The case of air pollution, urban

health, and sustainability 18-20 June 2018,

Washington, DC | USA

Evaluation report 30 July 2018

In collaboration with

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CONTENTS 1. INTRODUCTION

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2. OVERARCHING WORKSHOP LEARNING OBJECTIVES, STRUCTURE AND CONTENT

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3. PROFILES OF PARTICIPANTS 5

4. EVALUATION RESULTS: 6

4.1 GENERAL CONTENT COVERAGE 6

4.2 LEARNING OBJECTIVES 7

4.3 INDIVIDUAL ACTION PLANS 8

5. EVALUATION CONCLUSIONS 9

ANNEX 1: EVALUATION QUESTIONNAIRE 11

ANNEX 2: PARTICIPANTS LIST 13

ANNEX 3 : FACULTY

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1. INTRODUCTION

In June 2018, the World Health Organization (WHO) in collaboration with Association of Schools and Programs of Public Health (ASPPH), National Environmental Health Association (NEHA) and Pan-American Health Organization (PAHO) WHO Regional Office for Americas held a Health in All Policies workshop – the case of air pollution, urban health, and sustainability. The workshop focused on how the Health in All Policies (HiAP) approach can contribute to addressing complex multisectoral problems such as air pollution.

The workshop followed the WHO Health in All Policies Training Manual and, for communications, the BreatheLife campaign. This skill-building event marked the 21st World Health Organization (WHO)-sponsored HiAP workshop and the first time that a WHO HiAP training workshop strongly integrated air pollution and sustainability with the theme of Health in All Policies and with a joint academic and practitioner audience.

The training programme development was led by a core faculty: Nicole Valentine (WHO) with Laura Magaña (ASSPH), Elizabeth Weist (ASSPH), Sandra Whitehead (NEHA), and Julian Fisher (Hanover Medical School). The core faculty were supported by the organizing committee (OC) and guest faculty. In alphabetical order by institution the OC members were: Julia Caplan and Lianne Dillan (California HiAP Task Force); Jonathan Samet (Colorado School of public Health); David Djack (NEHA); Kira Fortune and Marcelo Korc (PAHO); Elaine Fletcher and Aleksandra Kuzmanovic (WHO). Several guest speakers contributed to the programme: Anneta Arno (DC Health, Government of District of Columbia); Eric Friedman (Georgetown University); and Jonathan Patz (University of Wisconsin-Madison). For the list of the organizing committee and their bios click here.

The workshop targeted academics and practitioners from a variety of disciplines who work in public and environmental health or environmental sciences, mostly from the US. Participants considered air pollution challenges, identified the skills needed in practice, and examined useful approaches for education/training and practice that will support reaching the United Nations Sustainable Development Goals. Prior to the workshop, participants undertook extensive pre-workshop readings and completed a preparatory exercise. Upon completion of the workshop, attendees were expected to emerge with an action plan relevant to their own context to put into place upon returning to their teaching and practice settings.

This report summarizes the evaluation feedback received in the questionnaires (see Annex 1) completed by the participants on Day 3 of the workshop. A total of 23 individuals participated in the workshop (excluding faculty, invited presenters, and WHO staff) and 100% completed the event evaluation forms. Out of 23 submitted evaluation forms, 18 were fully completed while five were substantially complete (four were missing one response and one was missing two responses).

This report presents responses to structured questions both quantitatively in figures and qualitatively according to key themes. The report concludes with reflections on these results and lessons learned.

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2. OVERARCHING WORKSHOP LEARNING OBJECTIVES, STRUCTURE AND CONTENT 2.1 Overarching learning objectives:

a) Explain the social determinants of health (SDH) framework, key Commission recommendations, and the definition of the Health in All Policies (HiAP) approach and related core concepts

b) Identify key policies, principles, mechanisms, examples of policy champions, stakeholders, and sectors (including health sector, governmental, and non-governmental) that are important for sustainability of the HIAP approach

c) Identify key policies, sectors and partnership/stakeholder strategies (including health sector, governmental, and non-governmental) that are important for addressing air pollution, urban health, equity and sustainability

d) Identify key implications of the SDH framework and the HiAP approaches for preventing and remediating air pollution

e) Identify key implications of the SDH framework and HiAP approaches for improving education and training and professional certification and advancing life-long learning in the health sector

f) Describe why air pollution is an important determinant of health and its relationship to other determinants of health and health equity

