Adelaide Statement on Health in All Policies 2010
Moving towards a shared governance for health and well-being
The Adelaide Statement was developed by the participants of the Health in All Policies International Meeting, Adelaide 13–15 April 2010. The Government of South Australia together with WHO invited 100 senior experts from a wide range of sectors and countries to discuss the implementation of the Health in All Policies approach. The main aim of the meeting was to move the agenda forward by identifying key principles and pathways that contribute to action for health across all sectors of government, and engage the health sector in contributing to the goals of other sectors.
The Adelaide Statement on Health in All Policies is to engage leaders and policy-makers at all levels of government—local, regional, national and international. It emphasizes that government objectives are best achieved when all sectors include health and well-being as a key component of policy development. This is because the causes of health and well-being lie outside the health sector and are socially and economically formed. Although many sectors already contribute to better health, significant gaps still exist.
The Adelaide Statement outlines the need for a new social contract between all sectors to advance human development, sustainability and equity, as well as to improve health outcomes. This requires a new form of governance where there is joined-up leadership within governments, across all sectors and between levels of government. The Statement highlights the contribution of the health sector in resolving complex problems across government.
Achieving social, economic and environmental development
A healthy population is a key requirement for the achievement of society’s goals. Reducing inequalities and the social gradient improves health and well-being for everyone. Good health enhances quality of life, improves workforce productivity, increases the capacity for learning, strengthens families and communities, supports sustainable habitats and environments, and contributes to security, poverty reduction and social inclusion. Yet escalating costs for treatment and care are placing unsustainable burdens on national and local resources such that broader developments may be held back.
This interface between health, well-being and economic development has been propelled up the political agenda of all countries. Increasingly, communities, employers and industries are expecting and demanding strong coordinated government action to tackle the determinants of health and well-being and avoid duplication and fragmentation of actions.
Need for joined-up government
The interdependence of public policy requires another approach to governance. Governments can coordinate policymaking by developing strategic plans that set out common goals, integrated responses and increased accountability across government departments. This requires a partnership with civil society and the private sector.
Since good health is a fundamental enabler and poor health is a barrier to meeting policy challenges, the health sector needs to engage systematically across government and with other sectors to address the health and well-being dimensions of their activities. The health sector can support other arms of government by actively assisting their policy development and goal attainment.
To harness health and well-being, governments need institutionalized processes which value cross-sector problem solving and address power imbalances. This includes providing the leadership, mandate, incentives, budgetary commitment and sustainable mechanisms that support government agencies to work collaboratively on integrated solutions.
Important Documents for Health in All Policies (HiAP)
Health in All Policies approach
The approach described above is referred to as ‘Health in All Policies’ and has been developed and tested in a number of countries. It assists leaders and policy-makers to integrate considerations of health, well-being and equity during the development, implementation and evaluation of policies and services.
Health in All Policies works best when:
- a clear mandate makes joined-up government an imperative;
- systematic processes take account of interactions across sectors;
- mediation occurs across interests;
- accountability, transparency and participatory processes are present;
- engagement occurs with stakeholders outside of government;
- practical cross-sector initiatives build partnerships and trust.
Drivers for achieving Health in All Policies
Building a process for Health in All Policies requires using windows of opportunity to change mindsets and decision-making cultures, and to prompt actions. Key drivers are context specific and can include:
- creating strong alliances and partnerships that recognize mutual interests, and share targets;
- building a whole of government commitment by engaging the head of government, cabinet and/or parliament, as well as the administrative leadership;
- developing strong high-level policy processes;
- embedding responsibilities into governments’ overall strategies, goals and targets;
- ensuring joint decision-making and accountability for outcomes;
- enabling openness and full consultative approaches to encourage stakeholder endorsement and advocacy;
- encouraging experimentation and innovation to find new models that integrate social, economic and environmental goals;
- pooling intellectual resources, integrating research and sharing wisdom from the field;
- providing feedback mechanisms so that progress is evaluated and monitored at the highest level.
It is not unusual that such a process can create tensions within government as conflicts over values and diverging interests can emerge. Resolution can be achieved through persistent and systematic engagement with political processes and key decision-makers.
New role for the health sector
To advance Health in All Policies the health sector must learn to work in partnership with other sectors. Jointly exploring policy innovation, novel mechanisms and instruments, as well as better regulatory frameworks will be imperative. This requires a health sector that is outward oriented, open to others, and equipped with the necessary knowledge, skills and mandate. This also means improving coordination and supporting champions within the health sector itself.
New responsibilities of health departments in support of a Health in All Policies approach will need to include:
- understanding the political agendas and administrative imperatives of other sectors;
- building the knowledge and evidence base of policy options and strategies;
- assessing comparative health consequences of options within the policy development process;
- creating regular platforms for dialogue and problem solving with other sectors;
- evaluating the effectiveness of intersectoral work and integrated policy-making;
- building capacity through better mechanisms, resources, agency support and skilled and dedicated staff;
- working with other arms of government to achieve their goals and in so doing advance health and well-being.
Next steps in the development process
The Adelaide Statement is part of a global process to develop and strengthen a Health in All Policies approach based on equity. It contributes to a critical debate that Member States and Regions of the World Health Organization (WHO) are now engaged in. The Statement reflects the track record of countries that have already gained experience in implementing such an approach.
The Statement provides valuable input into the World Conference on Social Determinants of Health in Brazil 2011, the 8th Global Conference on Health Promotion in Finland 2013, and preparations for the Millennium Development Goals (MDGs) post-2015.