A health-in-all-policies approach addresses many of Richmond, California's place-based hazards, stressors.

Poor and minority residents of Richmond, California, have faced a host of place-based hazards and stressors such as pollution, gun violence, and a dearth of economic opportunities, all of which have likely contributed to their poor health outcomes. In this article we describe the city's efforts to reverse its fortunes by embracing a health-in-all-policies strategy for community development. Starting in 2007, the city organized a series of participatory planning projects with residents, community activists, school officials, and other stakeholders to ensure that the city took health equity into account when devising each phase of its new community development strategy. The result was an approach designed to address the social determinants of health by directing development resources toward vulnerable communities and by adopting a health-in-all-policies ordinance. Specific projects focused on improving the built environment and community safety and redirecting government funds to areas of social need. The process has contributed to rising levels of resident satisfaction about personal health, the direction the city is taking, and the quality of neighborhood development. Richmond's experience suggests that adopting a health-in-all-policies strategy is one way to promote health equity in distressed cities.

Health in All Urban Policy: city services through the prism of health.

In April, 2014, the City of Richmond, California, became one of the first and only municipalities in the USA to adopt a Health in All Policies (HiAP) ordinance and strategy. HiAP is increasingly recognized as an important method for ensuring policy making outside the health sector addresses the determinants of health and social equity. A central challenge facing HiAP is how to integrate community knowledge and health equity considerations into the agendas of policymakers who have not previously considered health as their responsibility or view the value of such an approach. In Richmond, the HiAP strategy has an explicit focus on equity and guides city services from budgeting to built and social environment programs. We describe the evolution of Richmond's HiAP strategy and its content. We highlight how this urban HiAP was the result of the coproduction of science policy. Coproduction includes participatory processes where different public stakeholders, scientific experts, and government sector leaders come together to jointly generate policy goals, health equity metrics, and policy drafting and implementation strategies. We conclude with some insights for how city governments might consider HiAP as an approach to achieve "targeted universalism," or the idea that general population health goals can be achieved by targeting actions and improvements for specific vulnerable groups and places.