Health in All Policies

by

Louise St-Pierre

• LAST REVIEWED: 27 March 2014
• LAST MODIFIED: 27 March 2014
• DOI: 10.1093/obo/9780199756797-0103

Introduction

The phrase Health in All Policies (HiAP) became popular during Finland’s presidency of the European Union in 2006. It refers to an approach for promoting the health of the population through decisions made by all sectors of government at all levels of decision making. Interest in this approach has spread rapidly internationally, including interest among several governments; HiAP is seen as a way to address complex public health problems that cannot be solved by the health sector alone. According to the definition recently adopted by the World Health Organization, HiAP “is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity. It improves accountability of policymakers for health impacts at all levels of policy-making. It includes an emphasis on the consequences of public policies on health systems, determinants of health, and well-being” (World Health Organization 2013, p 1, cited under Country Case Studies). Therefore, at governmental level, HiAP calls for intersectoral governance for health and well being. Even though the ideas underlying this approach (that health is created outside of the health sector) and the principles of action governing it (intersectoral governance, upstream intervention, and shared responsibility toward population health) are not new to public health, HiAP establishes a strong, systematic process that takes the impact of health into account in a horizontal and permanent way across governments. Thus, it introduces a new challenge for the health sector as it has to learn to operate from within a complex decision-making process, overcome traditional “silos,” understand the reasoning behind decision making in other sectors, get acquainted with their vocabularies and thought processes, and pay attention to the achievement of their goals. However, HiAP is a concept that is still evolving. On the theoretical side, the boundaries between the concept of HiAP and that of healthy public policy or intersectoral policies for health are not always clearly delineated. This occasionally creates some confusion on the practical level. This article presents an overview of the discussions that have been taken place so far on this issue. It focuses exclusively on the experiences, questions, and processes that refer to the notion of HiAP, as defined here, and does not cover all the activities relating to intersectoral policies for health. There is still a lot to learn regarding how to implement this approach at governmental level, the conditions for success, its efficiency in terms of advancing population health, the limits of the approach, and the role of the public health sector.

Introductory Works

Several fundamental titles have been produced since the inception of the idea of HiAP in 2006. Most recent, and perhaps the more comprehensive to date, is Leppo, et al. 2013, a Finnish contribution to the 8th Global Conference on Health Promotion; it is intended to reach national-level policy makers within all government sectors. The first section, most notably Ollila, et al. 2013, provides a good introduction to HiAP, while the second part gives examples that cover eight policy areas. This book builds upon Ståhl, et al. 2006, which coined the term HiAP, and which is a legacy of the Finland’s presidency of the European Union in 2006. Both focus on the policy-making level and seek synergies with non-health sectors. Both contain many useful chapters on HiAP in practice. If in 2006 the legitimacy of the HiAP approach was based on economic arguments and the ability of the health sector to generate wealth, we have since seen its evolution. Leppo, et al. 2013 situates HiAP as having “a strong foundation on human rights and social justice” (p. 4). Kickbusch 2008 contributes to establishing the basis of HiAP, illustrating the HiAP approach established at the “upstream” level. Kickbusch and Buckett 2010, produced during the government of South Australia’s implementation of HiAP, is a collection of reports that support the organization of the 2010 International meeting on Health in All Policies in Adelaide. An influential theme of this volume is that of intersectoral governance as a means to address “wicked problems,” defined as problems that are extremely resistant to solution and that must be addressed by more than one sector. It frames HiAP in the third wave of the evolution of intersectoral policy, after intersectoral action for health and Healthy Public Policy, and introduces a new way of thinking and of working. In accordance with the other reference books cited here, there is a plea to work horizontally within the government and to systematically consider health in all policy processes. All of the books mentioned here share a common argument for the advantages of a healthy population: health is seen as a social and economic strength for societies and is instrumental in reaching goals that are pursued in other sectors.

• Kickbusch, I. 2008. Healthy societies: Addressing 21st century health challenges. Adelaide: Government of South Australia.

  Clearly positions the purpose of the approach and illustrates how it can be integrated into the governments’ strategic planning, confirming its pan-governmental character that goes beyond the healthcare sector.

• Kickbusch, I., and K. Buckett, eds. 2010. Implementing Health in All Policies: Adelaide 2010. Adelaide: Department of Health, Government of South Australia.

  Interesting points of view presenting different perspectives, both theoretical and practical. It was used as a reference document for the International Meeting on Health in All Policies that resulted in the 2010 Adelaide Statement for Health in All Policies. It is the result of reflections of several authors inspired by the 2006 document produced in Finland by Stahl, et al. (Ståhl, et al. 2006). It touches on aspects such as intersectoral governance and equity while discussing processes, methods, and tools.

• Leppo, K., E. Ollila, S. Peña, M. Wismar, and S. Cook, eds. 2013. Health in All Policies: Seizing opportunities, implementing policies. Helsinki: Ministry of Social Affairs and Health.

  This is an essential document in the field of HiAP. It was produced to support discussions at the 8th Global Conference on Health Promotion, held in Helsinki, 10–14 June, 2013. It presents the basis of the approach, its history, as well as case studies in eight policy areas including early childhood development, work and health, agriculture, and tobacco.

• Ollila, E., F. Baum, and S. Peña. 2013. Introduction to Health in All Policies and the analytical framework of the book. In Health in All Policies: Seizing opportunities, implementing policies. Edited by Leppo, K., E. Ollila, S. Peña, M. Wismar, and S. Cook, 3–24. Helsinki: Ministry of Social Affairs and Health.

  This introductory chapter gives the characteristics of the HiAP approach by providing a definition, stressing its foundations and outlining its main lines of action.

• Puska, P., and T. Ståhl. 2010. Health in All Policies—the Finnish initiative: Background, principles, and current issues. Annual Review of Public Health 31:315–328.

  DOI: 10.1146/annurev.publhealth.012809.103658

  It is a basic document that outlines the contours of HiAP from the experiences of Finland, a leader in the field of intersectoral policies in health. It distinguishes HiAP from previous intersectoral strategies, explains the reasons behind the renewed interest for the approach while stipulating that we should not focus as much on the “what” as much as the “how.”

• Ståhl, T., M. Wismar, E. Ollila, E. Lahtinen, and K. Leppo, eds. 2006. Health in All Policies: Prospects and potentials. Helsinki: Ministry of Social Affairs and Health.

  A founding document that presents the history, conditions, and basic principles of the approach as well as its importance in the European context. It provides the context of HiAP, the use of Health Impact Assessment, and the actual experiences in different sectors.