Critical HiAP analysis
There are some critical notions about HiAP and why it hasn’t gained a place in governments. Suggestions for collaboration and integration by explicitly designing intersectoral actions have been made. Also, assessment of the impact of all policies and programs for their effect on health should be considered more carefully. Some progress has been made to achieve these goals but considering the size of the problem the actions have not been sufficient. A successful operationalization of HiAP may require new structures and actions such as network of committees and joined-up processes.1
While political silos, difficulties in measuring impacts and challenges in governments’ long-term commitment still occur as obstacles, there are some suggested solutions for overcoming. More evaluation and economic modelling should be done, and effective tools be developed, tested, and encouraged to be used. Health Impact Assessment (HIA) can be seen as one central tool, but a more intersectional lens that identifies the complex relations between determinants of health needs to be improved.1
Cairney et al. (2021) challenge the general narrative that characterizes the discussion and research on HiAP. The interpreted misleading consensus may interrupt the implementation of HiAP and leads to the high hopes of the effects to appear more or less invisible. They argue that the dominant narrative of HIAP in theory does not reflect the meaning of HIAP in practice. The former is an ambitious plan to address the socioeconomic determinants of health by enacting radical policy changes in multi-sectoral settings. The latter is an ambitious strategy on paper only, representing moderate policy change at best. In the situation of extremely uneven resources and status, intersectoral action weakens the objectives of HIAP enthusiasts and doesn’t develop the policies they favor. They believe that the solution lies in gaining a more realistic and comprehensive knowledge of politics, power, and political processes, which may be facilitated by applying policy research theories.2
Sources:
- Greaves, L.J. & Bialystok, L.R. 2011. Health in All Policies — All Talk and Little Action? Can J Public Health 102, 407–409. https://doi.org/10.1007/BF03404187
- Cairney, P., St Denny, E., Mitchell, H. 2021. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. https://open-research-europe.ec.europa.eu/articles/1-23/v1