What we need to know about Health in All Policies (HiAP)?

Health in All Policies

Helsinki Statement on Health in All Policies 2013 stated that ”Health in All Policies is an approach to public policies across sectors 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.”– Helsinki Statement on Health in All Policies 2013; WHO (WHA67.12) 2014. Contributing to social and economic development: sustainable action across sectors to improve health and health equity.

Important Documents for Health in All Policies (HiAP)

Adelaide Statement on Health in All Policies 2010 & 2017
The Helsinki Statement on Health in All Policies 2013
What we need to know about Health in All Policies (HiAP)?

Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” To improve equity in health (including in Universal Health Coverage) it is necessary to change the underlying distribution of the role of social determinants of health.

Impacts Health in All Policies :Example

One in eight deaths is linked to air pollution exposure – mostly from heart and lung disease, and stroke. To tackle air pollution, a health ministry cannot act alone. Collaboration is needed within many sectors:

• Household energy– works to ensure clean cooking, heating and lighting technologies are available in the home, It educates people about adopting clean fuels (liquid gas, ethanol),avoiding coal and kerosene use in the home, and cooking in areas with good ventilation.
• Energy – works to increase use of low-emissions fuels and renewable combustion-free power sources (like solar, wind or hydropower); adopt co-generation of heat and power; and distributed energy generation (e.g. mini-grids and rooftop solar power generation). Also works to reduce reliance on wood, diesel and coal generators, and protect against deforestation, occupational risks from coal mining and fumes from combustion of dirty fuels.
• Transport – works to prioritize urban transit, walking, cycling networks in cities so there is less reliance on vehicles. It works to shift technologies to cleaner heavy duty vehicles and low-emissions vehicles and fuels, including fuels with reduced sulfur and particle content.
• Urban planning – works to make cities more compact, and thus energy efficient.
• Housing – works to improve the energy efficiency of buildings through healthy and affordable construction standards.
• Waste Management – works reduce waste through separation, recycling and reuse or waste reprocessing; as well as improved methods of biological waste management such as anaerobic waste digestion to produce biogas.
• Industry – uses clean technologies that reduce industrial smokestack emissions and improves management of urban and agricultural waste, including capture of methane gas emitted from waste sites as an alternative to incineration (for use as biogas).
• Health Sector – works to connect all sectors. It tracks data on air-pollution related diseases and health gains from key interventions nationally and supports the energy-sector in needs-based assessments and fuel evaluations for the energy use of disadvantaged groups. The sector also advocates for policies to introduce clean technologies and reduce fuel poverty, and adopts renewable energy sources, especially in remote areas dependent on diesel generators.
• International – WHO sets guidelines, determines which interventions have the greatest impact, builds global databases to monitor global progress on health impact and advocates for clean air..
• Local, Regional and Country Municipalities – works to develop policies to reduce tobacco smoking and thus second hand smoke. They also set emission rate targets, approve planning codes and housing development and grant tax incentives energy efficiency certification schemes.
• NGOs, donors, civil society – works to provide access to improved cooking stores and helps fund initiatives for clean home energy technologies and fuels.

Overall, the health sector is the champion for health, driving dialogues to keep health on the agenda.

Why do governments/ societies need Health in All Policies?

Health in All Policies (HiAP) is based on the recognition that our greatest health challenges—for example, noncommunicable diseases, health inequities and inequalities, climate change, and spiralling health care costs—are highly complex and often linked through the social determinants of health. The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the wider set of forces and systems affecting these circumstances: e.g. economic and development policies, social norms, social policies, and political systems.

In this context, promoting healthy communities, and in particular health equity across different population groups, requires that we address the social determinants of health, such as public transportation, education access, access to healthy food, economic opportunities, and more. While many public policies work to achieve this, conflicts of interest may arise. Alternatively, unintended impacts of policies are not measured and addressed. This requires innovative solutions, and structures that build channels for dialogue and decision-making that work across traditional government policy siloes.

What roles do ministries of health play in HiAP?

WHO resolution WHA67.12 calls upon ministries of health ”to champion health and the promotion of health equity as a priority and take efficient action on social, economic and environmental determinants of health”. Although each country has its own political structure and forms of administration, the role of the health ministry or similar body at the national level, in relation to health in all policies usually includes work on health determinants that includes:

• Supporting the growth of scientific knowledge on health determinants;
• Identifying and prioritizing emerging health issues resulting from changes in society;
• Monitoring the activities of other sectors that impact on health;
• Creating structures and mechanisms for dialogue across government and with whole of society;
• Facilitating negotiations between sectors and with non-government stakeholders; and
• Overseeing the implementation, monitoring and evaluation of policy with respect to health outcomes, health determinants and equity.