2.2 Structure: • Introduction to the social determinants of health, sustainable cities and Health in All Policies

[Day 1, morning] • Health in all Policies examples and approaches and skills for public health communication and

campaigns [Day 1, afternoon] • Sustainability (climate change), air pollution and urban health, and examples of the role of

government in HiAP [Day 2, morning] • Health in All Policies skills [Day 2, afternoon] • Evaluating HiAP progress and individual action plans [Day 3 morning only]

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2.3. CONTENT OF THE WORKSHOP AS SPECIFIC LEARNING OBJECTIVES

Day 1 Day 2 Day 3 Make linkages between the implementation of HiAP and actions to address air pollution and to improve urban health

Recognize important aspects of how the practice of HiAP needs to be reflected in public health skills and education and in your individual action plan

Explain the social determinants of health (SDH) framework and the definition of the HiAP approach and related core concepts

Identify key policies and sectors beyond the health sector that are important for addressing air pollution, urban health, equity and sustainability

Recognize different types of monitoring and evaluation approaches for Health in All Policies and intersectoral work

Identify urban determinants of health challenges and solutions

Understand key linkages between policies addressing climate change, health and air pollution ¨

Review indicators used for assessment from the SDGs and other sources, including those relevant to urban health and air pollution

Be familiar with the recommendations of the Commission on SDH and the concept of a SDH policy champion

Understand the relevance of policies addressing air pollution for child health, equity and noncommunicable diseases

Look at specific examples including the case of impact assessment

Describe global life expectancy trends and the estimation of burden of disease attributable to air pollution

Describe the role of government in the SDH and HiAP approach with examples from the broader region of the Americas

Review individual action plans

Describe the health impacts attributable to air pollution

Explain some of the barriers to closer intersectoral collaboration

Summarize key learning from the workshop and evaluation

Identify major social and environmental challenges associated with air pollution and explain some of the causal relationships

Describe conditions conducive to the HiAP approach including institutional aspects supporting work across sectors

Recognize the different sectors and stakeholder that could be involved in and affected by efforts to deal with air pollution and the role of regulation

Explain the leadership role of health sector in HiAP and challenges; reflect on the role of state and county governments

Recognize the HiAP approach and different models used with examples

Explain the benefits and challenges of non-government stakeholder engagement

Reflect on the use of co-benefits in Health in All Policies and actions to address SDH in urban health

List principles for effective and accountable stakeholder consultation

Explain the purpose of a public health campaign in the context of policy making and the importance of stakeholder analysis for communication

Identify formal and informal mechanisms for non-government stakeholder involvement in HiAP

Summarize characteristics of effective and influential public health campaign

Describe several approaches to policy negotiation with emphasis on cooperative negotiating

Develop and present a concept of a public health campaign in the form of Breathelife

Apply knowledge of negotiation to a role play (focused on air pollution and urban health)

HiAP

Air pollution

Overarching

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3. PROFILES OF PARTICIPANTS

• All 23 participants were from different institutions, predominantly based in the United States and external to WHO (others: Chile).

• Participants could apply as individuals but also as teams of two or three. The applicants went through a systematic selection process by the OC.

Academics 52%

Practitioners 48%

Figure 1. Participants' background

5 4

1 1

Local level (county/city) State/National Level No implemntationexperience

No response

Figure 1a. Practioner participants currently involved in HiAP implementation (n=11)

No of participants

6 4

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Designing/teaching courses No experience in designing/teaching No response

Figure 1b. Academic participant experience in designing and/or teaching courses (n=12)

No of participants

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4. EVALUTION RESULTS

4.1 GENERAL PERCEPTIONS ABOUT THE WORKSHOP

• The question, “Overall, how would you rate the usefulness of this workshop?” permitted responses on a four-point scale [1 – very useful, 2 – useful, 3 - :not useful, and 4 – I’m not sure]:

o 78% responded very useful o 18% responded useful o 4% (one person) did not respond to the question.

• The question “What did you value most about the workshop?” permitted open-ended responses, pattern-coded as follows:

o Useful and comprehensive teaching materials (17 participants) o Experienced faculty (11 participants) o The opportunity for networking among participants and with facilitators (9 participants) o Learning from other participants and learning by doing (9 participants) o Linking enviornmental and social determinants and addressing complexity (4

participants).

