In This Article Expand or collapse the "in this article" section Healthy Public Policy

  • Introduction
  • Applications and Local Activities
  • Intersectoral Action (for HPP)
  • Healthy Public Policies Generated by the Health Sector
  • Tools and Resources
  • International Activities and Statements
  • Other Web Resources
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Public Health Healthy Public Policy
by
Patrick Harris, Marilyn Wise
  • LAST REVIEWED: 13 December 2022
  • LAST MODIFIED: 25 March 2020
  • DOI: 10.1093/obo/9780199756797-0196

Introduction

Healthy public policy (HPP) became an important idea in the 1980s. The concept can be traced primarily to Nancy Milio, who produced a now hard-to-find book, Promoting Health through Public Policy (Philadelphia: Davis, 1981), and was subsequently cemented in the WHO’s Ottawa Charter for Health Promotion as a strategy to use in promoting, protecting, and maintaining the health of populations. HPP is not, however, a modern phenomenon. Historically HPP was embedded in the 16th-century Poor Laws and passed through to 19th- and early-20th-century public health activity and legislation. Across this history is the recognition that improving public health requires addressing the social and economic (and environmental) conditions created by public policy. It follows, as explained by many, that public health practice is inherently political. This bibliography introduces the large literature that falls under the broad pantheon of HPP. Definitions, as this bibliography will show, do matter. Central is the often underrealized truth that “healthy public policy” fundamentally concerns how public policy influences the health of populations. This, in turn, necessitates that HPP practice is interdisciplinary. For knowledge, this means much of the theory and evidence underpinning HPP is to be found in other disciplines that have public policy at their core, political science being the most obvious (public administration another). It is through HPP that societies in general and public health researchers and practitioners in particular seek to create social and economic and environmental conditions for whole populations. Attention thus moves “upstream” to policies and institutions rather than “downstream” to behaviors or health services. Not all healthy public policy is generated with the intention to influence population health directly. Nor are all public policies that impact on the health of populations generated by the health sector, although many are. A core goal of HPP is reducing inequities in health. These inequities are what the 2008 WHO Commission on the Social Determinants of Health named as a “toxic mix of poor social policies, unfair economic arrangements and bad politics.” Just as policy actors are responsible for policies that have created inequalities, so too are they responsible for developing and implementing policies in that overcome the unfair and unjust distribution of the resources necessary for good health and well-being. Public policies are formed through “contests for power” between the various actors involved in policy-making in part because they are value-laden. The choices actors make are influenced by powerful structures and ideas that are not always explicit. HPP, therefore, can never be “atheoretical” just as it cannot be divorced from a normative position (what is believed “should” happen) concerned with changing political conditions for the betterment of the health of the population in general and disadvantaged in particular. In recent years there has been some confusion (see Oxford Bibliographies article Health in All Policies) whether HiAP replaces HPP as a concept and method. This article errs on the side of history by suggesting HiAP, with intersectoral action, is one recent strategy to achieve HPP.

Introductory Works

There is a range of seminal texts introducing HPP. The “ecological” approach that is central to these early texts is notably out of date and has been replaced by a complex systems and network governance approach, but, as Milio argued, in order to achieve optimum population health and health equity all public policies must take into account the health interests of the public. HPP requires collaboration across sectors, levels of government and non-Government Organisations, community and private sectors. Simon Szreter and others provide an extensive historical analysis of public policymaking—a valuable backdrop to understanding HPP—beginning with the realization that HPP may be generated by any sector, and that progressive change requires democracy, sustained advocacy, and action by all forms of governance to bring the benefits of policy change to the whole population. Once change has been achieved, there must be vigilance to protect and maintain it. Healthy public policies can be, but are not always, generated by or with the health sector; many are instead generated by sectors other than health—with no a priori reference to health or health equity. A significant challenge for HPP work for population health, however, lies in identifying ways in which the workforce can advocate for, support, and work to secure the adoption of policy ideas intended to increase economic and social equity as contributions to the health of the population. It is a question as to whether this is a legitimate role for the population health workforce—or whether, instead, the work to secure the adoption of such policies lies in our roles as citizens, community members, and voters. Working through these introductory texts it will become clear that the journal Health Promotion International has played a central part in progressing HPP (and more recently HiAP). This is largely due to the mission of the journal to advance the ideas presented in the Ottawa Charter. Crucial across these articles is the identification that the HPP “oeuvre” has failed to take on theoretical insights from political science, the discipline most concerned with the same objective that HPP is concerned with—that is, “healthy” public policy. This is a theme taken up in two important glossaries in Journal of Epidemiology and Community Health (JECH) which provide the essential definitions to build a deeper understanding of HPP by being interdisciplinary in focus and turning to the political science literature.

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