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. It reaffirms public health's essential role in addressing policy and structural factors affecting health, as articulated by the Ten Essential Public Health Services, 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. 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. 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. 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.
History
HiAP builds off the concepts embedded in "healthy public policies" and "intersectoral action for health," promoted over the past four decades. 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. 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.
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. 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.
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". The South Australian model of HiAP is based on two basic elements: central governance and accountability and a "health lens" analysis process.