Very useful 78%

Useful 18%

No response 4%

Figure 2. Workshop usefulness to participants

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• The question “What could be improved to make the workshop more successful?” permitted open-ended responses, pattern-coded as follows :

o Narrow down pre-workshop readings and send pre work materials more in advance (7 participants)

o Workshop to last longer (at least the whole third day) (9 participants), allowing for : Enough time for interaction after presentations; Longer introduction session to meet each other; More time for free talks during breaks; More physical activity during the workshop Include evening activities into the agenda More time for peer-to-peer learning;

o More structured guidance and feedback on the action plans (3 participants) o Power points to be better structured (with less text, more bullets and harmonization) (2

participants) o To work towards developing more examples and tools for HiAP measurement and

evaluation (1 participant) o Link between HiAP and SDGs to be strengthened (1 participant).

4.2 EVALUATION OF SPECIFIC LEARNING OBJECTIVES

• The question, “How well did the workshop meet the stated learning objectives?” permitted evaluation of the items a to f listed below using a four-point scale: [1 - fully met, 2 – partially met, 3 – not met, and 4 - I’m not sure]. All the questions were responded 100%, except the last question f (missing 1).

a. Explain the social determinants of health framework, key Commission recommendations, and the definition of the HiAP approach and related core concepts

b. Identify key policies, principles, mechanisms, examples of policy champions, stakeholders, and sectors that are important for sustainability of the HiAP approach

c. Identify key policies, sectors and partnership/stakeholder strategies that are important for addressing air pollution, urban health, equity and sustainability

d. Identify key implications of the SDH framework and the HiAP approaches for preventing and remediating air pollution

e. Identify key implications of the SDH framework and the HiAP approaches for improving education and training and professional certification and advancing life-long learning in the health sector

f. Describe why air pollution is an important determinant of health and its relationship to other determinants of health and health equity

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4.3 PERSONALISED ACTION PLANS

• Feedback to the question, “Did you form an action plan relevant to your own context that demonstrates application of SDH and HiAP approaches to urban health problems, including air pollution, and, or, education and skills development?” was collected using three options [1 - Yes, Partly – 2, and No – 3]:

o 17 participants responded yes o 6 responded partly.

Evaluation questions related to the utility of the workshop for action

• The question, “Indicate whether your action plan includes the following elements”: permitted evaluation of the items a to c listed below using a four-point scale: [1 - yes, 2 – partly, 3 – no].

a. Taking evidence into policy and action to help solve complex public health challenges b. Strategizing for public health advocacy/communications campaigns c. Developing cross-sectoral partnerships

21 23

18 19 18 21

2 5 4

2 1 1 2

a b c d e f

Figure 3. How well the workshop met the stated learning objectives

Fully met Partially met Not met I am not sure

Yes 74%

Partly 26%

Figure 4. Participants' formation of an action plan

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5. EVALUTION CONCLUSIONS

One hundred percent of the participants found the workshop either useful or very useful, a very positive result indeed. The integration of the BreatheLife workshop and communication in public health campaigns, with the HiAP workshop, proved successful, with all participants’ action plans including some element of public health advocacy/communication campaigns.

Similar, future workshops could be useful in efforts by WHO and partners to advocate and build capacity for addressing air pollution, urban health and climate change as outlined in the joint action plan by WHO, UN Environment, World Meteorological Organization partnership, and supported by the Climate and Clean Air Coalition, “Delivering on air quality, climate change, and health”.

Distilling the workshop experience and evaluation results, some key considerations for designing future workshops using this curriculum from the perspective of the Organizing Committee are as follows.

This first workshop was presented in a high-income setting with existing legislation on air quality. Further efforts would need to be undertaken to develop a model workshop for lower-resource settings with more limited environmental legislative frameworks.

Second, participants came from various parts of the United States, with one attendee from Chile, and were at differing levels of their careers (beginning, mid-, and advanced). Participants came from both academic and practice settings, with differing levels of experience working intersectorally, or on air pollution. This is a positive sign regarding the usefulness of a general introductory workshop, and the ability for a diverse group of participants to manage the extensive content. This rich background may also have contributed to participants` expressed wish for the workshop to be longer and to allow for more peer-to-peer exchange. More opportunities for peer-to-peer exchange, and discussion with the faculty should be provided for in future workshops as well as a mechanism for follow up with participants over a set period of time after the workshop. In particular, it would be helpful if faculty were available afterwards to provide ongoing feedback for the action plans so they can be enhanced and further formalised.

