Health in All Policies Policy Statement
September 01, 2017
ASTHO Encourages Adoption and Implementation of a Health in All Policies Approach to Achieve Optimal Health for All
Community health is determined by a multitude of factors beyond healthcare and, in many cases, beyond the traditional scope of public health activities. Public health practitioners, researchers, and policymakers have started to look more closely at social, economic, and environmental circumstances as the root causes of diseases and health inequities. The United States must take decisive action to achieve health equity and create opportunities for optimal health for all individuals by eliminating the health disparities experienced disproportionately by some segments of the population.1
Health in All Policies (HiAP) is an encompassing approach that goes beyond the boundaries of the health sector through cross-sector collaboration to achieve health equity. ASTHO defines HiAP as a collaborative approach that integrates and articulates health considerations into policy making and programming across sectors, and at all levels, to improve the health of all communities and people.2 The 2011 National Prevention Strategy endorses a HiAP approach to increase the number of Americans who are healthy at every stage of life. Several state and local governments have also integrated HiAP strategies into their work and strategic plans through memorandums of understanding (MOUs), advisory boards, or task forces for cross-sector collaboration.3
The HiAP approach aims to have governmental entities consider health and health equity in all decisions to improve health outcomes, mitigate health disparities, and achieve optimal health for all by establishing a multidisciplinary framework that facilitates cross-sector collaboration to unite and advance the health of the population. ASTHO has identified the key elements of HiAP as defining mutually beneficial goals, cross-sector collaboration, stakeholder engagement, opportunity for policy change, and the promotion of health and health equity.4,5 HiAP can be applied to a one-time collaboration or to a comprehensive approach that aims to change government structures and processes so health is routinely considered.
Ultimately, HiAP strives to embed and institutionalize considerations of health, equity, and sustainability as a standard part of decision-making processes across multiple sectors.6 It is important for state and territorial health agencies (S/THAs) to embrace HiAP and assume a leadership role in the process to improve the long-term health and health equity of communities.
Recommendations and Strategies for Advancing HiAP
General HiAP Recommendations for S/THAs. ASTHO recognizes that population health and health equity cannot be improved without addressing disparities and their root causes.
- Work across sectors to improve the public’s health, acknowledging that decisions and policies made in non-health sectors significantly impact the health of all populations.
- Utilize HiAP as a strategy for moving S/THAs and their partners closer to the goal of achieving health equity and addressing the social, economic, and environmental determinants of health.
S/THA Leadership Opportunities. ASTHO supports S/THAs as leaders in promoting HiAP and encourages leadership in other sectors to incorporate health, equity, and environmental justice considerations into their work.7
- Work through existing networks with missions closely aligned with HiAP to help identify the win-win opportunities. ASTHO believes that HiAP is most effective in achieving sustained integration of health concepts into the work of non-health sectors (e.g., transportation planning, community zoning, etc.) when common goals are defined and specific activities are proposed that benefit both parties and advance mutual priorities. This may also include learning the language and terminology used by another sector to better understand their mission and principles.
- Provide ongoing consultation on health and health equity matters when current laws mandate the inclusion of health in state projects and policies.
- Integrate HiAP into ongoing S/THA work across all departments and levels, including policy, programs, and initiatives, as a means of employing a comprehensive approach to broadly address public health, health equity, and issues related to the social determinants of health.8,9
Strategies for Achieving HiAP. ASTHO supports the use of HiAP principles and strategies to align public health and healthcare systems. ASTHO also recognizes the crucial role of local partners, including local health agencies, nongovernmental agencies, tribal governments, and community members, in defining the health values and needs of their own communities and encourages S/THAs to provide support for their work within this HiAP context.
- Promote HiAP by framing key issues in a way that resonates with local decision makers and residents.
- Use health impact assessments and health lens analyses as promising tools for achieving HiAP and systematically identifying health impacts of proposed policies, programs, and initiatives.
- Assemble state-level, multi-agency task forces to begin discussions around HiAP or specific topics for collaboration, such as community planning.
- Engage private and business sector partners in HiAP initiatives.
- Recognize and enumerate the economic costs and benefits of HiAP strategies and activities.
