Colorado Department of Public Health and Environment: Seeking Diverse Perspectives Throughout State Health Improvement Planning and Evaluation

This blog post is part of a series highlighting the work of Healthy People State and Territorial Coordinators (Coordinators). Coordinators make Healthy People happen every day across the United States. ODPHP works with Coordinators to identify areas of alignment with their work and Healthy People 2030 goals and objectives.   

The Colorado Department of Public Health and Environment’s (CDPHE’s) mission is “Advancing Colorado’s health and protecting the places where we [Coloradans] live, learn, work, and play.”  As 1 of only 5 states to include both public health and environmental protection within 1 agency, and with a decentralized public health system mostly supported by single-county agencies, Colorado has positioned itself to holistically address social determinants of health (SDOH) with a focus on the needs of local communities.   

Engaging diverse perspectives ensures state efforts reflect the needs of all communities 

CDPHE develops their 5-year state health improvement plan (SHIP) working with a Public Health Improvement Committee (PHIC) composed of a diverse group of cross-sector partners from across the state. CDPHE recognizes that the diversity of Colorado’s geography goes hand in hand with the diversity of its communities and the people who live there — and that to be truly representative, recruitment efforts for PHIC members must branch out to all corners of the state.  

“Some processes can end up unintentionally being Denver-metro-centric,” says Kelsey Robinson, a public health planner with CDPHE. “We know that our eastern plains have really different needs than our metro areas, and some of our more rural mountain towns have different needs than resort mountain towns.”  

To meet this challenge, CDPHE recruits PHIC members from CDPHE staff, local public health agencies, area health education centers, community-based organizations, public health higher education institutions, and hospitals and community health centers throughout the state — from the plains in the east, to the Denver metro area, to the mountainous regions, to the western slope. This intentional selection ensures that the committee reflects residents in all communities. As the process — and these communities — evolve, CDPHE also invites additional groups into the PHIC. New members’ fresh perspectives enable CDPHE to meet local community needs and benefit from timely insights provided by those with subject matter expertise and lived experiences. 

Priority areas recognized in the SHA can help set the framework for the SHIP 

CDPHE tasks the Office of Public Health Practice Planning and Local Partnerships (OPHP) with leading the state health assessment (SHA).   

The SHA is developed over several years and informs development of the SHIP. In the initial stages, CDPHE reviews its development processes and identifies available data and data gaps using the BARHII model: a model for data gathering rooted in health equity.  

“We make sure that we’re pulling data for not just health outcomes and health behaviors, but also some of those upstream factors and social determinants of health,” says Robinson.    

The next stage focuses on gathering identified data that CDPHE is already collecting regularly at the state level. For the 2023-2024 SHA, CDPHE also deployed a qualitative community survey to capture insights from populations that may be underrepresented in state surveillance systems. This included reaching out to community-based organizations working with older adults, youth, people with disabilities, the LGBTQ+ community, immigrants, refugees, and non-English speaking populations. 

As data is collected, CDPHE begins analysis to identify how state-level efforts and data trends compare with Healthy People 2030 objectives. CDPHE aggregates this information into a SHA report. In the next SHA report, CDPHE plans to release both a written report and a data dashboard. Most recently, CDPHE identified 6 priority areas for the development of its next iteration of Colorado’s SHIP: air quality, climate change, communicable disease control, public health transformation, substance misuse prevention, and suicide prevention. In addition, CDPHE recognizes the roles that health equity and environmental justice play for individual and community health and well-being — and plans to emphasize strategies to support both in the upcoming 2025-2029 SHIP.   

Using Healthy People 2030 to align state and national metrics in the SHA and SHIP 

As the CDPHE collects and reviews data for the SHA, the OPHP flags all health and environment topic areas that align with Healthy People 2030 objectives. For example, the SHA includes metrics for Colorado’s “age-adjusted rate of suicide hospitalization” and “age-adjusted rate of suicide deaths,” which relate to objective MHMD-01: Reduce the suicide rate. Another example is the SHA metric of “percent of fatal crashes involving a driver or motorcycle operator with a Blood Alcohol Concentration of 0.08 and above” that relates to objective SU-11: Reduce the proportion of motor vehicle crash deaths that involve a drunk driver.  

