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: Joe.Hilbert@vdh.virginia.gov
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 predetermine states outcomes.

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
When we stopped and thought
expertise that was invaluable during the review of the
about it, we realized that if we
nutrition and physical activity strategies.
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

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.

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.

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

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

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.