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15

22

3

8

1 1

a b c

Figure 4a. Rate on elements included into action plans Yes Partly No

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Third, exciting examples were presented for discussion or role play on urban planning, active transport, housing and children’s health. Future workshops will aim to allocate more time to examples presented to show the importance of integrated and aligned policies and actions to address air pollution, climate change and social determinants in urban settings. The next meeting of the Global Network on Health in All Policies, hosted by the Quebec government in June 2019, will provide a possible forum. Further opportunities to link BreatheLife (http://breathelife2030.org/) and HiAP training were successfully explored and will be repeated in the future in the form of shorter workshops.

Fourth, having noted that the participants had exceptional academic qualifications and experience, it would be important to assess for future workshops whether participants with less qualifications would manage the breadth of topics covered. The pre-workshop readings were extensive, as noted in the evaluation and it may be that a more practice-oriented audience will need more than two weeks to complete it.

Fifth, this HiAP workshop was the first to integrate education and training concepts for HIAPs and the social determinants of health from the Sustainable Development Agenda into its content. The results and feedback show that this integration was successful within the time constraints of the workshop. Participants recognized the importance of a joint academic and practitioner, and valued the interprofessional learning environment. However the evaluation results indicate areas of improvement, which can be addressed in further iterations as clearer models are made available following extensive work that WHO, UNESCO and other partners are undertaking to define competencies and standards for Health in All Policies (2018/19). As part of this work going forward, the issue of education and competencies for addressing air pollution will be highlighted at WHO’s First WHO’s First Global Conference on Air Pollution and Health, 30 October - 1 November 2018.

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ANNEX 1: EVALUATION QUESTIONNAIRE

Authentic Assessment Workshop Evaluation

WHO/ASPPH/NEHA Health in All Policies Workshop: The case of air pollution, urban health and sustainability

Monday June 18 – Wednesday June 20, 2018 | Washington, DC

Please respond to the six questions below by filling out the form before you leave the workshop. All attendees who submit an evaluation will receive a digital certificate of workshop completion.

Name: _________________________________________________________

1. How well did the workshop meet the stated learning objectives for you to:

a. Explain the social determinants of health (SDH) framework and the definition of the Health in All

Policies (HiAP) approach and related core concepts? Fully met ____ Partially met ____ Not met ____ I’m not sure ____

b. Identify key policies, principles, mechanisms, examples of policy champions, stakeholders, and sectors

(including health sector, governmental, and non-governmental) that are important for sustainability of the HIAP approach?

Fully met ____ Partially met ____ Not met ____ I’m not sure ____

c. Identify key policies. sectors and partnership/stakeholder strategies (including health sector, governmental, and non-governmental) that are important for addressing air pollution, urban health, equity and sustainability

d. Identify key implications of SDH and HiAP approaches for preventing and remediating air pollution, Fully met ____ Partially met ____ Not met ____ I’m not sure ____

e. Identify key implications of SDH and HiAP approaches for improving education and training and professional certification and advancing life-long learning in the health sector?

Fully met ____ Partially met ____ Not met ____ I’m not sure ____

f. Describe why air pollution is an important determinant of health and its relationship to other determinants of health and health equity?

Fully met ____ Partially met ____ Not met ____ I’m not sure ____

2. Did you form an action plan relevant to your own context that demonstrates application of SDH and HiAP approaches to urban health problems, including air pollution, and, or, education and skills development?

Yes ____ Partly ____ No _____ Explain your answer below: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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3. If “Yes” or “Partly,” per #2 above, indicate whether your action plan includes the following elements:

a. Taking evidence into policy and action to help solve complex public health challenges Yes ____ Partly ____ No _____

b. Strategizing for public health advocacy/communications campaigns

Yes ____ Partly ____ No _____

c. Developing cross-sectoral partnerships and negotiating solutions Yes ____ Partly ____ No _____

4. Overall, how would you rate the usefulness of this workshop? Very useful ____ Useful ____ Not useful ____ I’m not sure ____

5. What did you value most about the workshop ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. What could be improved to make the workshop more successful? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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ANNEX 2: PARTICIPANTS LIST

