Getting the HiAP conversation started in rural California

In California’s rural central valley county of Tulare the focus is on economic growth. Policymakers are unfamiliar with the connection between economic policies and the health impact on county residents. Policy-decisions are frequently seen through a cost-benefit perspective, where a net-county cost weighs heavily against health benefits. What this means at a practical level is that economics take precedence, consuming policymakers’ time, discretionary funding, and personnel in finding strategies that grow the economy, which is particularly understandable in Tulare, one of California's poorest counties. Unfortunately, the cost-benefit analysis happens in the absence of grounded health research and collaboration with public health partners, stakeholders, and community members.

In Tulare County, the Public Health Department (PHD) supported the creation of the Board of Supervisors’ Health Advisory Committee with intersectoral representation, and providing the public with a new avenue to raise, discuss, and have county administrators act on issues impacting residents’ health. Additionally, the PHD has taken the approach of working with the Healthy for Life Coalition, a grouping of agency and partner representatives interested in advancing health policy in the county, particularly around improving nutrition and physical activity. Working with the coalition, the PHD has educated the members of the Health Advisory Committee on the Health in All Policies strategy, both from a conceptual and local implication points of view.

With multiple strategies attempted, lessons learned from these endeavors will be shared, including regional trainings, injecting health language into community plans, and adding health language to the county general plan.