Health in All Policies (HiAP) is a formal process for integrating health considerations into policies across multiple sectors with the goal of addressing the many social determinants of health (SDOH) that influence health outcomes. The National Prevention Strategy describes the need for this cross-sector approach to meet the goal of increasing the number of Americans who are healthy at every stage of life.
Key elements of HiAP include:
- Defining goals that provide benefits to many sectors and stakeholders.
- Engaging a range of stakeholders, including community members who will be affected by the policies under discussion.
- Creating permanent changes to the way that agencies make decisions in order to ensure that commitments addressing health are sustained over time.
- Recognizing the ways that inequity contributes to negative health outcomes, and incorporating equity considerations into policymaking.
Sectors that could be involved in a HiAP approach include:
- Agriculture – Relevant policies could involve food production and access to healthy food. Rural communities may also focus on the environmental implications of agricultural production and the health of farmers and farmworkers.
- Planning – Policies could involve land use decisions that affect SDOH, including zoning and density of residential housing, access to and preservation of open spaces, and bicycle- and pedestrian-friendly developments.
- Energy – Policies related to heating and energy usage could affect indoor and outdoor air quality.
- Housing – Housing policies can affect the location and availability of affordable housing, as well as the quality and safety of rural housing stock.
- Natural Resources – Policies could address the environmental effects of key industries in rural communities, including fishing and hunting. Policies could also involve management of water quality.
- Transportation – These policies could address the safety of pedestrians, drivers, and cyclists. Equitable access to transportation can also connect underserved populations to economic opportunities, healthcare services, healthy food, recreation, and other necessities.
Examples of Rural HiAP Programs Addressing SDOH:
- The State of Vermont provides a wealth of relevant resources for rural communities and states considering HiAP. Vermont's HiAP Task Force recognizes that many HiAP models have been developed and replicated in urban communities, and offers guidance for promoting cross-sector action from the perspective of a rural state.
- Monterey County in California is using HiAP to address persistent income and health inequities, particularly in the agricultural community. As part of the HiAP initiative, the Monterey County Health Department has identified key SDOH affecting community members and worked with the County Planning Department to incorporate health equity assessment tools into decision-making processes for land use.
- The Chatham County Public Health Department in North Carolina worked with Chatham County Planning, the Chatham County Board of Health, and the Chatham Health Alliance to implement a HiAP approach to updating the county's comprehensive plan. The final plan includes considerations for improving health through multiple sectors, including housing, neighborhood development, and transportation.
Implementation Considerations
When HiAP involves multiple sectors and collaborators, public health agencies can play key roles in creating awareness of health considerations in existing policies and opportunities to promote health equity in future policy development. The World Health Organization describes the need for building capacity to implement HiAP frameworks in their 2014 HiAP Framework for Country Action plan. Rural health professionals may need to both build their own policy analyses and communication skills and train other stakeholders in HiAP principles and tools.
Rural communities may find that Health Impact Assessments (HIAs) are useful tools to guide HiAP initiatives. HIAs help measure the health effects of proposed policies or projects. Module 4: Implementation Considerations provides additional examples of tools used to assess SDOH, including HIAs.
HiAP approaches can involve considerable time and investment. HiAP champions may need to plan for the resources required to inventory existing health-related policies across sectors, build collaborative partnerships across multiple agencies, create the infrastructure to monitor progress, and evaluate the results of the initiative.
Resources to Learn More
Health in All Policies Website Includes resources related to HiAP, including fact sheets, reports, and policies that have been enacted by states, counties, and cities across the country.
Organization(s): National Association of County and City Health Officials
Health in All Policies: Collaborating Across Sectors to Improve Health Website Lists resources to help communities implement their own HiAP approaches, including a toolkit with step-by-step HiAP strategies, a roadmap for HiAP, and model policies.
Organization(s): ChangeLab Solutions
Health in All Policies: Improving Health through Intersectoral Collaboration Document Describes lessons learned from the California Health in All Policies Task Force. Discusses benefits of and considerations for building cross-sectoral partnerships.
Author(s): Rudolph, L., Caplan, J., Mitchell, C., Ben-Moshe, K., & Dillon, L. Organization(s): Public Health Institute, Institute of Medicine Roundtable on Population Health Improvement
Date: 9/2013
A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States Document Describes evaluation considerations for HiAP approaches. Includes a logic model, example indicators, and case studies.
Author(s): Gase, L., Schooley, T., Lee, M., Rotakhina, S., Vick, J., & Caplan, J. Citation: Journal of Public Health Management and Practice, 23(4), 339-347
Date: 2017
Health in All Policies (HiAP) is an approach to public policy that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity.
Many of the social, environmental, and economic determinants of health have origins that extend beyond the health sector and health policies. Therefore, it is important that the impact on health be considered across sectors and at all levels of governance.
The HiAP approach focuses on legitimacy, accountability, transparency, access to information, participation, sustainability, and multi-sectoral collaboration. Support for HiAP is provided by intergovernmental organizations and structures, with the health sector serving a central role in promoting HiAP.
The concept of HiAP builds on the early principles of health promotion developed in the Alma-Ata Declaration on Primary Health Care (1978) and the Ottawa Charter for Health Promotion (1986). The HiAP approach was further developed in the 2010 Adelaide Statement on Health in All Policies. The more recent 2011 Rio Political Declaration on Social Determinants of Health and the UN General Assembly Resolution on the Prevention and Control of Non-Communicable Diseases (2011) further clarified the role of HiAP in health promotion and disease prevention. The concept of HiAP is in line with the Universal Declaration of Human Rights and the United Nations Millennium Declaration, and it has the potential to play an important role in the Post-2015 Development process.
During PAHO's 53rd Directing Council in September 2014, Member States adopted the Regional Plan of Action on Health in All Policies. The overall purpose of the Action Plan on HiAP is to define clear steps for implementation of the HiAP approach in the countries of the Region of the Americas. The Plan of Action corresponds to the WHO Health in All Policies Framework for Country Action, developed in January 2014 in a coordinated effort with countries in the Region of the Americas. The Plan contains strategic lines of action and indicators for the period 2014-2019, in accordance with the objectives outlined in the PAHO Strategic Plan 2014-2019.
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