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Health in All Policies: a manual for local government

Health in All Policies (HiAP) is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas. HiAP is based on the recognition that our greatest health challenges – for example, non-communicable diseases, health inequities and inequalities, climate change and spiralling health care costs – are highly complex and often linked through the social determinants of health. Just one government sector will not have all the tools knowledge capacity, let alone the budget to address this complexity.

We are also living in a world where governance has become less authoritarian and more collaborative and where organisations and sectors implementing public policy and delivering public services recognise their interdependence (WHO 2012). The goal of HiAP is to ensure that all decision-makers are informed about the health, equity, and sustainability consequences of various policy options during the policy development process. A HiAP approach identifies the ways in which decisions in many sectors affect health, and how better health can support the achievement of goals in many sectors. It engages a range of partners from government and local government and stakeholders to work together to improve health and health equity and, at the same time, advance other goals, such as educational attainment, improved housing and green spaces, environmental sustainability, promoting job creation and economic stability. An important principle of
HiAP is that it can only take place voluntarily when all stakeholders in the process see benefits in committing to the approach (Leeuw and Peters 2014)3.

While HiAP has gained significant traction in the last few years, its origins go back 38 years to the World Health Organisation (WHO) Declaration of Alma-Ata in 1978 which expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. The WHO defines HiAP as “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”.

HiAP ecompasses a wide spectrum of activities, ranging from one-off collaborative efforts with a single partner to approaches involving ongoing collaboration across many agencies. Ultimately, the HiAP approach seeks to embed considerations of health, equity and sustainability as a standard part of decision-making processes across a range of sectors and national and local government functions. In summary:

HiAP ideally starts with the policy area (eg economic development policy or transport policy) not with a public health issue. This encourages thinking about the range of potential direct and indirect benefits/risks for health that can be created from that policy rather than ‘just’ addressing obesity or mental health, for example, which is what could happen if starting with a public health issue.

Starting with a policy issue also demonstrates that this is about the core activities in that policy area, rather than a health ‘add-on’. Nevertheless, there may also be room in discussion for looking to see how the policy area might assist in a specific public health objective, as some of the case studies below demonstrate.

HiAP is about creating places (the physical and social environment) which support and generate good health.

HiAP is about governance/policy ideas based on collaboration, partnership, structured interaction and ongoing relationships, rather than specific decisions.

HiAP needs to be integrated with other cross-cutting policy interests, such as equity, sustainability and demographic considerations.