Important Documents for Health in All Policies (HiAP)

• Adelaide Statement on Health in All Policies 2010 & 2017
• The Helsinki Statement on Health in All Policies 2013
• What we need to know about Health in All Policies (HiAP)?
• Health in All Policies: A Guide for State and Local Governments
• FINAL REPORT The 1st Global Meeting of the Global Network for Health in All Policies (GNHiAP) 2017
• Key Learning on Health in All Policies Implementation from Around the World Information Brochure
• PRACTISING A HEALTH IN ALL POLICIES APPROACH— LESSONS FOR UNIVERSAL HEALTH COVERAGE AND HEALTH EQUITY A policy briefing for ministries of health based on experiences from Africa, South-East Asia and the Western Pacific
• HEALTH IN ALL POLICIES TRAINING MANUAL
• Progressing the Sustainable Development Goals through Health in All Policies: Case studies from around the world
• Health in All Policies Toolkit – ASTHO

The Helsinki Statement on Health in All Policies 2013

The 8th Global Conference on Health Promotion was held in Helsinki, Finland from 10-14 June 2013. The meeting builds upon a rich heritage of ideas, actions and evidence originally inspired by the Alma Ata Declaration on Primary Health Care (1978) and the Ottawa Charter for Health Promotion (1986). These identified intersectoral action and healthy public policy as central elements for the promotion of health, the achievement of health equity, and the realization of health as a human right. Subsequent WHO global health promotion conferences [Subsequent conferences were held in Adelaide (1988); Sundsvall (1991); Jakarta (1997); Mexico City (2000); Bangkok (2005); Nairobi (2009)]. cemented key principles for health promotion action. These principles have been reinforced in the 2011 Rio Political Declaration on Social Determinants of Health, the 2011 Political Declaration of the UN High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, and the 2012 Rio+20 Outcome Document (the Future We Want). They are also reflected in many other WHO frameworks, strategies and resolutions, and contribute to the formulation of the post-2015 development goals.

Health for All is a major societal goal of governments, and the cornerstone of sustainable development.

The participants of this conference

• Affirm their commitment to equity in health and recognize that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Participant recognize that governments have a responsibility for the health of their people and that equity in health is an expression of social justice. Participant knows that good health enhances quality of life, increases capacity for learning, strengthens families and communities and improves workforce productivity. Likewise, action aimed at promoting equity significantly contributes to health, poverty reduction, social inclusion and security.
• Health inequities between and within countries are politically, socially and economically unacceptable, as well as unfair and avoidable. Policies made in all sectors can have a profound effect on population health and health equity. In our interconnected world, health is shaped by many powerful forces, especially demographic change, rapid urbanization, climate change and globalization. While some diseases are disappearing as living conditions improve, many diseases of poverty still persist in developing countries. In many countries lifestyles and living and working environments are influenced by unrestrained marketing and subject to unsustainable production and consumption patterns. The health of the people is not only a health sector responsibility, it also embraces wider political issues such as trade and foreign policy. Tackling this requires political will to engage the whole of government in health.

• Health in All Policies is an approach to public policies across sectors 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. It improves accountability of policymakers for health impacts at all levels of policy-making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and well-being.

• Participants recognized that governments have a range of priorities in which health and equity do not automatically gain precedence over other policy objectives. We call on them to ensure that health considerations are transparently taken into account in policy-making, and to open up opportunities for co-benefits across sectors and society at large. Policies designed to enable people to lead healthy lives face opposition from many sides. Often they are challenged by the interests of powerful economic forces that resist regulation. Business interests and market power can affect the ability of governments and health systems to promote and protect health and respond to health needs. Health in All Policies is a practical response to these challenges.

• It can provide a framework for regulation and practical tools that combine health, social and equity goals with economic development, and manage conflicts of interest transparently. These can support relationships with all sectors, including the private sector, to contribute positively to public health outcomes.

• Participants saw that Health in All Policies as a constituent part of countries’ contribution to achieving the United Nations Millennium Development Goals and it must remain a key consideration in the drafting of the post-2015 Development Agenda.

The participants of this conference

• Prioritize health and equity as a core responsibility of governments to its peoples.
• Affirm the compelling and urgent need for effective policy coherence for health and well-being.
• Recognize that this will require political will, courage and strategic foresight.

Participants call on governments to fulfil their obligations to their peoples’ health and well-being by taking the following actions:

• Commit to health and health equity as a political priority by adopting the principles of Health in All Policies and taking action on the social determinants of health.
• Ensure effective structures, processes and resources that enable implementation of the Health in All Policies approach across governments at all levels and between governments.
• Strengthen the capacity of Ministries of Health to engage other sectors of government through leadership, partnership, advocacy and mediation to achieve improved health outcomes.
• Build institutional capacity and skills that enable the implementation of Health in All Policies and provide evidence on the determinants of health and inequity and on effective responses.
• Adopt transparent audit and accountability mechanisms for health and equity impacts that build trust across government and between governments and their people.
• Establish conflict of interest measures that include effective safeguards to protect policies from distortion by commercial and vested interests and influence.
• Include communities, social movements and civil society in the development, implementation and monitoring of Health in All Policies, building health literacy in the population.

Participants call on WHO to

• Support Member States to put Health in All Policies into practice
• Strengthen its own capacity in Health in All Policies
• Use the Health in All Policies approach in working with United Nations agencies and other partners on the unfinished Millennium Development Goals agenda and the post-2015 Development Agenda
• Urge the United Nations family, other international organizations, multilateral development banks and development agencies to achieve coherence and synergy in their work with Member States to enable implementation of Health in All Policies

The participants of this conference

• Commit ourselves to communicate the key messages of this Helsinki Statement to our governments, institutions and communities.

The Helsinki Statement on Health in All Policies

Important Documents for Health in All Policies (HiAP)

Adelaide Statement on Health in All Policies 2010 & 2017
The Helsinki Statement on Health in All Policies 2013
What we need to know about Health in All Policies (HiAP)?