No. Applicant Name Org/Institution Country

1. Liz Geltman CUNY School of Public Health

USA

2. Kerry Wyss Association of State and Territorial Health Officials

USA

3. Andrew Dannenberg

Univ. of Washington School of Public Health

USA

4. Sweta Shrestha UW-Madison Population Health Institute

USA

5. Megan Latshaw Johns Hopkins University USA

6. Alexander C. Ufelle

Slippery Rock University of Pennsylvania

USA

7. Luz Maria Gomez Bay Area Air Quality Management District

USA

8. Amy Stuart University of South Florida

USA

9. James Boulter University of Wisconsin-Eau Claire

USA

10. M. Mahmud Khan University of South Carolina

USA

11. Anne-Marie Coleman

Georgia Department of Public Health

USA

12. Ping Johnson Kennesaw State University

USA

13. Stephan Schwander

Rutgers School of Public Health

USA

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14. Ana Ortigoza Drexel University USA, Chile

15. Janine Sinno Janoudi

Ingham County Health Department

USA

16. Wesley H. Queen University of Maryland, School of Public Health

USA

17. Elizabeth Corcoran de Beaumont Foundation USA

18. Emma Zinsmeister U.S. Environmental Protection Agency

USA

19. Esther Mune Georgia Department of Public Health

USA

20. Stefanie Carignan Pew Trusts USA

21. Luke Sturgeon Tacoma-Pierce County Health Department

USA

22. Katherine Britt Indvik

International Institute for Global Health, United Nations University

Chile

23. Kate Robb American Public Health Association

USA

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ANNEX 3: FACULTY

WORKSHOP LEAD FACILITATOR

NICOLE VALENTINE ACTING COORDINATOR, SOCIAL DETERMINANTS OF HEALTH WORLD HEALTH ORGANIZATION (WHO), GENEVA

CO-ORGANIZING ATTENDING FACULTY

DR. LAURA MAGAÑA PRESIDENT AND CEO THE ASSOCIATION OF SCHOOLS AND PROGRAMS OF PUBLIC HEALTH (ASPPH)

ELIZABETH M. WEIST DIRECTOR, EDUCATION THE ASSOCIATION OF SCHOOLS AND PROGRAMS OF PUBLIC HEALTH (ASPPH)

SANDRA WHITEHEAD DIRECTOR OF PROGRAM AND PARTNERSHIP DEVELOPMENT NATIONAL ENVIRONMENTAL HEALTH ASSOCIATION

JULIAN FISHER SENIOR RESEARCHER AT PETER L. REICHERTZ INSTITUTE FOR MEDICAL INFORMATICS UNIVERSITY OF BRAUNSCHWEIG - INSTITUTE OF TECHNOLOGY AND HANNOVER MEDICAL SCHOOL, GERMANY

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LIANNE DILLON DEPUTY PROGRAM DIRECTOR, PUBLIC HEALTH INSTITUTE CALIFORNIA HEALTH IN ALL POLICIES TASK FORCE CALIFORNIA STRATEGIC GROWTH COUNCIL

ELAINE FLETCHER SCIENCE EDITOR & BREATHELIFE CAMPAIGN LEAD WORLD HEALTH ORGANIZATION

KIRA FORTUNE REGIONAL ADVISOR, SOCIAL DETERMINANTS OF HEALTH PAN AMERICAN HEALTH ORGANIZATION (PAHO/WHO)

MARCELO KORC

ADVISOR, AIR QUALITY PAN AMERICAN HEALTH ORGANIZATION (PAHO/WHO)

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ALEKSANDRA KUZMANOVIC CONSULTANT, SOCIAL DETERMINANTS OF HEALTH WORLD HEALTH ORGANIZATION (WHO), GENEVA

GUEST FACULTY

C. ANNETA ARNO DIRECTOR, OFFICE OF HEALTH EQUITY DC HEALTH, GOVERNMENT OF DISTRICT OF COLUMBIA

ERIC A. FRIEDMAN INSTITUTE ASSOCIATE AND PROJECT LEADER O`NEILL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW GEORGETOWN UNIVERSITY JONATHAN PATZ DIRECTOR, GLOBAL HEALTH INSTITUTE NELSON INSTITUTE FOR ENVIRONMENTAL STUDIES DEPARTMENT OF POPULATION HEALTH SCIENCES CENTER FOR SUSTAINABILITY & THE GLOBAL ENVIRONMENT (SAGE)