Health in All Policies (HiAP) was a term first used in Europe during the Finnish presidency of the European Union (EU), in 2006, with the aim of collaborating across sectors to achieve common goals. It is a strategy to include health considerations in policy making across different sectors that influence health, such as transportation, agriculture, land use, housing, public safety, and education.Leppo, K., Ollila, E. Health in All Policies: Seizing Opportunities, implementing policies. Ministry of Social Affairs and Health, Finland: Helsinki 2013Kickbusch I, Buckett K, editors. Implementing Health in All Policies: Adelaide 2010. Adelaide, South Australia: Department of Health, Government of South Australia; 2010. It reaffirms public health's essential role in addressing policy and structural factors affecting health, as articulated by the Ten Essential Public Health Services,"Public Health in America." Health.gov | Your Portal to Health Information from the U.S. Government. Public Health Functions Steering Committee, July 1995. and it has been promoted as an opportunity for the public health sector to engage a broader array of partners.
Overview
The 1978 World Health Organization (WHO) declaration at Alma-Ata was the first formal acknowledgment of the importance of intersectoral action for health.World Health Organization (WHO). Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. WHO, Geneva, 1978. Available at: The spirit of Alma-Ata was carried forward in the Ottawa Charter for Health Promotion (adopted in Ottawa in 1986), which discussed "healthy public policies" as a key area for health promotion.
HiAP is built on the rationale that health is determined by multiple factors outside the direct control of the health care sector, such as education, income, and the conditions in which people live, work, and play.Healthy People 2020. Department of Health and Human Services, 7 June 2012. Web. Jan. 2013. <http://www.healthypeople.gov>. Decisions made in other sectors can positively or negatively affect the determinants of health. HiAP is an approach to policy making in which decision-makers in other sectors routinely consider health outcomes, including benefits, harms, and health related-costs.
HiAP has also been described as an essential component of primary health care."The World Health Report 2008." WHO. World Health Organization, Web. Jan. 2013. <http://www.who.int/whr/2008/whr08_en.pdf>. HiAP has been most commonly implemented by federal, state and local governments, but it can also be applied to both private and non-profit policy-making."Health in All Policies." The National Association of County and City Health Officials | NACCHO. Web. Jan. 2013.
History HiAP builds off the concepts embedded in "healthy public policies" and "intersectoral action for health," promoted over the past four decades.Peña, Sebastián. "Health in All Policies: The emperor’s old clothes | Healthy Policies." Healthy Policies | For A Healthier World. Web. Jan. 2013. <http://www.healthypolicies.com/2011/08/health-in-all-policies-the-emperor’s-old-clothes/ >. The spirit of Alma-Ata was carried forward in the Ottawa Charter for Health Promotion (adopted in Ottawa in 1986), which discussed "healthy public policies" as a key area for health promotion. Increased attention to the role of non-health sectors in promoting health continued to grow with discussions held at the Second International Conference on Health Promotion in Adelaide, Australia in 1988.WHO and the Government of South Australia. (2010) The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Health Promotion International. In 2007, HiAP was recommended by Adelaide Thinker in Residence Ilona Kickbusch as a new approach to health and governance in South Australia.
Definition In the context of the 8th WHO Global Conference on Health Promotion, it has been defined as "an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity." Such an approach is founded on health-related rights and obligations. It emphasizes the consequences of public policies on health determinants and aims to improve the accountability of policy-makers for health impacts at all levels of policy-making.8th WHO Global Conference on Health Promotion. Official website. http://www.healthpromotion2013.org/health-promotion/health-in-all-policies
Examples worldwide
HiAP has been widely implemented in many parts of the world.
Finland One of the first countries to adopt a "healthy policies" approach to address public health concerns was Finland. The North Karelia Project, launched in 1972, aimed to reduce the impact of coronary heart disease in the Finnish region of North Karelia by engaging other sectors (like community organizations, dairy and meat producers, schools) to improve community health. The project, which involved the support of the Finnish authorities and the WHO, resulted in significant reductions in cardiovascular disease mortality and has been noted as a successful model for cross-sector collaboration.Puska, P.,Vartiainen, E. et al. The North Karelia Project: from North Karelia to National Action. National Institute for Health and Welfare: Finland 2009 Finland has continued its work in HiAP. For example, in 2001 Finland formulated the principles for the implementation of the Health 2015 cooperation program that provides a framework for intersectoral health promotion. The purpose of the long-term health policy strategy is to improve health, help promote the adoption of healthy lifestyles among the Finnish people and to reduce health disparities between different groups of the population."Health 2015 public health program." Ministry of Social Affairs and Health- Finland. Web. 5 Feb. 2013. <http://www.stm.fi/en/health_2015 >.