“Pulling some of these out in the state health assessment really just calls out where some of our state priorities are aligned with national priorities,” says Robinson. “I think it's also helpful pre-work for our state health improvement plan [so that] when we have priorities selected, [we’ve already started] thinking through what some of those measurable objectives are that we should work toward.” 

While these examples represent a small selection of the overlap between Healthy People 2030 and Colorado’s SHA, they illustrate the importance of the Healthy People 2030 framework’s call to align efforts across state and national levels. They also reflect the framework in principle and practice. For example, in developing their SHIP, CDPHE uses a results-based accountability framework to achieve specific outcomes by setting clear goals, measuring successes through key indicators, and working backward to understand the root causes and necessary strategies to achieve desired outcomes.  

CDPHE also looks for connections between Healthy People 2030 and their 6 SHIP priority areas, specifically within the context of corresponding state data. For example, the Healthy People 2030 suicide prevention objectives MHMD-01 and MHMD-02 track suicides per 100,000 population and adolescent suicide attempts per 100,000 population. Comparing this data with state level data from the Colorado Vital Statistics Program and Colorado Hospital Association, CDPHE is able to better see where it’s making progress in addressing the priority area of suicide prevention — and where it needs to improve relative to Healthy People 2030’s national objectives. These data comparisons also provide firm evidence for including certain priority areas in Colorado’s SHIP. 

Tracking and monitoring the SHIP benefits future development 

For CDPHE, monitoring and tracking their current SHIP is more than a best practice: it’s also an investment that benefits future improvement plans. Monitoring and tracking provide a status check on current initiatives, but also consistently provide new information that can improve future practices.  

CDPHE tracks current progress on the 2020-2024 SHIP in a dashboard displaying input from an implementation team that’s assigned to each priority area. The dashboard shows progress toward various quantitative, population-level measures for each priority area, as well as qualitative, narrative descriptions of CDPHE’s efforts to address each priority area’s goals and strategies. As the status of a goal changes, there is sometimes a need to modify strategies to better achieve that goal.

“As we do annual updates [for the next plan], rather than [only] giving a narrative of what we've been doing, we'll actually update the strategy itself,” says Robinson. “Either marking it as complete or still in progress, maybe tweaking it if needed, or, if we have completed a strategy, creating a new strategy for the next steps.” 

Lessons learned  

CDPHE keeps the following tips in mind when developing and implementing both SHAs and SHIPs: 

Consider risks and contingencies when developing your planning timeline. SHIP development involves collaboration across multiple offices and organizations — each with its own processes, workflows, and scheduling expectations. As you build out your workplan, make sure to acknowledge risks in your timeline and develop contingencies that provide flexibility when priorities shift. 

Understand power dynamics and use strategies to lessen or eliminate their impact. Every office and organization have mandates that govern their activities and goals. Fulfilling these mandates can sometimes obscure collaborative opportunities or creative ways to meet seemingly incompatible needs and complete initiatives. CDPHE finds that an external facilitator can help minimize power dynamics in meetings and ensure that all voices are heard — and that the discussion remains balanced and focused on shared goals. 

Plan for continuity between the intentions of plan writers and the actions of plan implementers. Involving some of the same people in both the writing and implementing process helps maintain alignment with policy aims, lessens miscommunication, and provides a through-line that connects goal setting with the work happening on the ground. It also ensures that there is buy-in from future plan implementers before the plan is even published. 

Prioritize diversity when selecting staff and partners for plan development and implementation. The SHIP will serve all people in your state or territory, so it must reflect the understanding and needs of everyone. Including a diverse group of people and organizations in developing and implementing the plan helps represent the needs of the regions they come from.  

Rely on established frameworks to guide your plan development. Use a framework — like Healthy People 2030 for planning and evaluation and the BARHII framework for data collection — to help guide both SHA and SHIP development. Frameworks help make sure you adhere to best practices and stay consistent and organized throughout your planning efforts.  

Ensure that priority indicators are measurable. Measurable indicators make monitoring and tracking progress over the course of the SHIP much more manageable. Ensure the indicators you select for tracking are measurable, good proxies for the outcomes you want to achieve, and available at regular intervals and reliable. Unsure of where to start? Check-out the Healthy People 2030 in States and Territories webpage and the leading health indicators.