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

HiAP in practice

Implementation research and evaluation

Shankardass et al. (2018) have created a systems framework, which they say is useful for explaining how, why, and under what conditions HiAP has been implemented successfully and unsuccessfully in the long run. It can be used by researchers to study the process, as well as policymakers and other public health actors to manage it. They also give a case study that uses the framework to examine the implementation of HiAP (the Health 2015 Strategy) in Finland.1

Greater transparency in the decision-making process, facilitating public discussion on important policy decisions, increasing awareness of potential health impacts before decisions are made, and strengthening the role of civil society organizations as watchdogs can all help to increase accountability for the health impacts of public policy decisions and their implementation. There should be systems in place to track and assess the effects of policies that have been implemented.2

WHO (2014) has also developed a “starter’s kit” framework that is based on successful implementation examples. It provides countries a practical tool for improving policy development and alignment, especially at the national level.3

Another practical WHO document (2018) lists recommendations on actions in initiating, implementing and sustaining HiAP approach and actions. This includes the need of ministries of health to take a different role and dedicated resources and investment support to mention.4

Regarding HiAP evaluation there has been little focus on comprehensive methods, and evaluation research has mostly focused on the HiAP strategies per se and the processes of cross-sectoral policy formation. Short-term evaluations and early policy development measures, which focus on monitoring the earliest steps of community participation and establishing integrated policies, appear to be well-established. The value of a larger, long-term review of HiAP work has been recognized.5

Gase et al. (2017) propose tools that combine principles from the increasing literature in the implementation and assessment of Health in All Policies. The tools may be used by practitioners and academics to enhance communication among stakeholders, clarify assumptions, determine how they will measure success, and apply data-driven strategies to improve their Health in All Policies work.6

 Sources:

  1. Shankardass, K., Muntaner, C., Kokkinen, L. et al. 2018. The implementation of Health in All Policies initiatives: a systems framework for government action. Health Research Policy and Systems 16, 26. https://doi.org/10.1186/s12961-018-0295-z
  2. Ministry of Social Affairs and Health 2013. Leppo, K., Ollila, E., Peña, S., Wismar, M & Cook, S. (Ed.). Health in All Policies. Seizing opportunities, implementing policies. 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. WHO 2018. Key learning on Health in All Policies implementation from around the world – Information Brochure. Geneva, Switzerland: World Health Organization. Available from https://apps.who.int/iris/bitstream/handle/10665/272711/WHO-CED-PHE-SDH-18.1-eng.pdf?ua=1
  5. Bauman, A. King, L & Nutbeam, D. 2014. Rethinking the evaluation and measurement of health in all policies, Health Promotion International. Volume 29, i143–i151. https://doi.org/10.1093/heapro/dau049
  6.  Gase, L., Taylor Schooley, M. L., Rotakhina, S., Vick, J., & Caplan, J. 2017. A practice-grounded approach for evaluating health in all policies initiatives in the United States. Journal of public health management and practice: JPHMP, 23(4), 339. https://doi.org/10.1097/PHH.0000000000000427

HiAP guidebooks

By addressing the core causes of disease and health inequities, the WHO advocates for increased worldwide efforts to promote health in some of the world’s poorest and most vulnerable populations. Their Training Manual was published in 2015 to address this issue to encourage action, create awareness, and simplify the implementation of a HiAP strategy.1

This manual is a training resource that increases understanding of the importance of Health in All Policies among health and other professionals. The material will form the basis of workshops, which will: “build capacity to promote, implement and evaluate HiAP; Encourage engagement and collaboration across sectors; Facilitate the exchange of experiences and lessons learned; Promote regional and global collaboration on HiAP and Promote dissemination of skills to develop training courses for trainers.”1

Another PAHO guide looks at how the health sector can effectively connect and collaborate with other sectors. It demonstrates case studies from the Region of the Americas to provide recommendations on effective approaches to collaborating with other sectors, and it proposes potential indicators under each of the six strategic lines of action identified in the WHO Health in All Policies Framework for Country Action. These ideas and indicators are meant to assist countries in developing their own national plans that incorporate Health in All Policies.2,3

International Association for Impact Assessment (IAIA) provides the international forum to advance best practice and innovation in impact assessment and advocates for its expanded use for the betterment of society and the environment. They offer a refined definition of Health Impact Assessment (HIA) to promote its use and lead to improved consideration of health when developing new projects, programs, plans, policies or strategies in all sectors. The definition emphasizes that HIA is concerned with protecting and improving health; it demonstrates that HIA can establish frameworks for monitoring and evaluation, indicating that it is relevant beyond the design stage of a development initiative; and it places HIA, and human health and wellbeing, at the heart of sustainable development.4

Sources:

  1. Pan American Health Organization (PAHO) 2015. Health in All Policies: Training Manual. Available from https://www3.paho.org/hq/index.php?option=com_content&view=article&id=10526:2015-health-in-all-policies-training-manual&Itemid=40177&lang=en
  2. World Health Organization (WHO) 2014. Health in All Policies (HiAP) Framework for Country Action. Available from https://www.who.int/cardiovascular_diseases/140120HPRHiAPFramework.pdf
  3. Pan American Health Organization (PAHO) 2015. Advancing the Health in All Policies Approach in the Americas: What Is the Health Sector’s Role? A Brief Guide and Recommendations for Promoting Intersectoral Collaboration. Available from https://www.paho.org/hq/dmdocuments/2015/hiap-Brief-Guide-and-Recomendations-ENG.pdf
  4. International Association for Impact Assessment (IAIA) 2021. Health Impact Assessment. Available from https://iaia.org/uploads/pdf/SP5%20HIA_21_5.pdf

HiAP in a pandemic and post-pandemic world

HiAP has been used as part of pandemic measures, but pandemic measures and health security have also become a more prominent part of HiAP measures. WHO Europe has engaged with and produced the so-called Monti Commission report, which is a Pan-European Commission on Health and Sustainable Development. The report has made recommendations for 53 countries in the WHO European Region, calling for action at all levels of society. It discusses and proposes measures for One health, inequality, innovation, investment, surveillance and monitoring, and global and regional governance to formulate a new strategy on sustainable development and health.1

Health in All Policies has also been seen as the key driver for health and wellbeing in a post-pandemic world.2 WHO has provided for evidence brief on COVID-19 and the social determinants of health and health equity, which traces the unequal impacts of the pandemic.3 WHO also has given policy recommendations for heads of government, ministries of finance and leaders outside the health sector in 2021 in order to mitigate the health and socioeconomic impacts of the coronavirus disease pandemic (COVID-19) on all aspects of society.4

Watch our webinar on pandemics, social security and HiAP: https://www.youtube.com/watch?v=0S1CA3JwiNQ

Sources:

    1. World Health Organization (WHO) 2021. Drawing light from the pandemic: A new strategy for health and sustainable development. Available from https://www.euro.who.int/en/health-topics/health-policy/european-programme-of-work/pan-european-commission-on-health-and-sustainable-development/publications/drawing-light-from-the-pandemic-a-new-strategy-for-health-and-sustainable-development-2021
    2. Green, L., Ashton, K., Bellis, M.A., Clemens, T. & Douglas, M. 2021. ‘Health in All Policies’-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph18189468
    3. World Health Organization (WHO) 2021. COVID-19 and the social determinants of health and health equity: evidence brief. Available from https://www.who.int/publications/i/item/9789240038387
    4. World Health Organization (WHO) 2021. Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: a brief on the WHO position. Available from https://www.who.int/publications/i/item/WHO-UHL-PHC-SP-2021.02