- Develop multi-sector planning groups and policies aimed at reducing adverse childhood experiences which can have lifelong health effects, including the development of chronic diseases later in life.10
- Consider built environment approaches combining transportation system interventions (e.g., street connectivity, sidewalk, trail, and bike infrastructure) with land use and environmental design (e.g., mixed-use communities and access to parks and recreation) to increase physical activity. 11
Healthy communities often share characteristics, such as access to quality, affordable housing, education, and healthcare services; equitable social policies; access to multi-modal transportation options in more densely populated areas; access to healthy food options, such as fresh produce, and safe agricultural practices that do not contribute to contaminated food or water; and neighborhood designs where the built environment enables safe physical activity. S/THAs are responsible for ensuring community health and well-being by providing and promoting basic public health services, protecting food and water sources, and encouraging a built environment that facilitates healthy lifestyles and injury prevention. As such, S/THAs are well-suited to integrate, educate, and inform health-protecting and health equity activities across the multiple divisions and programs in their agencies, as well as collaborate with other sectors to define and achieve mutually beneficial goals.
Many environmental conditions significantly affect health, but other factors such as education, employment opportunities, transportation, housing, social policies, and the criminal justice system also have a major influence on health and safety. These factors do not fall under the scope of any single agency or organization, including health agencies or the healthcare sector. Thus, to improve population health and achieve optimal health for all, it is imperative that diverse sectors work together to address these complex issues through a HiAP approach that fully evaluates both the health benefits and unintended consequences related to all public projects, policies, and programs.
While HiAP is a relatively new concept, many S/THAs are actively promoting cross-sector work that integrates health and health equity considerations in decision-making among non-health sectors. S/THAs have capacity and expertise that is valuable to internal and external stakeholders in a HiAP initiative. S/THAs are also well-positioned to further develop and sustain these efforts and help lead such collaboration.
In addition, collaborative approaches like HiAP applied broadly without an explicit focus on health equity will not attain the goal of optimal health for all. Partnering with other groups by participating in task forces, MOUs, advisory boards and serving as a health expert or liaison to various projects can be an opportunity and strategy for S/THAs to integrate health and health equity beyond the traditional purview of public health.
Environmental Health Policy Committee Review and Approval: June 28, 2017
Prevention Policy Committee Review and Approval: June 26, 2017
Board of Directors Review and Approval: August 23, 2017
Ratified by the ASTHO Assembly of Members: September 2017
Policy Expires: September 2020
Expiration Date Extension due to COVID-19: September 2022
1 ASTHO. Achieving Optimal Health for All - Policy Statement. Available at https://www.astho.org/globalassets/pdf/policy-statements/achieving-optimal-health-for-all-eliminating-structural-racism.pdf. Accessed 2-10-2022.
2 ASTHO. Health in All Policies: An Introduction. Available at http://www.astho.org/Programs/Health-in-All-Policies/Environmental-Health-in-All-Policies/Health-in-All-Policies-introduction/. Accessed 11-9-2017.
3 ASTHO. Health in All Policies: A Framework for State Health Leadership. Available at http://www.astho.org/HiAP/Framework/. Accessed 6-20-2017.
5 Public Health Institute. Health in All Policies: A Guide for State and Local Governments. Available at: http://www.phi.org/uploads/files/Health_in_All_Policies-A_Guide_for_State_and_Local_Governments.pdf. Accessed 5-25-2017.
7 U.S. Environmental Protection Agency. Summary of Executive Order 12898. Available at http://www.epa.gov/laws-regulations/summary-executive-order-12898-federal-actions-address-environmental-justice. Accessed 5-25-2017.
8 Centers for Disease Control and Prevention. Health Equity. Available at https://www.cdc.gov/healthequity/index.html. Accessed 6-28-2017.
9 Centers for Disease Control and Prevention. Social Determinants of Health. Available at https://www.cdc.gov/socialdeterminants/. Accessed 6-28-2017.
10 ASTHO. Adverse Childhood Experiences Legislation. Blogpost. Available at http://www.astho.org/StatePublicHealth/Adverse-Childhood-Experiences-Legislation/5-11-17/?blogid=4396. Accessed 5-25-2017.
11 The Community Guide. Physical Activity. Available at https://www.thecommunityguide.org/findings/physical-activity-built-environment-approaches. Accessed 5-25-2017.