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WHO Collaborating Centre on Health in All Policies and the Social Determinants of Health

HiAP approach

What is Health in All Policies (HiAP)?

The formal definition used in the WHO 2013 Health Promotion conference is that Health in All Policies (HiAP) is 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. A HiAP 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.1

Other definitions emphasize e.g. that HiAP is a strategy for promoting action on social    other determinants of health (SDH) by facilitating action in sectors where health is not a priority concern.2,3

In practice, HiAP approach aims to:

  • include health considerations into policy decisions in other policies, which affect health, health systems to improve population health and equity
  • provide information and evidence from a health policy perspective at the governance level, where the policies are shaped. It thus seeks to keep all sectors and levels of government more accountable for policy decisions that affect health and health systems and support intersectoral health action and solutions for better health outcomes
  • investigate the effects of policies and interventions on health determinants, risk/protective factors, health outcomes, and health systems, as well as the distribution of these effects across different population groups
  • inform policymakers from all sectors and the public about how policy decisions affect health and health systems, especially health distribution and equity.4

Sources:

  1. World Health Organization & Finnish Ministry of Social Affairs and Health 2013.  The Helsinki Statement on Health in All Policies. The 8th Global Conference on Health Promotion, Helsinki, Finland, 10-14 June 2013. https://www.who.int/healthpromotion/conferences/8gchp/8gchp_helsinki_statement.pdf
  2. Leppo, K., Ollila, E., Peña, S., Wismar, M. & Cook, S. Health in All Policies. Seizing opportunities, implementing policies. Ministry of Social Affairs and Health Available from https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/69920/URN_ISBN_978-952-00-3407-8.pdf?sequence=1&isAllowed=y
  3. WHO 2014. Health in All Policies (HiAP) Framework for Country Action. Available from https://www.who.int/cardiovascular_diseases/140120HPRHiAPFramework.pdf
  4. THL 2019. Health in All Policies – Management of health and wellbeing promotion. https://thl.fi/en/web/management-of-health-and-wellbeing-promotion/management-of-wellbeing/practices/health-in-all-policies [Read in Nov 2021]

Strategic approaches to HIAP

Health in All Policies can use different types of strategies depending on the problem, policy or level of decision-making in question. We can identify four basic strategies for HiAP, namely: health strategy, win-win strategy, cooperation strategy, and damage limitation strategy.1 These fit to different problems and challenges. HIAP can extend to parliamentary decision-making and bi-partisan policies or wider to civil society, but it can also be more limited to different sectors and actors under public policy or have an emphasis on local or national government.2

Health issues are now an integral element of policymaking across sectors. The basic goal of intersectoral action is to improve administrative cooperation within the public sector. For example, education, environment, water and sanitation, planning, labor, housing, traffic, agriculture, and nutrition policies have all contributed to significant improvements in health.3

Health policy priorities are often supported by other sectors simply because they make sense from their position. Nutritious food at school, as well as sports activities, can support students’ learning. It is beneficial to both the environment and one’s health to increase cycling and walking.3

Intersectoral action has also been used to address specific health challenges which extend to other sectors. Changes in laws, legislation, and regulation in other areas have benefited heart health by resulting in higher-quality food, less smoking, and more physical exercise.3

Strategic thinking is an essential element for Health in All Policies as it can be addressed in a variety of ways. This can include also responding to and assessing policy ideas and efforts from other sectors in order to guarantee responsibility for their consequences for health and equity. HIAP does not necessarily require cooperation or joined activities if these are not needed and different sectors, policies and problems may require different type of action.2,4

Constitutional commitments and legal statutory obligations can form strategic means for action. Issue-based actions are one key means to engage with HIAP. These are aimed at solving a specific problem (e.g., obesity) or focus for action (e.g., nutrition). Collaborative activities and processes are typically used to address a specific cross-sectoral issue or concern. This can support other ministries’ motivation and representation in such processes as it allows for the selection of individuals who are more inclined to work in a relevant substantive area for action.3

Sources:

  1. Ollila, E. 2011. Health in All Policies: From rhetoric to action. Scandinavian Journal of Public Health.  https://doi.org/10.1177/1403494810379895
  2. Ståhl, T, & Koivusalo, M. 2020. Health in All Policies: Concept, purpose, and implementation. In: Haring et al (eds) Handbook of Global Health. https://doi.org/10.1007/978-3-030-05325-3_80-1
  3. THL 2019. Management of health and wellbeing promotion. Strategies. Available from https://thl.fi/en/web/management-of-health-and-wellbeing-promotion/management-of-wellbeing/practices/health-in-all-policies/implementation/strategies
  4. Koivusalo, M. 2014. Health in All Policies ja Equity – Realising the Challenge. Discussion paper for the equity action project. National Institute for Health and Welfare. Available from https://www.julkari.fi/handle/10024/127134

Wellbeing economy as a new perspective

The emphasis on economy of wellbeing can be seen as an important opportunity to put wellbeing at the core of economic policy. However, we do not have a unified definition of the term and often this becomes considered more as a means to ensure that health measures contribute to economic growth. This is articulated in emphasis that: An economy of wellbeing gives potential to improve both wellbeing and economy at the same time. Economy of wellbeing puts human wellbeing at the center of economic policy. Economic success and stability are guided by a goal of human wellbeing. The opposite is also true: increased wellbeing has been enabled by economic growth and stability.1

The EU’s Well-Being Strategy seeks to demonstrate that wellbeing is no longer just another side note. However, this is an aspirational aim and realisation of such aim would require that health priorities have a greater role also in economic decision-making. While focus on economy of wellbeing remains on improving wellbeing, we have a challenge that economic and commercial policy priorities begin to shape health policy options rather than vice versa. This is reflected, for example, in the promotion of public-private partnerships and social impact investment under economy of wellbeing.2

WHO has also begun to develop an agenda on wellbeing with exploration also on wellbeing economy and health and wellbeing under health promotion, and sustainable development exploring situation and policies in different countries.3

Sources:

  1. Ministry of Social affairs and Health 2021. An economy of wellbeing simultaneously increases wellbeing and sustainable economic growth. Available from https://stm.fi/en/economy-of-wellbeing [Read in Nov 2021]
  2. Council of the European Union 2019. The Economy of Well-Being – Executive Summary of the OECD Background Paper on “Creating opportunities for people’s well-being and economic growth”. Available from https://data.consilium.europa.eu/doc/document/ST-10414-2019-INIT/en/pdf
  3. World Health Organization (WHO) 2021. Towards developing WHO’s agenda on well-being. Geneva. Available from https://www.who.int/publications/i/item/9789240039384

More:

Diener, E. & Seligman, M. 2004. Beyond Money: Toward an Economy of Well-Being. Psychological Science in the Public Interest. 5(1):1-31. https://doi.org/10.1111/j.0963-7214.2004.00501001.x