'Health in All Policies' Showcases Public Health’s Applicability Across Sectors

June 29, 2015|10:01 a.m.| Kristen Lewandowski

This is the first in a two-part series on how states are employing the concept of Health in All Policies to improve public health.

Health in All Policies: An Introduction

Minnesota Commissioner of Health Edward Ehlinger first started to adopt the public health best practice of Health in All Policies (HiAP), which he now champions at the state public health level, when he became a physician more than 45 years ago. Ehlinger recognized back then that his work during office visits with patients could sometimes be eclipsed by what they experienced once they walked out the door.

“I realized there were factors outside the clinic that were overwhelming the healthcare I was providing; things like tobacco use, obesity, occupational safety, clean environment—a whole variety of things,” says Ehlinger.

HiAP is defined by ASTHO as “a collaborative approach that integrates and articulates health considerations into policymaking and programming across sectors, and at all levels, to improve the health of all communities and people. The concept requires public health practitioners to collaborate with other sectors to define and achieve mutually beneficial goals.” Simply put, using a HiAP lens encourages governmental and nongovernmental decisionmakers and leaders to consider and recognize the health implications of their work, whether it’s a transportation department discussing how a highway project will impact pedestrian safety or a zoning committee investigating how street lighting regulations impact neighborhood crime.

HiAP strategies can take many shapes and range from information sharing to funded collaborations. “New HiAP initiatives can begin with activities that promote basic information exchange between partners to open up the door for engagement, build relationships, and even increase awareness of public health linkages; it doesn’t have to be something big,” says Kerry Wyss, ASTHO’s director of environmental health. “HiAP often begins with new relationship building. For example, inviting a health department member to sit on an advisory committee for a non-health entity is a win for both parties because it opens up an opportunity to raise new health considerations in a forum that might not already be considering them.”

Since its origins with the World Health Organization’s (WHO) 1978 Declaration of Alma-Ata, which proclaimed for the first time the right of “health for all,” HiAP has grown from a revolutionary way for public health leaders to engage other sectors in health-related issues to a standard public health practice that is recognized both internationally and domestically. HiAP was officially given its name in 2006, when it was the main theme of the Finnish European Union presidency, and WHO’s 2010 “Adelaide Statement on Health in All Policies” noted that “government objectives are best achieved when all sectors include health and well-being as a key component of policy development.” When LaQuandra Nesbitt was appointed director of the District of Columbia Department of Health in December 2014, her initial goal was to replicate her success at Kentucky’s Louisville Metro Department of Public Health by implementing an agency-wide HiAP focus.

Communicating HiAP to Others

Although HiAP is continually becoming more widely understood, it’s not always easy to obtain buy-in for the concept, even from others in the public health field. “Public health often suffers from the fact that people pigeonhole us into a certain place,” Ehlinger says. “For example, they’ll say, ‘that’s not your swim lane—housing is in charge of that.’ But, I’ll respond that public health doesn’t have a swim lane—we’re concerned about the entire pool. We shouldn’t limit ourselves to narrow notions of what public health does. Public health should focus on the conditions that create health.”

Ehlinger has found it helpful to sit down one on one with leaders from other sectors to help them see how their work directly impacts public health. “If you simply ask, ‘Do you have anything to do with health?’ many people will say no,” he says. “But [that changes] if you start to talk about the conditions that create health. With that perspective, my fellow commissioner in transportation quickly realizes how the work of his agency around complete streets, safe routs to school, and reducing motor vehicle deaths impacts public health. Similarly, the commissioner of corrections quickly recognizes that his agency’s role in health is not just how we treat inmates in prisons, but also about how we train and prepare inmates to go back into the world and whether they have safe and stable housing. When people really start to think about health from a broader definition than just disease and the role that living conditions play in determining health, they quickly understand their role in a Health in All Policies approach.”

Simply put, says Wyss, “HiAP adds a framework for providing evidence-based health and equity information to policy and program development in other sectors more explicitly and routinely. If you’re using this approach, you are opening new opportunities to consider health in decisionmaking.”

Learn more about ASTHO's Health in All Policies work on our HiAP web page.