthened as a result of its
participation in the ESPHL leadership retreats. Virginias project
team worked effectively in partnership with a wide range of
stakeholders throughout the project. Several stakeholder
organizations made presentations at team meetings, effectively
serving as extensions of the team. These organizations, including
the Virginia Academy of Nutrition and Dietetics, Virginia
Beverage Association, Department of Corrections, Department for
the Blind and Vision Impaired, Virginia Recreation and Park
Society, and Virginia Alliance of YMCAs, provided the team with
subject matter expertise that was invaluable during the review of
the nutrition and physical activity strategies. One area where the
team was challenged was obtaining Return on Investment (ROI)
estimates for each of the two strategies. Given restricted
resources, ROI estimates are critical to influencing the decisions
of policymakers concerning funding of public health services,
particularly services that embody primary prevention such as
improved nutrition and increased physical activity. VDH has
developed a model ROI calculator and is currently working to
develop basic ROI projections for many key public health metrics
and activities.
* ESPHL, a program of the Aspen Institute Justice & Society
Program, was made possible by a grant from the Robert
Wood Johnson Foundation.
When we stopped and thought about it, we realized that if we
took chronic health issues as the focus and put together a model
for public health policymaking,
then maybe wed have something by the end that would be not
only
useful in Virginia but could be instructive for other states.
And quite frankly, I think it worked
better than we thought.
- Dr. Marissa Levine, Interim Commissioner, Virginia Department
of
Health
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Model Process. The Model Process focuses on how to start with a
public health policy issue, define it in terms of a specific policy
proposal, and then evaluate the proposal in order to determine
whether, and how, to proceed. It is based on four key principles: A
Data-Driven Process; Extensive Stakeholder Engagement; Thorough
Vetting of Policy Proposals; and Resulting Policy Changes with
Broad-Based Benefit(s). The model has three stages: Foundation,
Action, and Consolidation & Decisions. The Foundation stage
involves recognizing and appreciating that there are various types
of information that need to be utilized and considered: Public
Health Data, Law and Legislative Activity, Stakeholders,
Evaluations and Analyses, and Best Practices. The Action stage
involves reviewing, analyzing and understanding those different
types and sources of information. A possible outcome of the model
is a decision not to proceed with the proposed policy change. One
of the assumptions underlying the Model Process is the ready and
convenient availability of various types of data and information.
Several themes and many valuable comments and suggestions emerged
from the stakeholder discussions. Implementation of the Model
Process would be beneficial, particularly given its proactive,
data-driven approach. However, some revisions to the Model were
suggested:
Stakeholder engagement should take place at the beginning of the
process to ensure appropriate issue definition different
stakeholders may have different understandings of the same
issue
Return on investment estimates should be examined earlier in the
process, as part of the overall data review
The model should include a timeline as well as internal
evaluation and feedback mechanisms
The model should have an associated website that can serve as a
vehicle for stakeholder communication and engagement.
Participants noted that elements of this type of process are
currently used in Virginia but often in a reactive manner. It was
also observed that various model components arent always well
connected with each other. Both of these observations attest to the
importance of the model, and the need to implement it in the
intended proactive manner. It was observed that, depending on the
issue, stakeholders often share goals and values but differ on
strategies for achieving shared goals. Participants also stated
that the involvement and engagement of private business, local
governments, and local school divisions was essential to further
assessment and implementation, and that not all policy changes
necessarily require changes in the law. Opportunities for
ESPHL has been a great opportunity for Virginia to bring some
people together
who havent necessarily talked about how health policy is
made in the commonwealth. It was a great catalyst to get us
moving.
- Dr. Marissa Levine, Interim Commissioner, Virginia
Department
of Health
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collaborative, voluntary efforts to drive policy changes within
the bounds of existing law should not be overlooked. The model was
never intended to depict a linear, step-by-step, process. Rather,
it should be viewed as a guide for stakeholder interaction and
engagement, in order to address health policy issues through
specific proposals that can be evaluated using a data-driven
approach. In other words, the model strives to bring order to what
can be a messy, confusing process.