Australia The implementation of HiAP in South Australia has focused on "developing a process to position HiAP as a core process of government, rather than an approach run by and for the health sector".Buckett, Kevin. "Health in All Policies Adelaide 2010 International Meeting." Public Health Bulletin SA 7.2 (2010): 1-60. Web. Jan. 2013.<http://www.health.sa.gov.au/pehs/publications/publichealthbulletin-pehs-sahealth-1007.pdf >. The South Australian model of HiAP is based on two basic elements: central governance and accountability and a "health lens" analysis process.
The 2010 Adelaide Statement of Health in All Policies describes instances in which HiAP works best and provides tools that can be useful at different phases of policy implementation. While South Australia has formally adopted the concept of shared governance for health, critics have noted that South Australia is still far from having an established "health in all policies" governance system.
Canada ActNow BC is an ongoing example of HiAP implementation in Canada. The intersectoral-based HiAP strategy aims to improve British Columbians' health by addressing common risk factors and reducing chronic diseases. Involving local governments, communities, employers, and schools, ActNow BC seeks to develop and promote programs that make British Columbians opt for healthy choices."Health in All Policies - CIHR." Canadian Institutes of Health Research. Web. Jan. 2013. <http://www.cihrirsc.gc.ca/e/43794.html>.
France With the goal of implementing a global strategy to fight cancer, France launched the Cancer Plan in 2003. One of its main objectives was to reduce cancer mortality by 20% in 5 years, by establishing goals that involved the participation of multiple sectors. Evaluation of the plan in 2008 revealed that although progress was made in some areas, several of the goals were not met. Among the weaknesses of the plan, was the lack of consideration of social inequalities and access to health care and an ineffective coordination of patient care.Haut Conseil de la Sante Publique, Evaluation du Plan Cancer, Rapport Final, 2009 in http://www.sante.gouv.fr/IMG/pdf/rapport_cancer_230209.pdf To address the deficiencies of the 2003 plan and continue with its implementation, the French Government launched the Cancer Plan 2009-2013 in November 2009.Institut National du Cancer, Cancer Plan 2009-2013, 2009 in www.e-cancer.fr/component/.../4787-plan-cancer-version-anglaise
Thailand Fueled by the health reform in 2000, Thailand has encouraged the practice of intersectoral collaboration by making the use of Health Impact Assessments (HIAs) mandatory at all levels of government.Kang, E; Park, H; Kim, J. Health Impact Assessment as a Strategy for Intersectoral Collaboration, Journal of Preventive & Public Health, 2011: 44(5): 201-209. HIAs have been conducted to help combat the increasing number of health problems caused by air pollution, pesticide contamination, coal-fired power plants, and other environmental hazards. HIAs are seen as a valuable tool to promote collaboration between stakeholders to consider diverse interests and identify approaches to design a healthier society.Phoolcharoen, W; Sukkumnoed, D & Kessomboon, P; Development of health impact assessment in Thailand: recent experiences and challenges; Bulletin of the World Health Organization 2003, 81 (6).
United States Federal Since 2009, the Departments of Transportation and Housing and Urban Development and the Environmental Protection Agency have worked together through the Partnership for Sustainable Communities. The three agencies jointly prioritized six livability principles that have been used to guide funding decisions, proposed policies, and legislative recommendations within the agencies. The principles target improvements in affordable housing, green building, transit, mixed-use development, water management, and brownfield space. Each of the principles promotes the mission of one or more of the individual agencies, such as efficient transportation, economic development, clean environment, etc. Many of the individual principles are also understood to contribute to health outcomes. Through a growing portfolio of case studies from at least 45 communities across the US, the partnership has demonstrated that individual elements of building healthier communities can contribute to other policy goals, such as greater economic development and better living conditions.
The concept of HiAP is included in section 4001 of the Patient Protection and Affordable Care Act (2010), which mandated creation of the National Prevention Council, led by the Surgeon General of the United States, and the development of the National Prevention Strategy.National Prevention Council, National Prevention Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011. The National Prevention Strategy, published in June 2011, calls for increased coordination between government agencies, as well as partnerships with community organizations, businesses, healthcare providers, and others. The National Prevention Strategy prioritizes work around four strategic directions: creating healthy community environments, empowering individuals to make healthy choices, integrating clinical and community preventive services, and reducing health disparities. That can be accomplished, for example, through creating more neighborhoods with better access to fruits and vegetables, active transportation, and clean air.
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